The Association Between Activity Pacing and Pain, Discomfort, Anxiety, and Quality of Life in Chronic Musculoskeletal Disorder Patients

Background: Chronic musculoskeletal disorders (CMSDs) are prevalent conditions that significantly impair physical functioning, mental health, and quality of life (QoL). Activity pacing is recommended as a strategy to manage symptoms, but its effectiveness and psychological impact are not fully understood. This study explores the associations between different components of activity pacing and outcomes related to pain, psychological distress, and QoL among individuals with CMSDs. Methods: A cross-sectional study was conducted with 248 participants recruited from primary physiotherapy centers. Validated self-report instruments were used to assess pain intensity, pain interference, psychological distress (depression, anxiety, stress), and QoL (physical, psychological, social, environmental domains). Correlation analyses were used to examine associations between activity pacing components (activity adjustment and general engagement) and health outcomes. Results: Activity adjustment was positively associated with pacing consistency, planning, progression, and acceptance. It was negatively correlated with pain interference, depression, and stress, but positively associated with pain severity and anxiety. It also demonstrated positive correlations with all domains of QoL. In contrast, general engagement in activity pacing was positively correlated with pain severity, pain interference, perceived risk of overactivity, and psychological distress, and negatively associated with all QoL domains. Conclusion: Activity pacing strategies are differentially associated with pain and psychological outcomes. While activity adjustment appears to support better QoL and lower psychological distress, general engagement may reflect maladaptive pacing associated with greater symptom burden. These findings underscore the importance of individualized, goal-oriented pacing interventions in CMSD management.