Objective

Activity behaviour patterns influence the development and perpetuation of musculoskeletal pain. Three major patterns have been observed in chronic pain patients: avoidance, pacing and persistence (also labelled “overdoing”, “confronting” or “endurance” pattern).

Material/patients and methods

Relationships between these patterns and clinical outcomes remain inconclusive. Associations between pain, disability, depressive symptoms, and poor self-efficacy have been consistently demonstrated for the avoidance model. In contrast, studies examining the two others patterns are scarce and show conflicting results. Persistence characterized by higher and more fluctuating levels of activity were also believed to be related to poor outcomes due to overuse. Nevertheless, the few studies available found that persistence may either be functional or dysfunctional depending upon association with activity avoidance, suggesting that the most efficient adaptive strategy may be a combination of low avoidance and weak persistence.

Results

Pacing commonly understood as a functional behaviour to deal with chronic pain (going slowly, taking breaks…) was also challenged by recent researches. For instance, some authors found that pacing may also be functional or dysfunctional and the latter also being related to poor outcomes. In such cases, pacing might reflect a “hidden form” of avoidance pattern. Moreover pacing is not always applicable, as it only takes into account the limited impact of the patients’ environment (for instance work environment) on possibilities to adopt activity-pacing strategies.

Discussion–conclusion

Taking all these results together, it seems that activity patterns may be more complex than expected. Chronic pain patients may also adopt several behaviours in order to engage or not in activities depending on personal goals. Better knowledge of pain behaviours patterns is important during rehabilitation. Rehabilitative approach of dysfunctional patterns, as well as strengthening of functional patterns may improve outcomes of patients with chronic musculoskeletal pain. The purpose of this conference is to present data on a large Swiss cohort of orthopaedic trauma patients (more than 900) recruited during musculoskeletal rehabilitation including vocational aspects. The focus will be put on associations of activity behaviour patterns with outcomes such as pain interference, depressive mood, disability, performance during functional capacity tasks, and perception of recovery at discharge of rehabilitation.