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Racine M, Jensen MP, Cane D, Moulin DE, Vlaeyen JWS, Nielson WR. The Activity Management Inventory for Pain (AMI-P): Initial Development and Validation of a Questionnaire Based on Operant Learning and Energy Conservation Models of Activity Management. Clin J Pain 2024; 40:200-211. [PMID: 38258309 DOI: 10.1097/ajp.0000000000001198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024]
Abstract
OBJECTIVES Activity management is an important treatment component in chronic pain programs. However, there are shortcomings in measures of this construct, leading to inconsistencies in research findings. Here, we describe the development of the Activity Management Inventory for Pain (AMI-P). MATERIALS AND METHODS The AMI-P was developed by a group of international researchers with extensive expertise in both chronic pain and activity management. The initial evaluation of the AMI-P items included 2 studies that were both conducted in Canadian tertiary pain care centers. RESULTS The resulting 20-item measure has 3 behavior scales (Rest, Alternating Activity, and Planned Activity), and 4 goal scales (Feel Less Pain, Get More Done, Complete the Task, and Save Energy). The behavior scales evidenced marginal to good internal consistency and test-retest reliability, and a moderate positive association with an existing pacing measure. The Rest and Alternating Activity scales were associated with greater pain interference, the Alternating Activity and Planned Activity scales were associated with less satisfaction with social roles, and the Planned Activity scale was associated with fewer depressive symptoms. The Alternating Activity scale increased significantly from pretreatment to posttreatment. All goal scales were positively associated with all behavior scales. The Feel Less Pain goal scale was positively associated with measures of avoidance and pain interference, while the Get More Done goal scale was negatively associated with measures of depressive symptoms and overdoing. DISCUSSION The findings support the reliability and validity of the AMI-P scales, while also highlighting the complexity and multidimensional aspects of activity management.
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Affiliation(s)
- Mélanie Racine
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Douglas Cane
- Pain Management Unit, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Dwight E Moulin
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University
| | - Johan W S Vlaeyen
- Research Group Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven
- Experimental Health Psychology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Warren R Nielson
- Department of Psychology, Western University and Lawson Health Research Institute, London, ON
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2
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Søvik ML, Eide REM, Rene B, Strand MM, Devik I, Liland DE, Kjeken I, Taule T. Rheumatic disease and fatigue: Participants' experiences of an activity-pacing group. Scand J Occup Ther 2021:1-12. [PMID: 34749574 DOI: 10.1080/11038128.2021.1998609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Fatigue is a common symptom of inflammatory rheumatic disease and has a great impact on everyday life. Activity-pacing is proposed as an intervention to increase participation in meaningful activities. AIMS To explore participants' experiences with an activity-pacing group, how participants perceived self-managing everyday life after group attendance, and their reflections on unmet needs that could enhance self-management of everyday life with fatigue. MATERIALS AND METHODS Semi-structured interviews were conducted with 10 participants who had attended an activity-pacing group. Thematic analyses were conducted. FINDINGS Prior to group attendance, the participants expressed an awareness of their lack of knowledge of fatigue. Through group attendance, they increased their understanding of fatigue and their ability to apply strategies to better manage everyday life. Participants found it difficult to balance their energy use and realised that implementing activity-pacing strategies takes time. Therefore, they requested follow-up sessions with the activity-pacing group. They also desire that rheumatologists pay more attention to and acknowledge fatigue. CONCLUSIONS AND SIGNIFICANCE Enhancing the understanding of fatigue and how to manage everyday life with fatigue, appears to be important. Group interventions led by occupational therapists and with a focus on activity-pacing may be a suitable approach. Follow-up sessions are recommended.
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Affiliation(s)
- Margaret L Søvik
- Department of Occupational Therapy, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway.,Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Ruth Else M Eide
- Department of Occupational Therapy, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
| | - Bjørg Rene
- Department of Occupational Therapy, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
| | | | - Ingvill Devik
- Department of Rheumatology, Nordland Hospital, Bodø, Norway
| | - Dag Einar Liland
- Patient Participation Group, Haukeland University Hospital, Bergen, Norway
| | - Ingvild Kjeken
- National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Tina Taule
- Department of Occupational Therapy, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
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Ecija C, Catala P, López-Roig S, Pastor-Mira MÁ, Gallardo C, Peñacoba C. Are Pacing Patterns Really Based on Value Goals? Exploring the Contextual Role of Pain Acceptance and Pain Catastrophizing in Women with Fibromyalgia. J Clin Psychol Med Settings 2021; 28:734-745. [PMID: 33538933 DOI: 10.1007/s10880-021-09762-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 01/02/2023]
Abstract
Pain catastrophizing and pain acceptance have been associated with functioning in fibromyalgia. In relation to activity patterns, pacing has been defined as a helpful pattern to regulate activities in the context of value-based goals, but results regarding whether it is adaptive or not are controversial. This study analyzes the moderating role of pain acceptance between pain catastrophizing and pacing in 231 women with fibromyalgia. Moderation analyses were conducted with model 1 from the PROCESS Macro version 3.4. The results showed a clear moderating effect of pain acceptance. At low levels of pain acceptance, catastrophizing and pacing patterns maintained significant and positive associations. However, at high levels of pain acceptance, pacing was independent of catastrophizing. Far from considering pacing patterns as functional or dysfunctional per se, our results suggest that women with low pain acceptance carry out pacing influenced by catastrophizing independently of their goal pursuit, while patients who accept their pain may use pacing as a regulatory mechanism according to their goals.
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Affiliation(s)
- Carmen Ecija
- Department of Psychology, Rey Juan Carlos University, Avda. de Atenas s/n, 28922, Alcorcón, Madrid, Spain
| | - Patricia Catala
- Department of Psychology, Rey Juan Carlos University, Avda. de Atenas s/n, 28922, Alcorcón, Madrid, Spain
| | - Sofía López-Roig
- Department of Behavioral Sciences and Health, Miguel Hernández University, Campus de Sant Joan, Alicante, Spain
| | - María Ángeles Pastor-Mira
- Department of Behavioral Sciences and Health, Miguel Hernández University, Campus de Sant Joan, Alicante, Spain
| | - Carmen Gallardo
- Department of Psychology, Rey Juan Carlos University, Avda. de Atenas s/n, 28922, Alcorcón, Madrid, Spain
| | - Cecilia Peñacoba
- Department of Psychology, Rey Juan Carlos University, Avda. de Atenas s/n, 28922, Alcorcón, Madrid, Spain.
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Racine M, Sánchez-Rodríguez E, de la Vega R, Galán S, Solé E, Jensen MP, Miró J, Moulin DE, Nielson WR. Pain-Related Activity Management Patterns as Predictors of Treatment Outcomes in Patients with Fibromyalgia Syndrome. PAIN MEDICINE 2021; 21:e191-e200. [PMID: 31626301 DOI: 10.1093/pm/pnz259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES This study sought to determine if pre- to post-treatment changes in pain-related activity patterns (i.e., overdoing, avoidance, and pacing) were associated with pre- to post-treatment changes in function (i.e., pain interference, psychological function, and physical function) in patients with fibromyalgia syndrome who participated in either an operant learning- or an energy conservation-based training in activity management. METHODS Sixty-nine patients with fibromyalgia syndrome participated in an activity management treatment (32 in an operant learning group and 37 in an energy conservation group). Outcomes were assessed at pre- and post-treatment, and patients provided demographic information and completed measures assessing pain intensity, pain interference, psychological function, physical function, and pain management activity patterns. Three linear hierarchical regression analyses predicting changes in pain outcomes from changes in pacing, overdoing, and avoidant activity patterns were performed. RESULTS Changes in pain-related activity patterns made significant contributions to the prediction of changes in patients' function. Specifically: (a) increases in overdoing predicted reductions in pain interference; (b) decreases in avoidance predicted improvements in psychological function; and (c) increases in pacing predicted improvements in physical function. CONCLUSIONS This study provides support for a role of activity management treatments in improved adjustment to chronic pain. Research is needed to replicate and extend these findings in order to build an empirical basis for developing more effective chronic pain treatments for facilitating improved physical and psychological function in individuals with chronic pain.
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Affiliation(s)
- Mélanie Racine
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Elisabet Sánchez-Rodríguez
- Unit for the Study and Treatment of Pain-ALGOS, Universitat Rovira i Virgili, Catalonia, Spain
- Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain
- Institut d'Investigación Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Rocío de la Vega
- Unit for the Study and Treatment of Pain-ALGOS, Universitat Rovira i Virgili, Catalonia, Spain
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Santiago Galán
- Unit for the Study and Treatment of Pain-ALGOS, Universitat Rovira i Virgili, Catalonia, Spain
- Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain
- Institut d'Investigación Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Ester Solé
- Unit for the Study and Treatment of Pain-ALGOS, Universitat Rovira i Virgili, Catalonia, Spain
- Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain
- Institut d'Investigación Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Jordi Miró
- Unit for the Study and Treatment of Pain-ALGOS, Universitat Rovira i Virgili, Catalonia, Spain
- Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain
- Institut d'Investigación Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Dwight E Moulin
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Warren R Nielson
- Department of Psychology, Western University and Lawson Health Research Institute, London, Ontario, Canada
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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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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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Timmer AJ, Unsworth CA, Browne M. A randomized controlled trial protocol investigating effectiveness of an activity-pacing program for deconditioned older adults. Can J Occup Ther 2019; 86:136-147. [DOI: 10.1177/0008417419830374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Acute hospitalization of older adults can lead to deconditioning and the need for rehabilitation to facilitate a return to home and previous lifestyle. An occupational therapy intervention to combat deconditioning is activity pacing, an active self-management strategy where individuals learn to modify how and when activities are completed with the aim of improving participation in occupation. Purpose. This study will examine the effectiveness of occupational therapy with activity pacing during rehabilitation for deconditioned older adults. Method. A randomized controlled trial is proposed with inclusion criteria of older adults, 65+ years old, living independently in the community prior to admission, with adequate cognition and language to participate in the intervention. Participation, health status, self-efficacy in daily activities, self-efficacy in activity pacing techniques, and symptom management (pain and fatigue) will be measured at admission, discharge, and 3 months postdischarge. Implications. Determining if an activity-pacing program is effective will provide occupational therapists with evidence to support service delivery.
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Timmer AJ, Unsworth CA, Browne M. Occupational therapy and activity pacing with hospital-associated deconditioned older adults: a randomised controlled trial. Disabil Rehabil 2019; 42:1727-1735. [PMID: 30653372 DOI: 10.1080/09638288.2018.1535630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To examine the efficacy of an occupational therapy activity pacing intervention with deconditioned older adults in rehabilitation.Method: Randomised, single-blind controlled trial of deconditioned older adults admitted for rehabilitation following treatment of an acute medical condition, allocated to intervention [n = 51, males = 14, mean age = 80(8)] or control [n = 49, males = 12, mean age = 81(7)] group. The intervention group received individual and group activity pacing education with practice and application of techniques to daily activities and the home environment, while the control group received a typical occupational therapy program, which included brief activity pacing education. Outcomes included participation in daily living skills, health status (including pain and fatigue symptoms), self-efficacy in daily activities and activity pacing techniques using the Australian Therapy Outcome Measures-Occupational Therapy (AusTOMs-OT), Short Form-36 Health Survey (SF-36), Self-Efficacy Gauge and Activity Pacing Assessment.Results: No differences in groups at admission. Comparison at discharge and three months post discharge using 2 × 2 mixed ANOVA demonstrated small differences in only one scale of the activity limitation domain of the AusTOMs-OT. No significant differences were found in other scales or domains of the AusTOMs-OT, nor secondary outcome measures.Conclusion: Activity pacing in addition to typical occupational therapy during inpatient rehabilitation did not demonstrate benefits to participants in the management of their daily activities on returning home post hospitalisation.Implications for rehabilitationActivity pacing has been identified as one of the commonly used occupational therapy interventions utilised with deconditioned older adults in rehabilitation.An activity pacing intervention in conjunction with typical occupational therapy demonstrated no benefits for deconditioned older adults over typical occupational therapy which included basic education on this topic.Continuation of the activity pacing intervention into the outpatient setting may be of benefit to older adults and requires further investigation.
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Affiliation(s)
- Amanda J Timmer
- School of Health Medical and Applied Sciences, Central Queensland University, Melbourne, Australia.,Ramsay Health Care, Donvale Rehabilitation Hospital, Donvale, Australia
| | - Carolyn A Unsworth
- School of Health Medical and Applied Sciences, Central Queensland University, Melbourne, Australia.,Department of Rehabilitation, Jönköping University, Jönköping, Sweden.,School of Allied Health, La Trobe University, Melbourne, Australia
| | - Matthew Browne
- School of Health Medical and Applied Sciences, Central Queensland University, Melbourne, Australia
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Pain-related Activity Management Patterns and Function in Patients With Fibromyalgia Syndrome. Clin J Pain 2018; 34:122-129. [DOI: 10.1097/ajp.0000000000000526] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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