Antcliff D1,2, Keenan A-M2, Keeley P3, Woby S4, McGowan L2
1Bury & Rochdale Care Organisation, Northern Care Alliance NHS Group, Physiotherapy Department, Bury, United Kingdom, 2University of Leeds, School of Healthcare, Leeds, United Kingdom, 3University of Huddersfield, Department of Health Sciences, Huddersfield, United Kingdom, 4Northern Care Alliance NHS Group, Research and Innovation Department, Salford, United Kingdom
Background: Activity pacing is frequently advised by healthcare professionals for patients with chronic pain/fatigue, including chronic low back pain, chronic widespread pain, fibromyalgia and chronic fatigue syndrome/myalgic encephalomyelitis. Activity pacing is a behavioural modification strategy aimed at improving function while managing symptoms. There is high demand for effective treatments to promote patients' self-management, but a paucity of standardised interventions and high quality trials. Activity pacing is one such strategy that continues to be frequently implemented in the absence of standardisation or empirical evidence.
Purpose: To develop a comprehensive and evidence-based activity pacing framework to structure and standardise how healthcare professionals instruct pacing to patients with chronic pain/fatigue.
Methods: Using the Medical Research Council complex intervention guidelines, the pacing framework has been developed using multi-staged, mixed methodology.
Stage I: Online survey identified current opinions on pacing across healthcare professionals in the National Health Service (NHS), England. Survey data were analysed using descriptive statistics for demographic/close-ended questions; and thematic analysis for open-ended questions. The survey findings together with existing research evidence were used to develop the initial pacing framework.
Stage II: Nominal group technique involved a consensus meeting across an expert panel of healthcare professionals and patients to review and refine the framework.
Stage III: Feasibility and acceptability studies are testing the framework in rehabilitation programmes for chronic pain/fatigue. Data are being collected from self-report questionnaires measuring: pain, fatigue, anxiety, depression, self-efficacy, avoidance and function (pre-treatment, post-treatment, 3-month's follow-up); and via qualitative semi-structured interviews with patients and healthcare professionals.
Results: Stage I recruited 92 eligible healthcare professionals (physiotherapists, occupational therapists, nurses, doctors and clinical psychologists). The survey found that pacing was highly utilised (n=83, 90.2% instructed pacing). The most championed aim of pacing was for the achievement of valued activities (24.5% of ranked votes); and the least corroborated aim of pacing was to conserve energy (0.1% of ranked votes). The most supported component of pacing was 'breaking down tasks' (n=91, 98.9%) and the least supported component of pacing was 'stopping activities when symptoms increase' (n=6, 6.5%). Thematic analysis showed recurring themes that pacing involved flexibility and sense of choice.
Stage II involved 10 panellists (four patients with chronic pain/fatigue, two physiotherapists, 2 occupational therapists and two psychological wellbeing practitioners). Consensus on the content of the framework included: a clear definition of pacing, the aims of pacing, background to pacing, who can benefit and how, barriers to pacing, components/stages of pacing and tailoring pacing.
Stage III is collecting data to explore the feasibility and acceptability of the framework, recruitment/retention rates and the appropriateness of the questionnaires.
Conclusion(s): The pacing framework forms the first evidence-based guide on instructing activity pacing, informed by healthcare professionals and patients. Pacing is a multifaceted construct that requires considered instructions to patients. The findings from Stage III will be used to plan a future clinical trial of pacing to explore the effects of pacing.
Implications: The activity pacing framework can standardise the instructions of pacing to add empirical evidence regarding the effects of pacing, and improve the implementation of efficacious coping strategies for chronic pain/fatigue.
Keywords: Activity pacing, Chronic pain, Chronic fatigue
Funding acknowledgements: Independent research funded by Health Education England/National Institute for Health Research. Views are the author(s) and not NHS/NIHR/Department of Health.
Purpose: To develop a comprehensive and evidence-based activity pacing framework to structure and standardise how healthcare professionals instruct pacing to patients with chronic pain/fatigue.
Methods: Using the Medical Research Council complex intervention guidelines, the pacing framework has been developed using multi-staged, mixed methodology.
Stage I: Online survey identified current opinions on pacing across healthcare professionals in the National Health Service (NHS), England. Survey data were analysed using descriptive statistics for demographic/close-ended questions; and thematic analysis for open-ended questions. The survey findings together with existing research evidence were used to develop the initial pacing framework.
Stage II: Nominal group technique involved a consensus meeting across an expert panel of healthcare professionals and patients to review and refine the framework.
Stage III: Feasibility and acceptability studies are testing the framework in rehabilitation programmes for chronic pain/fatigue. Data are being collected from self-report questionnaires measuring: pain, fatigue, anxiety, depression, self-efficacy, avoidance and function (pre-treatment, post-treatment, 3-month's follow-up); and via qualitative semi-structured interviews with patients and healthcare professionals.
Results: Stage I recruited 92 eligible healthcare professionals (physiotherapists, occupational therapists, nurses, doctors and clinical psychologists). The survey found that pacing was highly utilised (n=83, 90.2% instructed pacing). The most championed aim of pacing was for the achievement of valued activities (24.5% of ranked votes); and the least corroborated aim of pacing was to conserve energy (0.1% of ranked votes). The most supported component of pacing was 'breaking down tasks' (n=91, 98.9%) and the least supported component of pacing was 'stopping activities when symptoms increase' (n=6, 6.5%). Thematic analysis showed recurring themes that pacing involved flexibility and sense of choice.
Stage II involved 10 panellists (four patients with chronic pain/fatigue, two physiotherapists, 2 occupational therapists and two psychological wellbeing practitioners). Consensus on the content of the framework included: a clear definition of pacing, the aims of pacing, background to pacing, who can benefit and how, barriers to pacing, components/stages of pacing and tailoring pacing.
Stage III is collecting data to explore the feasibility and acceptability of the framework, recruitment/retention rates and the appropriateness of the questionnaires.
Conclusion(s): The pacing framework forms the first evidence-based guide on instructing activity pacing, informed by healthcare professionals and patients. Pacing is a multifaceted construct that requires considered instructions to patients. The findings from Stage III will be used to plan a future clinical trial of pacing to explore the effects of pacing.
Implications: The activity pacing framework can standardise the instructions of pacing to add empirical evidence regarding the effects of pacing, and improve the implementation of efficacious coping strategies for chronic pain/fatigue.
Keywords: Activity pacing, Chronic pain, Chronic fatigue
Funding acknowledgements: Independent research funded by Health Education England/National Institute for Health Research. Views are the author(s) and not NHS/NIHR/Department of Health.
Topic: Pain & pain management; Disability & rehabilitation; Musculoskeletal
Ethics approval required: Yes
Institution: Northern Care Alliance NHS Group
Ethics committee: Stages I/II: West Scotland REC 5; Stage III: London-Surrey REC
Ethics number: Stages I/II: 16/WS/0209; Stage III 18/LO/0655
All authors, affiliations and abstracts have been published as submitted.
