Testing a Newly Developed Activity Pacing Framework for Chronic Pain/fatigue: a Feasibility Study

Overview

Journal BMJ Open

Specialty General Medicine

Date 2021 Dec 9

PMID 34880007

Citations 2

Authors

Deborah Antcliff

Anne-Maree Keenan

Philip Keeley

Steve Woby

Linda McGowan

Affiliations

Soon will be listed here.

Abstract

Objectives: To test the feasibility of using a new activity pacing framework to standardise healthcare professionals' instructions of pacing, and explore whether measures of activity pacing/symptoms detected changes following treatment.

Design: Single-arm, repeated measures study.

Setting: One National Health Service (NHS) Pain Service in Northern England, UK.

Participants: Adult patients with chronic pain/fatigue, including chronic low back pain, chronic widespread pain, fibromyalgia and chronic fatigue syndrome/myalgic encephalomyelitis.

Interventions: Six-week rehabilitation programme, standardised using the activity pacing framework.

Outcome Measures: Feasibility was explored via patients' recruitment/attrition rates, adherence and satisfaction, and healthcare professionals' fidelity. Questionnaire data were collected from patients at the start and end of the programme (T1 and T2, respectively) and 3 months' follow-up (T3). Questionnaires included measures of activity pacing, current/usual pain, physical/mental fatigue, depression, anxiety, self-efficacy, avoidance, physical/mental function and quality of life. Mean changes in activity pacing and symptoms between T1-T2, T2-T3 and T1-T3 were estimated.

Results: Of the 139 eligible patients, 107 patients consented (recruitment rate=77%); 65 patients completed T2 (T1-T2 attrition rate=39%), and 52 patients completed T3 (T1-T3 attrition rate=51%). At T2, patients' satisfaction ratings averaged 9/10, and 89% attended ≥5 rehabilitation programme sessions. Activity pacing and all symptoms improved between T1 and T2, with smaller improvements maintained at T3.

Conclusion: The activity pacing framework was feasible to implement and patients' ability to pace and manage their symptoms improved. Future work will employ a suitable comparison group and test the framework across wider settings to explore the effects of activity pacing in a randomised controlled trial.

Trial Registration Number: NCT03497585.

Citing Articles

Barakou I, Seves B, Abonie U, Finch T, Hackett K, Hettinga F BMC Sports Sci Med Rehabil. 2025; 17(1):13.

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A Personalised Pacing and Active Rest Rehabilitation Programme for Post-Exertional Symptom Exacerbation and Health Status in Long COVID (PACELOC): A Prospective Cohort Study.

Godfrey B, Shardha J, Witton S, Bodey R, Tarrant R, Greenwood D J Clin Med. 2025; 14(1.

PMID: 39797180 PMC: 11722468. DOI: 10.3390/jcm14010097.

Self-regulation of effort for a better health-related quality of life: a multidimensional activity pacing model for chronic pain and fatigue management.

Barakou I, Hackett K, Finch T, Hettinga F Ann Med. 2023; 55(2):2270688.

PMID: 37871249 PMC: 10595396. DOI: 10.1080/07853890.2023.2270688.

A scoping review of 'Pacing' for management of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): lessons learned for the long COVID pandemic.

Sanal-Hayes N, Mclaughlin M, Hayes L, Mair J, Ormerod J, Carless D J Transl Med. 2023; 21(1):720.

PMID: 37838675 PMC: 10576275. DOI: 10.1186/s12967-023-04587-5.

References

Ware Jr J, Kosinski M, Keller S . A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996; 34(3):220-33. DOI: 10.1097/00005650-199603000-00003. View

Meeus M, Nijs J, De Meirleir K . Chronic musculoskeletal pain in patients with the chronic fatigue syndrome: a systematic review. Eur J Pain. 2006; 11(4):377-86. DOI: 10.1016/j.ejpain.2006.06.005. View

Andrews N, Deen M . Defining Activity Pacing: Is It Time to Jump Off the Merry-Go-Round?. J Pain. 2016; 17(12):1359-1362. DOI: 10.1016/j.jpain.2016.05.001. View

Nijs J, Meeus M, Van Oosterwijck J, Ickmans K, Moorkens G, Hans G . In the mind or in the brain? Scientific evidence for central sensitisation in chronic fatigue syndrome. Eur J Clin Invest. 2011; 42(2):203-12. DOI: 10.1111/j.1365-2362.2011.02575.x. View

Arendt-Nielsen L, Morlion B, Perrot S, Dahan A, Dickenson A, Kress H . Assessment and manifestation of central sensitisation across different chronic pain conditions. Eur J Pain. 2017; 22(2):216-241. DOI: 10.1002/ejp.1140. View

Murphy S, Clauw D . Activity pacing: what are we measuring and how does that relate to intervention?. Pain. 2010; 149(3):582-583. DOI: 10.1016/j.pain.2010.03.031. View

Nicholas M . The pain self-efficacy questionnaire: Taking pain into account. Eur J Pain. 2006; 11(2):153-63. DOI: 10.1016/j.ejpain.2005.12.008. View

Racine M, Jensen M, Harth M, Morley-Forster P, Nielson W . Operant Learning Versus Energy Conservation Activity Pacing Treatments in a Sample of Patients With Fibromyalgia Syndrome: A Pilot Randomized Controlled Trial. J Pain. 2018; 20(4):420-439. DOI: 10.1016/j.jpain.2018.09.013. 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

10.

McCracken L, Dhingra L . A short version of the Pain Anxiety Symptoms Scale (PASS-20): preliminary development and validity. Pain Res Manag. 2005; 7(1):45-50. DOI: 10.1155/2002/517163. View

11.

Abonie U, Sandercock G, Heesterbeek M, Hettinga F . Effects of activity pacing in patients with chronic conditions associated with fatigue complaints: a meta-analysis. Disabil Rehabil. 2018; 42(5):613-622. DOI: 10.1080/09638288.2018.1504994. View

12.

Davis L, Kroenke K, Monahan P, Kean J, Stump T . The SPADE Symptom Cluster in Primary Care Patients With Chronic Pain. Clin J Pain. 2015; 32(5):388-93. PMC: 4761335. DOI: 10.1097/AJP.0000000000000286. View

13.

Spitzer R, Kroenke K, Williams J, Lowe B . A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006; 166(10):1092-7. DOI: 10.1001/archinte.166.10.1092. View

14.

Vlaeyen J, Linton S . Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000; 85(3):317-332. DOI: 10.1016/S0304-3959(99)00242-0. View

15.

Greenberg J, Lin A, Zale E, Kulich R, James P, Millstein R . Development And Early Feasibility Testing Of A Mind-Body Physical Activity Program For Patients With Heterogeneous Chronic Pain; The GetActive Study. J Pain Res. 2019; 12:3279-3297. PMC: 6912090. DOI: 10.2147/JPR.S222448. View

16.

Chiarotto A, Vanti C, Cedraschi C, Ferrari S, De Lima E Sa Resende F, Ostelo R . Responsiveness and Minimal Important Change of the Pain Self-Efficacy Questionnaire and Short Forms in Patients With Chronic Low Back Pain. J Pain. 2016; 17(6):707-18. DOI: 10.1016/j.jpain.2016.02.012. View

17.

Ericsson A, Mannerkorpi K . How to manage fatigue in fibromyalgia: nonpharmacological options. Pain Manag. 2016; 6(4):331-8. DOI: 10.2217/pmt-2016-0015. View

18.

Antcliff D, Keenan A, Keeley P, Woby S, McGowan L . Engaging stakeholders to refine an activity pacing framework for chronic pain/fatigue: A nominal group technique. Musculoskeletal Care. 2019; 17(4):354-362. DOI: 10.1002/msc.1430. View

19.

Antcliff D, Campbell M, Woby S, Keeley P . Assessing the Psychometric Properties of an Activity Pacing Questionnaire for Chronic Pain and Fatigue. Phys Ther. 2015; 95(9):1274-86. PMC: 4556956. DOI: 10.2522/ptj.20140405. View

20.

Tavel M . Somatic symptom disorders without known physical causes: one disease with many names?. Am J Med. 2015; 128(10):1054-8. DOI: 10.1016/j.amjmed.2015.04.041. View