ACTIVITY PACING: AN OFTEN USED BUT POORLY UNDERSTOOD NON-PHARMACOLOGICAL TREATMENT IN RHEUMATOID ARTHRITIS

Background: Activity pacing (AP) is an adaptation strategy often used for patients with Rheumatoid Arthritis (RA) to reduce pain and fatigue by preserving energy during the day. However, to date no uniform definition or research data are available for AP. In this study we defined AP as going slower and taking breaks or breaking activities up into smaller pieces (Brown, 2002). We aimed to gain more insight in patient and disease related characteristics associated with AP. Furthermore, we investigated the relationship between AP and physical activity, as we hypothesized AP might invoke physical inactivity. Objectives: To gain insight in patient and disease related characteristics and activity level between adequate and non-adequate pacers in RA patients. Methods: Thirty RA patients (80% female, mean age 59 years (SD=8)) not bound to a wheelchair were included in this study. Patients completed a set of questionnaires to measure socio-demographics, pain, self-reported functioning, kinesiophobia, self-efficacy, and fatigue. Subsequently, patients wore an Actometer (ankle worn accelerometer) and completed an activity diary for five days. An occupational therapist and specialized nurse analyzed the diaries and classified the participants as adequate or non-adequate pacers, according to the AP definition of Brown (2002). Inter-rater agreement was assessed by Cohen's Kappa. For each patient average physical activity and compliance to the Dutch Physical Activity Norm (DPAN) was calculated on the basis of the Actometer. The DPAN is defined as performing moderate activity (3-6 Metabolic Equivalents) five days a week for 30 minutes a day. Afterwards patients were asked whether they believed they met the DPAN. Physical activity and disease-related characteristics were compared for adequate and non-adequate pacers by using T-test statistics. The relation between the amount of physical activity and patient characteristics were examined by correlation coefficients. Results: Inter-rater agreement between both assessors of the diaries was 0.57 (0.36 - 0.75, 95% Confidence Interval [CI]). Adequate pacers (n=14) reported better functioning (Delta: -12.1 points; 95% CI, -23.9 - -0.3: p<0.01) and less pain during activities (Delta: 20.6 points; 95% CI, 1.0 - 40.3: p=0.01). Adequate pacing was also related to lower self-efficacy (r=0.4, p=0.02). We found no differences (Delta: -11.5; 95% CI, -33.8 - 10.8: p=0.30) in the amount of physical activity between adequate and non-adequate pacers. More physical activity was associated with a lower body mass index (r=-0.53, p<0.01) and less problems in functioning (r=0.57, p<0.01). Three participants met the DPAN, whereas 14 participants thought they did. Conclusion: The moderate agreement between our assessors supports the plea for a uniform definition of AP. Our results indicate that adequate activity pacers experience less physical complaints and perform an equal amount of physical activity compared to non-adequate pacers. However, it appeared that most participants were physically inactive although this was not recognized by patients. Therefore, we recommend that health care professionals should - in addition to AP - also encourage their patients to incorporate short moments of moderate physical activity (eg. walking, dancing) in their daily living. References: 1. Brown, CA. BJOT 2002;65,398-404. Disclosure of Interest: None declaredCitation: Annals of the Rheumatic Diseases, volume 69, supplement 3, year 2010, page 734Session: Occupational therapy (Poster Presentations )