title: Exploring patients' opinions of activity pacing and a new activity pacing questionnaire for chronic pain and/or fatigue: a qualitative study.
abstract: OBJECTIVE
  Despite the frequent recommendation of activity pacing as a coping strategy for patients with chronic pain and/or fatigue, pacing is interpreted in different ways and there is an absence of a widely accepted pacing scale. We have developed a new Activity Pacing Questionnaire (APQ). The aims of this study were to explore patients' views and beliefs about the concept of pacing, together with the acceptability of the APQ.
  
  
  METHODS
  Qualitative pragmatic study using semi-structured telephone interviews. Data were analysed using Framework analysis.
  
  
  METHODS
  16 adult patients attending secondary care physiotherapy out-patient departments were recruited via purposive sampling. Diagnoses included chronic low back pain, chronic widespread pain, fibromyalgia and chronic fatigue syndrome/myalgic encephalomyelitis.
  
  
  RESULTS
  Pacing emerged as a multifaceted concept from participants' descriptions. The implementation of pacing was influenced by participants' age, the presence of co-morbidities and participants' emotions. The APQ was found to be generally acceptable in comparison to two existing pacing subscales. Participants undertook activities using quota/symptom-contingent approaches. Four behavioural typologies emerged: Task avoidance, Task persistence, Task fluctuation (boom-bust) and Task modification (activity pacing).
  
  
  CONCLUSIONS
  The APQ appears to be easy to complete, and acceptable to patients who are attending physiotherapy for the management of long-term conditions. It emerged that individual patients implemented different pacing facets to varying degrees, and that different behavioural typologies were apparent. The relationships between behavioural typologies and facets of pacing warrant further investigation to facilitate the development of effective tailored pacing interventions.
authors.affiliation: The Pennine Acute Hospitals NHS Trust, Physiotherapy Department, North Manchester General Hospital, Manchester M8 5RB, UK; School of Nursing, Midwifery and Social Work, University of Manchester, Manchester M13 9PL, UK. Electronic address: Deborah.Antcliff@pat.nhs.uk.
authors.forename: Deborah
authors.initials: D
authors.lastname: Antcliff
authors.affiliation: Department of Health Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK.
authors.forename: Philip
authors.initials: P
authors.lastname: Keeley
authors.affiliation: School of Nursing, Midwifery and Social Work, University of Manchester, Manchester M13 9PL, UK.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Campbell
authors.affiliation: The Pennine Acute Hospitals NHS Trust, Research and Development Department, North Manchester General Hospital, Manchester M8 5RB, UK.
authors.forename: Steve
authors.initials: S
authors.lastname: Woby
authors.affiliation: School of Healthcare, Baines Wing, University of Leeds, Leeds LS2 9JT, UK.
authors.forename: Linda
authors.initials: L
authors.lastname: McGowan
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D059350:Chronic Pain / Q000523:psychology* / Q000534:rehabilitation*; D015673:Fatigue Syndrome, Chronic / Q000473:pathology* / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D009043:Motor Activity; D026741:Physical Therapy Modalities; D011594:Psychometrics; D036301:Qualitative Research; D011795:Surveys and Questionnaires
keywords: Acceptability; Activity pacing; Chronic fatigue; Chronic pain; Qualitative; Questionnaire