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Brief time-based activity pacing instruction as a singular behavioral intervention was not effective in participants with symptomatic osteoarthritis

Murphy, Susan L.; Kratz, Anna L.; Kidwell, Kelley; Lyden, Angela K.; Geisser, Michael E.; Williams, David A.

doi: 10.1097/j.pain.0000000000000549
Research Paper
Global Year 2016

Osteoarthritis (OA) of the lower extremities is a prevalent cause of disability in which symptoms interfere with mobility and activity participation. Behavioral self-management for OA symptomatology is commonly recommended; but these interventions are underutilized, unstandardized in application, and at times, unavailable in the context of clinical care. For people with chronic pain, rehabilitation professionals may select to apply activity pacing instruction as one behavioral strategy to manage symptoms. Activity pacing is widely used in combination with other pharmacological and behavioral interventions but has not been studied as a singular behavioral intervention for people with OA. The purpose of this study was to evaluate the effectiveness of an occupational therapist-delivered, time-based activity pacing program for treatment of pain, fatigue, and physical function in people with symptomatic knee or hip OA. A 3-arm randomized controlled trial was conducted in which 193 people were randomized into tailored activity pacing, general activity pacing, or usual care arms. Assessments were done at 10 weeks and 6 months after baseline. Using linear mixed models, Western Ontario and McMaster Universities Osteoarthritis Index pain scores changed over time, decreasing the most in the general and usual care groups; only the usual care group had decreased pain over 6 months. The tailored and general activity pacing groups reported higher frequency of pacing behaviors than the usual care group at 10 weeks, but pacing was not sustained at 6 months. This trial does not support the use of time-based pacing as a singular behavioral strategy for people with knee or hip OA.

Supplemental Digital Content is Available in the Text.Time-based activity pacing as a singular behavioral intervention did not improve outcomes. The interventions may not be appropriate for people with knee and hip osteoarthritis and would need refinements for further testing.

aDepartment of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA

bGeriatric Research Education and Clinical Center, VA Ann Arbor Health Care System, GRECC, Ann Arbor, MI, USA

Departments of cBiostatistics

dCardiology, and

eAnesthesiology, University of Michigan, Ann Arbor, MI, USA

Corresponding author. Address: Department of Physical Medicine and Rehabilitation, University of Michigan, 24 Frank Lloyd Wright Dr, Suite 3100 Lobby M, Ann Arbor, MI 48105-5737, USA. Tel.: 734-936-2123. E-mail address: (S. L. Murphy).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received December 10, 2015

Received in revised form February 03, 2016

Accepted February 29, 2016

© 2016 International Association for the Study of Pain
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