• Welcome to Phoenix Rising!

    Created in 2008, Phoenix Rising is the largest and oldest forum dedicated to furthering the understanding of and finding treatments for complex chronic illnesses such as chronic fatigue syndrome (ME/CFS), fibromyalgia (FM), long COVID, postural orthostatic tachycardia syndrome (POTS), mast cell activation syndrome (MCAS), and allied diseases.

    To become a member, simply click the Register button at the top right.

Assessing the Psychometric Properties of an Activity Pacing Questionnaire for Chronic Pain & Fatigue

Dolphin

Senior Member
Messages
17,567
Probably not of interest to many but I've just read this paper and will post some thoughts.

Assessing the Psychometric Properties of an Activity Pacing Questionnaire for Chronic Pain and Fatigue.
Antcliff D1, Campbell M2, Woby S3, Keeley P4.

Phys Ther. 2015 Apr 23. [Epub ahead of print]

Abstract
BACKGROUND:
Therapists frequently advise the use of activity pacing as a coping strategy to manage long-term conditions (eg, chronic low back pain, chronic widespread pain, chronic fatigue syndrome/myalgic encephalomyelitis). However, activity pacing has not been clearly operationalized, and there is a paucity of empirical evidence regarding pacing. This paucity of evidence may be partly due to the absence of a widely used pacing scale. To address the limitations of existing pacing scales, the 38-item Activity Pacing Questionnaire (APQ-38) was previously developed using the Delphi technique.

OBJECTIVE:
The aims of this study were: (1) to explore the psychometric properties of the APQ-38, (2) to identify underlying pacing themes, and (3) to assess the reliability and validity of the scale.

DESIGN:
This was a cross-sectional questionnaire study.

METHODS:
Three hundred eleven adult patients with chronic pain or fatigue participated, of whom 69 completed the test-retest analysis. Data obtained for the APQ-38 were analyzed using exploratory factor analysis, internal and test-retest reliability, and validity against 2 existing pacing subscales and validated measures of pain, fatigue, anxiety, depression, avoidance, and mental and physical function.

RESULTS:
Following factor analysis, 12 items were removed from the APQ-38, and 5 themes of pacing were identified in the resulting 26-item Activity Pacing Questionnaire (APQ-26): activity adjustment, activity consistency, activity progression, activity planning, and activity acceptance. These themes demonstrated satisfactory internal consistency (Cronbach α=.72-.92), test-retest reliability (intraclass correlation coefficient=.50-.78, P≤.001), and construct validity. Activity adjustment, activity progression, and activity acceptance correlated with worsened symptoms; activity consistency correlated with improved symptoms; and activity planning correlated with both improved and worsened symptoms.

LIMITATIONS:
Data were collected from self-report questionnaires only.

CONCLUSIONS:
Developed to be widely used across a heterogeneous group of patients with chronic pain or fatigue, the APQ-26 is multifaceted and demonstrates reliability and validity. Further study will explore the effects of pacing on patients' symptoms to guide therapists toward advising pacing themes with empirical benefits.

© 2015 American Physical Therapy Association.

PMID: 25908522

[PubMed - as supplied by publisher]
 

Simon

Senior Member
Messages
3,789
Location
Monmouth, UK
I'd be interested to know if patients were involved in either directly developing the pacing scale, or commenting on the APQ-38, or revised APQ-26, so patients could assess face validity. They might just have something to add.

I also wonder with all these scales that demonstrate 'statisfactory' internal consistency, test/retest etc, like it's an ok-ish pass. How about trying to develop something really good? Because that's how it will be interpreted when used in future studies.

Sorry, pre-empting you there. As you were.
 

Dolphin

Senior Member
Messages
17,567
I'd be interested to know if patients were involved in either directly developing the pacing scale, or commenting on the APQ-38, or revised APQ-26, so patients could assess face validity. They might just have something to add.
They weren't really asked to assess face validity as measures of pacing.

However, the questionnaire was influenced a little by the results from patients:
To develop a comprehensive, yet acceptable, scale containing logical subscales, APQ-38 items were considered for removal if they had high numbers of missing answers (5.0%), together with coinciding comments from patients indicating a lack of understanding

Also
Participants rated the ease of completion of each pacing scale on a 5-point Likert scale (0“very difficult” to 4“very easy”) and were invited to make comments.*

This led to a heading "Face Validity of the APQ-38" in the results but I'm not sure it's a great measure of face validity:
The ease of completion and number of missing answers per item of the APQ-38 and the CPCI and PARQ pacing subscales are summarized in Table 1. Some participants made general comments referring to challenges of completing the APQ-38 due to its length. Several participants reported difficulties with the CPCI rating scale (0 –7 days). Problems were highlighted with regard to the pain-oriented items of the CPCI and PARQ pacing subscales among participants who experienced symptoms other than pain or who were currently pain-free.

Item 15 was removed due to high correlations with item 13 (r.69), together with comments referring to repetitive items.
 

Dolphin

Senior Member
Messages
17,567
The main point I want to make is how pacing is changing from what people like Ellen Goudsmit traditionally wrote about pacing for M.E.

Here are some examples of questions
I gradually increased how long I could spend on my activities

I gradually increased activities that I had been avoiding because of my symptoms
To me these are more like graded activity than pacing. The authors do say these sorts of questions haven't been included in other pacing questionnaires.

Such findings may explain the increased numbers reporting being made worse by pacing in the 2015 ME Association survey:
http://www.meassociation.org.uk/2015/05/23959/
Some of the comments in the survey also show that some of the therapists giving pacing courses were using graded activity or "graded pacing".
 

Dolphin

Senior Member
Messages
17,567
As the abstract says, the 26 questions were broken down, using factor analysis, into five factors or groups of questions which were given the headings: activity adjustment, activity consistency, activity progression, activity planning, and activity acceptance.

The authors then correlated the results with the scores on various instruments measuring:
Current pain; Usual pain; Physical fatigue; Mental fatigue; Anxiety; Depression; Cognitive anxiety; Escape and avoidance; Fearful thoughts; Physiological anxiety; Physical function; Mental function.

They reported these results in two ways: one as correlations where it is not clear which came first but also they started saying some types of pacing seemed better than others so ignoring the point that these were correlations. It is good that they said one couldn't be sure about cause and effect but given that they do try to say at some points some pacing strategies seem better, it is unclear whether they mention that one shouldn't read the correlations as cause and effect because they are honest scientists or alternatively because one or more reviewers insisted on it.

Sample:

Activity consistency emerged as the most beneficial theme of pacing.

The point about correlations is that people who are doing well may be able to use certain strategies that people who are worse are unable to do. This doesn't mean that the strategies themselves make people better and similarly that not doing them makes one worse.
 
Last edited:

Dolphin

Senior Member
Messages
17,567
An example of where the authors are coming from:
Activity planning refers to quota contingency, a strategy recommended in preference to symptom contingency, to challenge activity withdrawal and deconditioning due to expectations of worsening symptoms. 18 –20
 

Sean

Senior Member
Messages
7,378
Just part of the ongoing propaganda process of blurring GET into pacing, and vice-versa, so that this dishonest cowardly profession does not have to face truth about what it has done to us, and that we were right all along.

Here's a tip: Anytime these gits invoke deconditioning, you can be pretty sure that what follows is shite.

Better stop there for the sake of my own reputation. :mad: