Activity Pacing in Chronic Pain Management: One Aim, but Which Method? Part Two: National Activity Pacing Survey

Abstract

Part one of this paper suggested that, in order to attain activity goals, it is important to replace activity contingent on pain with activity contingent on quota, such as time or number. This is one aspect of activity pacing, which can help to break the detrimental overactivity-underactivity cycle. However, there are few established guidelines regarding activity pacing. Part two reports a study which sought to answer two questions: what are the main principles underlying activity pacing and how are activity pacing principles taught? A questionnaire was posted to all 78 members of the National Occupational Therapy Pain Association in order to sample current practice. The 49 (63%) respondents endorsed nine behaviours contributing to activity pacing, including planning activities, breaking activities into manageable parts, increasing activity amounts gradually and alternating tasks. The occupational therapists used varied methods to teach these behaviours and only half of them used time as the unit of increase. These therapists disagreed about how long to continue timer use for and what activities to use it for. The importance of time-contingency in activity pacing, and related teaching methods, is contentious. No alternatives were suggested to time-contingency to break the pattern of pain-contingency in activities. Studies are urgently needed concerning the efficacy of time-contingency, the efficacy of any alternatives and their acceptability to patients.