1
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Enomoto K, Sasaki J. Relationship between perfectionism, overactivity, pain severity, and pain interference in individuals with chronic pain: A cross-lagged panel model analysis. Scand J Pain 2024; 24:sjpain-2023-0087. [PMID: 38451487 DOI: 10.1515/sjpain-2023-0087] [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: 07/02/2023] [Accepted: 12/22/2023] [Indexed: 03/08/2024]
Abstract
OBJECTIVES Overactivity is a characteristic of individuals with chronic pain. Previous cross-sectional studies demonstrated a relationship between perfectionism and overactivity. Therefore, the present study used a longitudinal design to determine whether pain severity and pain interference were exacerbated by overactivity and whether overactivity was exacerbated by perfectionism. METHODS Participants with chronic pain were recruited using crowdsourcing. The participants completed the questionnaires at three time points: T1, T2, and T3 (September, October, and November 2021, respectively). The questionnaire assessed overactivity, perfectionistic strivings, perfectionistic concerns, pain severity, and pain interference. We created cross-lagged panel models to examine the hypothesized relationships among pain, overactivity, and perfectionism. RESULTS After excluding ineligible participants and invalid response sets, we analyzed the questionnaires completed by 666 participants at T1, 560 at T2, and 554 at T3. The average duration of chronic pain at T1 was 36.35 ± 53.53 months. Perfectionistic strivings were partially linked to overactivity, and pain interference was partially related to overactivity. Contrary to our expectations, overactivity did not predict pain severity or pain interference. CONCLUSIONS The hypotheses that perfectionism exacerbates overactivity and that overactivity exacerbates pain severity and pain interference were not supported. These results may have been affected by the quality of the assessment of overactivity. Therefore, further research with a refined evaluation of overactivity is required.
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Affiliation(s)
- Kiyoka Enomoto
- Pain Management Clinic, Shiga University of Medical Science Hospital, Seta Tsukinowa-cho, Otsu, Shiga, Japan
- Department of Child Development, United Graduate School of Child Development, Osaka University, Suita, Osaka, Japan
| | - Jun Sasaki
- Graduate School of Human Sciences, Osaka University, Suita, Osaka, Japan
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2
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The Effect of Occupational Engagement on Lifestyle in Adults Living with Chronic Pain: A Systematic Review and Meta-analysis. Occup Ther Int 2022; 2022:7082159. [PMID: 35814357 PMCID: PMC9208937 DOI: 10.1155/2022/7082159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/24/2022] [Accepted: 03/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background. Healthy lifestyle is important to decrease health risks in individuals living with chronic pain. From an occupational therapy perspective, human health and lifestyle are linked to occupational engagement in meaningful everyday activities. This study is aimed at investigating the effect of including occupational engagement in chronic pain interventions on lifestyle. Methods. In this systematic review (PROSPERO reg. CRD42020159279), we included randomized controlled trials (RCTs) on interventions involving occupational engagement (i.e., occupational performance based on involvement, choice, positive meaning, and commitment) and assessing modifiable lifestyle factors: physical activity, body anthropometrics, alcohol consumption, smoking, stress, and sleep. We sought the databases Ovid MEDLINE, Embase, PsycINFO, CINAHL, Cochrane, Scopus, Web of Science, OTseeker, ClinicalTrials.gov, OpenGrey, and the web engine Google Scholar and citations and references of relevant publications. We evaluated methodological quality with the Cochrane risk-of-bias tool 2.0, determined the overall evidence certainty using the GRADE methodology, and performed meta-analysis when two or more trials reported on the outcomes. Results. Of the 9526 items identified, 286 were full text screened. We included twelve articles with eleven RCTs comprising 995 adults and assessing physical activity, sleep quality, stress, and Body Mass Index. Sufficient data for meta-analysis was only available for physical activity and sleep quality. The meta-analysis suggested a moderate increase in physical activity after behavioral interventions for fibromyalgia and musculoskeletal pain (
(0.29; 1.09)) and a small increase in sleep quality up to 6 months after multidisciplinary self-management of fibromyalgia (
(95% CI 0.08; 0.61)). The overall certainty of the evidence was deemed low. Conclusion. Including occupational engagement in chronic pain interventions may increase short-term physical activity and long-term sleep quality. Due to the few available RCTs including occupational engagement in chronic pain treatment for adults living with chronic pain, further high-quality RCTs are needed and will likely change the conclusion.
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3
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Overactivity in Chronic Pain, the Role of Pain-related Endurance and Neuromuscular Activity: An Interdisciplinary, Narrative Review. Clin J Pain 2021; 36:162-171. [PMID: 31833914 DOI: 10.1097/ajp.0000000000000785] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Decades of research have convincingly shown that fear of pain and pain-related avoidance behavior are important precursors of disability in daily life. Reduced activity as a consequence of avoidance, however, cannot be blamed for chronic disability in all patients. A contrasting behavior, pain-related dysfunctional endurance in a task and overactivity has to be considered. Currently, there is a need to better understand the psychological determinants of overactivity, dysfunctional endurance, and neurobiomechanical consequences. METHODS This is a narrative review. RESULTS The first part of this review elucidates research on self-reported overactivity, showing associations with higher levels of pain and disability, especially in spinal load positions, for example, lifting, bending, or spending too long a time in specific positions. In addition, measures of habitual endurance-related pain responses, based on the avoidance-endurance model, are related to objective assessments of physical activity and, again, especially in positions known to cause high spinal load (part 2). The final part reveals findings from neuromuscular research on motor control indicating the possibility that, in particular, overactivity and dysfunctional endurance may result in a number of dysfunctional adaptations with repetitive strain injuries of muscles, ligaments, and vertebral segments as precursors of pain. DISCUSSION This narrative review brings together different research lines on overactivity, pain-related endurance, and supposed neuromuscular consequences. Clinicians should distinguish between patients who rest and escape from pain at low levels of pain, but who have high levels of fear of pain and those who predominantly persist in activities despite severely increasing pain until a break will be enforced by intolerable pain levels.
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4
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Heigl F, Tobler-Ammann B, Villiger PM, Gantschnig BE. Relationship between the perceived burden of suffering and the observed quality of ADL task performance before and after a 12-week pain management programme. Scand J Occup Ther 2021; 29:660-669. [PMID: 33813985 DOI: 10.1080/11038128.2021.1903988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND/OBJECTIVE Constant pain causes suffering and affects performance of activities of daily living (ADL). In clients with chronic musculoskeletal pain, we wanted to determine (i) the relationship between the perceived burden of suffering (measured with the Pictorial Representation of Illness and Self Measure (PRISM)) and the observed quality of ADL task performance (measured with the Assessment of Motor and Process Skills (AMPS)); and (ii) the change in these assessments before and after a 12-week pain programme. METHODS In this cross-sectional cohort study, we retrospectively collected data from participants in a Swiss pain management programme. We calculated the relationship, correlations and effect sizes for the PRISM and AMPS using non-parametric tests. We set the level of significance at α = 0.05. RESULTS Out of 138 clients, 74 participated. We found no significant correlations between the PRISM and AMPS (p = 0.55-0.36), except for the PRISM and AMPS process ability measure after the pain management programme (p = 0.023). Pre-post-correlations of the AMPS and PRISM were significant, with medium to strong effect sizes (-0.48-0.66). CONCLUSION Participation in this pain programme improved both, the PRISM and AMPS scores. The lack of correlation between these assessments in clients with chronic musculoskeletal pain, however, strongly argues for a thorough clinical assessment.
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Affiliation(s)
- Franziska Heigl
- Department of Rheumatology and Immunology, University Hospital (Inselspital), and University of Bern, Bern, Switzerland
| | - Bernadette Tobler-Ammann
- Department of Orthopaedic, Plastic and Hand Surgery, Hand Therapy Research Unit, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Peter M Villiger
- Department of Rheumatology and Immunology, University Hospital (Inselspital), and University of Bern, Bern, Switzerland
| | - Brigitte E Gantschnig
- Department of Rheumatology and Immunology, University Hospital (Inselspital), and University of Bern, Bern, Switzerland.,Institute of Occupational Therapy, School of Health Professions, ZHAW Zürich University of Applied Sciences, Winterthur, Switzerland
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5
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Suso-Ribera C, Catalá P, Ecija C, Sanromán L, López-Gómez I, Pastor-Mira Á, Peñacoba-Puente C. Exploring the contextual role of pain severity as a moderator of the relationship between activity patterns and the physical and mental functioning of women with fibromyalgia. Eur J Pain 2020; 25:257-268. [PMID: 32996660 DOI: 10.1002/ejp.1669] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 09/27/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION In past years, and mostly due to contextual psychological therapies, it has been argued that particular behavioural patterns may be useful in certain contexts, but not in others. The goal of this study has been to explore whether pain severity is indeed a contextual factor influencing the relationship between two controversial activity patterns, namely pacing and persistence, and functionality in people with fibromyalgia. METHODS Participants were 231 women diagnosed with fibromyalgia. A multivariate regression was conducted to explore the moderating role of pain severity in the relationship between activity patterns and outcomes (i.e. fibromyalgia impact and depressive symptoms). RESULTS Excessive persistence (interaction: t = -2.45, p = 0.015) and pain-contingent persistence (interaction: t= -2.13, p = 0.034) were more strongly associated with fibromyalgia impact when people experienced less severe pain. Pacing for pain reduction was only significantly related to depressive symptoms at very severe (M = 10) pain levels (interaction: β= -0.18, t= -2.73). CONCLUSIONS The results here reported suggest that the context in which behaviour occurs is relevant when the utility of certain behaviour patterns is considered. The clinical implications of this are clear, as it would justify adapting the recommendations given to patients according to their pain severity status. SIGNIFICANCE This manuscript shows that some activity patterns (i.e. pacing to conserve energy for valued activities) might be advisable regardless of pain levels. Conversely, some patterns might be especially recommended (i.e. pain-reduction pacing) or inadvisable (i.e. excessive and pain-contingent persistence) depending on pain levels (i.e. severe and mild pain, respectively).
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Affiliation(s)
- Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Castellon, Spain
| | - Patricia Catalá
- Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Carmen Ecija
- Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Lucía Sanromán
- Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | | | - Ángeles Pastor-Mira
- Department of Behavioral Sciences and Health, Miguel Hernández University, Alicante, Spain
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6
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Andrews NE, Chien CW, Ireland D, Varnfield M. Overactivity assessment in chronic pain: The development and psychometric evaluation of a multifaceted self-report assessment. Eur J Pain 2020; 25:225-242. [PMID: 32965735 PMCID: PMC7821341 DOI: 10.1002/ejp.1664] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 09/17/2020] [Accepted: 09/17/2020] [Indexed: 11/19/2022]
Abstract
Background Overactivity in the context of chronic pain (i.e. activity engagement that significantly exacerbates pain) is an important clinical issue that has gained empirical attention in the last decade. Current assessment concepts of overactivity tend to focus on frequency to quantify the severity of the pain behaviour. This study aimed to develop and validate a more comprehensive self‐assessment, the Overactivity in Persistent Pain Assessment (OPPA). Methods A sample of 333 individuals with chronic pain completed the OPPA. A subset of 202 individuals also completed a set of existing measures of pain‐related outcomes and activity patterns. The remaining 131 participants were provided with a second copy of the OPPA to fill in one week following their initial assessment. Results A principal component analysis confirmed that the OPPA items were best represented by a single construct. The OPPA was found to correlate with pain‐related measures in an expected way that is supported by both theory and qualitative data. When compared to existing overactivity measures, the OPPA was the only measure to contribute significantly to the regression models predicting higher levels of pain severity, more pain interference and lower levels of activity participation after controlling for age, gender and activity avoidance. In addition, the OPPA scale exhibited acceptable internal consistency and good test–retest reliability. Conclusion The results of this study reinforce the potentially important role of overactivity in the maintenance of pain‐related suffering and supports a corresponding assessment tool with preliminary psychometric evidence for clinical and research applications. Significance This study deconstructs the overactivity concept and develop a corresponding assessment based on five quantifiable severity features: severity of pain exacerbation, maladaptive coping strategies used, impact on occupational performance, recovery time and frequency. Results of the psychometric evaluation indicate that this comprehensive assessment of overactivity severity features may be necessary to understand the impact of overactivity on pain severity and physical functioning from both a clinical and research perspective.
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Affiliation(s)
- Nicole E Andrews
- RECOVER Injury Research Centre, The University of Queensland, Herston, Qld., Australia.,Department of Occupational Therapy, The Royal Brisbane and Women's Hospital, Herston, Qld., Australia.,Tess Cramond Pain and Research Centre, The Royal Brisbane and Women's Hospital, Herston, Qld., Australia
| | - Chi-Wen Chien
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - David Ireland
- The Australian eHealth Research Centre, CSIRO, Herston, Qld., Australia
| | - Marlien Varnfield
- The Australian eHealth Research Centre, CSIRO, Herston, Qld., Australia
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7
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Huijnen IPJ, Schasfoort FC, Smeets RJEM, Sneekes E, Verbunt JA, Bussmann JBJ. Subgrouping patients with chronic low back pain: What are the differences in actual daily life behavior between patients classified as avoider or persister? J Back Musculoskelet Rehabil 2020; 33:303-311. [PMID: 31450487 DOI: 10.3233/bmr-171048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE The purpose of this study is to determine whether patients, classified by their treating consultant in rehabilitation medicine as avoider or persister, show differences in a large set of detailed outcomes of actual, objectively measured daily physical behaviour. METHODS In this explorative cross-sectional study, 16 patients were included; 9 patients were categorized as avoider and 7 patients as persister. Subjects wore the VitaMove activity monitor, a high-end accelerometry-based device that allowed automatic detection of a large set of body postures and motions. Physical behaviour was assessed in detail by total duration of body postures and motions as percentages of 24 hours, as well as by the number of sit-to-stand transfers, overall activity level, walking speed, and the distribution of bouts of physical activity and sedentary behaviour. Differences between groups were tested with the Mann Whitney U test. RESULTS There were no significant differences between groups in any of the physical behaviour outcomes. CONCLUSIONS Our study showed that activity-related behavioural style categorization by consultants in rehabilitation medicine is not expressed in objectively measured detailed outcomes of daily physical behaviour.
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Affiliation(s)
- Ivan P J Huijnen
- Department of Rehabilitation Medicine, Research Program Functioning and Rehabilitation, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands.,Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands.,Department of Rehabilitation Medicine, Research Program Functioning and Rehabilitation, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Fabienne C Schasfoort
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine, Research Program Functioning and Rehabilitation, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Rob J E M Smeets
- Department of Rehabilitation Medicine, Research Program Functioning and Rehabilitation, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands.,CIR Revalidatie Location Eindhoven, Eindhoven, The Netherlands
| | - Emiel Sneekes
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Jeanine A Verbunt
- Department of Rehabilitation Medicine, Research Program Functioning and Rehabilitation, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands.,Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - Johannes B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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8
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Task-Contingent Persistence is Related to Better Performance-Based Measures in Patients with Chronic Musculoskeletal Pain. Pain Res Manag 2020; 2020:1765456. [PMID: 32655723 PMCID: PMC7317324 DOI: 10.1155/2020/1765456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 05/20/2020] [Indexed: 11/17/2022]
Abstract
Purpose Pacing, avoidance, and overdoing are considered the three main behavioral strategies, also labeled activity patterns. Their relationship with functioning of patients with chronic pain is debated. The purpose of this study was to measure the influence of activity patterns on lifting tasks commonly used in daily life. Method We performed a monocentric observational study and included patients performing Functional Capacity Evaluation (FCE). Avoidance, pacing, and persistence were assessed with using the Patterns of Activity Measures-Pain (POAM-P). Maximal safe performance was measured for floor-to-waist, waist-to-overhead, horizontal lift, and carrying with dominant-hand tests according to the FCE guidelines. Descriptive statistics, associations of POAM-P subscales with various sociodemographic variables, and correlations are presented. Standard multiple linear regression models were applied to measure the associations between FCE tests and POAM-P subscales, adjusting for the following potential confounders: age, gender, body mass index (BMI), pain severity, trauma severity, localization of injury, and education. Results Persistence was significantly positively associated with performance on the 4 FCE tests: floor-to-waist (coefficient = 0.20; p=0.001), waist-to-overhead (coefficient = 0.13; p=0.004), horizontal lift (coefficient = 0.31; p ≤ 0.001), and dominant-handed lifting (coefficient = 0.19; p=0.001). Pacing was found to have a negative influence on the carrying dominant-hand test (coefficient = -0.14; p=0.034), and avoidance was not found to have an influence on the 4 FCE tests. Conclusion This study shows that task-persistence pattern is positively associated with physical performance in FCE, whereas pacing can have a negative influence on some tests.
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9
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Kalisvaart H, van Broeckhuysen-Kloth S, van Busschbach JT, Geenen R. Development of the Body-Relatedness Observation Scale: A feasibility study. Physiother Theory Pract 2020; 38:830-838. [PMID: 32648494 DOI: 10.1080/09593985.2020.1790067] [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: 10/23/2022]
Abstract
BACKGROUND One characteristic of somatoform (DSM-IV) and somatic symptom disorder (DSM-5) is the troubled relation of patients to their body. To assess body-relatedness, standardized observation by a physical therapist may add valuable information to questionnaires. Purpose: This study examines the feasibility of a physiotherapeutic observation instrument: the Body-Relatedness Observation Scale (BROS). Methods: Factorial validity and inter-rater reliability of observer scores were studied in 191 patients performing two short exercises, lying face up. Fourteen indicators of body-relatedness were selected, covering execution of instructions, perception of the body, muscle tension, and behavioral adaptation to somatic symptoms. Results: Inter-rater reliability values (Kappa or Intraclass correlation [ICC] according to model 1,1) were excellent for four observation scores, substantial for two, fair for two, and poor for six. Four out of five items relating to patients' ability to perceive the body had low inter-rater reliability values (ICC < 0.40 or Kappa < 0.20). Categorical principal components analysis with the eight reliable scores indicated a 1-factor structure including seven items with Cronbach's alpha 0.69. Conclusion: This initial analysis of a structured physical therapeutic observation for people with somatic symptom disorder indicated modestly sound psychometric quality of observations of execution of instructions, muscle tension, and behavioral adaptation, but not of patients' ability to perceive the body adequately. This shows that body-related observations are feasible and indicates the viability of further development of the BROS.
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Affiliation(s)
- Hanneke Kalisvaart
- Altrecht Psychosomatic Medicine, Zeist, The Netherlands.,School of Human Movement and Education, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | | | - Jooske T van Busschbach
- School of Human Movement and Education, Windesheim University of Applied Sciences, Zwolle, The Netherlands.,University Medical Center, University Center of Psychiatry, University of Groningen, Groningen, The Netherlands
| | - Rinie Geenen
- Altrecht Psychosomatic Medicine, Zeist, The Netherlands.,Department of Psychology, Utrecht University, Utrecht, The Netherlands
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10
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Exploring Changes in Activity Patterns in Individuals with Chronic Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103560. [PMID: 32438693 PMCID: PMC7277738 DOI: 10.3390/ijerph17103560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/12/2020] [Accepted: 05/18/2020] [Indexed: 02/05/2023]
Abstract
This longitudinal study explored whether activity patterns change over time in a sample of 56 individuals with chronic musculoskeletal pain over a 15-day period. Once a day, the participants recorded their level of pain intensity and the degree to which they had engaged in several specific activity patterns. Linear mixed models with random coefficients were used to investigate the rate of change in the activity patterns. Age, sex, pain intensity, and pain duration were controlled. The results show that excessive persistence was the only self-reported activity pattern to show a linear change over the 15-day period. There was a decrease in excessive persistence, and this decrease was slower with higher levels of activity avoidance. However, no significant association was found between sex, age, pain intensity, and pain duration and excessive persistence at baseline or change over time. At baseline, a positive association was found between excessive persistence and pain avoidance, pain-related persistence, and pacing to reduce pain, and a negative association was found between excessive persistence and pacing to save energy for valued activities. This result suggests a profile characterized by alternate periods of high and low activity that, in this study, were unrelated to longitudinal changes in pain intensity.
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11
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Stankevitz D, Larkins L, Baker RT. Electronic Patient-Reported Outcome Validation: Disablement in the Physically Active Scale. J Athl Train 2019; 54:319-323. [PMID: 30816052 DOI: 10.4085/1062-6050-420-17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Determining patient outcomes is essential to quality health care. Administering electronic patient-reported outcomes measures (PROMs) offers potential advantages, including faster completion and efficient data access and storage. However, commonly used PROMs have not been studied across multiple administration modes, limiting clinicians to paper forms until the electronic versions are validated. OBJECTIVE To determine the validity of an electronic version of the Disablement in the Physically Active (DPA) scale compared with the paper version. MAIN OUTCOME MEASURE(S) Electronic and paper versions of the DPA scale were randomly administered to 117 participants (38 women, 79 men; age = 21.6 ± 5.9 years) 24 to 48 hours apart. Responses were compared using Pearson product moment correlations, canonical correlations, and covariance modeling. RESULTS The electronic version of the DPA scale was strongly correlated with the paper version when compared using a bivariate correlation (r = 0.86, P < .001) or covariance modeling approach (r = 0.90, P < .001). CONCLUSIONS The electronic version of the DPA scale was comparable with the paper version, making the former more efficient for use in athletic training. This study provides a template for other clinician-researchers to perform similar evaluations of electronic PROMs to determine their equivalency with the paper versions before implementing them in practice.
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Affiliation(s)
- Diane Stankevitz
- Athletic Medicine and Rehabilitation Clinic, East Los Angeles College, Monterey Park, CA
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12
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Hayashi K, Kako M, Suzuki K, Takagi Y, Terai C, Yasuda S, Kadono I, Seki T, Hiraiwa H, Ushida T, Nishida Y. Impact of variation in physical activity after total joint replacement. J Pain Res 2018; 11:2399-2406. [PMID: 30425553 PMCID: PMC6200437 DOI: 10.2147/jpr.s178853] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Patients who undergo total knee arthroplasty (TKA) or total hip arthroplasty (THA) often develop postoperative pain. Exercise approaches are recommended postoperatively; however, the impact of excessive variation in physical activity is unclear. The purpose of the present preliminary study was to investigate the impact of excessive variation in physical activity using the accelerometer in the early period after TKA or THA. PATIENTS AND METHODS Seventy-two patients were enrolled in the study. Forty patients underwent initial TKA, and 32 initial THA. Physical activity was measured for 8 days from postoperative day 3 to 10. Patients with substantial correlation between physical activity and postoperative day were classified as the "good-pacing" group. Patients with no correlation between them were classified as the "poor-pacing" group. They were also evaluated using a pain visual analog scale (VAS), pain catastrophizing scale, and hospital anxiety and depression scale. RESULTS The average age was 68 years, and 59 patients (82%) were women. The average maximum number of steps per day was 2,181. There were 45 patients with good pacing and 27 with poor pacing. The poor-pacing group showed significantly lower maximum number of steps per day, higher postoperative average VAS score, higher postoperative worst VAS score, and longer duration of postoperative hospital stay than the good-pacing group. CONCLUSION Patients with excessive variation in physical activity showed severe postoperative pain and prolonged postoperative hospital stay. The postoperative variation in physical activity could be an outcome for improvement in patients after lower-limb arthroplasty.
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Affiliation(s)
- Kazuhiro Hayashi
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan,
- Department of Rehabilitation, Aichi Medical University Hospital, Nagakute, Japan,
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan,
| | - Masato Kako
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan,
| | - Kentaro Suzuki
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan,
| | - Yui Takagi
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan,
| | - Chiaki Terai
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan,
| | - Shotaro Yasuda
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan,
| | - Izumi Kadono
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan,
| | - Taisuke Seki
- Department of Orthopaedic Surgery, Nagoya University Graduate School and School of Medicine, Nagoya, Japan
| | - Hideki Hiraiwa
- Department of Orthopaedic Surgery, Nagoya University Graduate School and School of Medicine, Nagoya, Japan
| | - Takahiro Ushida
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan,
| | - Yoshihiro Nishida
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan,
- Department of Orthopaedic Surgery, Nagoya University Graduate School and School of Medicine, Nagoya, Japan
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13
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Psychosoziale Risikofaktoren für chronischen Rückenschmerz in der Allgemeingesellschaft und im Leistungssport. MANUELLE MEDIZIN 2018. [DOI: 10.1007/s00337-018-0450-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Luthi F, Vuistiner P, Favre C, Hilfiker R, Léger B. Avoidance, pacing, or persistence in multidisciplinary functional rehabilitation for chronic musculoskeletal pain: An observational study with cross-sectional and longitudinal analyses. PLoS One 2018; 13:e0203329. [PMID: 30180195 PMCID: PMC6122830 DOI: 10.1371/journal.pone.0203329] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/17/2018] [Indexed: 01/05/2023] Open
Abstract
Background Three main activity patterns have been distinguished in describing chronic pain (avoidance, pacing and persistence). However, their influence on patient outcomes remains a question of debate. This observational study aimed to measure the associations between the avoidance, pacing, and persistence (labelled overdoing) scales of the Patterns of Activity Measure–Pain (POAM-P), self-reported outcomes (pain-interference, depression, functional ability), and observational outcomes (walking, lifting test, physical fitness). Methods We conducted an observational study with cross-sectional and longitudinal analyses. The data were collected prospectively before and after treatment, which was a 5-week functional rehabilitation including vocational aspects. In addition to self-reported and observational outcomes, patients were asked if they thought they would be able to return to work at 6 months. Analyses were conducted with treatment effect sizes, correlations, and multiple regression models. Results In this sample (891 patients), we found on average small to moderate improvements for pain-interference and observational outcomes (Cohen’s d: 0.37 to 0.64). According to the multivariable models, overdoing was associated with most of the beneficial psychosocial and observational outcomes (β -0.13 to 0.17; all p<0.01). Avoidance was related to negative psychosocial outcomes before treatment (β -0.09 to 0.17; all p<0.015). Pacing, which had moderate correlation with avoidance (r = 0.46), was not associated with most of the outcomes. The feeling that the goal of returning to work was attainable was associated with lower avoidance scores (adjusted OR 0.97; p = 0.024). Conclusions The overdoing POAM-P scale probably measures a task-contingent persistence, which appears appropriate in the setting of this study. Persistent behavior was indeed related to small or moderate positive biopsychosocial outcomes, before and after treatment. Moreover feeling able to return to work was related to lower avoidance. Further studies should test the efficacy of motivational strategies that may promote functional task-contingent persistence and reduce avoidance of painful tasks.
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Affiliation(s)
- François Luthi
- Department for Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation suva, Sion, Switzerland
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation suva, Sion, Switzerland
- Department of Physical Medicine and Rehabilitation, Orthopedic Hospital, Lausanne University Hospital, Lausanne, Switzerland
- * E-mail:
| | - Philippe Vuistiner
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation suva, Sion, Switzerland
| | - Christine Favre
- Unit of Psychosomatic Medicine, Clinique Romande de Réadaptation suva, Sion, Switzerland
| | - Roger Hilfiker
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation suva, Sion, Switzerland
- School of Health Science, University of Applied Sciences and Arts Western Switzerland Valais (HES-SO Valais-Wallis), Sion, Switzerland
| | - Bertrand Léger
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation suva, Sion, Switzerland
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15
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Andrews NE, Strong J, Meredith PJ, Branjerdporn GS. Approach to activity engagement and differences in activity participation in chronic pain: A five-day observational study. Aust Occup Ther J 2018; 65:575-585. [DOI: 10.1111/1440-1630.12516] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Nicole E. Andrews
- Division of Occupational Therapy; School of Health and Rehabilitation Sciences; The University of Queensland; St. Lucia Queensland Australia
- Department of Occupational Therapy; The Royal Brisbane and Women's Hospital; Herston Queensland Australia
- The Professor Tess Cramond Multidisciplinary Pain Centre; The Royal Brisbane and Women's Hospital; Herston Queensland Australia
| | - Jenny Strong
- Division of Occupational Therapy; School of Health and Rehabilitation Sciences; The University of Queensland; St. Lucia Queensland Australia
- Department of Occupational Therapy; The Royal Brisbane and Women's Hospital; Herston Queensland Australia
| | - Pamela J. Meredith
- Division of Occupational Therapy; School of Health and Rehabilitation Sciences; The University of Queensland; St. Lucia Queensland Australia
| | - Grace S. Branjerdporn
- Division of Occupational Therapy; School of Health and Rehabilitation Sciences; The University of Queensland; St. Lucia Queensland Australia
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16
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Hasenbring MI. Approach to activity in pain: benefits and consequences of endurance despite severe pain. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2018. [DOI: 10.1080/21679169.2018.1495605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M. I. Hasenbring
- Department of Medical Psychology and Medical Sociology Faculty of Medicine, Ruhr-University of Bochum, Germany
- Faculty of Health Science, University of Southern Denmark, Odense, Denmark
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17
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[Psychosocial risk factors for chronic back pain in the general population and in competitive sports : From theory to clinical screening-a review from the MiSpEx network]. Schmerz 2018; 32:259-273. [PMID: 29946960 DOI: 10.1007/s00482-018-0307-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Lumbar back pain and the high risk of chronic complaints is not only an important health concern in the general population but also in high performance athletes. In contrast to non-athletes, there is a lack of research into psychosocial risk factors in athletes. Moreover, the development of psychosocial screening questionnaires that would be qualified to detect athletes with a high risk of chronicity is in the early stages. The purpose of this review is to give an overview of research into psychosocial risk factors in both populations and to evaluate the performance of screening instruments in non-athletes. METHODS The databases MEDLINE, PubMed, and PsycINFO were searched from March to June 2016 using the keywords "psychosocial screening", "low back pain", "sciatica" and "prognosis", "athletes". We included prospective studies conducted in patients with low back pain with and without radiation to the legs, aged ≥18 years and a follow-up of at least 3 months. RESULTS We identified 16 eligible studies, all of them conducted in samples of non-athletes. Among the most frequently published screening questionnaires, the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) demonstrated a sufficient early prediction of return to work and the STarT Back Screening Tool (SBT) revealed acceptable performance predicting pain-related impairment. The prediction of future pain was sufficient with the Risk Analysis of Back Pain Chronification (RISC-BP) and the Heidelberg Short Questionnaire (HKF). CONCLUSION Psychosocial risk factors of chronic back pain, such as chronic stress, depressive mood, and maladaptive pain processing are becoming increasingly more recognized in competitive sports. Screening instruments that have been shown to be predictive in the general population are currently being tested for suitability in the German MiSpEx research consortium.
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18
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Grisart J, Scaillet N, Michaux M, Masquelier E, Fantini C, Luminet O. Determinants of representational and behavioral hyperactivity in patients with fibromyalgia syndrome. J Health Psychol 2018; 25:1128-1137. [DOI: 10.1177/1359105317751616] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Fibromyalgia is associated with a premorbid hyperactivity. This study examines how contextual and personality factors contribute to premorbid hyperactivity. A total of 45 patients completed questionnaires. The results show that the number of children and the basic bodily needs neglect (and their interaction) explain nearly 50 percent of the variance of hyperactivity. The neglect toward bodily needs completely mediates the relation between self-oriented perfectionism and hyperactivity. This study suggests that hyperactivity itself would not have a pathological value, but that the neglect of basic bodily needs would represent a vulnerability factor in a hyperactive premorbid lifestyle in fibromyalgia patients.
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Affiliation(s)
| | | | | | - Etienne Masquelier
- University Hospital Saint-Luc, Belgium
- CHU Dinant Godinne UCL Namur, Belgium
- Institute of Neurosciences, Belgium
| | | | - Olivier Luminet
- Université catholique de Louvain, Belgium
- Belgian Fund for Scientific Research (F.R.S.-FNRS), Belgium
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19
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Comparisons in Muscle Function and Training Rehabilitation Outcomes Between Avoidance-Endurance Model Subgroups. Clin J Pain 2017; 33:912-920. [DOI: 10.1097/ajp.0000000000000479] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Psychological generators of stress-headaches. J Behav Med 2017; 41:109-121. [DOI: 10.1007/s10865-017-9872-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 07/06/2017] [Indexed: 01/03/2023]
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21
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Abstract
Activity pacing is frequently included among the strategies provided to individuals with chronic pain to manage pain and improve functioning. Individuals with chronic pain may, however, limit their use of activity pacing because they perceive significant obstacles to its use. This study describes the development of a measure to assess obstacles to activity pacing and examines the relationship of this measure to activity patterns and functioning. A sample of 637 individuals with chronic pain completed items describing potential obstacles to activity pacing as part of their pretreatment assessment. Item analyses were used to construct a 14-item measure of obstacles to activity pacing. A subset of these individuals completed the measure again after completion of a group treatment program. The resulting measure demonstrated excellent internal consistency and was minimally affected by social desirability. Correlations with measures of activity and psychosocial functioning provided initial construct validity for the measure. Sex differences were found with women initially identifying more obstacles to activity pacing. Fewer obstacles were identified by both men and women after treatment, and these changes were related to modest changes in activity patterns and functioning. The present results identify a number of obstacles that may limit the use of activity pacing by individuals with chronic pain. Treatment may result in a decrease in the number of obstacles identified, and this change is related to changes in the individual's activity pattern and psychosocial functioning.
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22
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Mollayeva T, Cassidy JD, Shapiro CM, Mollayeva S, Colantonio A. Concussion/mild traumatic brain injury-related chronic pain in males and females: A diagnostic modelling study. Medicine (Baltimore) 2017; 96:e5917. [PMID: 28207508 PMCID: PMC5319497 DOI: 10.1097/md.0000000000005917] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Pain is an unpleasant, complex, and perceived experience that places a significant burden on patients and clinicians. Its severity may be mediated by emotion, attitude, and environmental influences, and pain may be expressed differently in males and females. Traumatic brain injury (TBI) is frequently associated with chronic pain. This diagnostic modeling study examined sex differences in the construct of chronic pain in patients with delayed recovery from concussion/mild traumatic brain injury (mTBI).Data were collected from standardized questionnaires, neuroimaging records, and comprehensive clinical assessments. Bivariate associations were calculated using the Spearman correlation coefficient or analysis of variance. We established sex-specific stepwise multivariate linear regression models of factors associated with pain.Of the 94 participants diagnosed with mTBI (the mean age was 45.20 ± 9.94 years; 61.2% were males; the median time since injury was 197 days [interquartile range 139-416]), head/neck, and bodily pain were reported by 93% and 64%, respectively. No sex differences were identified in pain frequencies or severity. Pain was significantly associated with certain socio-demographic, injury-related, behavioral, and clinical variables. In the multivariable regression analysis, several determinants explained 60% of the pain variance in males and 46% in females.Pain is common in patients with delayed recovery from mTBI and is significantly associated with potentially modifiable clinical and nonclinical variables. Examining the multidimensional construct of pain in concussion/mTBI through a sex lens garners new directions for future longitudinal research on the pain mechanisms involved in postconcussion syndrome.
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Affiliation(s)
- Tatyana Mollayeva
- Rehabilitation Sciences Institute, Faculty of Medicine
- Department of Occupational Science and Occupational Therapy, University of Toronto
- Toronto Rehabilitation Institute
| | - J. David Cassidy
- Division of Health Care and Outcomes Research, University Health Network
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto
| | - Colin M. Shapiro
- Toronto Western Hospital, University Health Network
- Youthdale Child & Adolescent Sleep Clinic
| | - Shirin Mollayeva
- Department of Biology, University of Toronto, Mississauga, Ontario, Canada
| | - Angela Colantonio
- Rehabilitation Sciences Institute, Faculty of Medicine
- Department of Occupational Science and Occupational Therapy, University of Toronto
- Toronto Rehabilitation Institute
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23
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Peters ML, Esteve R, Ramírez-Maestre C, López-Martínez AE. Response to Andrews and Deen on Defining Activity Pacing. THE JOURNAL OF PAIN 2016; 17:1363-1364. [PMID: 27890166 DOI: 10.1016/j.jpain.2016.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 09/07/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Madelon L Peters
- Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands.
| | - Rosa Esteve
- Faculty of Psychology, University of Málaga, Málaga, Spain
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Andrews NE, Strong J, Meredith PJ, Fleming JA. The relationship between overactivity and opioid use in chronic pain: a 5-day observational study. Pain 2016; 157:466-474. [PMID: 26458090 DOI: 10.1097/j.pain.0000000000000384] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
With increasing concerns about the potential harm of long-term opioid therapy, there is a need for the development and implementation of alternative treatment strategies for patients with chronic pain who have been using opioids for a prolonged period of time. Based on the findings from a recent qualitative investigation that suggested there may be a bidirectional association between opioid reliance and habitual overactivity behaviour (activity engagement that significantly exacerbates pain), this study was designed to quantitatively investigate the association between opioid use and habitual overactivity over a 5-day period in a group of chronic pain patients. Participants provided a list of their prescribed pain medication, completed a self-report measure of habitual overactivity, and then commenced 5 days of data collection. Data collection required participants to wear an activity monitor and to complete a diary that detailed their daily activities and the time at which they took medication. Individuals reporting higher levels of habitual overactivity were more likely to be prescribed opioids. In addition, higher levels of habitual overactivity were associated with more frequent pro re nata ("as needed") opioid use over the 5 days, and with a discrepancy between the prescribed and actual oral morphine-equivalent daily dose, where more medication was taken than was prescribed. There was no predominant context for pro re nata use. The results of this study support the idea that habitual overactivity behaviour may play a role in the development of reliance on opioid medication and that such an association may provide a potential treatment target for opioid therapy rationalisation.
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Affiliation(s)
- Nicole Emma Andrews
- Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Queensland, Australia Department of Occupational Therapy, The Royal Brisbane and Women's Hospital, Queensland, Australia The Professor Tess Cramond Multidisciplinary Pain Centre, The Royal Brisbane and Women's Hospital, Queensland, Australia
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25
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Esteve R, Ramírez-Maestre C, Peters ML, Serrano-Ibáñez ER, Ruíz-Párraga GT, López-Martínez AE. Development and Initial Validation of the Activity Patterns Scale in Patients With Chronic Pain. THE JOURNAL OF PAIN 2015; 17:451-61. [PMID: 26724275 DOI: 10.1016/j.jpain.2015.12.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 12/05/2015] [Accepted: 12/05/2015] [Indexed: 02/05/2023]
Abstract
UNLABELLED Several self-report measures were used to identify 6 activity patterns in chronic pain patients: pain avoidance, activity avoidance, task-contingent persistence, excessive persistence, pain-contingent persistence, and pacing. Instruments for assessing pacing should include 3 pacing behaviors (breaking tasks into smaller tasks, taking frequent short rests, slowing down), each of which relate to a single goal (increasing activity levels, conserving energy for valued activities, and reducing pain). This article presents the Activity Patterns Scale (APS), which assesses these 6 activity patterns. Study 1 included 291 participants with chronic pain, and tested 3 structures using confirmatory factor analyses. The structure with the best fit had 8 factors corresponding to the hypothesized scales. High correlations in the expected direction were found between the APS subscales and the "Patterns of Activity Measure-Pain." Study 2 included 111 patients with chronic pain, and aimed at examining the association between the APS subscales and adjustment to pain. It was found that that activity avoidance was associated with daily functioning and impairment. Negative affect was positively associated with activity avoidance and excessive persistence, and negatively associated with task-contingent persistence, which was also positively associated with positive affect. This study showed that the APS is a valid and reliable instrument for clinical practice and research. PERSPECTIVE This article presents a valid and reliable instrument to assess activity patterns in patients with chronic pain. The findings suggest that avoidance, persistence, and pacing are multidimensional constructs. Distinguishing between these dimensions sheds light on previous contradictory results and has direct clinical implications regarding recommending the most advisable activity patterns.
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Affiliation(s)
- Rosa Esteve
- Universidad de Málaga, Andalucía Tech, Facultad de Psicología, Málaga, Spain.
| | | | - Madelon L Peters
- Maastricht University, Department of Psychology and Neuroscience, Clinical Psychological Science, Behavioural Medicine, Maastricht, The Netherlands
| | | | - Gema T Ruíz-Párraga
- Universidad de Málaga, Andalucía Tech, Facultad de Psicología, Málaga, Spain
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