The aim of this study was to adapt the activity pacing framework as an intervention for primary care.
Following ADAPT guidance (adapting interventions to new contexts), the study included a systematic review and three sequential stakeholder workshops. The systematic review identified previous studies (any type, e.g. randomised controlled trials (RCTs), qualitative) that had evaluated activity pacing interventions based on the operant approach (pre-registered PROSPERO:CRD42023451469). Two independent reviewers extracted data, including a description of interventions based on TIDieR guidelines, appraised risk of bias and evaluated certainty of the research (GRADE).
The stakeholder workshops involved clinicians and patient and public involvement (PPI) representatives discussing the components of activity pacing interventions, and issues around implementing activity pacing in primary care and planning a future RCT.
The systematic review included nine studies (described in 11 papers). The activity pacing interventions that were tested, were heterogeneous in content, length (2-10 treatment sessions) and were both tailored and untailored to participants’ baseline behaviours. Synthesis was limited by risk of bias across the studies and low certainty of the research.
Stakeholder workshops involved seven clinicians and seven PPI representatives. Suggested adaptions to the activity pacing intervention included adding more information to the component of flare-up management, and developing ‘easy to use’ resources for both patients and clinicians. Stakeholders advised some general practitioners/first contact practitioners may struggle to deliver this complex intervention within their appointment times. However, earlier access to activity pacing resources was recommended and this could be via signposting from those with time-limited resources, or delivery by clinicians in wider services.
Co-developed adaptions have been suggested to develop an activity pacing framework that is more user-friendly for both clinicians and patients. Further work will implement the activity pacing intervention in a pilot study ahead of a future RCT into the effects of activity pacing.
The implications for physiotherapy practice include the provision of a comprehensive activity pacing intervention for clinical use. A future RCT of activity pacing will add empirical evidence regarding the effects of activity pacing on symptoms of chronic pain.
Chronic pain
Complex intervention
