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Testing the activity pacing questionnaire for validity, reliability and responsiveness: An outcome measure validation

Deborah Antcliff1, Gareth McCray2, Rosa MacKenzie3

  • 1Bury Integrated Pain Service, Northern Care Alliance NHS Foundation Trust, Radcliffe Primary Care Centre, Greater Manchester M26 2SP, UK; School of Medicine, Keele University, Staffordshire ST5 5BG, UK.

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Summary

A new 12-item Activity Pacing Questionnaire (APQ-12) was developed to measure activity pacing in chronic pain patients. The APQ-12 shows promise for clinical and research use to assess pacing behaviors and their impact on pain symptoms.

Keywords:
Activity pacingChronic painQuestionnaireScale validation

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Area of Science:

  • Rehabilitation Medicine
  • Psychometrics
  • Pain Management

Background:

  • Activity pacing is crucial for managing chronic pain and improving function by modifying behaviors like avoidance and overdoing.
  • Existing research on activity pacing effectiveness is limited by the lack of a validated measurement scale.
  • The previously developed 28-item Activity Pacing Questionnaire (APQ-28) had five domains: Activity adjustment, planning, consistency, progression, and acceptance.

Purpose of the Study:

  • To shorten the APQ-28 and provide evidence for the validity, reliability, and responsiveness of a new scale.
  • To develop a psychometrically sound instrument for assessing activity pacing in chronic pain populations.
  • To facilitate research and clinical practice by offering a reliable measure of pacing behaviors.

Main Methods:

  • Data were collected from 347 chronic pain patients in England using paper-based questionnaires at baseline, 2 weeks, and 12 weeks.
  • Factor analysis was used to refine the scale, resulting in the 12-item, four-domain APQ-12 (Activity adjustment, planning, consistency, progression).
  • Statistical analyses included assessments of internal consistency, test-retest reliability, responsiveness, and measurement error.

Main Results:

  • The APQ-12 demonstrated good model fit (CFI=0.995, TLI=0.992, RMSEA=0.052) and satisfactory internal consistency (Cronbach's alpha=0.70-0.84).
  • Test-retest reliability was acceptable (ICC=0.53-0.64), with only Activity consistency showing significant responsiveness (Rho=0.27).
  • Measurement error metrics (smallest detectable change, standard error of measurement, minimally important change) were established for the APQ-12 domains.

Conclusions:

  • The 12-item Activity Pacing Questionnaire (APQ-12) is a promising multi-domain measure for assessing activity pacing.
  • The APQ-12 exhibits favorable psychometric properties, including validity, reliability, and responsiveness, for use in clinical settings.
  • This validated tool can aid in evaluating changes in activity pacing and understanding its effects on chronic pain symptoms in research and practice.