Abstract
Andrews NE, Strong J, Meredith PJ. Activity pacing, avoidance, endurance, and associations
with patient functioning in chronic pain: a systematic review and meta-analysis.
Objective
To systematically review the associations between different approaches to activity
(ie, activity pacing, avoidance, or endurance) and indicators of patient functioning
in chronic pain samples.
Data Sources
A key word search was conducted in PsycINFO, MEDLINE via Ovid, EMBASE, and PubMed
up to March 2011.
Study Selection
To be included, studies had to (1) be written in English, (2) report on an adult chronic
pain sample, and (3) report a correlation coefficient between at least 1 measure of
1 of the 3 “approach to activity” variables and an indicator of patient functioning.
Data Extraction
Two reviewers independently screened abstracts and full-text articles for eligibility
and extracted the data. Results of correlation analyses were grouped on the basis
of measure of approach to activity (pacing/avoidance/endurance) and the criterion
variable measured (pain/physical functioning/psychological functioning), resulting
in 9 categories. Random-effects modeling was then used to pool data across studies
in each category.
Data Synthesis
Forty-one studies were eligible for inclusion. Results demonstrated that avoidance
of activity was consistently associated with more pain, poorer psychological functioning,
and more physical disability. While enduring with activity was associated with enhanced
physical and psychological functioning, these relationships appeared to be dependent
on the measure used, with measures more reflective of persisting with activities to
the point of severe pain aggravation (overactivity) linked to poorer outcomes. Pacing
was generally linked to better psychological functioning but more pain and disability.
Conclusions
Although causation cannot be determined, results of this study suggest that both avoidance
of activity and overactivity are associated with poorer patient outcomes. Unexpected
results relating to pacing may reflect either the ineffectiveness of pacing if not
used to gradually increase an individual's activity level or the notion that individuals
with better psychological functioning but more pain and disability are more inclined
to pace activity.
Key Words
List of Abbreviations:
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Article info
Publication history
Published online: June 25, 2012
Footnotes
In-press corrected proof published online on Aug 17, 2012, at www.archives-pmr.org.
Supported by a Royal Brisbane and Women's Hospital Foundation Scholarship and the Cramond Fellowship in Occupational Therapy and Pain Management at the Royal Brisbane and Women's Hospital.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
Identification
Copyright
© 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
