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Ackah M, Ameyaw L, Appiah R, Owiredu D, Boakye H, Donaldy W, Yarfi C, Abonie US. 30-day in-hospital stroke case fatality and significant risk factors in sub-Saharan-Africa: A systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002769. [PMID: 38241232 PMCID: PMC10798456 DOI: 10.1371/journal.pgph.0002769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/01/2024] [Indexed: 01/21/2024]
Abstract
Existing studies investigating 30-day in-hospital stroke case fatality rates in sub-Saharan Africa have produced varying results, underscoring the significance of obtaining precise and reliable estimations for this indicator. Consequently, this study aimed to conduct a systematic review and update of the current scientific evidence regarding 30-day in-hospital stroke case fatality and associated risk factors in sub-Saharan Africa. Medline/PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), APA PsycNet (encompassing PsycINFO and PsychArticle), Google Scholar, and Africa Journal Online (AJOL) were systematically searched to identify potentially relevant articles. Two independent assessors extracted the data from the eligible studies using a pre-tested and standardized excel spreadsheet. Outcomes were 30-day in-hospital stroke case fatality and associated risk factors. Data was pooled using random effects model. Ninety-three (93) studies involving 42,057 participants were included. The overall stroke case fatality rate was 27% [25%-29%]. Subgroup analysis revealed 24% [21%-28%], 25% [21%-28%], 29% [25%-32%] and 31% [20%-43%] stroke case fatality rates in East Africa, Southern Africa, West Africa, and Central Africa respectively. Stroke severity, stroke type, untyped stroke, and post-stroke complications were identified as risk factors. The most prevalent risk factors were low (<8) Glasgow Coma Scale score, high (≥10) National Institute Health Stroke Scale score, aspiration pneumonia, hemorrhagic stroke, brain edema/intra-cranial pressure, hyperglycemia, untyped stroke (stroke diagnosis not confirmed by neuroimaging), recurrent stroke and fever. The findings indicate that one in every four in-hospital people with stroke in sub-Saharan Africa dies within 30 days of admission. Importantly, the identified risk factors are mostly modifiable and preventable, highlighting the need for context-driven health policies, clinical guidelines, and treatments targeting these factors.
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Affiliation(s)
- Martin Ackah
- Faculty of Health and Life Sciences Northumbria University University, Department of Sport, Exercise & Rehabilitation, Newcastle upon Tyne, United Kingdom
| | - Louise Ameyaw
- Department of Medicine, Achimota Government Hospital, Accra, Ghana
| | - Richard Appiah
- Faculty of Health and Life Sciences Northumbria University University, Department of Psychology, Newcastle upon Tyne, United Kingdom
- Department of Occupational therapy, College of Health Sciences, University of Ghana, Korle-Bu, Accra, Ghana
| | - David Owiredu
- Centre for Evidence synthesis, University of Ghana, Accra, Ghana
| | - Hosea Boakye
- Department of Physiotherapy, LEKMA Hospital, Accra, Ghana
| | | | - Comos Yarfi
- Department of Physiotherapy, University of Allied and Health Sciences, Ho, Ghana
| | - Ulric S. Abonie
- Faculty of Health and Life Sciences Northumbria University University, Department of Sport, Exercise & Rehabilitation, Newcastle upon Tyne, United Kingdom
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Casson S, Jones MD, Cassar J, Kwai N, Lloyd AR, Barry BK, Sandler CX. The effectiveness of activity pacing interventions for people with chronic fatigue syndrome: a systematic review and meta-analysis. Disabil Rehabil 2023; 45:3788-3802. [PMID: 36345726 DOI: 10.1080/09638288.2022.2135776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/29/2022] [Accepted: 10/09/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE To investigate whether activity pacing interventions (alone or in conjunction with other evidence-based interventions) improve fatigue, physical function, psychological distress, depression, and anxiety in people with chronic fatigue syndrome (CFS). MATERIALS AND METHODS Seven databases were searched until 13 August 2022 for randomised controlled trials that included activity pacing interventions for CFS and a validated measure of fatigue. Secondary outcomes were physical function, psychological distress, depression, and anxiety. Two reviewers independently screened studies by title, abstract and full text. Methodological quality was evaluated using the PEDro scale. Random-effects meta-analyses were performed in R. RESULTS 6390 articles were screened, with 14 included. Good overall study quality was supported by PEDro scale ratings. Activity pacing interventions were effective (Hedges' g (95% CI)) at reducing fatigue (-0.52 (-0.73 to -0.32)), psychological distress (-0.37 (-0.51 to -0.24)) and depression (-0.29 (-0.49 to -0.09)) and improving physical function (mean difference 7.18 (3.17-11.18)) when compared to no treatment/usual care. The extent of improvement was greater for interventions that encouraged graded escalation of physical activities and cognitive activities. CONCLUSION Activity pacing interventions are effective in reducing fatigue and psychological distress and improving physical function in CFS, particularly when people are encouraged to gradually increase activities. REGISTRATION PROSPERO CRD42016036087. IMPLICATIONS FOR REHABILITATIONA key feature of chronic fatigue syndrome (CFS) is a prolonged post-exertional exacerbation of symptoms following physical activities or cognitive activities.Activity pacing is a common strategy often embedded in multi-component management programs for CFS.Activity pacing interventions are effective in reducing fatigue and psychological distress and improving physical function in CFS, particularly when patients are encouraged to gradually increase their activities.Healthcare professionals embedding activity pacing as part of treatment should work collaboratively with patients to ensure successful, individualised self-management strategies.
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Affiliation(s)
- Sally Casson
- The Kirby Institute, The University of New South Wales, Sydney, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Matthew D Jones
- School of Health Sciences, The University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Joanne Cassar
- The Kirby Institute, The University of New South Wales, Sydney, Australia
| | - Natalie Kwai
- The Kirby Institute, The University of New South Wales, Sydney, Australia
- School of Medical Sciences, University of Sydney, Sydney, Australia
| | - Andrew R Lloyd
- The Kirby Institute, The University of New South Wales, Sydney, Australia
| | - Benjamin K Barry
- School of Health Sciences, The University of New South Wales, Sydney, Australia
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Carolina X Sandler
- The Kirby Institute, The University of New South Wales, Sydney, Australia
- School of Health Sciences, Campbelltown Campus, Western Sydney University, Sydney, Australia
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
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Blackwell S, Crowfoot G, Davey J, Drummond A, English C, Galloway M, Mason G, Simpson D. Management of post-stroke fatigue: an Australian health professional survey. Disabil Rehabil 2023; 45:3893-3899. [PMID: 36369739 DOI: 10.1080/09638288.2022.2143578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 10/23/2022] [Accepted: 10/30/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE Evidence for post-stroke fatigue management is limited. We aimed to explore how Australian health professionals assess and assist fatigue management. Our objectives were to identify fatigue assessment tools and interventions used, explore clinician's confidence managing fatigue and explore whether management of post-stroke fatigue differs from management of fatigue related to other conditions. MATERIALS AND METHODS An online cross-sectional survey was completed by Australian health professionals (n = 60) providing services to people with fatigue. Analysis of open-ended questions identified common interventions and descriptive statistics were calculated for closed and dichotomized questions. RESULTS Routine use of formal fatigue assessment tools was low (17%, n = 10). Most respondents reporting use of the Fatigue Impact Scale, Fatigue Assessment Scale and Fatigue Severity Scale. To address fatigue, respondents reported providing energy optimization strategies, education, and exercise interventions in clinical practice. Less frequently reported interventions were strategies to adapt tasks, sleep hygiene, psychology, nutrition, and pharmacology interventions. Respondents were "moderately" confident managing post-stroke fatigue. Respondents did not report differences between how they manage post-stroke fatigue and fatigue present in other conditions. CONCLUSIONS Few Australian health professionals formally assess post-stroke fatigue. Management is multidisciplinary and based on evidence from fatigue management in other conditions.Implications for rehabilitationMost health professionals are not routinely using formal assessment tools for fatigue, possibly due to a lack of consensus on best practice in research.Common strategies recommended by health professionals include energy optimisation strategies, education and exercise.Comprehensive guidelines for post-stroke fatigue management are yet to be established.Health professionals should assess post-stroke fatigue using a validated tool to ensure an individualised approach to management based on the current available clinical guidelines.
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Affiliation(s)
| | - Gary Crowfoot
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Julie Davey
- Stroke Consumer Partner, Melbourne, Victoria, Australia
| | - Avril Drummond
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Coralie English
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia
| | - Margaret Galloway
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia
- Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience and Hunter Medical Research Institute, New Lambton, Australia
| | - Gillian Mason
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia
- Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience and Hunter Medical Research Institute, New Lambton, Australia
- Consumer Partner, with lived experience of fatigue, NSW, Australia
| | - Dawn Simpson
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia
- Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience and Hunter Medical Research Institute, New Lambton, Australia
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Barakou I, Hackett KL, Finch T, Hettinga FJ. Self-regulation of effort for a better health-related quality of life: a multidimensional activity pacing model for chronic pain and fatigue management. Ann Med 2023; 55:2270688. [PMID: 37871249 PMCID: PMC10595396 DOI: 10.1080/07853890.2023.2270688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/10/2023] [Indexed: 10/25/2023] Open
Abstract
PURPOSE To propose a comprehensive multidimensional model of activity pacing that improves health-related quality of life and promotes sustained physical activity engagement among adults with chronic conditions. MATERIALS AND METHODS A narrative review was conducted to examine the existing literature on activity pacing, health-related quality of life, pain and fatigue management, and physical activity promotion in chronic conditions. RESULTS The literature revealed a lack of a cohesive approach towards a multidimensional model for using activity pacing to improve health-related quality of life. A comprehensive multidimensional model of activity pacing was proposed, emphasizing the importance of considering all aspects of pacing for sustained physical activity engagement and improved health-related quality of life. The model incorporates elements such as rest breaks, self-regulatory skills, environmental factors, and effective coping strategies for depression/anxiety. It takes into account physical, psychological, and environmental factors, all of which contribute significantly to the enhancement of health-related quality of life, physical function, and overall well-being, reflecting a holistic approach. CONCLUSIONS The model offers guidance to researchers and clinicians in effectively educating patients on activity pacing acquisition and in developing effective interventions to enhance physical activity engagement and health outcomes among adults with chronic conditions. Additionally, it serves as a tool towards facilitating discussions on sustained physical activity and a healthy lifestyle for patients, which can eventually lead to improved quality of life.
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Affiliation(s)
- Ioulia Barakou
- Department of Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, UK
| | - Katie L. Hackett
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
- CRESTA Fatigue Clinic, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Tracy Finch
- Department of Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, UK
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Barakou I, Sakalidis KE, Abonie US, Finch T, Hackett KL, Hettinga FJ. Effectiveness of physical activity interventions on reducing perceived fatigue among adults with chronic conditions: a systematic review and meta-analysis of randomised controlled trials. Sci Rep 2023; 13:14582. [PMID: 37666869 PMCID: PMC10477297 DOI: 10.1038/s41598-023-41075-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/21/2023] [Indexed: 09/06/2023] Open
Abstract
Fatigue is barrier of physical activity participation in adults with chronic conditions. However, physical activity alleviates fatigue symptoms. This systematic review and meta-analysis aimed to (1) synthesise evidence from randomised controlled trials (RCTs) exploring the effects of physical activity interventions on fatigue reduction and (2) evaluate their effectiveness. Medline/CINAHL/EMBASE/Web of Science and Scopus were searched up to June 24th, 2023. Two reviewers independently conducted study screening and selection (RCTs), extracted data and assessed risk of bias (RoB2). Outcome was the standardised mean difference (SMD) with 95% confidence intervals in fatigue between experimental and control groups. 38 articles met the inclusion criteria. Overall, physical activity interventions moderately reduced fatigue (SMD = 0.54, p < 0.0001). Interventions lasting 2-6 weeks demonstrated a larger effect on fatigue reduction (SMD = 0.86, p < 0.00001). Interventions with 18-24 sessions showed a large effect on fatigue reduction (SMD = 0.97, p < 0.00001). Aerobic cycling and combination training interventions had a large to moderate effect (SMD = 0.66, p = 0.0005; SMD = 0.60, p = 0.0010, respectively). No long-term effects were found during follow-up. Physical activity interventions moderately reduced fatigue among adults with chronic conditions. Duration, total sessions, and mode of physical activity were identified as key factors in intervention effectiveness. Further research is needed to explore the impact of physical activity interventions on fatigue.
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Affiliation(s)
- Ioulia Barakou
- Department of Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, NE7 7XA, UK
| | - Kandianos Emmanouil Sakalidis
- Department of Sport Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumberland Building, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK
| | - Ulric Sena Abonie
- Department of Sport Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumberland Building, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK
| | - Tracy Finch
- Department of Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, NE7 7XA, UK
| | - Katie L Hackett
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
- CRESTA Fatigue Clinic, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Florentina Johanna Hettinga
- Department of Sport Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumberland Building, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK.
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6
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Ghali A, Lacombe V, Ravaiau C, Delattre E, Ghali M, Urbanski G, Lavigne C. The relevance of pacing strategies in managing symptoms of post-COVID-19 syndrome. J Transl Med 2023; 21:375. [PMID: 37291581 PMCID: PMC10248991 DOI: 10.1186/s12967-023-04229-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 05/25/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Post-COVID-19 syndrome (PCS) shares many features with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). PCS represents a major health issue worldwide because it severely impacts patients' work activities and their quality of life. In the absence of treatment for both conditions and given the beneficial effect of pacing strategies in ME/CFS, we conducted this study to assess the effectiveness of pacing in PCS patients. METHODS We retrospectively included patients meeting the World Health Organization definition of PCS who attended the Internal Medicine Department of Angers University Hospital, France between June 2020 and June 2022, and were followed up until December 2022. Pacing strategies were systematically proposed for all patients. Their medical records were reviewed and data related to baseline and follow-up assessments were collected. This included epidemiological characteristics, COVID-19 symptoms and associated conditions, fatigue features, perceived health status, employment activity, and the degree of pacing adherence assessed by the engagement in pacing subscale (EPS). Recovery was defined as the ability to return to work, and improvement was regarded as the reduction of the number and severity of symptoms. RESULTS A total of 86 patients were included and followed-up for a median time of 10 [6-13] months. Recovery and improvement rates were 33.7% and 23.3%, respectively. The EPS score was the only variable significantly associated with recovery on multivariate analysis (OR 40.43 [95% CI 6.22-262.6], p < 0.001). Patients who better adhered to pacing (high EPS scores) experienced significantly higher recovery and improvement rates (60-33.3% respectively) than those with low (5.5-5.5% respectively), or moderate (4.3-17.4% respectively) scores. CONCLUSION Our findings demonstrated that pacing is effective in the management of patients with PCS, and that high levels of adherence to pacing are associated with better outcomes.
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Affiliation(s)
- Alaa Ghali
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, 4 Rue Larrey, 49000, Angers, France.
| | - Valentin Lacombe
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, 4 Rue Larrey, 49000, Angers, France
| | - Camille Ravaiau
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, 4 Rue Larrey, 49000, Angers, France
| | - Estelle Delattre
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, 4 Rue Larrey, 49000, Angers, France
| | - Maria Ghali
- Department of General Medicine, Faculty of Medicine of Angers, Angers, France
| | - Geoffrey Urbanski
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, 4 Rue Larrey, 49000, Angers, France
| | - Christian Lavigne
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, 4 Rue Larrey, 49000, Angers, France
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Turner GM, McMullan C, Aiyegbusi OL, Hughes SE, Walker A, Jeyes F, Adler Y, Chong A, Buckland L, Stanton D, Davies EH, Haroon S, Calvert M. Co-production of a feasibility trial of pacing interventions for Long COVID. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:18. [PMID: 36997975 PMCID: PMC10061378 DOI: 10.1186/s40900-023-00429-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/22/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND The high incidence of COVID-19 globally has led to a large prevalence of Long COVID but there is a lack of evidence-based treatments. There is a need to evaluate existing treatments for symptoms associated with Long COVID. However, there is first a need to evaluate the feasibility of undertaking randomised controlled trials of interventions for the condition. We aimed to co-produce a feasibility study of non-pharmacological interventions to support people with Long COVID. METHODS A consensus workshop on research prioritisation was conducted with patients and other stakeholders. This was followed by the co-production of the feasibility trial with a group of patient partners, which included the design of the study, the selection of interventions, and the production of dissemination strategies. RESULTS The consensus workshop was attended by 23 stakeholders, including six patients. The consensus from the workshop was to develop a clinical trial platform that focused on testing different pacing interventions and resources. For the co-production of the feasibility trial, patient partners selected three pacing resources to evaluate (video, mobile application, and book) and co-designed feasibility study processes, study materials and undertook usability testing of the digital trial platform. CONCLUSION In conclusion, this paper reports the principles and process used to co-produce a feasibility study of pacing interventions for Long COVID. Co-production was effective and influenced important aspects of the study.
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Affiliation(s)
- Grace M Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - Christel McMullan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK.
- NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK.
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK.
- NIHR Birmingham-Oxford Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK.
| | - Olalekan Lee Aiyegbusi
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- NIHR Birmingham-Oxford Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Sarah E Hughes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Anita Walker
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- NIHR Birmingham-Oxford Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Felicity Jeyes
- Patient Partner, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - Yvonne Adler
- Patient Partner, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - Amy Chong
- Patient Partner, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - Lewis Buckland
- Patient Partner, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - David Stanton
- Patient Partner, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | | | - Shamil Haroon
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- NIHR Birmingham-Oxford Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
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Getu MA, Wang P, Addissie A, Seife E, Chen C, Kantelhardt EJ. The effect of cognitive behavioural therapy integrated with activity pacing on cancer-related fatigue, depression and quality of life among patients with breast cancer undergoing chemotherapy in Ethiopia: A randomised clinical trial. Int J Cancer 2023; 152:2541-2553. [PMID: 36744446 DOI: 10.1002/ijc.34452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 02/07/2023]
Abstract
Fatigue is a common symptom experienced by 80% of individuals who receive chemotherapy and is one of the major factors that affect quality of life (QoL) of patients with breast cancer. Our study aimed to assess the effect of cognitive behavioural therapy integrated with activity pacing (CBT-AP) on cancer-related fatigue among patients with breast cancer undergoing chemotherapy. A parallel-group, randomised controlled trial was conducted. Severely fatigued patients were randomly assigned to the CBT-AP or usual care (UC) groups using a computer-generated random sequence. The new intervention was designed for seven sessions: three 2-hour face-to-face and four 30-minute telephone sessions. The primary outcome (fatigue severity) and the secondary outcomes (depression and QoL) were assessed at the end of the intervention and after 3 months. The data were analysed by repeated measures analyses of covariance (RM-ANCOVA). CBT-AP had a significant time effect (P < .001, ηp2 = 0.233) in reducing fatigue from baseline (adjusted mean = 7.48) to the end of the intervention (adjusted mean = 6.37) and the 3-month follow-up (adjusted mean = 6.54). Compared to the UC group, the CBT-AP group had lower fatigue and depression scores, and higher global health status scores. The group × time interaction revealed a significant reduction in fatigue and depression in the CBT-AP group compared to the UC group. Therefore, CBT-AP appears to be effective in reducing fatigue and depression and improving QoL in patients with breast cancer undergoing chemotherapy. It is highly recommended to integrate a CBT-AP intervention in routine cancer care.
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Affiliation(s)
- Mikiyas Amare Getu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,School of Nursing and Health, Zhengzhou University, Zhengzhou, China.,School of Nursing, Woldia University, Woldia, Ethiopia.,Global Health Working Group, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Panpan Wang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Adamu Addissie
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle (Saale), Germany.,School of Public Health, Department of Preventive Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Edom Seife
- Tikur Anbessa Specialized Hospital, Department of Oncology, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Changying Chen
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Eva Johanna Kantelhardt
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle (Saale), Germany.,Department of Gynecology, Martin-Luther-University, Halle (Saale), Germany
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Menting SGP, Edwards AM, Hettinga FJ, Elferink-Gemser MT. Pacing Behaviour Development and Acquisition: A Systematic Review. SPORTS MEDICINE - OPEN 2022; 8:143. [PMID: 36484867 PMCID: PMC9733766 DOI: 10.1186/s40798-022-00540-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 11/18/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The goal-directed decision-making process of effort distribution (i.e. pacing) allows individuals to efficiently use energy resources as well as to manage the impact of fatigue on performance during exercise. Given the shared characteristics between pacing behaviour and other skilled behaviour, it was hypothesized that pacing behaviour would adhere to the same processes associated with skill acquisition and development. METHODS PubMed, Web of Science and PsycINFO databases between January 1995 and January 2022 were searched for articles relating to the pacing behaviour of individuals (1) younger than 18 years of age, or (2) repeatedly performing the same exercise task, or (3) with different levels of experience. RESULTS The search resulted in 64 articles reporting on the effect of age (n = 33), repeated task exposure (n = 29) or differing levels of experience (n = 13) on pacing behaviour. Empirical evidence identifies the development of pacing behaviour starts during childhood (~ 10 years old) and continues throughout adolescence. This development is characterized by an increasingly better fit to the task demands, encompassing the task characteristics (e.g. duration) and environment factors (e.g. opponents). Gaining task experience leads to an increased capability to attain a predetermined pace and results in pacing behaviour that better fits task demands. CONCLUSIONS Similar to skilled behaviour, physical maturation and cognitive development likely drive the development of pacing behaviour. Pacing behaviour follows established processes of skill acquisition, as repeated task execution improves the match between stimuli (e.g. task demands and afferent signals) and actions (i.e. continuing, increasing or decreasing the exerted effort) with the resulting exercise task performance. Furthermore, with increased task experience attentional capacity is freed for secondary tasks (e.g. incorporating opponents) and the goal selection is changed from achieving task completion to optimizing task performance. As the development and acquisition of pacing resemble that of other skills, established concepts in the literature (e.g. intervention-induced variability and augmented feedback) could enrich pacing research and be the basis for practical applications in physical education, healthcare, and sports.
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Affiliation(s)
- Stein Gerrit Paul Menting
- grid.4494.d0000 0000 9558 4598Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, PO Box 196, 9700 AD The Netherlands
| | - Andrew Mark Edwards
- grid.127050.10000 0001 0249 951XSchool of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, UK
| | - Florentina Johanna Hettinga
- grid.42629.3b0000000121965555Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Room 238, Northumberland Building, Newcastle Upon Tyne, NE1 8ST UK
| | - Marije Titia Elferink-Gemser
- grid.4494.d0000 0000 9558 4598Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, PO Box 196, 9700 AD The Netherlands
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10
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Whiteson JH, Azola A, Barry JT, Bartels MN, Blitshteyn S, Fleming TK, McCauley MD, Neal JD, Pillarisetti J, Sampsel S, Silver JK, Terzic CM, Tosto J, Verduzco‐Gutierrez M, Putrino D. Multi-disciplinary collaborative consensus guidance statement on the assessment and treatment of cardiovascular complications in patients with post-acute sequelae of SARS-CoV-2 infection (PASC). PM R 2022; 14:855-878. [PMID: 35657351 PMCID: PMC9347705 DOI: 10.1002/pmrj.12859] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/27/2022] [Accepted: 06/01/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Jonathan H. Whiteson
- Department of Rehabilitation Medicine and Department of MedicineRusk Rehabilitation, NYU Langone HealthNew YorkNew YorkUSA
| | - Alba Azola
- Department of Physical Medicine and RehabilitationJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - John T. Barry
- Good Shepherd Penn Partners, Penn Therapy & Fitness—University CityPhiladelphiaPennsylvaniaUSA
| | - Matthew N. Bartels
- Department of Rehabilitation Medicine, Montefiore Health SystemAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Svetlana Blitshteyn
- Department of NeurologyUniversity at Buffalo Jacobs School of Medicine and Biomedical SciencesBuffaloNew YorkUSA
| | - Talya K. Fleming
- Department of Physcial Medicine and RehabilitationJFK Johnson Rehabilitation Institute at Hackensack Meridian HealthEdisonNew JerseyUSA
| | - Mark D. McCauley
- Department of Medicine, Section of CardiologyUniversity of Illinois at Chicago and Jesse Brown VA Medical CenterChicagoIllinoisUSA
| | - Jacqueline D. Neal
- Physical Medicine and RehabilitationNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA,Physical Medicine and RehabilitationPhysical Medicine and Rehabilitation, Jesse Brown VA Medical CenterChicagoIllinoisUSA
| | - Jayasree Pillarisetti
- Division of Cardiology, Department of MedicineUniversity of Texas Health San AntonioSan AntonioTexasUSA
| | | | - Julie K. Silver
- Department of Physical Medicine and RehabilitationHarvard Medical School, Spaulding Rehabilitation HospitalBostonMassachusettsUSA
| | - Carmen M. Terzic
- Department of Physical Medicine and Rehabilitation and Department of Cardiovascular MedicineMayo ClinicRochesterMinnesotaUSA
| | - Jenna Tosto
- Department of Rehabilitation and Human Performance, Abilities Research CenterIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | | | - David Putrino
- Department of Rehabilitation and Human PerformanceIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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11
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Antcliff D, Keenan AM, Keeley P, Woby S, McGowan L. Testing a newly developed activity pacing framework for chronic pain/fatigue: a feasibility study. BMJ Open 2021; 11:e045398. [PMID: 34880007 PMCID: PMC8655535 DOI: 10.1136/bmjopen-2020-045398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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.
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Affiliation(s)
- Deborah Antcliff
- Department of Physiotherapy, Fairfield General Hospital, Northern Care Alliance NHS Group, Bury, UK
- School of Healthcare, University of Leeds, Leeds, UK
| | - Anne-Maree Keenan
- School of Healthcare, University of Leeds, Leeds, UK
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Philip Keeley
- School of Nursing and Midwifery, Keele University, Staffordshire, UK
| | - Steve Woby
- Department of Research and Innovation, Northern Care Alliance NHS Group, Salford, UK
- School of Health and Society, University of Salford, Salford, UK
| | - Linda McGowan
- School of Healthcare, University of Leeds, Leeds, UK
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12
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Abonie US, Saxton J, Baker K, Hettinga FJ. Objectively-assessed physical activity and self-reported activity pacing in adults with multiple sclerosis: A pilot study. Clin Rehabil 2021; 35:1781-1788. [PMID: 34132109 PMCID: PMC8552369 DOI: 10.1177/02692155211024135] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/24/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine the association between self-reported activity pacing (a strategy to manage fatigue symptoms) and objectively-measured physical activity behaviours in adults with multiple sclerosis. DESIGN Single cross-sectional study. SETTING Multiple sclerosis rehabilitation centre in Colchester, United Kingdom. SUBJECTS Twenty-one adults (59 ± 9 years) with multiple sclerosis. MAIN MEASURES Physical activity behaviours (activity level: activity counts per minute; activity variability: highest activity counts per minute each day divided by activity counts per minute on that day) were measured with accelerometers. Self-reported activity pacing (Activity Pacing and Risk of Overactivity Questionnaire), fatigue severity (Fatigue Severity Scale) and health-related quality of life (RAND-12-Item Short-Form Health Survey) were measured. Scatter plots were used to explore associations between measures. RESULTS Activity level was 258 ± 133 counts per minutes, activity variability was 4 ± 1, self-reported activity pacing was 3 ± 1, fatigue severity was 5 ± 2 and health-related quality of life was 43 ± 8. Increased self-reported activity pacing was associated with lower activity levels and less variability in daily activities. CONCLUSION This investigation suggests that people with multiple sclerosis who have low physical activity levels could be inappropriately using activity pacing as a reactionary response to their multiple sclerosis symptoms.
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Affiliation(s)
- Ulric S Abonie
- Department of Physiotherapy and Rehabilitation Sciences, University of Health and Allied Sciences, Ho, Volta Region, Ghana
- School of Sport, Rehabilitation and Exercise Science, University of Essex, Colchester, UK
| | - John Saxton
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Katherine Baker
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Florentina J Hettinga
- School of Sport, Rehabilitation and Exercise Science, University of Essex, Colchester, UK
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
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13
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Abonie US, Seves BL, Hoekstra F, Hoekstra T, van der Woude LH, Dekker R, Hettinga FJ. Assessment of Activity Pacing in Relation to Physical Activity and Health-Related Quality of Life in Adults with Multiple Sclerosis: A Foundation for Further Intervention Development. Int J MS Care 2021; 23:207-212. [PMID: 34720760 PMCID: PMC8550481 DOI: 10.7224/1537-2073.2020-047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND Activity pacing is a behavioral strategy for coping with fatigue, optimizing physical activity (PA) levels, and achieving a paced approach to lifestyle and sustainable self-regulated exercise practice to optimize health and well-being. Yet little is known about how activity pacing affects PA and health-related quality of life (HRQOL) while controlling for fatigue and demographic characteristics over time in adults with multiple sclerosis (MS). This study examined the natural use of activity pacing and how it is associated with PA and HRQOL over time in adults with MS. METHODS Sixty-eight adults with MS (mean ± SD age, 45.2 ± 10.9 years) completed questionnaires on their activity pacing, fatigue, PA, and HRQOL 14, 33, and 52 weeks after rehabilitation. Associations between the variables were examined using multilevel models. RESULTS No associations were found between activity pacing and PA (β = -0.01, P = .89) or between activity pacing and HRQOL (β = -0.15, P = .09). CONCLUSIONS This study provides an initial understanding of how activity pacing relates to PA and HRQOL in people with MS over time and indicates that there is no clear strategy among adults with MS that is successful in improving PA and HRQOL in the short or long term. Persons with MS may benefit from goal-directed activity pacing interventions to improve longitudinal engagement in PA, and the present study provides a foundation for further intervention development.
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Affiliation(s)
- Ulric S. Abonie
- From the Department of Physiotherapy and Rehabilitation Sciences, University of Health and Allied Sciences, Ho, Ghana (USA)
- School of Sport, Rehabilitation, and Exercise Science, University of Essex, Colchester, UK (USA)
| | - Bregje L. Seves
- Center for Human Movement Sciences (BLS, FH, TH, LHVvdW), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Femke Hoekstra
- Center for Human Movement Sciences (BLS, FH, TH, LHVvdW), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Rehabilitation (FH, LHVvdW, RD), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Trynke Hoekstra
- Center for Human Movement Sciences (BLS, FH, TH, LHVvdW), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Health Sciences and Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (TH)
| | - Lucas H.V. van der Woude
- Center for Human Movement Sciences (BLS, FH, TH, LHVvdW), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Rehabilitation (FH, LHVvdW, RD), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Rienk Dekker
- Department of Rehabilitation (FH, LHVvdW, RD), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Florentina J. Hettinga
- Department of Sport, Exercise, and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK (FJH)
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14
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Edwards AM, Abonie US, Hettinga FJ, Pyne DB, Oh TM, Polman RCJ. Practical and Clinical Approaches Using Pacing to Improve Selfregulation in Special Populations such as Children and People with Mental Health or Learning Disabilities. JOURNAL OF REHABILITATION MEDICINE - CLINICAL COMMUNICATIONS 2021; 4:1000058. [PMID: 33968335 PMCID: PMC8101060 DOI: 10.2340/20030711-1000058] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 11/16/2022]
Abstract
For special populations such as people with a mental health issue or learning disability, a disconnect between the ability to accurately monitor and regulate exercise behaviour can lead to reduced levels of physical activity, which, in turn, is associated with additional physical or mental health problems. Activity pacing is a strategy used in clinical settings to address issues of pain amelioration, while self-pacing research is now well addressed in sport and exercise science literature. It has been proposed recently that these overlapping areas of investigation collectively support the development of self-regulatory, lifestyle exercise skills across broad population groups. Activity pacing appears to have substantial application in numerous development and rehabilitation settings and, therefore, the purpose of this short communication is to articulate how an activity pacing approach could be utilized among population groups in whom self-regulatory skills may require development. This paper provides specific examples of exercise practice across 2 discrete populations: children, and people with mental health and learning difficulties. In these cases, homeostatic regulatory processes may either be altered, or the individual may require extrinsic support to appropriately self-regulate exercise performance. A support-based exercise environment or approach such as programmatic activity (lifestyle) pacing would be beneficial to facilitate supervised and education-based self-regulation until such time as fully self-regulated exercise is feasible.
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Affiliation(s)
- Andrew M Edwards
- School of Psychology & Life Sciences, Canterbury Christ Church University, Canterbury, UK!
| | - Ulric S Abonie
- Department of Physiotherapy and Rehabilitation Sciences, University of Health and Allied Sciences, Volta Region, Ghana
| | - Florentina J Hettinga
- Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - David B Pyne
- Research Institute for Sport and Exercise (UCRISE), University of Canberra, Canberra, Australia
| | - Tomasina M Oh
- Faculty of Health: Medicine, Dentistry & Human Sciences, University of Plymouth, Plymouth, UK
| | - Remco C J Polman
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
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15
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Bench S, Stayt L, Shah A, Dhiman P, Czuber-Dochan W. Prevalence and experience of fatigue in survivors of critical illness: a mixed-methods systematic review. Anaesthesia 2021; 76:1233-1244. [PMID: 33694157 DOI: 10.1111/anae.15441] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 12/11/2022]
Abstract
We conducted a mixed methods systematic review to investigate the prevalence, experience and management of fatigue in survivors of critical illness. We identified 76 studies investigating fatigue or vitality in adults discharged from an intensive care unit and split the extracted data into three datasets: vitality scores from the Short Form Health Survey-36 (n = 54); other quantitative data (n = 19); and qualitative data (n = 9). We assessed methodological quality using critical appraisal skills programme tools. We adopted a segregated approach to mixed-methods synthesis. In a final step, we attributed combined results to one of four qualitative themes: prevalence and severity; contributing factors; impacts on quality of life; and assessment and management. Prevalence of fatigue ranged from 13.8 to 80.9%. Short Form Health Survey-36 vitality scores were commonly used as a marker of fatigue. Vitality scores reached a nadir approximately one month following ICU discharge (mean (SD) 56.44 (32.30); 95%CI 52.92-59.97). They improved over time but seldom reached reference population scores. Associated biological, disease-related and psychological factors included age, poor pre-morbid status, sleep and psychological disturbance. Qualitative data highlight the profound negative impact of fatigue on survivors' quality of life. Survivors seldom had any information provided on the potential impact of fatigue. No fatigue assessment tools specific to critical illness or evidence-based interventions were reported. Fatigue is highly prevalent in survivors of critical illness, and negatively impacts recovery. Further research on developing fatigue assessment tools specifically for critically ill patients and evaluating the impact of pharmacological and non-pharmacology interventions is needed.
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Affiliation(s)
- S Bench
- School of Health and Social Care, London South Bank University, London, UK
| | - L Stayt
- Oxford Brookes University, Oxford, UK
| | - A Shah
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - P Dhiman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - W Czuber-Dochan
- Florence Nightingale School of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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16
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Wormgoor MEA, Rodenburg SC. The evidence base for physiotherapy in myalgic encephalomyelitis/chronic fatigue syndrome when considering post-exertional malaise: a systematic review and narrative synthesis. J Transl Med 2021; 19:1. [PMID: 33397399 PMCID: PMC7780213 DOI: 10.1186/s12967-020-02683-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/15/2020] [Indexed: 12/12/2022] Open
Abstract
Background Due to the inconsistent use of diagnostic criteria in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), it is unsure whether physiotherapeutic management regarded effective in ME/CFS is appropriate for patients diagnosed with criteria that consider post-exertional malaise (PEM) as a hallmark feature. Purpose To appraise current evidence of the effects of physiotherapy on symptoms and functioning in ME/CFS patients in view of the significance of PEM in the applied diagnostic criteria for inclusion. Methods A systematic review of randomized controlled trials published over the last two decades was conducted. Studies evaluating physiotherapeutic interventions for adult ME/CFS patients were included. The diagnostic criteria sets were classified into three groups according to the extent to which the importance of PEM was emphasized: chronic fatigue (CF; PEM not mentioned as a criterion), CFS (PEM included as an optional or minor criterion) or ME (PEM is a required symptom). The main results of included studies were synthesized in relation to the classification of the applied diagnostic criteria. In addition, special attention was given to the tolerability of the interventions. Results Eighteen RCTs were included in the systematic review: three RCTs with CF patients, 14 RCTs with CFS patients and one RCT covering ME patients with PEM. Intervention effects, if any, seemed to disappear with more narrow case definitions, increasing objectivity of the outcome measures and longer follow-up. Conclusion Currently, there is no scientific evidence when it comes to effective physiotherapy for ME patients. Applying treatment that seems effective for CF or CFS patients may have adverse consequences for ME patients and should be avoided.
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Affiliation(s)
- Marjon E A Wormgoor
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway. .,Division Physical Medicine and Rehabilitation, Vestfold Hospital Trust, Stavern, Norway.
| | - Sanne C Rodenburg
- Department of Physiotherapy, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands
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17
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Abonie US, Hettinga FJ. Effect of a Tailored Activity Pacing Intervention on Fatigue and Physical Activity Behaviours in Adults with Multiple Sclerosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:E17. [PMID: 33375123 PMCID: PMC7792946 DOI: 10.3390/ijerph18010017] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/14/2020] [Accepted: 12/14/2020] [Indexed: 11/16/2022]
Abstract
Tailored activity pacing could help manage fatigue and improve physical activity. However, little is known about how to tailor activity pacing for people with multiple sclerosis. This study aims to evaluate the effect of a tailored activity pacing intervention on fatigue and physical activity behaviours in adults with multiple sclerosis. Twenty-one adults with multiple sclerosis, stratified by age and gender, are randomly allocated to either a tailored pacing or control group. Participants wear an accelerometer for seven days that measures physical activity behaviours, and self-report fatigue at the baseline and four-week follow-up. Physical activity behaviours are assessed by examining activity level (seven-day average activity counts per minute) and activity variability (seven-day average highest activity counts each day divided by activity counts on that day). The intervention improves activity levels (Mean difference = 40.91; 95% Confidence Interval [CI] (3.84-77.96); p = 0.03) and lessens activity variability (Mean difference = -0.63; 95% CI (-1.25-0.02); p = 0.04). No significant effect is found for fatigue (Mean difference = -0.36; 95% CI (-1.02-0.30); p = 0.27). This investigation shows that tailoring activity pacing based on physical activity behaviours and fatigue is effective in improving physical activity levels, without exacerbating fatigue symptoms.
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Affiliation(s)
- Ulric S. Abonie
- Department of Physiotherapy and Rehabilitation Sciences, University of Health and Allied Sciences, Ho, Volta Region PMB 31, Ghana;
- School of Sport, Rehabilitation and Exercise Science, University of Essex, Wivenhoe Park, Colchester CO4 3SQ, UK
| | - Florentina J. Hettinga
- School of Sport, Rehabilitation and Exercise Science, University of Essex, Wivenhoe Park, Colchester CO4 3SQ, UK
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
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18
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Edmealem A, Ademe S, Tegegne B. Level of Physical Activity and Its Associated Factors Among Type II Diabetes Patients in Dessie Referral Hospital, Northeast Ethiopia. Diabetes Metab Syndr Obes 2020; 13:4067-4075. [PMID: 33149646 PMCID: PMC7605610 DOI: 10.2147/dmso.s279772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/02/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Overweight and obesity results in poor control of chronic illnesses such as diabetes mellitus. The main reason for being overweight and obese among patients with chronic illness is low level of physical activity. Thus, this study aimed to assess level of physical activity and its associated factors among type II diabetes patients at Dessie Referral Hospital, Northeast Ethiopia. METHODS A hospital-based cross-sectional study was employed from October 1 to November 25 2019 in Dessie Referral Hospital. The study utilized systematic sampling technique to recruit the sample population of 364 diabetic patients. Face-to-face exit interview was used to collect the data. The data were presented with text and tables. Bivariable and multivariable binary logistic regression was employed to identify independent predictors of low level of physical activity at a P-value of <0.05. RESULTS From the total study participants, 110 (33.1%) of them did not perform health enhancing physical activity. Patients whose body mass index was below 18.5 kg/m2 did not perform health enhancing physical activity twice more likely compared with patients whose weight was normal (AOR=2.36, 95%CI: 0.02-5.42). Patients who were depressed did not perform health enhancing physical activity five times more likely compared with their counterparts (AOR=4.83, 95%CI: 1.46-15.96). In addition, being widowed (P=0.037), living in an urban area (P=0.028) and duration of disease (P=0.020) were statistically associated with low level of physical activity. CONCLUSION AND RECOMMENDATIONS The level of physical activity among patients with type II diabetes was low. Being widowed, living in an urban area, being underweight, duration of disease and being depressed were independent predictors of low level of physical activity. Health education should be given in every visit to patients with type II diabetes. Promotion of physical activity through campaign should be done.
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Affiliation(s)
- Afework Edmealem
- Department of Nursing, School of Nursing and Midwifery, Wollo University, Dessie, Ethiopia
| | - Sewunet Ademe
- Department of Nursing, School of Nursing and Midwifery, Wollo University, Dessie, Ethiopia
| | - Belachew Tegegne
- Department of Nursing, School of Nursing and Midwifery, Wollo University, Dessie, Ethiopia
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19
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Trajectories of health-related quality of life among people with a physical disability and/or chronic disease during and after rehabilitation: a longitudinal cohort study. Qual Life Res 2020; 30:67-80. [PMID: 32986126 PMCID: PMC7847859 DOI: 10.1007/s11136-020-02647-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2020] [Indexed: 11/06/2022]
Abstract
Purpose To identify Health-related Quality of Life (HR-QoL) trajectories in a large heterogeneous cohort of people with a physical disability and/or chronic disease during and after rehabilitation and to determine which factors before discharge are associated with longitudinal trajectory membership. Methods A total of 1100 people with a physical disability and/or chronic disease were included from the longitudinal cohort study Rehabilitation, Sports and Active lifestyle. All participants participated in a physical activity promotion programme in Dutch rehabilitation care. HR-QoL was assessed using the RAND-12 Health Status Inventory questionnaire at baseline (T0: 3–6 weeks before discharge) and at 14 (T1), 33 (T2) and 52 (T3) weeks after discharge from rehabilitation. A data-driven approach using Latent Class Growth Mixture modelling was used to determine HR-QoL trajectories. Multiple binomial multivariable logistic regression analyses were used to determine person-, disease- and lifestyle-related factors associated with trajectory membership. Results Three HR-QoL trajectories were identified: moderate (N = 635), high (N = 429) and recovery (N = 36). Trajectory membership was associated with person-related factors (age and body mass index), disease-related factors (perceived fatigue, perceived pain and acceptance of the disease) and one lifestyle-related factor (alcohol consumption) before discharge from rehabilitation. Conclusions Most of the people who participated in a physical activity promotion programme obtained a relatively stable but moderate HR-QoL. The identified HR-QoL trajectories among our heterogeneous cohort are disease-overarching. Our findings suggest that people in rehabilitation may benefit from person-centred advice on management of fatigue and pain (e.g. activity pacing) and the acceptance of the disability. Electronic supplementary material The online version of this article (10.1007/s11136-020-02647-7) contains supplementary material, which is available to authorized users.
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20
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Abonie US, Hoekstra F, Seves BL, van der Woude LHV, Dekker R, Hettinga FJ. Associations between Activity Pacing, Fatigue, and Physical Activity in Adults with Multiple Sclerosis: A Cross Sectional Study. J Funct Morphol Kinesiol 2020; 5:jfmk5020043. [PMID: 33467259 PMCID: PMC7739300 DOI: 10.3390/jfmk5020043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/07/2020] [Accepted: 06/09/2020] [Indexed: 01/09/2023] Open
Abstract
Fatigue is common in people with multiple sclerosis (MS). Activity pacing is a behavioral way to cope with fatigue and limited energy resources. However, little is known about how people with MS naturally pace activities to manage their fatigue and optimize daily activities. This study explored how activity pacing relates to fatigue and physical activity in people with MS. Participants were 80 individuals (60 females, 20 males) with a diagnosis of MS. The participants filled in questionnaires on their activity pacing, fatigue, physical activity, and health-related quality of life, 3-6 weeks before discharge from rehabilitation. The relationships between the variables were examined using hierarchical regression. After controlling for demographics, health-related quality of life, and perceived risk of overactivity, no associations were found between activity pacing and fatigue (β = 0.20; t = 1.43, p = 0.16) or between activity pacing and physical activity (β = -0.24; t = -1.61, p = 0.12). The lack of significant associations between activity pacing and fatigue or physical activity suggests that without interventions, there appears to be no clear strategy amongst people with MS to manage fatigue and improve physical activity. People with MS may benefit from interventions to manage fatigue and optimize engagement in physical activity.
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Affiliation(s)
- Ulric S. Abonie
- Department of Physiotherapy and Rehabilitation Sciences, University of Health and Allied Sciences, Ho PMB 31 Volta Region, Ghana;
- School of Sport, Rehabilitation and Exercise Science, University of Essex, Colchester CO4 3SQ, Essex, UK
| | - Femke Hoekstra
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, PO Box 72, 9700 AB Groningen, The Netherlands; (F.H.); (B.L.S.); (L.H.V.v.d.W.)
- Department of Rehabilitation, University Medical Center Groningen, University of Groningen, PO Box 72, 9700 AB Groningen, The Netherlands;
| | - Bregje L. Seves
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, PO Box 72, 9700 AB Groningen, The Netherlands; (F.H.); (B.L.S.); (L.H.V.v.d.W.)
| | - Lucas H. V. van der Woude
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, PO Box 72, 9700 AB Groningen, The Netherlands; (F.H.); (B.L.S.); (L.H.V.v.d.W.)
- Department of Rehabilitation, University Medical Center Groningen, University of Groningen, PO Box 72, 9700 AB Groningen, The Netherlands;
| | - Rienk Dekker
- Department of Rehabilitation, University Medical Center Groningen, University of Groningen, PO Box 72, 9700 AB Groningen, The Netherlands;
| | - Florentina J. Hettinga
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne NE1 8SB, UK
- Correspondence: ; Tel.: +44-77-648-853-76
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Antcliff D, Keenan AM, 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; 17:354-362. [PMID: 31750627 DOI: 10.1002/msc.1430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 09/05/2019] [Accepted: 09/07/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Due to the current absence of a standardized guide for activity pacing, the concept of pacing is interpreted in various ways by healthcare professionals, patients and researchers. Consequently, the effects of pacing across different conditions are unclear. The present study aimed to undertake the second stage in the development of an activity pacing framework for chronic pain/fatigue. METHODS The newly developed activity pacing framework was refined using a consensus method. A nominal group technique (NGT) was selected to engage stakeholders to reach agreement on the top 10 priorities for inclusion in the framework and accompanying appendices. Participants included patients with diagnoses of chronic pain/fatigue and healthcare professionals working in fields of chronic pain/fatigue. RESULTS Ten participants were recruited via purposive sampling: four patients, two physiotherapists, two occupational therapists and two psychological wellbeing practitioners. The top priorities for the pacing framework included a clear definition of pacing, and stating the aims and context of pacing. The appendices were refined as a teaching guide, including priorities of detailing the stages of pacing, the overactivity-underactivity cycle/pain cycle and goal setting. CONCLUSIONS Incorporating a diverse panel of stakeholders was an effective and inclusive method to refine the activity pacing framework. The framework has been purposefully designed for wider use across patients with chronic pain/fatigue and by various healthcare professionals. The framework provides a comprehensive definition, background and manual for healthcare professionals to instruct activity pacing. Further study will test the clinical usability of the framework, to enable the standardization of activity pacing in future investigations.
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Affiliation(s)
- Deborah Antcliff
- Physiotherapy Department, Bury and Rochdale Care Organisation, Northern Care Alliance NHS Group, Bury, UK.,School of Healthcare, University of Leeds, Leeds, UK
| | | | - Philip Keeley
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Steve Woby
- Research and Innovation Department, Northern Care Alliance NHS Group, Bury, UK.,School of Health and Society, University of Salford, Salford, UK.,Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Linda McGowan
- School of Healthcare, University of Leeds, Leeds, UK
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Albergoni A, Hettinga FJ, La Torre A, Bonato M, Sartor F. The Role of Technology in Adherence to Physical Activity Programs in Patients with Chronic Diseases Experiencing Fatigue: a Systematic Review. SPORTS MEDICINE-OPEN 2019; 5:41. [PMID: 31512075 PMCID: PMC6739434 DOI: 10.1186/s40798-019-0214-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 08/19/2019] [Indexed: 12/29/2022]
Abstract
Background The beneficial role of physical activity (PA) to manage the health condition of patients with chronic diseases is well known. However, adherence to PA guidelines in this group is still low. Monitoring and user-interface technology could represent a significant tool to increase exercise adherence to those particular groups who experience difficulties in adhering to regular and substantial physical activity, and could be supportive in increasing the success of PA programs and interventions. This systematic review aimed at evaluating the effect of physical activity monitoring technology in improving adherence to a PA program in patients with chronic diseases experiencing fatigue. Methods This systematic review was conducted according to PRISMA guidelines. The literature search was performed in Embase, Medline, Biosis, Scopus, and SPORTDiscus. We filtered the literature according to the question: “Does monitoring technology affect adherence to physical activity and exercise programs in patients with chronic diseases perceiving fatigue?”. Results The search resulted in 1790 hits; finally, eight studies were included, with a total number of 205 patients. Study quality was moderate except for one study of high quality. Only three disease types emerged, COPD, HF, and cancer. PA programs were rather short (from 8 to 13 weeks) except for one 3-year-long study. Five studies employed pedometers and two an activity monitor. Three studies based their adherence on steps, the remaining studies focused on active minutes. Adherence was explicitly reported in two studies, and otherwise derived. Four studies showed high adherence levels (85% week-10, 89% week-8, 81% week-13, 105% week-13, 83% average week-1–12) and three low levels (56% week-12, 41% year-2, 14 year-3). Conclusion The small number of studies identified did not allow to establish whether the use of monitoring technology could improve adherence to PA programs in patients with chronic diseases experiencing fatigue, but the current evidence seems to suggest that this is a field warranting further study, particularly into how monitoring technology can help to engage patients to adhere to PA programs.
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Affiliation(s)
- Andrea Albergoni
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,Department of Patient Care & Measurements, Philips Research, Eindhoven, The Netherlands
| | - Florentina J Hettinga
- School of Sport Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK.,Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, UK
| | - Antonio La Torre
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | - Francesco Sartor
- Department of Patient Care & Measurements, Philips Research, Eindhoven, The Netherlands. .,School of Sport Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK. .,College of Health & Behavioural Science, Bangor University, Bangor, UK. .,Philips Electronics Nederland B.V, HTC 34 1.011, P.O. Box WB61, 5656, AE, Eindhoven, The Netherlands.
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Antcliff D, Keenan AM, Keeley P, Woby S, McGowan L. Survey of activity pacing across healthcare professionals informs a new activity pacing framework for chronic pain/fatigue. Musculoskeletal Care 2019; 17:335-345. [PMID: 31430038 PMCID: PMC6973284 DOI: 10.1002/msc.1421] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Activity pacing is considered a key component of rehabilitation programmes for chronic pain/fatigue. However, there are no widely used guidelines to standardize how pacing is delivered. This study aimed to undertake the first stage in developing a comprehensive evidence-based activity pacing framework. METHODS An online survey across pain/fatigue services in English National Health Service trusts explored healthcare professionals' opinions on the types/uses of pacing, aims, facets and perceived effects. Data were analysed using descriptive statistics for closed-ended questions and thematic analysis for open-ended questions. Purposeful recruitment with a snowball effect engaged 92 healthcare professionals (physiotherapists, occupational therapists, nurses, doctors and psychologists) to the study. RESULTS Pacing was highly utilized, with perceived long-term benefits for patients (n = 83, 90.2% healthcare professionals instructed pacing). The most endorsed aim of pacing was "achievement of meaningful activities" (24.5% of ranked votes). The least endorsed aim was "to conserve energy" (0.1% of ranked votes). The most frequently supported facet of pacing was "breaking down tasks" (n = 91, 98.9%). The least supported facet was "stopping activities when symptoms increase" (n = 6, 6.5%). Thematic analysis showed recurring themes that pacing involved flexibility and sense of choice. CONCLUSIONS Pacing is a multidimensional coping strategy and complex behaviour. The message is clear that pacing should enable increases in meaningful activities, as opposed to attempting to avoid symptoms. The survey findings have informed the development of an activity pacing framework to guide healthcare professionals on the multiple components of pacing. This will help to standardize and optimize treatments for chronic pain/fatigue and enable future investigations.
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Affiliation(s)
- Deborah Antcliff
- Physiotherapy Department, Bury and Rochdale Care Organisation, Northern Care Alliance NHS Group, Bury, UK.,School of Healthcare, University of Leeds, Leeds, UK
| | | | - Philip Keeley
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Steve Woby
- Research and Innovation Department, Northern Care Alliance NHS Group, Salford, UK.,School of Health and Society, University of Salford, Salford, UK.,Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Linda McGowan
- School of Healthcare, University of Leeds, Leeds, UK
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