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Importance: Pacing is a key pain management strategy used by occupational therapy practitioners when working with people with chronic pain. However, there is a paucity of evidence and a lack of consensus regarding the effectiveness of pacing as a pain management strategy for people with chronic pain. Objective: To evaluate the evidence for the effectiveness of pacing as a learned strategy for people with chronic pain. Data Sources: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to undertake a systematic review. Six databases were searched in March 2016 for randomized controlled trials (RCTs). Combinations of keywords and MeSH terms were used as search terms. Study Selection and Data Collection: We sought intervention studies that included participants using pacing as a strategy. Studies were assessed for eligibility on the basis of predetermined criteria. Of the 2,820 articles located, 7 RCTs met inclusion criteria. Findings: Pacing does not reduce the severity of pain or alter psychological traits; however, it can assist in lessening joint stiffness and the interference of fatigue and in decreasing the variability of physical activity. Conclusions and Relevance: Current evidence supports the delivery of a learned pacing intervention to reduce the interference of fatigue, reduce joint stiffness, and decrease physical activity variability but does not support the use of learned pacing to reduce pain severity. Future research should investigate the effectiveness of pacing as a pain management strategy within the International Classification of Functioning, Disability and Health domains of activity and participation. What This Article Adds: This systematic review examines existing research on pacing as a learned intervention strategy. The findings will support the clinical reasoning of occupational therapy practitioners, to determine when a learned pacing strategy is indicated, and considerations for how it may be delivered.

The efficacy of non-pharmacological interventions for improving driving outcomes in young drivers with attention deficit hyperactivity disorder has not been established. Such interventions are of interest to occupational therapists who work with this population to attain driving independence. This research article had two aims: (1) to systematically review the effectiveness of behavioural interventions to improve driving outcomes for this population, and (2) to identify studies detailing behavioural interventions that could be used to improve driving skills. Method: Nineteen databases were searched and 13 studies were appraised using the PEDro scale (the Physiotherapy Evidence Database), where appropriate. Findings: For the first aim, while two studies reported training led to significant improvements in driver skills, methodological problems limited the validity of one study. Eleven studies were reviewed in relation to the second aim, describing nine interventions. Of these, situation awareness training, such as commentary driving, show particular promise. Conclusion: Several interventions have the potential to improve the driving skills of this population. These interventions warrant further research and in the interim could be used clinically by occupational therapy driver assessors. Further research is required to determine if non-pharmacological interventions are of benefit for young drivers with attention deficit hyperactivity disorder. Situation awareness training may be beneficial for improving driving skills.

Introduction Progressive Supranuclear Palsy (PSP) is a debilitating form of atypical Parkinsonism. People living with PSP experience movement disorders affecting walking, balance and eye movements. The role of exercise in optimising movement remains unclear. Aims To identify beliefs about exercise and structured physical activity through the experience of people with PSP. Methods Using a phenomenological theoretical framework, qualitative methods were employed to obtain the views of people living with PSP, and their care partners, by in-depth interviews. Questions derived from a systematic review and expert opinions guided the interviews which were audio-recorded, transcribed and de-identified. Two researchers independently conducted thematic analysis and reached consensus on emerging themes. Results There were 16 participants. Four themes were identified: (i) there are beliefs and preferences about exercise and physical activity that can impact on engagement; (ii) difficulty coping with disease progression impacts activities; (iii) facilitators to exercise include individual preferences, access to facilities and expert advice; and (iv) perceived barriers include beliefs about limited exercise options, falls risk, cost, transport and access to credible information.