Assessing the Psychometric Properties of an Activity Pacing Questionnaire for Chronic Pain and Fatigue

Overview

Journal Phys Ther

Publisher Oxford University Press

Specialty Rehabilitation Medicine

Date 2015 Apr 25

PMID 25908522

Citations 13

Authors

Deborah Antcliff

Malcolm Campbell

Steve Woby

Philip Keeley

Affiliations

Soon will be listed here.

Abstract

Background: Therapists frequently advise the use of activity pacing as a coping strategy to manage long-term conditions (eg, chronic low back pain, chronic widespread pain, chronic fatigue syndrome/myalgic encephalomyelitis). However, activity pacing has not been clearly operationalized, and there is a paucity of empirical evidence regarding pacing. This paucity of evidence may be partly due to the absence of a widely used pacing scale. To address the limitations of existing pacing scales, the 38-item Activity Pacing Questionnaire (APQ-38) was previously developed using the Delphi technique.

Objective: The aims of this study were: (1) to explore the psychometric properties of the APQ-38, (2) to identify underlying pacing themes, and (3) to assess the reliability and validity of the scale.

Design: This was a cross-sectional questionnaire study.

Methods: Three hundred eleven adult patients with chronic pain or fatigue participated, of whom 69 completed the test-retest analysis. Data obtained for the APQ-38 were analyzed using exploratory factor analysis, internal and test-retest reliability, and validity against 2 existing pacing subscales and validated measures of pain, fatigue, anxiety, depression, avoidance, and mental and physical function.

Results: Following factor analysis, 12 items were removed from the APQ-38, and 5 themes of pacing were identified in the resulting 26-item Activity Pacing Questionnaire (APQ-26): activity adjustment, activity consistency, activity progression, activity planning, and activity acceptance. These themes demonstrated satisfactory internal consistency (Cronbach α=.72-.92), test-retest reliability (intraclass correlation coefficient=.50-.78, P≤.001), and construct validity. Activity adjustment, activity progression, and activity acceptance correlated with worsened symptoms; activity consistency correlated with improved symptoms; and activity planning correlated with both improved and worsened symptoms.

Limitations: Data were collected from self-report questionnaires only.

Conclusions: Developed to be widely used across a heterogeneous group of patients with chronic pain or fatigue, the APQ-26 is multifaceted and demonstrates reliability and validity. Further study will explore the effects of pacing on patients' symptoms to guide therapists toward advising pacing themes with empirical benefits.

Citing Articles

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Hotz-Boendermaker S, Tirez J, Morf R, Esteve R BMC Musculoskelet Disord. 2024; 25(1):884.

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McDermott K, Levey N, Brewer J, Ehmann M, Hooker J, Pasinski R JMIR Res Protoc. 2023; 12:e52117.

PMID: 38157234 PMC: 10787331. DOI: 10.2196/52117.

References

White P, Goldsmith K, Johnson A, Potts L, Walwyn R, DeCesare J . Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet. 2011; 377(9768):823-36. PMC: 3065633. DOI: 10.1016/S0140-6736(11)60096-2. View

Ferreira-Valente M, Pais-Ribeiro J, Jensen M . Validity of four pain intensity rating scales. Pain. 2011; 152(10):2399-2404. DOI: 10.1016/j.pain.2011.07.005. View

Kindermans H, Roelofs J, Goossens M, Huijnen I, Verbunt J, Vlaeyen J . Activity patterns in chronic pain: underlying dimensions and associations with disability and depressed mood. J Pain. 2011; 12(10):1049-58. DOI: 10.1016/j.jpain.2011.04.009. View

Goudsmit E, Nijs J, Jason L, Wallman K . Pacing as a strategy to improve energy management in myalgic encephalomyelitis/chronic fatigue syndrome: a consensus document. Disabil Rehabil. 2011; 34(13):1140-7. DOI: 10.3109/09638288.2011.635746. View

Andrews N, Strong J, Meredith P . Activity pacing, avoidance, endurance, and associations with patient functioning in chronic pain: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2012; 93(11):2109-2121.e7. DOI: 10.1016/j.apmr.2012.05.029. View

Cane D, Nielson W, McCarthy M, Mazmanian D . Pain-related activity patterns: measurement, interrelationships, and associations with psychosocial functioning. Clin J Pain. 2012; 29(5):435-42. DOI: 10.1097/AJP.0b013e31825e452f. View

Nielson W, Jensen M, Karsdorp P, Vlaeyen J . Activity pacing in chronic pain: concepts, evidence, and future directions. Clin J Pain. 2012; 29(5):461-8. DOI: 10.1097/AJP.0b013e3182608561. View

Antcliff D, Keeley P, Campbell M, Oldham J, Woby S . The development of an activity pacing questionnaire for chronic pain and/or fatigue: a Delphi technique. Physiotherapy. 2013; 99(3):241-6. DOI: 10.1016/j.physio.2012.12.003. View

Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C . The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014; 73(6):968-74. DOI: 10.1136/annrheumdis-2013-204428. View

10.

Nielson W, Jensen M, Karsdorp P, Vlaeyen J . A content analysis of activity pacing in chronic pain: what are we measuring and why?. Clin J Pain. 2013; 30(7):639-45. DOI: 10.1097/AJP.0000000000000024. View

11.

Nielson W, Jensen M, Hill M . An activity pacing scale for the chronic pain coping inventory: development in a sample of patients with fibromyalgia syndrome. Pain. 2001; 89(2-3):111-5. DOI: 10.1016/s0304-3959(00)00351-1. View

12.

Bjelland I, Dahl A, Haug T, Neckelmann D . The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. 2002; 52(2):69-77. DOI: 10.1016/s0022-3999(01)00296-3. View

13.

Silver A, Haeney M, Vijayadurai P, Wilks D, Pattrick M, Main C . The role of fear of physical movement and activity in chronic fatigue syndrome. J Psychosom Res. 2002; 52(6):485-93. DOI: 10.1016/s0022-3999(01)00298-7. View

14.

Clauw D, Crofford L . Chronic widespread pain and fibromyalgia: what we know, and what we need to know. Best Pract Res Clin Rheumatol. 2003; 17(4):685-701. DOI: 10.1016/s1521-6942(03)00035-4. View

15.

Nielson W, Jensen M . Relationship between changes in coping and treatment outcome in patients with Fibromyalgia Syndrome. Pain. 2004; 109(3):233-241. DOI: 10.1016/j.pain.2004.01.002. View

16.

Boonen A, van der Heijde D, Landewe R, Chorus A, van Lankveld W, Miedema H . Is avoidant coping independent of disease status and stable over time in patients with ankylosing spondylitis?. Ann Rheum Dis. 2004; 63(10):1264-8. PMC: 1754761. DOI: 10.1136/ard.2003.012435. View

17.

Zigmond A, SNAITH R . The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983; 67(6):361-70. DOI: 10.1111/j.1600-0447.1983.tb09716.x. View

18.

Bland J, Altman D . Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986; 1(8476):307-10. View

19.

Chalder T, Berelowitz G, Pawlikowska T, Watts L, Wessely S, Wright D . Development of a fatigue scale. J Psychosom Res. 1993; 37(2):147-53. DOI: 10.1016/0022-3999(93)90081-p. View

20.

van Lankveld W, vant Pad Bosch P, van de Putte L, Naring G, van der Staak C . Disease-specific stressors in rheumatoid arthritis: coping and well-being. Br J Rheumatol. 1994; 33(11):1067-73. DOI: 10.1093/rheumatology/33.11.1067. View