Testing the Activity Pacing questionnaire for validity, rEliability and Responsiveness: an outcome measure for chronic Pain (TAPER-Pain)

Gareth McCray, Rosa MacKenzie, Janiece Marriott-Smith, Deborah Antcliff, Melanie Holden
Purpose:

To test the validity, reliability and responsiveness of the APQ. Secondary objectives included reducing the number of APQ items to lessen the scale burden.

Methods:

Underpinned by the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) checklist, we implemented a questionnaire-based study. Paper questionnaires were administered to adult patients with chronic pain attending English healthcare services (UK). Questionnaires included the APQ, an existing pacing subscale and measures of symptoms. Questionnaires were administered at baseline, two- and twelve-weeks (for test-retest reliability and responsiveness, respectively). Analyses included confirmatory factor analysis (for structural validity), concurrent/convergent validity (for construct validity), test-retest reliability (for repeatability), responsiveness to change, and measurement error (variation from true values). The study protocol was pre-registered (osf.io/hbsku).

Results:

Factor analysis (n=347) showed poor model fit for the five-factor model, leading to selecting a four-factor model (removing Activity Acceptance), with three items per domain to form the APQ-12. The four remaining domains showed satisfactory internal validity (Cronbach’s alpha:0.70-0.84) and test-retest reliability (n=130, ICC:0.53-0.64). Construct validity showed a varied pattern of significant correlations between the four domains and measures of symptoms. Only Activity consistency showed significant responsiveness to change (Rho=0.27, 95% CI=0.1-0.43). Measurement error of the APQ-12 was similar to the existing pacing subscale.

Conclusion(s):

The APQ-12 is a multi-domain scale with satisfactory validity and reliability. The responsiveness of the APQ-12 may be limited due to methodological issues. Since scale responsiveness is often under-reported, the responsiveness of the APQ-12 cannot be compared with other measures. Future studies will re-assess responsiveness using other methods. Despite this, the APQ-12 shows promise as a multi-domain measure for clinical and research use.

Implications:

The implications for physiotherapy practice include the provision of a comprehensive scale that captures more of the components of activity pacing. The APQ-12 can be used clinically to measure patients’ activity pacing to assess their behaviours and change in behaviours with treatment. The APQ-12 will be used in a future trial to add empirical evidence regarding the effects of activity pacing on symptoms of chronic pain.

Funding acknowledgements:
Funded by the NIHR School for Primary Care Research and Chartered Society of Physiotherapy Charitable Trust. Views are authors’ own.
Keywords:
Activity pacing
Chronic pain
Scale validation
Primary topic:
Pain and pain management
Second topic:
Musculoskeletal
Third topic:
Disability and rehabilitation
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
Health Research Authority, and Health and Care Research Wales; Yorkshire and The Humber - Leeds East Research Ethics Committee (UK).
Provide the ethics approval number:
REC Reference: 22/YH/0292
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
No

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