Characterizing the concept of activity pacing as a non-pharmacological intervention in rheumatology care: results of an international Delphi survey.
OBJECTIVE
To develop a consensual list of the most important aspects of activity pacing (AP) as an intervention within the context of non-pharmacological rheumatology care.


METHODS
An international, multidisciplinary expert panel comprising 60 clinicians and/or healthcare providers experienced in AP across 12 different countries participated in a Delphi survey. Over four Delphi rounds, the panel identified and ranked the most important goals of AP, behaviours of AP (the actions people take to meet the goal of AP), strategies to change behaviour in AP, and contextual factors that should be acknowledged when instructing AP. Additionally, topics for future research on AP were formulated and prioritized.


RESULTS
The Delphi panel prioritized 9 goals, 11 behaviours, 9 strategies to change behaviour, and 10 contextual factors of AP. These items were integrated into a consensual list containing the most important aspects of AP interventions in non-pharmacological rheumatology care. Nine topics for future research on AP with the highest ranking were included in a research agenda highlighting that future research should focus on the effectiveness of AP interventions and on appropriate outcome measures to assess its effectiveness, as selected by 64% and 82% of the panellists, respectively.


CONCLUSIONS
The diversity and number of items included in the consensual list developed in the current study reflect the heterogeneity of the concept of AP. This study is an important first step in achieving more transparency and homogeneity in the concept of AP in both rheumatology daily clinical practice and research.
a Department of Rheumatology , Sint Maartenskliniek , Nijmegen , The Netherlands.
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Cuperus
b Department of Orthopaedics , University Medical Centre , Leiden , The Netherlands.
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Vliet Vlieland
c Division of Physiotheraphy , Department of Neurobiology, Care Sciences and Society, Karolinska Institutet , Huddinge , Sweden.|d Orthopaedic Clinic, Division of Physiotheraphy , Danderyd Hospital , Stockholm , Sweden.
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Brodin
e Centre for Health Sciences Research, University of Salford , UK.
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Hammond
f National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway.
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Kjeken
g Faculty of Health Sciences , Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark , Odense , Denmark.
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Lund
h Department of Physical Medicine and Rehabilitation , University of Michigan , Ann Arbor , MI , USA.|i VA Ann Arbor Health Care System, Geriatric Research Education and Clinical Center (GRECC) , Ann Arbor , MI , USA.
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Murphy
a Department of Rheumatology , Sint Maartenskliniek , Nijmegen , The Netherlands.
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Neijland
j Division of Physiotherapy, Department of Neurobiology , Care Sciences and Society, Karolinska Institutet , Stockholm, Sweden.|k Department of Rheumatology , Karolinska University Hospital , Stockholm , Sweden.
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Opava
l Private Practice of Physical Therapy and Croatian Society of Patients with Scleroderma , Zagreb , Croatia.
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Roškar
m Department of Clinical and Organizational Psychology , Vilnius University , Lithuania.
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Sargautyte
n Division of Rheumatology, Department of Internal Medicine III , Medical University of Vienna , Austria.|o Department of Health , University of Applied Sciences, FH Campus Wien , Vienna , Austria.
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Stamm
p Psychiatry and Clinical Psychology Service, Clinic Institute of Neurosciences, Hospital Clinic of Barcelona , Spain.
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Mata
f National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway.
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Uhlig
q Department of Rheumatology , National Resource Centre for Rehabilitation in Rheumatology (NRRK), Diakonhjemmet Hospital , Oslo , Norway.
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Zangi
a Department of Rheumatology , Sint Maartenskliniek , Nijmegen , The Netherlands.
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