Can pacing self-management alter physical behavior and symptom severity in chronic fatigue syndrome? A case series

Abstract

Abstract-Given the lack of evidence in support of pacing self-management for patients with chronic fatigue syndrome (CFS), we examined whether physical behavior and health status of patients with CFS would improve in response to a pacing self-management program. We performed an observational study of pacing self-management in seven CFS patients using a single-case study design. Stages A1 and A2 (7-day assessment periods) of the A1-B-A2 design corresponded to the baseline and posttreatment measurements of physical behavior (realtime activity monitoring) and health status (self-reported measures), respectively. Stage B (3 weeks of treatment) consisted of three individual treatment sessions of pacing self-management. When comparing pre-versus posttreatment data, we found that the patients' ability to perform daily activities and the severity of their symptom complexes were improved (p = 0.043). Concentration difficulties, mood swings, muscle weakness, and intolerance to bright light improved as well. A statistically significant decrease in the mean time spent doing light activity (<3 metabolic equivalents) was observed, but a change in the way physical activity was spread throughout the day was not. We found that 3 weeks of pacing self-management was accompanied by a modest improvement in symptom severity and daily functioning. The outcome of the present study calls for a randomized controlled clinical trial to examine the effectiveness of pacing self-management for people with CFS.

Activity Pacing Self-Management in Chronic Fatigue Syndrome: A Randomized Controlled Trial

“…The decrease in fatigue scores, confirming Hypothesis 3, is in accordance with findings from other studies of behavioral treatments for CFS, including fatigue amelioration in response to cognitive-behavioral therapy (Prins et al, 2001;White et al, 2011;Wiborg, Knoop, Prins, & Bleijenberg, 2011), graded exercise therapy (Wallman, Morton, Goodman, Grove, & Guilfoyle, 2004;White et al, 2011), and activity pacing (Goudsmit et al, 2009;Nijs et al, 2009). In addition, the finding that APSM was effective for participants with CFS adds to the findings from the PACE trial (White et al, 2011) showing that adaptive pacing alone was not effective in treating CFS.…”

“…Several randomized controlled trials (RCTs) have shown positive effects of treatment programs based on activity pacing for people with CFS (Cox, 2002;Crawley et al, 2013;Goudsmit et al, 2012;Jason et al, 2013;Pemberton & Cox, 2014;Taylor, 2004). The findings of these studies are in line with those of a pilot study in which several of the current authors participated (Nijs et al, 2009).…”

“…Required sample size was calculated with GpPower Version 3.1.7 (Faul, Erdfelder, Lang, & Buchner, 2007) using the pilot sample's change scores on the Canadian Occupational Performance Measure (COPM; Law et al, 2005;Nijs et al, 2009). With a significance level of .05 and a power of .80, the total sample size needed to be at least 17 participants.…”

“…The APSM program consists of a stabilization phase and a grading phase (Nijs, Paul, & Wallman, 2008;Nijs et al, 2009). The stabilization phase focuses on coaching clients in how to perform daily life activities within the limits of their actual capacity.…”

Quality and acceptability of patient-reported outcome measures used in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): a systematic review

“…Limited evidence supports the responsiveness of the IMQ following a lifestyle management programme [40], but suggests that the CFS-APQ and CFS-SL are not responsive to change in health following exercise programmes [41,42]. Where reported, the statistical significance of score change or between groups difference was described; no study reported the clinical significance of score change or specifically evaluated PROM responsiveness or interpretation of score change.…”