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Volume 46 Number 7, 2009
   Pages 985 — 996

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

Jo Nijs, PhD, PT;1-3* Inge van Eupen, OT;4 Jo Vandecauter, PT;1 Els Augustinus, PT;1 Geerte Bleyen, OT;4 Greta Moorkens, PhD, MD;5-6 Mira Meeus, PhD, PT1-2

1Division of Musculoskeletal Physiotherapy, Department of Health Care Sciences, Artesis University College Antwerp, Antwerp, Belgium; 2Department of Human Physiology, Faculty of Physical Education and Physiotherapy, Vrije
Universiteit Brussel, Brussels, Belgium; 3Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium; 4Division of Occupational Therapy, Department of Health Care Sciences, Artesis University College Antwerp, Antwerp, Belgium; 5Department of Internal Medicine, University Hospital Antwerp, Antwerp, Belgium; 6Faculty of Medicine, University of Antwerp, Antwerp, Belgium

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 (real-time 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.

Key words: activity, activity peak, behavior, CFS, chronic fatigue, pacing, rehabilitation, self-management, syndrome, therapy.

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