Chair: Morten Høgh, Denmark
Morten Høgh, Denmark
PROMS and PROMIS
Caroline Terwee, Netherlands
Jonathan Hill, United Kingdom
Albère Köke, Netherlands
Optimizing physical activity is an important goal in treatment of patients with chronic pain. Physical activity is defined as any bodily movement produced by skeletal muscles that results in a substantial increase over resting energy expenditure. To measure this we must look at 4 different aspect; type of activity, intensity, frequency and duration. There are three options to measure physical activity; self report questionnaires, performance tasks and activity trackers. All have pros and cons.
First, self report questionnaires are easy to administer and reliability is adequate. Validity remains a problem due to recall bias. Patients must use their memory to fill in what they did last week, how often and how long. This can lead to an overestimation of levels of physical activity. The second method are performance tasks, which are standardized tests a patient performs in the clinic. This can be a walking test, a sit up and stand test or lifting test. There are many test based on daily activities. The pros are that they are not influenced by education level or cognitive skills, and reliability and validity are adequate and test as sit up and stand, 1-minute stairclimbing and the Timed Up &Go-test are responsive to measure change. But the performance can be influenced by motivation and/or the severity of pain at that moment. Another cons is that the test situation is not the same as in daily life.
The third method are activity trackers, which are wearables that register movements, the so called accelerometers. With activity trackers really daily life activities can be assessed during a day or week. The tri-axiaal accelerometers can distinguish between several activities, and give therefore insight in activity patterns and fluctuations throughout a day or week. They are easy to use and wear, mostly at wrist or hip. But patients motivation to use them as instructed does affect the results. Also responsiveness is not well studied yet in chronic pain. For a valid assessment at least 5 days, including one day in the weekend, is needed. A valid day consists of a minimum of 600 minutes of registration and patients should use a diary to fill in when and when not they used the accelerometer. As no consensus exists of what of these methods is the best, a physiotherapist must choose the methods that best suits his or patients goal.