Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia.
Arch Phys Med Rehabil. 2012 Nov;93(11):2109-2121.e7. doi: 10.1016/j.apmr.2012.05.029. Epub 2012 Jun 21.
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.
A key word search was conducted in PsycINFO, MEDLINE via Ovid, EMBASE, and PubMed up to March 2011.
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.
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.
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.
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.
系统地回顾不同活动方式（即活动节奏、回避或耐力）与慢性疼痛样本中患者功能指标之间的关联。
通过 Ovid 中的 PsycINFO、MEDLINE、EMBASE 和 PubMed 进行了关键词搜索，检索截至 2011 年 3 月。
为了纳入研究，研究必须（1）用英语书写，（2）报告成人慢性疼痛样本，（3）报告至少有 1 个“活动方式”变量中的 1 个测量指标与患者功能指标之间的相关系数。
两名审查员独立筛选摘要和全文文章以确定其是否符合入选标准，并提取数据。根据活动方式的测量方法（节奏/回避/耐力）和所测量的标准变量（疼痛/身体功能/心理功能）对相关分析的结果进行分组，共分为 9 类。然后，使用随机效应模型对每种类别中的研究数据进行汇总。
有 41 项研究符合入选标准。结果表明，回避活动与更多的疼痛、较差的心理功能和更多的身体残疾有关。虽然坚持活动与身体和心理功能的改善有关，但这些关系似乎取决于所使用的测量方法，那些更能反映坚持活动到严重疼痛加剧程度（过度活动）的测量方法与较差的结果有关。节奏通常与较好的心理功能有关，但与更多的疼痛和残疾有关。
尽管不能确定因果关系，但这项研究的结果表明，回避活动和过度活动都与较差的患者结果有关。与节奏有关的意外结果可能反映了如果不逐渐增加个体的活动水平，节奏的无效性，或者具有更好的心理功能但更多的疼痛和残疾的个体更倾向于节奏活动的观点。
