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

Phys Ther. 2015 Sep;95(9):1274-86. doi: 10.2522/ptj.20140405. Epub 2015 Apr 23.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Chronic Pain / rehabilitation*
  • Cross-Sectional Studies
  • Delphi Technique
  • Factor Analysis, Statistical
  • Fatigue Syndrome, Chronic / rehabilitation*
  • Female
  • Humans
  • Low Back Pain / rehabilitation*
  • Male
  • Middle Aged
  • Motor Activity*
  • Physical Therapy Modalities*
  • Psychometrics
  • Reproducibility of Results
  • Surveys and Questionnaires*