Activity pacing in chronic pain: concepts, evidence, and future directions.

BACKGROUND: Activity pacing (AP) is a concept that is central to many chronic pain theories and treatments, yet there remains confusion regarding its definition and effects. OBJECTIVE: To review the current knowledge concerning AP and integrate this knowledge in a manner that allows for a clear definition and useful directions for future research. METHODS: A narrative review of the major theoretical approaches to AP and of the empirical evidence regarding the effects of AP interventions, followed by an integrative discussion. RESULTS: The concept of AP is derived from 2 main traditions: operant and energy conservation. Although there are common elements across these traditions, significant conceptual and practical differences exist, which has led to confusion. Little empirical evidence exists concerning the efficacy of AP as a treatment for chronic pain. DISCUSSION: Future research on AP should be based on a clear theoretical foundation, consider the context in which the AP behavior occurs and the type of pacing problem ("underactivity" vs. "overactivity"), and should examine the impact of AP treatment on multiple clinical outcomes. We provide a provisional definition of AP and specific recommendations that we believe will move the field forward.

Older people's preferences regarding programme formats for managing concerns about falls.

OBJECTIVE: to explore the preferences of community-dwelling older persons regarding different programme formats for managing concerns about falls. SUBJECTS AND DESIGN: cross-sectional study of 5,755 community-dwelling people aged ≥ 70 years in the Netherlands. METHODS: a questionnaire assessed people's willingness to participate per programme format (n=6), i.e. a programme at home, via telephone, via home visits and telephone consultations, via television or via Internet. RESULTS: of the 2,498 responders, 62.7% indicated no interest in any of the formats. The willingness to participate per programme format varied between 21.5 (at home) and 9.4% (via Internet). Among people interested in at least one of the formats (n=931), higher levels of fall-related concerns were associated with increased preference for a programme with home visits. Poor perceived health and age ≥ 80 years were associated with less preference for a group programme. Higher educated people were more in favour of a programme via Internet compared with their lower educated counterparts. CONCLUSION: the majority of community-dwelling older people are not likely to participate in any of the six proposed programme formats for managing concerns about falls. However, when diverse formats of effective programmes will be made available, uptake and adherence may be increased since programme preferences are associated to specific population characteristics.