Observational studyPloS one2018
Avoidance, pacing, or persistence in multidisciplinary functional rehabilitation for chronic musculoskeletal pain: An observational study with cross-sectional and longitudinal analyses.
Observational study in PloS one, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
19 citing papers in PubMed, 1 synthesis or guideline pooled it, 38 citations in OpenAlex.
- Relationship Between Fear of Movement and Physical Activity in Patients With Cardiac, Rheumatologic, Neurologic, Pulmonary, or Pain Conditions: A Systematic Review and Meta-Analysis.Physical therapy · 2025Pooled it
- Pain medication associated with decreased physical performance and rehabilitation progress.Pain reports · 2025Article
- Persistence, not avoidance, is associated with low back pain-An observational cohort study.European journal of pain (London, England) · 2025Observational
- Lifestyle factors and determination of optimal cut-off values for forward head posture in young adults with neck pain: a cross-sectional analysis.BMC musculoskeletal disorders · 2025Article
- "I'm Not Who I Used to Be!" The Compelled Metamorphosing Process of Coping with Brucellosis Among Chinese Patients: A Qualitative Study.Healthcare (Basel, Switzerland) · 2024Article
- Translation, reliability, and validity of the German version of the Activity Patterns Scale (APS) in musculoskeletal pain: a methodological study.BMC musculoskeletal disorders · 2024Article
- Physical activity based on daily steps in patients with chronic musculoskeletal pain: evolution and associated factors.BMC musculoskeletal disorders · 2024Article
- How to Promote Walking in Women with Fibromyalgia: A Look at Catastrophizing, Goal Conflict, and Avoidance from a Self-Emotional Regulatory Perspective.European journal of investigation in health, psychology and education · 2024Article
- Should we separately measure the pain parameter of the Constant-Murley score in patients with chronic shoulder pain?BMC musculoskeletal disorders · 2023Article
- The Role of Self-Efficacy and Activity Patterns in the Physical Activity Levels of Women with Fibromyalgia.Biology · 2023Article
- The Relationship Between Pain Intensity and Pain-Related Activity Patterns in Older Adults with Chronic Musculoskeletal Pain: Mediating Roles of Pain Resilience and Pain Catastrophizing.Journal of pain research · 2023Article
- Validation of the Japanese version of the patterns of activity measure-pain in individuals with chronic pain.BioPsychoSocial medicine · 2022Article
- Are Pacing Patterns Really Based on Value Goals? Exploring the Contextual Role of Pain Acceptance and Pain Catastrophizing in Women with Fibromyalgia.Journal of clinical psychology in medical settings · 2021Article
- How to objectively assess and observe maladaptive pain behaviors in clinical rehabilitation: a systematic search and review.Archives of physiotherapy · 2021Review
- Activity Patterns and Functioning. A Contextual-Functional Approach to Pain Catastrophizing in Women with Fibromyalgia.International journal of environmental research and public health · 2021Article
- A scoping review to ascertain the parameters for an evidence synthesis of psychological interventions to improve work and wellbeing outcomes among employees with chronic pain.Health psychology and behavioral medicine · 2021Article
- Overactivity assessment in chronic pain: The development and psychometric evaluation of a multifaceted self-report assessment.European journal of pain (London, England) · 2021Article
- The self-assessment INTERMED predicts healthcare and social costs of orthopaedic trauma patients with persistent impairments.Clinical rehabilitation · 2021Article
- Task-Contingent Persistence is Related to Better Performance-Based Measures in Patients with Chronic Musculoskeletal Pain.Pain research & management · 2020Observational
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThree main activity patterns have been distinguished in describing chronic pain (avoidance, pacing and persistence). However, their influence on patient outcomes remains a question of debate. This observational study aimed to measure the associations between the avoidance, pacing, and persistence (labelled overdoing) scales of the Patterns of Activity Measure-Pain (POAM-P), self-reported outcomes (pain-interference, depression, functional ability), and observational outcomes (walking, lifting test, physical fitness).
methodsWe conducted an observational study with cross-sectional and longitudinal analyses. The data were collected prospectively before and after treatment, which was a 5-week functional rehabilitation including vocational aspects. In addition to self-reported and observational outcomes, patients were asked if they thought they would be able to return to work at 6 months. Analyses were conducted with treatment effect sizes, correlations, and multiple regression models.
resultsIn this sample (891 patients), we found on average small to moderate improvements for pain-interference and observational outcomes (Cohen's d: 0.37 to 0.64). According to the multivariable models, overdoing was associated with most of the beneficial psychosocial and observational outcomes (β -0.13 to 0.17; all p<0.01). Avoidance was related to negative psychosocial outcomes before treatment (β -0.09 to 0.17; all p<0.015). Pacing, which had moderate correlation with avoidance (r = 0.46), was not associated with most of the outcomes. The feeling that the goal of returning to work was attainable was associated with lower avoidance scores (adjusted OR 0.97; p = 0.024).
conclusionsThe overdoing POAM-P scale probably measures a task-contingent persistence, which appears appropriate in the setting of this study. Persistent behavior was indeed related to small or moderate positive biopsychosocial outcomes, before and after treatment. Moreover feeling able to return to work was related to lower avoidance. Further studies should test the efficacy of motivational strategies that may promote functional task-contingent persistence and reduce avoidance of painful tasks.
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Registered trials
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