Physiotherapy Department, Bury Care Organisation, Northern Care Alliance NHS Group, Bury, England, UK.
School of Healthcare, University of Leeds, Leeds, England, UK.
Musculoskeletal Care. 2022 Mar;20(1):99-110. doi: 10.1002/msc.1557. Epub 2021 May 6.
We have developed and feasibility tested an activity pacing framework for clinicians to standardise their recommendations of activity pacing to patients with chronic pain/fatigue. This study aimed to explore the acceptability and fidelity to this framework in preparation for a future trial of activity pacing.
Acceptability and fidelity were explored using semi-structured interviews. Data were analysed using framework analysis.
Patients who attended a rehabilitation programme for chronic pain/fatigue underpinned by the framework, and clinicians (physiotherapists and psychological wellbeing practitioners) who led the programmes.
Seventeen interviews were conducted, involving 12 patients with chronic pain/fatigue and five clinicians. The framework analysis revealed four deductive themes: (1) Acceptability of the activity pacing framework, (2) Acceptability of the feasibility study methods, (3) Processes of change and (4) Barriers and facilitators to activity pacing; and one inductive theme: (5) Perspectives of patients and clinicians.
The activity pacing framework appeared acceptable to patients and clinicians, and adherence to the framework was demonstrated. Processes of behaviour change included patients' regulation of activities through activity pacing. Barriers to pacing included work/social commitments and facilitators included identifying the benefits of pacing on symptoms. Different perspectives emerged between clinicians and patients regarding interpretations of symptom-contingent and quota-contingent strategies. The framework recognises fluctuations in symptoms of chronic pain/fatigue and encourages a quota-contingent approach with flexibility. Future work will develop a patient friendly guide ahead of a clinical trial to explore the effects of pacing.
我们开发并检验了一种活动节奏框架，供临床医生用于标准化向慢性疼痛/疲劳患者提出的活动节奏建议。本研究旨在探讨该框架的可接受性和忠实度，为未来的活动节奏试验做准备。
采用半结构化访谈法探讨可接受性和忠实度。使用框架分析法进行数据分析。
参加以该框架为基础的慢性疼痛/疲劳康复项目的患者，以及负责该项目的临床医生（物理治疗师和心理福利从业者）。
共进行了 17 次访谈，涉及 12 名慢性疼痛/疲劳患者和 5 名临床医生。框架分析揭示了四个演绎主题：（1）活动节奏框架的可接受性，（2）可行性研究方法的可接受性，（3）变化过程，以及（4）活动节奏的障碍和促进因素；以及一个归纳主题：（5）患者和临床医生的观点。
活动节奏框架似乎得到了患者和临床医生的认可，并且对该框架的遵循得到了证明。行为改变的过程包括患者通过活动节奏来调节活动。节奏的障碍包括工作/社会承诺，而促进因素包括认识到节奏对症状的益处。临床医生和患者对症状相关和配额相关策略的解释存在不同的观点。该框架认识到慢性疼痛/疲劳症状的波动，并鼓励采用灵活的配额相关方法。未来的工作将在临床试验之前制定一个患者友好型指南，以探讨节奏的效果。
