APS Scale: Measuring the Impact of Chronic Pain on Daily Activities

“[A]lthough further research is needed, this study provides evidence that the APS, which assesses 8 activity patterns with a relatively low number of items, is a promising instrument for clinical practice and research,” the authors write.

Clinical Pain Advisor had the opportunity to discuss the APS in greater detail via e-mail with lead author Rosa Esteve, PhD.

Clinical Pain Advisor: What led you and your colleagues to develop the APS and how did it evolve?

Dr Esteve: As part of our current research project, we needed to measure activity patterns. When reviewing the literature, we found that several authors suggested there may be a need to develop new measures of activity patterns or to refine existing ones. In particular, 3 papers stood out and were very influential in our conceptualization of the instrument: an article by Kindermans et al., and two by Nielson et al.2-4

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The Kindermans et al. article used exploratory factor analyses of various activity patterns self-report measures and identified 6 patterns: pain avoidance, activity avoidance, task-contingent persistence, excessive persistence, pain-contingent persistence, and pacing.2

The articles by Nielson et al. suggested that existing measures did not include some key pacing subdomains and that future measures should be developed that address specific pacing behaviors based on the goal of the pacing.3,4

Based on the aforementioned research, the 3 items with the highest factor loading in each activity patterns dimension found by Kindermans et al. were included in our instrument, along with 3 goal-based pacing scales.

Clinical Pain Advisor: In validating the APS, what was your key finding?

Dr Esteve: Our key finding is that the goals of avoidance, persistence, and pacing behaviors are crucial factors that influence disability and wellbeing, rather than being considered intrinsically adaptive or maladaptive. This distinction between functional and dysfunctional forms of avoidance, persistence, and pacing could contribute to refining the treatment instructions aimed at regulating patients’ activity and in providing a more individualized approach to care.

Clinical Pain Advisor: Any area for future development or refinement of the scale?

Dr Esteve: Currently, professors Madelon Peters, a co-developer of the APS, and Hanne Kindermans, whose article helped lay the foundation of the scale, are working on translating/adapting the instrument into Dutch. At the same time, they are investigating the validity of the dimensions of the APS activity patterns by studying if their relationship with measures of psychosocial functioning differs from that of existing activity patterns measures. In addition to this research, future research should test the construct validity of the dimensions included in the instrument using objective measures, rather than just relying on self-reports.