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Pacing
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===In ME/CFS === Pacing has been used in several multi-component treatment trials. In 1996 Goudsmit conducted a controlled trial for patients with post-infectious fatigue syndrome. Pacing was one component of a multidisciplinary treatment protocol prescribed by Darrel O. Ho-Yen<ref>Ho-Yen DO. Better recovery from viral illnesses. 3rd ed. Inverness: Dodona Books, 1993.</ref> which also included medical care, emotional support and advice on avoiding stress. More than 80% of patients reported feeling better. At 6 months there was a significant difference between controls on outcome measures such as fatigue or self-efficacy. Twenty-three percent of the patients had improved to such a degree that they were discharged.<ref name=":2" /><ref name=":3" /> In 2004 [[Renee Taylor]] offered a similar multidisciplinary program to 47 ME/CFS-patients in a randomized clinical trial.<ref name=":4" /> This study was part of the Chronic Fatigue Syndrome Empowerment project, a federally funded research project designed to develop and evaluate the effects of a consumer-driven rehabilitation program for individuals with chronic fatigue syndrome. Participants received four months of illness management groups followed by seven month one-on-one self-advocacy training. Besides pacing the program focused on economic self-sufficiency, coping skills and nutritional advice. Results indicated that overall quality of life had significant improved in the treatment group – a remarkable finding, since trials on cognitive behavioral therapy or graded exercise therapy, often fail to improve quality of life in ME/CFS patients.<ref>{{Cite book | url =https://www.ncbi.nlm.nih.gov/books/NBK379582/| title = July 2016 Addendum | last = Smith | first = M. E. Beth | last2 = Nelson | first2 = Heidi D. | last3 = Haney | first3 = Elizabeth | last4 = Pappas | first4 = Miranda | last5 = Daeges | first5 = Monica | last6 = Wasson | first6 = Ngoc | last7 = McDonagh | first7 = Marian | date = Dec 2014|publisher=Agency for Healthcare Research and Quality (US)|language=en}}</ref> Further evidence supporting pacing, comes from research on the [[Energy Envelope Theory|envelope theory]], an energy management strategy developed by Leonard Jason which is based on similar principles. Patients are advised to stay within the envelope; meaning the limits the disease has imposed upon them. Patients who over-exert themselves are advised to cut back while those who have been inactive for a long time are encouraged to gradually increase their activity. An analysis of the activity pattern of 144 ME/CFS patients showed that those who extend their activities beyond their energy envelope, experience more disability.<ref>{{Cite journal | last= Jason | first = Leonard | last2 = Muldowney | first2 = Kathleen | last3 = Torres-Harding | first3 = Susan | date = May 2008| title = The Energy Envelope Theory and myalgic encephalomyelitis/chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/18578185|journal=AAOHN journal: official journal of the American Association of Occupational Health Nurses|volume=56|issue=5|pages=189–195|issn=0891-0162|pmid=18578185}}</ref> These results were confirmed in a larger 2017 study involving 429 patients from different locations.<ref name=":10">{{Cite journal | last = O'Connor | first = Kelly | last2 = Sunnquist | first2 = Madison | last3 = Nicholson | first3 = Laura | last4 = Jason | first4 = Leonard A. | last5 = Newton | first5 = Julia L. | last6 = Strand | first6 = Elin B. | date = 2017-01-01| title = Energy envelope maintenance among patients with myalgic encephalomyelitis and chronic fatigue syndrome: Implications of limited energy reserves|url=https://www.ncbi.nlm.nih.gov/pubmed/29231037|journal=Chronic Illness|pages=1742395317746470|doi=10.1177/1742395317746470|issn=1745-9206|pmc=5750135|pmid=29231037}}</ref> Furthermore, a prospective study of 44 patients who were part of a study on nonpharmacological interventions in ME/CFS, showed that “those who were within their energy envelope before treatment showed more improvement in physical functioning and fatigue compared to those outside of their energy envelope."<ref name=":11">{{Cite journal | last = Brown | first = Molly | last2 = Khorana | first2 = Neha | last3 = Jason | first3 = Leonard A. | date = Mar 2011| title = The Role of Changes in Activity as a Function of Perceived Available and Expended Energy in Non-Pharmacological Treatment Outcomes for ME/CFS|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3164291/|journal=Journal of clinical psychology|volume=67|issue=3|pages=253–260|doi=10.1002/jclp.20744|issn=0021-9762|pmc=3164291|pmid=21254053}}</ref> In several large patient surveys, respondents indicated they’ve found pacing to be helpful in managing ME/CFS. A 1999 survey (n = 820) by the CFIDS Association of America (now Solve ME/CFS initiative) showed that 71% of patients rated pacing as helpful.<ref name=":5" /> In a survey conducted by Action for ME (n = 2338) in 2001, 89% of the respondents found pacing to be helpful.<ref name=":6" /> These results were confirmed in a follow-up study by Action for ME in 2008.<ref>{{Cite web|url=https://afme.wordpress.com/category/survey-2008/| title = Survey 2008 « Action for M.E.|website=afme.wordpress.com|language=en|access-date=2018-08-19}}</ref> {| class="wikitable" ! colspan="7" |Action for M.E.’s survey results on treatments in 2001 and 2008<ref name=":12">[https://www.actionforme.org.uk/uploads/pdfs/pacing-for-people-with-me-booklet.pdf Pacing for people with ME]. Action for ME. December 2013.</ref> |- ! ! colspan="2" |Helpful ! colspan="2" |No change ! colspan="2" |Made Worse |- | |2001 survey |2008 survey |2001 survey |2008 survey |2001 survey |2008 survey |- |Pacing |89% |82% |9% |15% |2% |3% |- |CBT |7% |50% |67% |38% |26% |12% |- |GET |34% |45% |16% |21% |50% |34% |} Another large survey set up by the ME Association (n =1428) showed patients preferred pacing over CBT or GET and judged this approach to be more appropriate to their needs. The survey concluded: <blockquote>“Pacing was consistently shown to be the most effective, safe, acceptable and preferred form of activity management for people with ME/CFS and should therefore be a key component of any illness management programme […]The benefit of Pacing may relate to helping people cope and adapt to their illness rather than contributing to a significant improvement in functional status.”<ref name=":7" /> </blockquote>
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