Background/Purpose: To examine the how individuals naturally use the behavioral strategy of activity pacing in daily life and how its usage relates to pain and fatigue within days among older adults with knee or hip osteoarthritis. Specifically, we hypothesized that pain and fatigue increases would precede increased natural use of pacing (i.e., pacing behavior would be symptom-contingent) and that individuals would experience a “pay-off” from pacing in that pain and fatigue would decrease after using pacing.

Methods:  Participants (N=147) were community-living adults 65 years and older who reported mild to moderate pain severity with evidence of osteoarthritis in a corresponding hip or knee joint. Participants wore a wrist-worn accelerometer for five days and were asked to report frequency of activity pacing behaviors (modified from the activity pacing scale of the Chronic Pain Coping Inventory), pain severity, and fatigue severity five times per day. Physical performance and survey data were also collected.  

Results:  Multi-linear mixed models (N = 147), including key demographic and clinical variables, showed that both pain and fatigue increases were associated with subsequent increased use of natural pacing. The increased use of pacing was associated with subsequent increases in both pain and fatigue. 

Conclusion: The natural use of pacing appears to be symptom-contingent which is different from how pacing is taught as part of behavioral treatment. Natural use of pacing was not shown to be adaptive in terms of short-term symptom reduction; rather self-reported pacing behaviors were related to increased symptoms. Future studies are warranted to further examine these relationships by capturing more complex contextual issues such as medication effects, social context, and momentary mood.  

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-natural-use-of-activity-pacing-in-daily-life-does-not-result-in-lower-symptoms-in-osteoarthritis/