a case study on management

Top 40 Most Popular Case Studies of 2017

We generated a list of the 40 most popular Yale School of Management case studies in 2017 by combining data from our publishers, Google analytics, and other measures of interest and adoption. In compiling the list, we gave additional weight to usage outside Yale

We generated a list of the 40 most popular Yale School of Management case studies in 2017 by combining data from our publishers, Google analytics, and other measures of interest and adoption. In compiling the list, we gave additional weight to usage outside Yale.

Case topics represented on the list vary widely, but a number are drawn from the case team’s focus on healthcare, asset management, and sustainability. The cases also draw on Yale’s continued emphasis on corporate governance, ethics, and the role of business in state and society. Of note, nearly half of the most popular cases feature a woman as either the main protagonist or, in the case of raw cases where multiple characters take the place of a single protagonist, a major leader within the focal organization. While nearly a fourth of the cases were written in the past year, some of the most popular, including Cadbury and Design at Mayo, date from the early years of our program over a decade ago. Nearly two-thirds of the most popular cases were “raw” cases - Yale’s novel, web-based template which allows for a combination of text, documents, spreadsheets, and videos in a single case website.

Read on to learn more about the top 10 most popular cases followed by a complete list of the top 40 cases of 2017.  A selection of the top 40 cases are available for purchase through our online store . 

#1 - Coffee 2016

Faculty Supervision: Todd Cort

Coffee 2016 asks students to consider the coffee supply chain and generate ideas for what can be done to equalize returns across various stakeholders. The case draws a parallel between coffee and wine. Both beverages encourage connoisseurship, but only wine growers reap a premium for their efforts to ensure quality.  The case describes the history of coffee production across the world, the rise of the “third wave” of coffee consumption in the developed world, the efforts of the Illy Company to help coffee growers, and the differences between “fair” trade and direct trade. Faculty have found the case provides a wide canvas to discuss supply chain issues, examine marketing practices, and encourage creative solutions to business problems. 

#2 - AXA: Creating New Corporate Responsibility Metrics

Faculty Supervision: Todd Cort and David Bach

The case describes AXA’s corporate responsibility (CR) function. The company, a global leader in insurance and asset management, had distinguished itself in CR since formally establishing a CR unit in 2008. As the case opens, AXA’s CR unit is being moved from the marketing function to the strategy group occasioning a thorough review as to how CR should fit into AXA’s operations and strategy. Students are asked to identify CR issues of particular concern to the company, examine how addressing these issues would add value to the company, and then create metrics that would capture a business unit’s success or failure in addressing the concerns.

#3 - IBM Corporate Service Corps

Faculty Supervision: David Bach in cooperation with University of Ghana Business School and EGADE

The case considers IBM’s Corporate Service Corps (CSC), a program that had become the largest pro bono consulting program in the world. The case describes the program’s triple-benefit: leadership training to the brightest young IBMers, brand recognition for IBM in emerging markets, and community improvement in the areas served by IBM’s host organizations. As the program entered its second decade in 2016, students are asked to consider how the program can be improved. The case allows faculty to lead a discussion about training, marketing in emerging economies, and various ways of providing social benefit. The case highlights the synergies as well as trade-offs between pursuing these triple benefits.

#4 - Cadbury: An Ethical Company Struggles to Insure the Integrity of Its Supply Chain

Faculty Supervision: Ira Millstein

The case describes revelations that the production of cocoa in the Côte d’Ivoire involved child slave labor. These stories hit Cadbury especially hard. Cadbury's culture had been deeply rooted in the religious traditions of the company's founders, and the organization had paid close attention to the welfare of its workers and its sourcing practices. The US Congress was considering legislation that would allow chocolate grown on certified plantations to be labeled “slave labor free,” painting the rest of the industry in a bad light. Chocolate producers had asked for time to rectify the situation, but the extension they negotiated was running out. Students are asked whether Cadbury should join with the industry to lobby for more time?  What else could Cadbury do to ensure its supply chain was ethically managed?

#5 - 360 State Real Options

Faculty Supervision: Matthew Spiegel

In 2010 developer Bruce Becker (SOM ‘85) completed 360 State Street, a major new construction project in downtown New Haven. Just west of the apartment building, a 6,000-square-foot pocket of land from the original parcel remained undeveloped. Becker had a number of alternatives to consider in regards to the site. He also had no obligation to build. He could bide his time. But Becker worried about losing out on rents should he wait too long. Students are asked under what set of circumstances and at what time would it be most advantageous to proceed?

#6 - Design at Mayo

Faculty Supervision: Rodrigo Canales and William Drentell

The case describes how the Mayo Clinic, one of the most prominent hospitals in the world, engaged designers and built a research institute, the Center for Innovation (CFI), to study the processes of healthcare provision. The case documents the many incremental innovations the designers were able to implement and the way designers learned to interact with physicians and vice-versa.

In 2010 there were questions about how the CFI would achieve its stated aspiration of “transformational change” in the healthcare field. Students are asked what would a major change in health care delivery look like? How should the CFI's impact be measured? Were the center's structure and processes appropriate for transformational change? Faculty have found this a great case to discuss institutional obstacles to innovation, the importance of culture in organizational change efforts, and the differences in types of innovation.

This case is freely available to the public.

#7 - Ant Financial

Faculty Supervision: K. Sudhir in cooperation with Renmin University of China School of Business

In 2015, Ant Financial’s MYbank (an offshoot of Jack Ma’s Alibaba company) was looking to extend services to rural areas in China by providing small loans to farmers. Microloans have always been costly for financial institutions to offer to the unbanked (though important in development) but MYbank believed that fintech innovations such as using the internet to communicate with loan applicants and judge their credit worthiness would make the program sustainable. Students are asked whether MYbank could operate the program at scale? Would its big data and technical analysis provide an accurate measure of credit risk for loans to small customers? Could MYbank rely on its new credit-scoring system to reduce operating costs to make the program sustainable?

#8 - Business Leadership in South Africa’s 1994 Reforms

Faculty Supervision: Ian Shapiro

This case examines the role of business in South Africa's historic transition away from apartheid to popular sovereignty. The case provides a previously untold oral history of this key moment in world history, presenting extensive video interviews with business leaders who spearheaded behind-the-scenes negotiations between the African National Congress and the government. Faculty teaching the case have used the material to push students to consider business’s role in a divided society and ask: What factors led business leaders to act to push the country's future away from isolation toward a "high road" of participating in an increasingly globalized economy? What techniques and narratives did they use to keep the two sides talking and resolve the political impasse? And, if business leadership played an important role in the events in South Africa, could they take a similar role elsewhere?

#9 - Shake Shack IPO

Faculty Supervision: Jake Thomas and Geert Rouwenhorst

From an art project in a New York City park, Shake Shack developed a devoted fan base that greeted new Shake Shack locations with cheers and long lines. When Shake Shack went public on January 30, 2015, investors displayed a similar enthusiasm. Opening day investors bid up the $21 per share offering price by 118% to reach $45.90 at closing bell. By the end of May, investors were paying $92.86 per share. Students are asked if this price represented a realistic valuation of the enterprise and if not, what was Shake Shack truly worth? The case provides extensive information on Shake Shack’s marketing, competitors, operations and financials, allowing instructors to weave a wide variety of factors into a valuation of the company.

#10 - Searching for a Search Fund Structure

Faculty Supervision: AJ Wasserstein

This case considers how young entrepreneurs structure search funds to find businesses to take over. The case describes an MBA student who meets with a number of successful search fund entrepreneurs who have taken alternative routes to raising funds. The case considers the issues of partnering, soliciting funds vs. self-funding a search, and joining an incubator. The case provides a platform from which to discuss the pros and cons of various search fund structures.

40 Most Popular Case Studies of 2017

Click on the case title to learn more about the dilemma. A selection of our most popular cases are available for purchase via our online store .

• Browse All Articles
• Newsletter Sign-Up

ManagementStyle →

No results found in working knowledge.

• Were any results found in one of the other content buckets on the left?
• Try removing some search filters.
• Use different search filters.

7 Favorite Business Case Studies to Teach—and Why

Explore more.

• Case Teaching
• Course Materials

FEATURED CASE STUDIES

The Army Crew Team . Emily Michelle David of CEIBS

ATH Technologies . Devin Shanthikumar of Paul Merage School of Business

Fabritek 1992 . Rob Austin of Ivey Business School

Lincoln Electric Co . Karin Schnarr of Wilfrid Laurier University

Pal’s Sudden Service—Scaling an Organizational Model to Drive Growth . Gary Pisano of Harvard Business School

The United States Air Force: ‘Chaos’ in the 99th Reconnaissance Squadron . Francesca Gino of Harvard Business School

Warren E. Buffett, 2015 . Robert F. Bruner of Darden School of Business

To dig into what makes a compelling case study, we asked seven experienced educators who teach with—and many who write—business case studies: “What is your favorite case to teach and why?”

The resulting list of case study favorites ranges in topics from operations management and organizational structure to rebel leaders and whodunnit dramas.

1. The Army Crew Team

Emily Michelle David, Assistant Professor of Management, China Europe International Business School (CEIBS)

“I love teaching  The Army Crew Team  case because it beautifully demonstrates how a team can be so much less than the sum of its parts.

I deliver the case to executives in a nearby state-of-the-art rowing facility that features rowing machines, professional coaches, and shiny red eight-person shells.

After going through the case, they hear testimonies from former members of Chinese national crew teams before carrying their own boat to the river for a test race.

The rich learning environment helps to vividly underscore one of the case’s core messages: competition can be a double-edged sword if not properly managed.

Executives in Emily Michelle David’s organizational behavior class participate in rowing activities at a nearby facility as part of her case delivery.

Despite working for an elite headhunting firm, the executives in my most recent class were surprised to realize how much they’ve allowed their own team-building responsibilities to lapse. In the MBA pre-course, this case often leads to a rich discussion about common traps that newcomers fall into (for example, trying to do too much, too soon), which helps to poise them to both stand out in the MBA as well as prepare them for the lateral team building they will soon engage in.

Finally, I love that the post-script always gets a good laugh and serves as an early lesson that organizational behavior courses will seldom give you foolproof solutions for specific problems but will, instead, arm you with the ability to think through issues more critically.”

2. ATH Technologies

Devin Shanthikumar, Associate Professor of Accounting, Paul Merage School of Business

“As a professor at UC Irvine’s Paul Merage School of Business, and before that at Harvard Business School, I have probably taught over 100 cases. I would like to say that my favorite case is my own,   Compass Box Whisky Company . But as fun as that case is, one case beats it:  ATH Technologies  by Robert Simons and Jennifer Packard.

ATH presents a young entrepreneurial company that is bought by a much larger company. As part of the merger, ATH gets an ‘earn-out’ deal—common among high-tech industries. The company, and the class, must decide what to do to achieve the stretch earn-out goals.

ATH captures a scenario we all want to be in at some point in our careers—being part of a young, exciting, growing organization. And a scenario we all will likely face—having stretch goals that seem almost unreachable.

It forces us, as a class, to really struggle with what to do at each stage.

After we read and discuss the A case, we find out what happens next, and discuss the B case, then the C, then D, and even E. At every stage, we can:

see how our decisions play out,

figure out how to build on our successes, and

address our failures.

The case is exciting, the class discussion is dynamic and energetic, and in the end, we all go home with a memorable ‘ah-ha!’ moment.

I have taught many great cases over my career, but none are quite as fun, memorable, and effective as ATH .”

3. Fabritek 1992

Rob Austin, Professor of Information Systems, Ivey Business School

“This might seem like an odd choice, but my favorite case to teach is an old operations case called  Fabritek 1992 .

The latest version of Fabritek 1992 is dated 2009, but it is my understanding that this is a rewrite of a case that is older (probably much older). There is a Fabritek 1969 in the HBP catalog—same basic case, older dates, and numbers. That 1969 version lists no authors, so I suspect the case goes even further back; the 1969 version is, I’m guessing, a rewrite of an even older version.

There are many things I appreciate about the case. Here are a few:

It operates as a learning opportunity at many levels. At first it looks like a not-very-glamorous production job scheduling case. By the end of the case discussion, though, we’re into (operations) strategy and more. It starts out technical, then explodes into much broader relevance. As I tell participants when I’m teaching HBP's Teaching with Cases seminars —where I often use Fabritek as an example—when people first encounter this case, they almost always underestimate it.

It has great characters—especially Arthur Moreno, who looks like a troublemaker, but who, discussion reveals, might just be the smartest guy in the factory. Alums of the Harvard MBA program have told me that they remember Arthur Moreno many years later.

Almost every word in the case is important. It’s only four and a half pages of text and three pages of exhibits. This economy of words and sparsity of style have always seemed like poetry to me. I should note that this super concise, every-word-matters approach is not the ideal we usually aspire to when we write cases. Often, we include extra or superfluous information because part of our teaching objective is to provide practice in separating what matters from what doesn’t in a case. Fabritek takes a different approach, though, which fits it well.

It has a dramatic structure. It unfolds like a detective story, a sort of whodunnit. Something is wrong. There is a quality problem, and we’re not sure who or what is responsible. One person, Arthur Moreno, looks very guilty (probably too obviously guilty), but as we dig into the situation, there are many more possibilities. We spend in-class time analyzing the data (there’s a bit of math, so it covers that base, too) to determine which hypotheses are best supported by the data. And, realistically, the data doesn’t support any of the hypotheses perfectly, just some of them more than others. Also, there’s a plot twist at the end (I won’t reveal it, but here’s a hint: Arthur Moreno isn’t nearly the biggest problem in the final analysis). I have had students tell me the surprising realization at the end of the discussion gives them ‘goosebumps.’

Finally, through the unexpected plot twist, it imparts what I call a ‘wisdom lesson’ to young managers: not to be too sure of themselves and to regard the experiences of others, especially experts out on the factory floor, with great seriousness.”

4. Lincoln Electric Co.

Karin Schnarr, Assistant Professor of Policy, Wilfrid Laurier University

“As a strategy professor, my favorite case to teach is the classic 1975 Harvard case  Lincoln Electric Co.  by Norman Berg.

I use it to demonstrate to students the theory linkage between strategy and organizational structure, management processes, and leadership behavior.

This case may be an odd choice for a favorite. It occurs decades before my students were born. It is pages longer than we are told students are now willing to read. It is about manufacturing arc welding equipment in Cleveland, Ohio—a hard sell for a Canadian business classroom.

Yet, I have never come across a case that so perfectly illustrates what I want students to learn about how a company can be designed from an organizational perspective to successfully implement its strategy.

And in a time where so much focus continues to be on how to maximize shareholder value, it is refreshing to be able to discuss a publicly-traded company that is successfully pursuing a strategy that provides a fair value to shareholders while distributing value to employees through a large bonus pool, as well as value to customers by continually lowering prices.

However, to make the case resonate with today’s students, I work to make it relevant to the contemporary business environment. I link the case to multimedia clips about Lincoln Electric’s current manufacturing practices, processes, and leadership practices. My students can then see that a model that has been in place for generations is still viable and highly successful, even in our very different competitive situation.”

5. Pal’s Sudden Service—Scaling an Organizational Model to Drive Growth

Gary Pisano, Professor of Business Administration, Harvard Business School

“My favorite case to teach these days is  Pal’s Sudden Service—Scaling an Organizational Model to Drive Growth .

I love teaching this case for three reasons:

1. It demonstrates how a company in a super-tough, highly competitive business can do very well by focusing on creating unique operating capabilities. In theory, Pal’s should have no chance against behemoths like McDonalds or Wendy’s—but it thrives because it has built a unique operating system. It’s a great example of a strategic approach to operations in action.

2. The case shows how a strategic approach to human resource and talent development at all levels really matters. This company competes in an industry not known for engaging its front-line workers. The case shows how engaging these workers can really pay off.

3. Finally, Pal’s is really unusual in its approach to growth. Most companies set growth goals (usually arbitrary ones) and then try to figure out how to ‘backfill’ the human resource and talent management gaps. They trust you can always find someone to do the job. Pal’s tackles the growth problem completely the other way around. They rigorously select and train their future managers. Only when they have a manager ready to take on their own store do they open a new one. They pace their growth off their capacity to develop talent. I find this really fascinating and so do the students I teach this case to.”

6. The United States Air Force: ‘Chaos’ in the 99th Reconnaissance Squadron

Francesca Gino, Professor of Business Administration, Harvard Business School

“My favorite case to teach is  The United States Air Force: ‘Chaos’ in the 99th Reconnaissance Squadron .

The case surprises students because it is about a leader, known in the unit by the nickname Chaos , who inspired his squadron to be innovative and to change in a culture that is all about not rocking the boat, and where there is a deep sense that rules should simply be followed.

For years, I studied ‘rebels,’ people who do not accept the status quo; rather, they approach work with curiosity and produce positive change in their organizations. Chaos is a rebel leader who got the level of cultural change right. Many of the leaders I’ve met over the years complain about the ‘corporate culture,’ or at least point to clear weaknesses of it; but then they throw their hands up in the air and forget about changing what they can.

Chaos is different—he didn’t go after the ‘Air Force’ culture. That would be like boiling the ocean.

Instead, he focused on his unit of control and command: The 99th squadron. He focused on enabling that group to do what it needed to do within the confines of the bigger Air Force culture. In the process, he inspired everyone on his team to be the best they can be at work.

The case leaves the classroom buzzing and inspired to take action.”

7. Warren E. Buffett, 2015

Robert F. Bruner, Professor of Business Administration, Darden School of Business

“I love teaching   Warren E. Buffett, 2015  because it energizes, exercises, and surprises students.

Buffett looms large in the business firmament and therefore attracts anyone who is eager to learn his secrets for successful investing. This generates the kind of energy that helps to break the ice among students and instructors early in a course and to lay the groundwork for good case discussion practices.

Studying Buffett’s approach to investing helps to introduce and exercise important themes that will resonate throughout a course. The case challenges students to define for themselves what it means to create value. The case discussion can easily be tailored for novices or for more advanced students.

Either way, this is not hero worship: The case affords a critical examination of the financial performance of Buffett’s firm, Berkshire Hathaway, and reveals both triumphs and stumbles. Most importantly, students can critique the purported benefits of Buffett’s conglomeration strategy and the sustainability of his investment record as the size of the firm grows very large.

By the end of the class session, students seem surprised with what they have discovered. They buzz over the paradoxes in Buffett’s philosophy and performance record. And they come away with sober respect for Buffett’s acumen and for the challenges of creating value for investors.

Surely, such sobriety is a meta-message for any mastery of finance.”

More Educator Favorites

Emily Michelle David is an assistant professor of management at China Europe International Business School (CEIBS). Her current research focuses on discovering how to make workplaces more welcoming for people of all backgrounds and personality profiles to maximize performance and avoid employee burnout. David’s work has been published in a number of scholarly journals, and she has worked as an in-house researcher at both NASA and the M.D. Anderson Cancer Center.

Devin Shanthikumar  is an associate professor and the accounting area coordinator at UCI Paul Merage School of Business. She teaches undergraduate, MBA, and executive-level courses in managerial accounting. Shanthikumar previously served on the faculty at Harvard Business School, where she taught both financial accounting and managerial accounting for MBAs, and wrote cases that are used in accounting courses across the country.

Robert D. Austin is a professor of information systems at Ivey Business School and an affiliated faculty member at Harvard Medical School. He has published widely, authoring nine books, more than 50 cases and notes, three Harvard online products, and two popular massive open online courses (MOOCs) running on the Coursera platform.

Karin Schnarr is an assistant professor of policy and the director of the Bachelor of Business Administration (BBA) program at the Lazaridis School of Business & Economics at Wilfrid Laurier University in Waterloo, Ontario, Canada where she teaches strategic management at the undergraduate, graduate, and executive levels. Schnarr has published several award-winning and best-selling cases and regularly presents at international conferences on case writing and scholarship.

Gary P. Pisano is the Harry E. Figgie, Jr. Professor of Business Administration and senior associate dean of faculty development at Harvard Business School, where he has been on the faculty since 1988. Pisano is an expert in the fields of technology and operations strategy, the management of innovation, and competitive strategy. His research and consulting experience span a range of industries including aerospace, biotechnology, pharmaceuticals, specialty chemicals, health care, nutrition, computers, software, telecommunications, and semiconductors.

Francesca Gino studies how people can have more productive, creative, and fulfilling lives. She is a professor at Harvard Business School and the author, most recently, of  Rebel Talent: Why It Pays to Break the Rules at Work and in Life . Gino regularly gives keynote speeches, delivers corporate training programs, and serves in advisory roles for firms and not-for-profit organizations across the globe.

Robert F. Bruner is a university professor at the University of Virginia, distinguished professor of business administration, and dean emeritus of the Darden School of Business. He has also held visiting appointments at Harvard and Columbia universities in the United States, at INSEAD in France, and at IESE in Spain. He is the author, co-author, or editor of more than 20 books on finance, management, and teaching. Currently, he teaches and writes in finance and management.

Related Articles

We use cookies to understand how you use our site and to improve your experience, including personalizing content. Learn More . By continuing to use our site, you accept our use of cookies and revised Privacy Policy .

Case collection: MIT Sloan School of Management

About MIT Sloan School of Management

MIT Sloan is a different kind of management school. It’s not iterating on a better widget or cashing in on the latest business fad. It’s not talking about management in the abstract.

As part of the world’s leading research institution, MIT Sloan brings together today’s brightest minds to tackle global challenges. For real.

At the intersection of business and technology, MIT Sloan explores the future of work. It launches companies that kick start local economies in the developing world. It retools systems to make health care work better and to engage people around the world in addressing climate change.

For students , this means different kinds of opportunities. Hands-on learning. Global experience. And a relentless focus on impact.

For faculty , this means different fields of research. New work in emerging areas that don’t fit into existing departments. And colleagues across MIT.

For alumni , this means a vibrant global network of like-minded innovators, ready to help you advance your career and turn your vision into reality.

For organisational leaders the world over, this means a wellspring of ideas and talent. Brilliant minds. Practical problem-solvers. Meaningful research. And tools you can apply to your own work.

MIT Sloan. Ideas made to matter .

About the collection

Case studies are narratives that facilitate class discussion about a particular business or management issue. Teaching cases are meant to spur debate among students rather than promote a particular point of view or steer students in a specific direction. 

Some of the case studies in this collection highlight the decision-making process in a business or management setting. Other cases are descriptive or demonstrative in nature, showcasing something that has happened or is happening in a particular business or management environment.

Whether decision-based or demonstrative, case studies give students the chance to be in the shoes of a protagonist. With the help of context and detailed data, students can analyse what they would and would not do in a particular situation, why, and how.

Since 2009, the MIT Sloan School of Management has provided open and free access to its case study collection. Every case carries a creative commons license allowing it to be downloaded, copied, and distributed/used free of charge by anyone worldwide, no permission required. While this collection covers a wide array of industries, companies, and organisations, it focuses mainly on areas in which MIT Sloan’s innovative research and teaching are world renowned. 

MIT Sloan Management Review

At MIT Sloan Management Review (MIT SMR) they share with their readers an excitement and curiosity about how the practice of management is transforming in the digital age. The MIT SMR expert contributors help leaders explore the trends that are shaping how organisations operate, compete, and create value in a technology-fuelled world. They deliver the kind of evidence-based analysis and practical insight that will inspire leaders to do great work.

Collection contact

For any queries related to the MIT Sloan School of Management case collection, please contact:

Cate Reavis e   [email protected] t   +1 617 253 3673

Browse the case collection Browse prize-winning cases Browse MIT SMR articles

Available from The Case Centre

The MIT Sloan School of Management’s collection of over 60 cases, and their accompanying instructor materials and software, is available from The Case Centre.

Also available are over 1,700 articles from MIT Sloan Management Review .

See what's available

There are restrictions on the distribution of some items. To see any restrictions login to our site (or register if you've not already done so) and use our online search to find the item you're interested in. Any restrictions will be shown alongside the product.

https://mitsloan.mit.edu/teaching-resources-library/about

https://sloanreview.mit.edu

Top ten bestselling cases

Browse the top ten bestselling cases from MIT Sloan School of Management in 2023.

Browse the full collection

View all case collections

Learning with cases can be a challenging experience.

Our interactive study guide takes students through the process, providing practical tips, tricks and tools.

Discover more

Smart. Open. Grounded. Inventive. Read our Ideas Made to Matter.

Which program is right for you?

Through intellectual rigor and experiential learning, this full-time, two-year MBA program develops leaders who make a difference in the world.

A rigorous, hands-on program that prepares adaptive problem solvers for premier finance careers.

A 12-month program focused on applying the tools of modern data science, optimization and machine learning to solve real-world business problems.

Earn your MBA and SM in engineering with this transformative two-year program.

Combine an international MBA with a deep dive into management science. A special opportunity for partner and affiliate schools only.

A doctoral program that produces outstanding scholars who are leading in their fields of research.

Bring a business perspective to your technical and quantitative expertise with a bachelor’s degree in management, business analytics, or finance.

A joint program for mid-career professionals that integrates engineering and systems thinking. Earn your master’s degree in engineering and management.

An interdisciplinary program that combines engineering, management, and design, leading to a master’s degree in engineering and management.

Executive Programs

A full-time MBA program for mid-career leaders eager to dedicate one year of discovery for a lifetime of impact.

This 20-month MBA program equips experienced executives to enhance their impact on their organizations and the world.

Non-degree programs for senior executives and high-potential managers.

A non-degree, customizable program for mid-career professionals.

Teaching Resources Library

Case studies.

The teaching business case studies available here are narratives that facilitate class discussion about a particular business or management issue. Teaching cases are meant to spur debate among students rather than promote a particular point of view or steer students in a specific direction.  Some of the case studies in this collection highlight the decision-making process in a business or management setting. Other cases are descriptive or demonstrative in nature, showcasing something that has happened or is happening in a particular business or management environment. Whether decision-based or demonstrative, case studies give students the chance to be in the shoes of a protagonist. With the help of context and detailed data, students can analyze what they would and would not do in a particular situation, why, and how.

Case Studies By Category

Have a language expert improve your writing

Run a free plagiarism check in 10 minutes, generate accurate citations for free.

• Knowledge Base

Methodology

• What Is a Case Study? | Definition, Examples & Methods

What Is a Case Study? | Definition, Examples & Methods

Published on May 8, 2019 by Shona McCombes . Revised on November 20, 2023.

A case study is a detailed study of a specific subject, such as a person, group, place, event, organization, or phenomenon. Case studies are commonly used in social, educational, clinical, and business research.

A case study research design usually involves qualitative methods , but quantitative methods are sometimes also used. Case studies are good for describing , comparing, evaluating and understanding different aspects of a research problem .

Table of contents

When to do a case study, step 1: select a case, step 2: build a theoretical framework, step 3: collect your data, step 4: describe and analyze the case, other interesting articles.

A case study is an appropriate research design when you want to gain concrete, contextual, in-depth knowledge about a specific real-world subject. It allows you to explore the key characteristics, meanings, and implications of the case.

Case studies are often a good choice in a thesis or dissertation . They keep your project focused and manageable when you don’t have the time or resources to do large-scale research.

You might use just one complex case study where you explore a single subject in depth, or conduct multiple case studies to compare and illuminate different aspects of your research problem.

Here's why students love Scribbr's proofreading services

Discover proofreading & editing

Once you have developed your problem statement and research questions , you should be ready to choose the specific case that you want to focus on. A good case study should have the potential to:

• Provide new or unexpected insights into the subject
• Challenge or complicate existing assumptions and theories
• Propose practical courses of action to resolve a problem
• Open up new directions for future research

TipIf your research is more practical in nature and aims to simultaneously investigate an issue as you solve it, consider conducting action research instead.

Unlike quantitative or experimental research , a strong case study does not require a random or representative sample. In fact, case studies often deliberately focus on unusual, neglected, or outlying cases which may shed new light on the research problem.

Example of an outlying case studyIn the 1960s the town of Roseto, Pennsylvania was discovered to have extremely low rates of heart disease compared to the US average. It became an important case study for understanding previously neglected causes of heart disease.

However, you can also choose a more common or representative case to exemplify a particular category, experience or phenomenon.

Example of a representative case studyIn the 1920s, two sociologists used Muncie, Indiana as a case study of a typical American city that supposedly exemplified the changing culture of the US at the time.

While case studies focus more on concrete details than general theories, they should usually have some connection with theory in the field. This way the case study is not just an isolated description, but is integrated into existing knowledge about the topic. It might aim to:

• Exemplify a theory by showing how it explains the case under investigation
• Expand on a theory by uncovering new concepts and ideas that need to be incorporated
• Challenge a theory by exploring an outlier case that doesn’t fit with established assumptions

To ensure that your analysis of the case has a solid academic grounding, you should conduct a literature review of sources related to the topic and develop a theoretical framework . This means identifying key concepts and theories to guide your analysis and interpretation.

There are many different research methods you can use to collect data on your subject. Case studies tend to focus on qualitative data using methods such as interviews , observations , and analysis of primary and secondary sources (e.g., newspaper articles, photographs, official records). Sometimes a case study will also collect quantitative data.

Example of a mixed methods case studyFor a case study of a wind farm development in a rural area, you could collect quantitative data on employment rates and business revenue, collect qualitative data on local people’s perceptions and experiences, and analyze local and national media coverage of the development.

The aim is to gain as thorough an understanding as possible of the case and its context.

Receive feedback on language, structure, and formatting

Professional editors proofread and edit your paper by focusing on:

• Academic style
• Vague sentences
• Style consistency

See an example

In writing up the case study, you need to bring together all the relevant aspects to give as complete a picture as possible of the subject.

How you report your findings depends on the type of research you are doing. Some case studies are structured like a standard scientific paper or thesis , with separate sections or chapters for the methods , results and discussion .

Others are written in a more narrative style, aiming to explore the case from various angles and analyze its meanings and implications (for example, by using textual analysis or discourse analysis ).

In all cases, though, make sure to give contextual details about the case, connect it back to the literature and theory, and discuss how it fits into wider patterns or debates.

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

• Normal distribution
• Degrees of freedom
• Null hypothesis
• Discourse analysis
• Control groups
• Mixed methods research
• Non-probability sampling
• Quantitative research
• Ecological validity

Research bias

• Rosenthal effect
• Implicit bias
• Cognitive bias
• Selection bias
• Negativity bias
• Status quo bias

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the “Cite this Scribbr article” button to automatically add the citation to our free Citation Generator.

McCombes, S. (2023, November 20). What Is a Case Study? | Definition, Examples & Methods. Scribbr. Retrieved April 16, 2024, from https://www.scribbr.com/methodology/case-study/

Is this article helpful?

Shona McCombes

Other students also liked, primary vs. secondary sources | difference & examples, what is a theoretical framework | guide to organizing, what is action research | definition & examples, what is your plagiarism score.

• Technical Support
• Find My Rep

You are here

Cases in Human Resource Management

• David Kimball - Elms College
• Description

Cases in Human Resource Management provides students with insights into common challenges, dilemmas, and issues human resource managers face in the workplace. Using a wide variety of well-known companies and organizations, author David Kimball engages students with original, real-world cases that illustrate HRM topics and functions in action. Each case is designed to encourage students to find new solutions to human resource issues and to stimulate class discussion. Case questions challenge students to think critically, apply concepts, and develop their HRM skills. The contents are organized using the same topical coverage and structure as most HRM textbooks, making Kimball the ideal companion for any introductory HRM course.

See what’s new to this edition by selecting the Features tab on this page. Should you need additional information or have questions regarding the HEOA information provided for this title, including what is new to this edition, please email [email protected] . Please include your name, contact information, and the name of the title for which you would like more information. For information on the HEOA, please go to http://ed.gov/policy/highered/leg/hea08/index.html .

For assistance with your order: Please email us at [email protected] or connect with your SAGE representative.

SAGE 2455 Teller Road Thousand Oaks, CA 91320 www.sagepub.com

Supplements

May adopt as a supplementary Text in the future.

KEY FEATURES

• Original case studies bring concepts to life through a number of well-known organizations, including Apple, Amazon, Google, LinkedIn, and Zappos.
• Case questions require students to think critically about HR issues and apply HR concepts to each case.
• An emphasis on important issues and current trends in HRM brings up key topics in the field such as state and federal minimum wage, succession planning, executive compensation, mindfulness, cyber attacks, CSR, and managing a multigenerational workforce.
• A chapter on international HRM topics examines important issues like that of helping expatriates succeed.

Sample Materials & Chapters

Chapter 7: Training, Leading, Talent Management and Development

Chapter 16: Global Issues for Human Resource Managers

For instructors

Select a purchasing option.

This title is also available on SAGE Knowledge , the ultimate social sciences online library. If your library doesn’t have access, ask your librarian to start a trial .

• SUGGESTED TOPICS
• The Magazine
• Newsletters
• Managing Yourself
• Managing Teams
• Work-life Balance
• The Big Idea
• Data & Visuals
• Reading Lists
• Case Selections
• HBR Learning
• Topic Feeds
• Account Settings
• Email Preferences

Employee performance management

• Leadership and managing people
• Managing people

How to Set Up a Remote Employee for Success on Day One

• James M. Citrin
• Darleen DeRosa
• May 10, 2021

Negative Feedback Rarely Leads to Improvement

• Scott Berinato
• From the January–February 2018 Issue

The Art of Evidence-Based Medicine

• Christopher Worsham
• Anupam B. Jena
• January 30, 2019

How Will You Give Tough Feedback?

• Harvard Business Publishing
• July 19, 2023

Introduction to Performance Appraisals

• October 07, 2013

Coaching the Alpha Male

• Kate Ludeman
• Eddie Erlandson
• May 01, 2004

When Your Star Player Asks to Go Part-Time (HBR Case Study and Commentary)

• Thomas J. DeLong
• Elizabeth McKinnon
• Rachel Thomas
• From the January–February 2021 Issue

Experience Doesn't Predict a New Hire's Success

• Chad H. Van Iddekinge
• Alison Beard
• From the September–October 2019 Issue

Will You Help or Heave Your Underperformers?

• Harvard Management Update
• February 28, 2008

Research: Why Gender Bias Persists, Even When Organizations Try to Curb It

• Alison Wynn
• Emily K. Carian
• Sofia Kennedy
• JoAnne Wehner
• December 20, 2023

Co-Creating the Employee Experience

• Diane Gherson
• Lisa Burrell
• From the March–April 2018 Issue

How to Decide Whether to Fire Someone

• Rebecca Knight
• January 28, 2019

Service Comes First: An Interview with USAA's Robert F. McDermott

• Robert F. McDermott
• Thomas A. Teal
• From the September-October 1991 Issue

What Companies Get Wrong About Talent Management

• Peter Cappelli
• Mark Mortensen
• Amy C. Edmondson
• Roger L. Martin
• January 01, 2023

Case of AIDS

• Richard S. Tedlow
• Michele S. Marram
• From the November-December 1991 Issue

Job Sculpting: The Art of Retaining Your Best People

• Timothy Butler
• James Waldroop
• From the September–October 1999 Issue

New Game Plan for C Players (HBR OnPoint Enhanced Edition)

• Beth Axelrod
• Helen Handfield-Jones
• Ed Michaels
• January 01, 2002

Confidence Doesn't Always Boost Performance

• Don A. Moore
• Gardiner Morse
• From the November–December 2020 Issue

Leading the Team You Inherit

• Michael D. Watkins
• From the June 2016 Issue

Making Yourself Indispensable

• John H. Zenger
• Joseph Folkman
• Scott Edinger
• From the October 2011 Issue

Orientation to the Reflected Best-Self Feedback Exercise

• Laura Morgan Roberts
• October 12, 2005

Pret A Manger

• Frances X. Frei
• RIck Goldberg
• Stephanie van Sice
• April 24, 2012

Evaluate Goals

• September 14, 2014

Orientation to the Subarctic Survival Situation

• Linda A. Hill
• Katherine S. Weber
• November 30, 1993

Ottawa Voyageurs

• David L. Ager
• Scott Baldwin
• Chris Strong
• Andrew Feng
• July 23, 2003

Stress in the Workplace: Mental Health Conversations-The Boss

• Gabrielle Adams
• Jazmin Brown-Iannuzzi
• Jaclyn Lisnek
• Melanie Prengler
• Gerry Yemen
• August 06, 2023

Managing with Fairness in an Operational Context

• John T. Jost
• Jennifer Buechel
• June 13, 2002

Wells Fargo Online Financial Services (A)

• Robert S. Kaplan
• Nicole Tempest
• June 12, 1998

Performance Appraisal

• May 15, 2016

Moderna: Pioneering a People Platform to Accelerate Science Innovation

• Tatiana Sandino
• Samuel Grad
• April 01, 2024

Harvard Business Review 20-Minute Manager Ultimate Boxed Set (16 Books)

• Harvard Business Review
• March 12, 2019

Collaborating for Growth: Duane Morris in a Turbulent Legal Sector

• Heidi K. Gardner
• Annelena Lobb
• July 26, 2013

A Change for Drill Sergeants?

• Karen E. Boroff
• Russell P. Lemler
• Alexander Boroff
• June 01, 2017

Hamptonshire Express

• V.G. Narayanan
• Ananth Raman
• March 01, 1998

Harvard ManageMentor: Full Suite

• HBP Corporate Learning
• November 17, 2020

Sears Auto Centers (A) (Abridged)

• Lynn Sharp Paine
• December 18, 2003

Cafes Monte Bianco: Building a Profit Plan

• Robert Simons
• Antonio Davila
• January 26, 1998

Purity Steel Corporation, 2012

• March 04, 1997

Transport Corporation of India (A): The Cross-selling Conundrum

• Saloni Chaturvedi
• May 14, 2013

How to Be Good at Performance Appraisals: Simple, Effective, Done Right

• July 05, 2011

Sears Auto Centers (A) and (B) (Abridged) and (C), Teaching Note

• August 22, 2006

Our Delusions About Talent

• April 20, 2017

Unit Structure: Defining a Primary Customer as a Basis for Organizational Architecture

• June 16, 2005

Popular Topics

Partner center.

Advertisement

Integration of Lean Six Sigma with Internet of Things (IoT) for productivity improvement: a case study of contactor manufacturing industry

• CASE STUDIES
• Published: 04 July 2023
• Volume 14 , pages 1990–2018, ( 2023 )

Cite this article

• Santosh B. Rane 1 ,
• Sandesh Wavhal 1 &
• Prathamesh R. Potdar   ORCID: orcid.org/0000-0001-8896-5322 2  

497 Accesses

2 Citations

Explore all metrics

In today's era of digitalization and competitive market environment, organizations are more focused on manufacturing quality products at optimum cost to capture maximum business as a variety of options are available to customers for purchasing goods and services. In this scenario, the latest technologies-based productivity improvement can help organizations to achieve set targets of production and ensure the quality of products. In this study, the contactor manufacturing industry has been considered to demonstrate integrated Lean Six Sigma with the Internet of Things (IoT) approach for productivity improvement. A systematic literature survey was performed to understand the concept of Lean Six Sigma (LSS), Define Measure Analysis Improve Control approach and IoT technology. The implementation of the LSS approach reduced the rejection rate of contactors and saved the total production cost (Rs. 51,88,260/-) annually. The annual consumption of grinding wheels has been reduced by 8 quantities to produce the same quantity of contactors. The surface quality of magnets has been identified as a root cause for contactor rejections as it contributes 53.4% of total rejections. The improvement measures are recommended based on the expert's suggestions as grinding wheel dressing must be performed after the completion of a batch of 20,000 parts. The condition monitoring and IoT approach implementation are done by monitoring grinding speed (650–950 RPM), grinding wheel thickness reduction by 0.4–0.6 mm after dressing and dressing of grinding wheel after completion of 20,000 for reducing rejections. This study concluded that industries should implement the Lean Six Sigma approach with the latest technologies and appropriate tools at each stage to set processes to world-class standards and industries should identify opportunities for process and product improvement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price includes VAT (Russian Federation)

Instant access to the full article PDF.

Rent this article via DeepDyve

Institutional subscriptions

Similar content being viewed by others

Progress and Trends in Industry 4.0 and Lean Six Sigma Integration

Promote Intelligent Manufacturing with Lean Six Sigma Management Concept

Challenges of Introducing Lean Six Sigma, IoT in Industry 4.0, and Supply Chain Management: A Review

Abrol SA, Bhargava C, Sharma PK (2021) Reliability analysis and condition monitoring of polymer based dye sensitized solar cell: a DOE approach. Mater Res Express 8:045309. https://doi.org/10.1088/2053-1591/abf629

Article   Google Scholar  

Alaba FA, Othman M, Hashem IAT, Alotaibi F (2017) Internet of Things security: a survey. J Netw Comput Appl 88:10–28. https://doi.org/10.1016/j.jnca.2017.04.002

Ali SM, Hossen MdA, Mahtab Z, Kabir G, Paul SK, ulAdnan ZH (2020) Barriers to Lean Six Sigma implementation in the supply chain: An ISM model. Comput Ind Eng 149:106843. https://doi.org/10.1016/j.cie.2020.106843

Alimohammadlou M, Mohammadi S (2016) Evaluating the productivity using malmquist index based on double frontiers data. Proced Soc Behav Sci 230:58–66. https://doi.org/10.1016/j.sbspro.2016.09.008

Antony J (2012) A SWOT analysis on six sigma: some perspectives from leading academics and practitioners. Int J Product Perform Manag 61:691–698. https://doi.org/10.1108/17410401211249229

Arias Velásquez RM (2020) Root cause analysis for inverters in solar photo-voltaic plants. Eng Fail Anal 118:104856. https://doi.org/10.1016/j.engfailanal.2020.104856

Arias Velásquez RM, Mejía Lara JV (2020) Root cause analysis improved with machine learning for failure analysis in power transformers. Eng Fail Anal 115:104684. https://doi.org/10.1016/j.engfailanal.2020.104684

Arias Velásquez RM, Mejía Lara JV (2020) Root cause analysis methodology for circuit breaker associated to GIS. Eng Fail Anal 115:104680. https://doi.org/10.1016/j.engfailanal.2020.104680

Bahari Z, Elgadi M, Rivet J, Dugué J (2009) Experimental study of the ternary Ag–Cu–In phase diagram. J Alloy Compd 477:152–165. https://doi.org/10.1016/j.jallcom.2008.10.030

Barot RS, Patel J, Sharma B, Rathod B, Solanki H, Patel Y (2020) Lean Six Sigma feasibility and implementation aspect in cast iron foundry. Mater Today Proc 28:1084–1091. https://doi.org/10.1016/j.matpr.2020.01.087

Belhadi A, Kamble SS, Zkik K, Cherrafi A, Touriki FE (2020) The integrated effect of big data analytics, Lean Six Sigma and green manufacturing on the environmental performance of manufacturing companies: the case of North Africa. J Clean Prod 252:119903. https://doi.org/10.1016/j.jclepro.2019.119903

Bidikar SG, Rane SB, Potdar PR (2022) Product development using design for six sigma approach: case study in switchgear industry. Int J Syst Assur Eng Manag 13:203–230. https://doi.org/10.1007/s13198-021-01199-4

Boutora S, Bentarzi H (2019) Ferroresonance study using false trip root cause analysis. Energy Proced Emerg Renew Energy Gener Autom 162:306–314. https://doi.org/10.1016/j.egypro.2019.04.032

Broder JS, Al-Jarani B, Lanan B, Brooks K (2020) Pigtail catheter insertion error: root cause analysis and recommendations for patient safety. J Emerg Med 58:464–472. https://doi.org/10.1016/j.jemermed.2019.10.003

Caro Teller JM, Pablos Bravo S, Serrano Garrote O, Ojeda García C, Carro Ruiz AM, Guede González AM, Ferrari Piquero JM (2020) Implementación Lean Six Sigma en la mejora del circuito de dispensación de medicación. J Healthc Qual Res 35:364–371. https://doi.org/10.1016/j.jhqr.2020.04.005

Chang DS, Kuo YC, Chen TY (2008) Productivity measurement of the manufacturing process for outsourcing decisions: the case of a Taiwanese printed circuit board manufacturer. Int J Prod Res 46:6981–6995. https://doi.org/10.1080/00207540701429934

Chaudhari SS, Bhole KS, Rane S (2023a) Comparison on conventional and digital technology assisted design methodologies of process heater radiant section. Int J Interact Des Manuf. https://doi.org/10.1007/s12008-023-01201-2

Chaudhari SS, Bhole KS, Rane S (2023b) An application of IIoT framework in system design, performance monitoring and control for industrial process heater. Int J Interact Des Manuf. https://doi.org/10.1007/s12008-023-01235-6

Cheah CK, Prakash J, Ong KS (2020) Overall equipment effectiveness: a review and development of an integrated improvement framework. IJPQM 30:46–71. https://doi.org/10.1504/IJPQM.2020.107240

Chi C-F, Sigmund D, Astardi MO (2020) Classification scheme for root cause and failure modes and effects analysis (FMEA) of passenger vehicle recalls. Reliab Eng Syst Saf 200:106929. https://doi.org/10.1016/j.ress.2020.106929

Costa LBM, Godinho Filho M, Fredendall LD, Gómez Paredes FJ (2018) Lean, six sigma and Lean Six Sigma in the food industry: a systematic literature review. Trends Food Sci Technol 82:122–133. https://doi.org/10.1016/j.tifs.2018.10.002

Costa LBM, Godinho Filho M, Fredendall LD, Ganga GMD (2020) The effect of Lean Six Sigma practices on food industry performance: Implications of the Sector’s experience and typical characteristics. Food Control 112:107110. https://doi.org/10.1016/j.foodcont.2020.107110

Costa LBM, Godinho Filho M, Fredendall LD, Devós Ganga GM (2021) Lean Six Sigma in the food industry: construct development and measurement validation. Int J Prod Econ 231:107843. https://doi.org/10.1016/j.ijpe.2020.107843

Dandage R, Mantha SS, Rane SB (2018a) Ranking the risk categories in international projects using the TOPSIS method. Int J Manag Proj Bus 11:317–331. https://doi.org/10.1108/IJMPB-06-2017-0070

Dandage RV, Mantha SS, Rane SB, Bhoola V (2018b) Analysis of interactions among barriers in project risk management. J Ind Eng Int 14:153–169. https://doi.org/10.1007/s40092-017-0215-9

Dandage RV, Mantha SS, Rane SB (2019) Strategy development using TOWS matrix for international project risk management based on prioritization of risk categories. Int J Manag Proj Bus 12:1003–1029. https://doi.org/10.1108/IJMPB-07-2018-0128

Darmawan MA, Putra MP, Wiguna B (2014) Value chain analysis for green productivity improvement in the natural rubber supply chain: a case study. J Clean Prod 85:201–211. https://doi.org/10.1016/j.jclepro.2014.01.098

Darmawan MA, Widhiarti RP, Teniwut YK (2018) Green productivity improvement and sustainability assessment of the motorcycle tire production process: a case study. J Clean Prod 191:273–282. https://doi.org/10.1016/j.jclepro.2018.04.228

de Marques PA, Matthé R (2017) Six Sigma DMAIC project to improve the performance of an aluminum die casting operation in Portugal. Int J Qual Reliab Manag 34:307–330. https://doi.org/10.1108/IJQRM-05-2015-0086

Dias J, Nunes E, Sousa S (2020) Productivity improvement of transmission electron microscopes-a case study. Proced Manuf 51:1559–1566. https://doi.org/10.1016/j.promfg.2020.10.217

Djatna T, Munichputranto F (2015) An analysis and design of mobile business intelligence system for productivity measurement and evaluation in tire curing production line. Proced Manuf 4:438–444. https://doi.org/10.1016/j.promfg.2015.11.060

Duan P, He Z, He Y, Liu F, Zhang A, Zhou D (2020) Root cause analysis approach based on reverse cascading decomposition in QFD and fuzzy weight ARM for quality accidents. Comput Ind Eng 147:106643. https://doi.org/10.1016/j.cie.2020.106643

Dweiri F, Ishaq S (2020) Cable insulation productivity improvement using Lean Six Sigma. IJPQM 30:488–508. https://doi.org/10.1504/IJPQM.2020.108573

Ferreras-Higuero E, Leal-Muñoz E, García de Jalón J, Chacón E, Vizán A (2020) Robot-process precision modelling for the improvement of productivity in flexible manufacturing cells. Robot Comput-Integr Manuf 65:101966. https://doi.org/10.1016/j.rcim.2020.101966

Fritz M, Berger PD (2015) Comparing two designs (or anything else!) using paired sample T-tests. In: Fritz M, Berger PD (eds) Improving the user experience through practical data analytics. Morgan Kaufmann, Boston, pp 71–89. https://doi.org/10.1016/B978-0-12-800635-1.00003-3

Chapter   Google Scholar  

Gavareshki MHK, Abbasi M, Karbasian M, Rostamkhani R (2020) Presenting a productive and sustainable model of integrated management system for achieving an added value in organisational processes. IJPQM 30:429–461. https://doi.org/10.1504/IJPQM.2020.108569

Ge J, Fu Y, Xie R, Liu Y, Mo W (2018) The effect of GVC embeddedness on productivity improvement: from the perspective of R&D and government subsidy. Technol Forecast Soc Chang 135:22–31. https://doi.org/10.1016/j.techfore.2018.07.057

Ghatorha KS, Sharma R, Singh G (2020) Application of root cause analysis to increase material removal rate for productivity improvement: a case study of the press manufacturing industry. Mater Today 26:1780–1783. https://doi.org/10.1016/j.matpr.2020.02.374

Gleeson F, Coughlan P, Goodman L, Newell A, Hargaden V (2019) Improving manufacturing productivity by combining cognitive engineering and lean-six sigma methods. Proced CIRP 81:641–646. https://doi.org/10.1016/j.procir.2019.03.169

Globerson S, Vitner G (2019) Measuring productivity in multi-stage, multi-product environment. IJPQM 26:290–304. https://doi.org/10.1504/IJPQM.2019.098365

Gupta P, Vardhan S (2016) Optimizing OEE, productivity and production cost for improving sales volume in an automobile industry through TPM: a case study. Int J Prod Res 54:2976–2988. https://doi.org/10.1080/00207543.2016.1145817

Gurley K, Edlow J, Burstein JL, Grossman SA (2020) Errors in decisionmaking in emergency medicine: the case of the landscaper’s back and root cause analysis. Ann Emerg Med. https://doi.org/10.1016/j.annemergmed.2020.05.031

Harikrishnan R, Rajeswaran M, Sathish Kumar S, Dinesh K (2020) Productivity improvement in poly-cover packing line through line balancing and automation. Mater Today 33:102–111. https://doi.org/10.1016/j.matpr.2020.03.253

Harris AM, Ziemba J, Bylund J (2020) Implementing a root cause analysis program to enhance patient safety education in urology residency. Urology 138:24–29. https://doi.org/10.1016/j.urology.2019.11.059

Hynes JP, Murray AS, Murray OM, Eustace SK, Gilchrist S, Dolan A, Lawler LP (2019) Use of Lean Six Sigma methodology shows reduction of inpatient waiting time for peripherally inserted central catheter placement. Clin Radiol 74:733.e5-733.e9. https://doi.org/10.1016/j.crad.2019.04.022

Inui T, Kawakami A, Miyagawa T (2012) Market competition, differences in technology, and productivity improvement: an empirical analysis based on Japanese manufacturing firm data. Jpn World Econ 24:197–206. https://doi.org/10.1016/j.japwor.2012.04.002

Islamoglu NE, Ryu K, Moon I (2014) Labour productivity in modular assembly: a study of automotive module suppliers. Int J Prod Res 52:6954–6970. https://doi.org/10.1080/00207543.2014.917773

Ismail R (2018) The impact of human capital and innovation on labour productivity of Malaysian small and medium enterprises. IJPQM 25:245–261. https://doi.org/10.1504/IJPQM.2018.094769

Jadhav JR, Mantha SS, Rane SB (2014a) Exploring barriers in lean implementation. Int J Lean Six Sigma 5(2):122–148. https://doi.org/10.1108/IJLSS-12-2012-0014

Jadhav JR, Mantha SS, Rane SB (2014b) Development of framework for sustainable Lean implementation: an ISM approach. J Ind Eng Int 10:72. https://doi.org/10.1007/s40092-014-0072-8

Jiang G, Zhang R, Ma W, Zhou D, Wang X, He X (2017) Cultivated land productivity potential improvement in land consolidation schemes in Shenyang, China: assessment and policy implications. Land Use Policy 68:80–88. https://doi.org/10.1016/j.landusepol.2017.07.001

Jones EC, Parast MM, Adams SG (2010) A framework for effective six sigma implementation. Total Qual Manag Bus Excell 21:415–424. https://doi.org/10.1080/14783361003606720

Kamble R, Wankhade L (2017) Perspectives on productivity: identifying attributes influencing productivity in various industrial sectors. IJPQM 22:536–566. https://doi.org/10.1504/IJPQM.2017.087868

Kaswan MS, Rathi R (2020) Green Lean Six Sigma for sustainable development: integration and framework. Environ Impact Assess Rev 83:106396. https://doi.org/10.1016/j.eiar.2020.106396

Khan SA, Badar MA, Alzaabi M (2020) Productivity improvement using DMAIC in a Caravan Manufacturing company. IJPQM 30:234–251. https://doi.org/10.1504/IJPQM.2020.107825

Kirkire MS, Rane SB (2017) Evaluation of success factors for medical device development using grey DEMATEL approach. J Model Manag 12:204–223. https://doi.org/10.1108/JM2-09-2015-0062

Kirkire MS, Rane SB, Jadhav JR (2015) Risk management in medical product development process using traditional FMEA and fuzzy linguistic approach: a case study. J Ind Eng Int 11:595–611. https://doi.org/10.1007/s40092-015-0113-y

Kirkire MS, Rane SB, Abhyankar GJ (2020) Structural equation modelling—FTOPSIS approach for modelling barriers to product development in medical device manufacturing industries. J Model Manag 15:967–993. https://doi.org/10.1108/JM2-09-2018-0139

Klefsjö B, Wiklund H, Edgeman RL (2001) Six sigma seen as a methodology for total quality management. Meas Bus Excell 5:31–35. https://doi.org/10.1108/13683040110385809

Kulkarni RG, Kulkarni VN, Gaitonde VN (2018) Productivity improvement in assembly workstation of motor winding unit. Mater Today Proc 5:23518–23525. https://doi.org/10.1016/j.matpr.2018.10.139

Kumar R, Kalra P, Kant S (2020) Productivity enhancement of assembly line by using Maynard operation sequence technique after identification of lean wastages. IJPQM 29:463–482. https://doi.org/10.1504/IJPQM.2020.106400

Kumar Banga H, Kumar R, Kumar P, Purohit A, Kumar H, Singh K (2020) Productivity improvement in manufacturing industry by lean tool. Mater Today Proc 28:1788–1794. https://doi.org/10.1016/j.matpr.2020.05.195

Kusneniwar A, Potdar P, Rane S (2019) Evaluation of performance characteristics and bite condition of single ferrule bite fitting by finite element analysis (FEA). In: Vasudevan H, Kottur VKN, Raina AA (Eds.) Proceedings of international conference on intelligent manufacturing and automation. Springer, Singapore, pp. 239–252. https://doi.org/10.1007/978-981-13-2490-1_22

Liang C, Zhou S, Yao B, Hood D, Gong Y (2020) Toward systems-centered analysis of patient safety events: improving root cause analysis by optimized incident classification and information presentation. Int J Med Inform 135:104054. https://doi.org/10.1016/j.ijmedinf.2019.104054

Liu W-Y, Chen C-H, Chen W-T, Shu C-M (2017) A study of caprolactam storage tank accident through root cause analysis with a computational approach. J Loss Prev Process Ind 50:80–90. https://doi.org/10.1016/j.jlp.2017.09.004

Liu C, Lore KG, Jiang Z, Sarkar S (2021) Root-cause analysis for time-series anomalies via spatiotemporal graphical modeling in distributed complex systems. Knowl-Based Syst 211:106527. https://doi.org/10.1016/j.knosys.2020.106527

Machado CG, Winroth MP, Ribeiro da Silva EHD (2020) Sustainable manufacturing in industry 4.0: an emerging research agenda. Int J Prod Res 58:1462–1484. https://doi.org/10.1080/00207543.2019.1652777

Mahalakshmi S, Arokiasamy A (2020) Productivity and quality enrichment through multi criteria trajectory optimisation of an industrial robot. IJPQM 30:279–303. https://doi.org/10.1504/IJPQM.2020.108380

Mahalakshmi S, Arokiasamy A, Ahamed JFA (2019) Productivity improvement of an eco friendly warehouse using multi objective optimal robot trajectory planning. IJPQM 27:305–328. https://doi.org/10.1504/IJPQM.2019.101517

Meena ML, Jain R, Kumar P, Gupta S, Dangayach GS (2018) Process improvement in an Indian automotive part manufacturing company: a case study. IJPQM 23:524–551. https://doi.org/10.1504/IJPQM.2018.090263

Mexia JT (1990) Best linear unbiased estimates, duality of F tests and the Scheffé multiple comparison method in the presence of controlled heteroscedasticity. Comput Stat Data Anal 10:271–281. https://doi.org/10.1016/0167-9473(90)90007-5

Article   MathSciNet   MATH   Google Scholar  

Mishra N, Rane SB (2019a) Business excellence initiative success prediction model based on logistic regression and artificial neural network. Int J Qual Innov 4:132–166. https://doi.org/10.1504/IJQI.2019.105749

Mishra N, Rane SB (2019b) Prediction and improvement of iron casting quality through analytics and Six Sigma approach. Int J Lean Six Sigma 10(1):189–210. https://doi.org/10.1108/IJLSS-11-2017-0122

Mishra DP, Sugla M, Singha P (2013) Productivity improvement in underground coal mines—a case study. J Sustain Min 12:48–53. https://doi.org/10.7424/jsm130306

Molan G, Molan M (2020) Theoretical model for accident prevention based on root cause analysis with graph theory. Saf Health Work. https://doi.org/10.1016/j.shaw.2020.09.004

Article   MATH   Google Scholar  

Motlagh MA, Valmohammadi C, Modiri M (2020) Developing a qualitative model of productivity for service companies using fuzzy analytic hierarchy process: a case study. IJPQM 29:126–147. https://doi.org/10.1504/IJPQM.2020.104519

Mulugeta L (2020) Productivity improvement through lean manufacturing tools in Ethiopian garment manufacturing company. Mater Today Proc. https://doi.org/10.1016/j.matpr.2020.06.599

Murali CS, Prabukarthi A (2020) Productivity improvement in furniture industry using lean tools and process simulation. IJPQM 30:214–233. https://doi.org/10.1504/IJPQM.2020.107812

Murray A, Papa A, Cuozzo B, Russo G (2016) Evaluating the innovation of the Internet of Things: empirical evidence from the intellectual capital assessment. Bus Process Manag J 22:341–356. https://doi.org/10.1108/BPMJ-05-2015-0077

Nakamura K, Kaihatsu S, Yagi T (2019) Productivity improvement and economic growth: lessons from Japan. Econ Anal Policy 62:57–79. https://doi.org/10.1016/j.eap.2018.11.002

Nandakumar N, Saleeshya PG, Harikumar P (2020) Bottleneck identification and process improvement by Lean Six Sigma DMAIC methodology. Mater Today Proc 24:1217–1224. https://doi.org/10.1016/j.matpr.2020.04.436

Padhy R (2017) Six sigma project selections: a critical review. Lean Six Sigma J 8:244–258. https://doi.org/10.1108/IJLSS-06-2016-0025

Pandey H, Garg D, Luthra S (2018) Identification and ranking of enablers of green Lean Six Sigma implementation using AHP. IJPQM 23:187–217. https://doi.org/10.1504/IJPQM.2018.089156

Parmar PS, Desai TN (2020) Evaluating Sustainable Lean Six Sigma enablers using fuzzy DEMATEL: a case of an Indian manufacturing organization. J Clean Prod 265:121802. https://doi.org/10.1016/j.jclepro.2020.121802

Patil RB, Kothavale BS (2020) Failure modes and effects analysis of CNC turning center. In: Gupta VK, Varde PV, Kankar PK, Joshi N (eds.) Reliability and risk assessment in engineering, Lecture notes in mechanical engineering. Springer, Singapore, pp. 49–59. https://doi.org/10.1007/978-981-15-3746-2_5

Patil RB, Kothavale BS (2018) Failure modes and effects analysis (FMEA) of computerized numerical control (CNC) turning center. Int Rev Mech Eng (IREME) 12:78–87. https://doi.org/10.15866/ireme.v12i1.14156

Potdar P, Rane S (2018) Selection of the best manufacturer using TOPSIS and PROMETHEE for asset propelled industry (API). Ind Eng J 11:1–21. https://doi.org/10.26488/IEJ.11.10.1147

Potdar P, Rane S, Mishra N (2020) Design of experiments and Monte Carlo simulation based prediction model for productivity improvement in printing industry. Int J Prod Qual Manag. https://doi.org/10.1504/ijpqm.2020.10033290

Potdar P, Rane S (2017) Exploring success factors for effective implementation of business analytics. National conference on Changing Technology and Rural Development -2017. ISSN [ONLINE]: 2395-1052. 156–163. https://ijsart.com/Home/IssueDetail/20732

Prashar A (2014) Process improvement in farm equipment sector (FES): a case on six sigma adoption. Lean Six Sigma J 5:62–88. https://doi.org/10.1108/IJLSS-08-2013-0049

Rane SB, Kirkire MS (2016) Analysis of barriers to medical device development in India: an interpretive structural modelling approach. Int J Syst Assur Eng Manag 7:356–369. https://doi.org/10.1007/s13198-016-0497-0

Rane SB, Kirkire MS (2017) Interpretive structural modelling of risk sources in medical device development process. Int J Syst Assur Eng Manag 8:451–464. https://doi.org/10.1007/s13198-015-0399-6

Rane SB, Mishra N (2018) Roadmap for business analytics implementation using DIPPS model for sustainable business excellence: case studies from the multiple fields. Int J Bus Excell 15:308–334. https://doi.org/10.1504/IJBEX.2018.092574

Rane SB, Narvel YAM (2016) Reliability assessment and improvement of air circuit breaker (ACB) mechanism by identifying and eliminating the root causes. Int J Syst Assur Eng Manag 7:305–321. https://doi.org/10.1007/s13198-015-0405-z

Rane SB, Narvel YAM (2021) Data-driven decision making with Blockchain-IoT integrated architecture: a project resource management agility perspective of industry 40. Int J Syst Assur Eng Manag. https://doi.org/10.1007/s13198-021-01377-4

Rane S, Potdar P (2020) Blockchain-IoT based risk management approach for Project Procurement process of Asset Propelled Industries (API). Int J Procure Manag 1:1. https://doi.org/10.1504/ijpm.2020.10032403

Rane SB, Thakker SV (2020) Green procurement process model based on blockchain–IoT integrated architecture for a sustainable business. Manag Environ Qual Int J 31:741–763. https://doi.org/10.1108/MEQ-06-2019-0136

Rane SB, Narvel YAM, Khatua N (2017) Development of mechanism for mounting secondary isolating contacts (SICs) in air circuit breakers (ACBs) with high operational reliability. Int J Syst Assur Eng Manag 8:1816–1831. https://doi.org/10.1007/s13198-017-0678-5

Rane SB, Potdar PR, Rane S (2019a) Accelerated life testing for reliability improvement: a case study on Moulded Case Circuit Breaker (MCCB) mechanism. Int J Syst Assur Eng Manag 10:1668–1690. https://doi.org/10.1007/s13198-019-00914-6

Rane SB, Potdar PR, Rane S (2019) Development of Project Risk Management framework based on Industry 40 technologies. Benchmarking Int J 28:1451–1481. https://doi.org/10.1108/BIJ-03-2019-0123

Rane SB, Potdar PR, Mewada M (2021) Implementation of a Six Sigma strategy for process improvement in the wiper motor manufacturing industry. Int J Six Sigma Compet Adv 13:241–270. https://doi.org/10.1504/IJSSCA.2021.120219

Rehman A, Ramzan MB, Shafiq M, Rasheed A, Naeem MS, Savino MM (2019) Productivity improvement through time study approach: a case study from an apparel manufacturing industry of Pakistan. Proced Manuf 39:1447–1454. https://doi.org/10.1016/j.promfg.2020.01.306

Reosekar RS, Pohekar SD (2014) Six Sigma methodology: a structured review. Lean Six Sigma J 5:392–422. https://doi.org/10.1108/IJLSS-12-2013-0059

Schiermoch PD, Beisheim B, Rahimi-Adli K, Engell S (2020) A methodology for data based root-cause analysis for process performance deviations in continuous processes. In: Pierucci S, Manenti F, Bozzano GL, Manca D (eds.) Computer aided chemical engineering, 30 European Symposium on Computer Aided Process Engineering. Elsevier, pp. 1873–1878. https://doi.org/10.1016/B978-0-12-823377-1.50313-X

Schuh G, Potente T, Wesch-Potente C, Weber AR, Prote J-P (2014) Collaboration mechanisms to increase productivity in the context of industrie 4.0. Proced CIRP 19:51–56. https://doi.org/10.1016/j.procir.2014.05.016

Selvam G, Prince SAD, Prakash VS, Rohit T (2018) Quality and productivity improvement through spot welding process optimisation in automobile body shop. IJPQM 23:110–127. https://doi.org/10.1504/IJPQM.2018.088611

Siddiqui SQ, Ullah F, Thaheem MJ, Gabriel HF (2016) Six sigma in construction: a review of critical success factors. Lean Six Sigma J 7:171–186. https://doi.org/10.1108/IJLSS-11-2015-0045

Singh M, Rathi R, Garza-Reyes JA (2021) Analysis and prioritization of Lean Six Sigma enablers with environmental facets using best worst method: a case of indian MSMEs. J Clean Prod 279:123592. https://doi.org/10.1016/j.jclepro.2020.123592

Sommer AC, Blumenthal EZ (2019) Implementation of lean and six sigma principles in ophthalmology for improving quality of care and patient flow. Surv Ophthalmol 64:720–728. https://doi.org/10.1016/j.survophthal.2019.03.007

Steenwinckel B, De Paepe D, Vanden Hautte S, Heyvaert P, Bentefrit M, Moens P, Dimou A, Van Den Bossche B, De Turck F, Van Hoecke S, Ongenae F (2021) FLAGS: a methodology for adaptive anomaly detection and root cause analysis on sensor data streams by fusing expert knowledge with machine learning. Futur Gener Comput Syst 116:30–48. https://doi.org/10.1016/j.future.2020.10.015

Steere L, Rousseau M, Durland L (2018) Lean Six Sigma for intravenous therapy optimization: a hospital use of lean thinking to improve occlusion management. J Assoc Vasc Access 23:42–50. https://doi.org/10.1016/j.java.2018.01.002

Sunder MV (2016) Lean Six Sigma project management—a stakeholder management perspective. TQM J 28:132–150. https://doi.org/10.1108/TQM-09-2014-0070

Swarnakar V, Singh AR, Tiwari AK (2020) Effect of Lean Six Sigma on firm performance: a case of Indian automotive component manufacturing organization. Mater Today Proc. https://doi.org/10.1016/j.matpr.2020.07.115

Tenera A, Pinto LC (2014) A Lean Six Sigma (LSS) project management improvement model. Proced Soc Behav Sci 119:912–920. https://doi.org/10.1016/j.sbspro.2014.03.102

Thangaiah ISS, Sharma V, Sundharam VN (2018) Analysing of customer feedback on critical quality parameters to improve productivity in manufacturing—a case study. IJPQM 23:349–368. https://doi.org/10.1504/IJPQM.2018.089805

Timans W, Ahaus K, Antony J (2014) Six Sigma methods applied in an injection moulding company. Lean Six Sigma J 5:149–167. https://doi.org/10.1108/IJLSS-07-2013-0037

Titmarsh R, Assad F, Harrison R (2020) Contributions of Lean Six Sigma to sustainable manufacturing requirements: an industry 4.0 perspective. Proced CIRP 90:589–593. https://doi.org/10.1016/j.procir.2020.02.044

Uddin MA, Stranieri A, Gondal I, Balasubramanian V (2021) A survey on the adoption of blockchain in IoT: challenges and solutions. Blockchain Res Appl. https://doi.org/10.1016/j.bcra.2021.100006

Waibel MW, Steenkamp LP, Moloko N, Oosthuizen GA (2017) Investigating the effects of smart production systems on sustainability elements. Proced Manuf 8:731–737. https://doi.org/10.1016/j.promfg.2017.02.094

Wang S, Wan J, Li D, Zhang C (2016) Implementing smart factory of industrie 4.0: an outlook. Int J Distrib Sens Netw 12(1):3159805. https://doi.org/10.1155/2016/3159805

Wang J, Yang Z, Su J, Zhao Y, Gao S, Pang X, Zhou D (2018) Root-cause analysis of occurring alarms in thermal power plants based on Bayesian networks. Int J Electr Power Energy Syst 103:67–74. https://doi.org/10.1016/j.ijepes.2018.05.029

Wu C, Yi D, Weng W, Li S, Zhou J, Zheng F (2015) Arc erosion behavior of Ag/Ni electrical contact materials. Mater Des 85:511–519. https://doi.org/10.1016/j.matdes.2015.06.142

Yadav S, Luthra S, Garg D (2022) Internet of things (IoT) based coordination system in Agri-food supply chain: development of an efficient framework using DEMATEL-ISM. Oper Manag Res 15:1–27. https://doi.org/10.1007/s12063-020-00164-x

Yang J, Zhan Z, Chou CC, Yang R-J, Zheng L, Guo G (2018) Root cause analysis strategy for robust design domain recognition. Eng Optim 50:1325–1346. https://doi.org/10.1080/0305215X.2017.1391241

Yue W, Chen X, Huang K, Zeng Z, Xie Y (2018) Knowledge modeling for root cause analysis of complex systems based on dynamic fuzzy cognitive maps. IFAC-PapersOnLine 51:13–18. https://doi.org/10.1016/j.ifacol.2018.09.385

Zahraee SM, Rohani JM, Wong KY (2018) Application of computer simulation experiment and response surface methodology for productivity improvement in a continuous production line: case study. J King Saud Univ 30:207–217. https://doi.org/10.1016/j.jksues.2018.04.003

Zhong X, Xu Y, Liu Y, Wu X, Zhao D, Zheng Y, Jiang J, Deng Z, Fu X, Li X (2020) Root cause analysis and diagnosis of solid oxide fuel cell system oscillations based on data and topology-based model. Appl Energy 267:114968. https://doi.org/10.1016/j.apenergy.2020.114968

Zu X, Fredendall LD (2009) Enhancing six sigma implementation through human resource management. Qual Manag J 16:41–54. https://doi.org/10.1080/10686967.2009.11918249

Download references

Author information

Authors and affiliations.

Sardar Patel College of Engineering, Mumbai, India

Santosh B. Rane & Sandesh Wavhal

Parul Institute of Technology, Vadodara, India

Prathamesh R. Potdar

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Prathamesh R. Potdar .

Ethics declarations

Conflict of interest.

This research has no potential conflict of Interest.

Human and animals rights

This research involves human participation only for survey purposes and does not involve any animals.

Informed consent

This research does not require any informed consent.

Additional information

Publisher's note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Rane, S.B., Wavhal, S. & Potdar, P.R. Integration of Lean Six Sigma with Internet of Things (IoT) for productivity improvement: a case study of contactor manufacturing industry. Int J Syst Assur Eng Manag 14 , 1990–2018 (2023). https://doi.org/10.1007/s13198-023-01980-7

Download citation

Received : 03 May 2022

Revised : 04 April 2023

Accepted : 06 June 2023

Published : 04 July 2023

Issue Date : October 2023

DOI : https://doi.org/10.1007/s13198-023-01980-7

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Productivity improvement
• Lean Six Sigma
• Internet of Things (IoT)
• Contactor manufacturing industry
• Electro magnetic contactor
• Find a journal
• Publish with us
• Track your research

ABM Students Participate at NGA Show

Gained valuable experience at grocery industry event.

Best Bagger

Students assisted with the "Best Bagger" competition.

Student Standout Awards

Students evaluated products and services for the Student Standout Awards.

Case Study Competition

Students developed a business strategy for a grocery chain.

April 16, 2024

Seven agribusiness and food industry management students recently brought home valuable experience and recognition from the National Grocers Association (NGA) Show.

Held at Caesar's Palace Forum in Las Vegas, the NGA Show is a premier event for the grocery industry, bringing together retailers, wholesalers, and a passionate student community that included students from Cornell, University of Findlay, St. Joseph’s University, Arizona State, Kansas State, Auburn, Cal Poly San Luis Obispo and Fresno State.

Students Justin Kipper, Carmen Diaz, Elizabeth Vargas, Ariadna Castro, Megan Ebner, Avalon Anderson, and Irvin Ayon were not just attendees; they were active participants at the show in several activities.

One of the activities was the Student Standout Awards, which tasked them with forming cross-university teams and evaluating hundreds of products and services showcased on the expansive NGA Show Expo Floor.

The floor included 350 companies eager to connect with industry stakeholders. From Center Store and Fresh Food innovations to cutting-edge technology solutions, the students had a front-row seat to the future of grocery retailing.

The cross-university teams each tackled a specific award category: Center Store, Fresh, Health & Wellness, Pharmacy, Operational Services, Sustainability in Store Design & Equipment, and Technology.

Armed with a set of insightful questions, they approached each booth, engaging with company representatives and learning how these products and services could empower independent grocers.

Through these insightful dialogues, the expo transformed into a real-world learning lab for the students, exposing them to the grocery landscapes and giving them invaluable industry knowledge while honing their critical thinking and communication skills.

Best Bagger Competition

Cal Poly Pomona students Castro, Vargas, and Diaz also assisted with the Best Bagger Competition, which puts the spotlight on a fundamental skill in the grocery industry – bagging – and on customer service and company pride.

Grocery store baggers from across the country battled it out for the coveted championship title and a grand prize of $10,000.

The students’ support ensured a smooth-running event and exemplified the collaborative spirit fostered by the agribusiness program.

Student Case Study

In the ever-evolving landscape of the grocery industry, maintaining a competitive edge requires not just adaptation but forward-thinking strategies that anticipate future trends.

This was the challenge the agribusiness management students embraced in the Student Case Study.

Their mission was clear: to revitalize Niemann Foods Inc. by transitioning its County Market stores into B-level stores, rebranded as "Niemann's Market."

Niemann Foods faced the dual challenge of executing a successful rebranding strategy to build customer loyalty while adapting to the changing dynamics of the grocery industry.

The team was comprised of Kipper, serving as the senior program manager, Anderson as head of marketing strategy, Ayon as senior community activities director, Diaz as visual design manager, with valuable contributions from Vargas, Castro, and Ebner.

Under the expert guidance of Lecturer Katie Horvath, a seasoned professional with 15 years of experience in the grocery and consumer packaged goods) retail sector, the student consultant team embarked on a journey to redefine the shopping experience at Niemann's Market

The key questions posed to the student team revolved around creating an integrated shopping experience, aligning the rebranding with future customer preferences—especially in the fresh category—and differentiating Niemann's Market in the coming decade.

The students' proposal focused on leveraging technology and community engagement to revolutionize the shopping experience at Niemann's Market. Their strategic plan included the implementation of Custom Shelf Talkers and new cost-saving Electronic Shelf Labels (ESL) Digital Shelf Tags.

These innovations aimed not only to enhance the in-store experience but also to achieve significant cost savings through labor reduction and efficiency in promotional activities.

Furthermore, the team devised a compelling marketing strategy titled "Look closer, find more at Niemann's," emphasizing the unique value proposition of the rebranded stores. By integrating these elements, the students projected a rate of investment of 73 percent or more, with substantial savings in labor and material costs, while also saving valuable time spent on price changes each week.

Gerry Kettler, Niemann’s director of consumer affairs, lauded the students' presentation, highlighting the impactful ideas they brought to the table.

"Your students rocked the presentation with their ideas! I cannot wait to work with these students," he remarked.

Although the team did not clinch the top prize, their innovative cost-saving initiative caught the attention of independent grocers across the United States, with seven grocers keen on implementing their strategies.

As these bright minds continue to make their mark on the industry, the experience gained from the Student Case Study serves as a foundation for their future endeavors. Their work with Niemann's Market is a testament to the transformative power of innovative thinking in maintaining a competitive edge in the dynamic grocery industry.

The collaboration between Cal Poly Pomona students and Niemann Foods, Inc. exemplifies the potential for academic institutions and industry leaders to work together in addressing real-world challenges.

The students' ability to apply their knowledge, creativity, and strategic thinking to a complex business scenario underscores the quality of education and training provided by agribusiness and food industry management program at the Huntley College of Agriculture.

• Open access
• Published: 14 October 2023

A scoping review of ‘Pacing’ for management of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): lessons learned for the long COVID pandemic

• Nilihan E. M. Sanal-Hayes 1 , 7 ,
• Marie Mclaughlin 1 , 8 ,
• Lawrence D. Hayes 1 ,
• Jacqueline L. Mair   ORCID: orcid.org/0000-0002-1466-8680 2 , 3 ,
• Jane Ormerod 4 ,
• David Carless 1 ,
• Natalie Hilliard 5 ,
• Rachel Meach 1 ,
• Joanne Ingram 6 &
• Nicholas F. Sculthorpe 1  

Journal of Translational Medicine volume  21 , Article number:  720 ( 2023 ) Cite this article

3333 Accesses

5 Citations

21 Altmetric

Metrics details

Controversy over treatment for people with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a barrier to appropriate treatment. Energy management or pacing is a prominent coping strategy for people with ME/CFS. Whilst a definitive definition of pacing is not unanimous within the literature or healthcare providers, it typically comprises regulating activity to avoid post exertional malaise (PEM), the worsening of symptoms after an activity. Until now, characteristics of pacing, and the effects on patients’ symptoms had not been systematically reviewed. This is problematic as the most common approach to pacing, pacing prescription, and the pooled efficacy of pacing was unknown. Collating evidence may help advise those suffering with similar symptoms, including long COVID, as practitioners would be better informed on methodological approaches to adopt, pacing implementation, and expected outcomes.

In this scoping review of the literature, we aggregated type of, and outcomes of, pacing in people with ME/CFS.

Eligibility criteria

Original investigations concerning pacing were considered in participants with ME/CFS.

Sources of evidence

Six electronic databases (PubMed, Scholar, ScienceDirect, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials [CENTRAL]) were searched; and websites MEPedia, Action for ME, and ME Action were also searched for grey literature, to fully capture patient surveys not published in academic journals.

A scoping review was conducted. Review selection and characterisation was performed by two independent reviewers using pretested forms.

Authors reviewed 177 titles and abstracts, resulting in 17 included studies: three randomised control trials (RCTs); one uncontrolled trial; one interventional case series; one retrospective observational study; two prospective observational studies; four cross-sectional observational studies; and five cross-sectional analytical studies. Studies included variable designs, durations, and outcome measures. In terms of pacing administration, studies used educational sessions and diaries for activity monitoring. Eleven studies reported benefits of pacing, four studies reported no effect, and two studies reported a detrimental effect in comparison to the control group.

Conclusions

Highly variable study designs and outcome measures, allied to poor to fair methodological quality resulted in heterogenous findings and highlights the requirement for more research examining pacing. Looking to the long COVID pandemic, our results suggest future studies should be RCTs utilising objectively quantified digitised pacing, over a longer duration of examination (i.e. longitudinal studies), using the core outcome set for patient reported outcome measures. Until these are completed, the literature base is insufficient to inform treatment practises for people with ME/CFS and long COVID.

Introduction

Post-viral illness occurs when individuals experience an extended period of feeling unwell after a viral infection [ 1 , 2 , 3 , 4 , 5 , 6 ]. While post-viral illness is generally a non-specific condition with a constellation of symptoms that may be experienced, fatigue is amongst the most commonly reported [ 7 , 8 , 9 ]. For example, our recent systematic review found there was up to 94% prevalence of fatigue in people following acute COVID-19 infection [ 3 ]. The increasing prevalence of long COVID has generated renewed interest in symptomology and time-course of post-viral fatigue, with PubMed reporting 72 articles related to “post-viral fatigue” between 2020 and 2022, but less than five for every year since 1990.

As the coronavirus pandemic developed, it became clear that a significant proportion of the population experienced symptoms which persisted beyond the initial viral infection, meeting the definition of a post-viral illness. Current estimates suggest one in eight people develop long COVID [ 10 ] and its symptomatology has repeatedly been suggested to overlap with clinical demonstrations of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). In a study by Wong and Weitzer [ 11 ], long COVID symptoms from 21 studies were compared to a list of ME/CFS symptoms. Of the 29 known ME/CFS symptoms the authors reported that 25 (86%) were reported in at least one long COVID study suggesting significant similarities. Sukocheva et al. [ 12 ] reported that long COVID included changes in immune, cardiovascular, metabolic, gastrointestinal, nervous and autonomic systems. When observed from a pathological stance, this list of symptoms is shared with, or is similar to, the symptoms patients with ME/CFS describe [ 13 ]. In fact, a recent article reported 43% of people with long COVID are diagnosed with ME/CFS [ 13 ], evidencing the analogous symptom loads.

A striking commonality between long COVID and similar conditions such as ME/CFS is the worsening of symptoms including fatigue, pain, cognitive difficulties, sore throat, and/or swollen lymph nodes following exertion. Termed post exertional malaise (PEM) [ 14 , 15 , 16 , 17 ], lasting from hours to several days, it is arguably one of the most debilitating side effects experienced by those with ME/CFS [ 16 , 17 , 18 ]. PEM is associated with considerably reduced quality of life amongst those with ME/CFS, with reduced ability to perform activities of daily living, leading to restraints on social and family life, mental health comorbidities such as depression and anxiety, and devastating employment and financial consequences [ 19 , 20 , 21 , 22 ]. At present, there is no cure or pharmacological treatments for PEM, and therefore, effective symptom management strategies are required. This may be in part because the triggers of PEM are poorly understood, and there is little evidence for what causes PEM, beyond anecdotal evidence. The most common approach to manage PEM is to incorporate activity pacing into the day-to-day lives of those with ME/CFS with the intention of reducing the frequency of severity of bouts of PEM [ 23 ]. Pacing is defined as an approach where patients are encouraged to be as active as possible within the limits imposed by the illness [ 23 , 24 , 25 ]. In practice, pacing requires individuals to determine a level at which they can function, but which does not lead to a marked increase in fatigue and other symptoms [ 26 , 27 ].

Although long COVID is a new condition [ 3 , 14 ], the available evidence suggests substantial overlap with the symptoms of conditions such as ME/CFS and it is therefore pragmatic to consider the utility of management strategies (such as pacing) used in ME/CFS for people with long COVID. In fact, a recent Delphi study recommended that management of long COVID should incorporate careful pacing to avoid PEM relapse [ 28 ]. This position was enforced by a multidisciplinary consensus statement considering treatment of fatigue in long COVID, recommending energy conservation strategies (including pacing) for people with long COVID [ 29 ]. Given the estimated > 2 million individuals who have experienced long COVID in the UK alone [ 30 , 31 , 32 ], there is an urgent need for evidence-based public health strategies. In this context, it seems pragmatic to borrow from the ME/CFS literature.

From a historical perspective, the 2007 NICE guidelines for people with ME/CFS advised both cognitive behavioural therapy (CBT) and graded exercise therapy (GET) should be offered to people with ME/CFS [ 33 ]. As of the 2021 update, NICE guidelines for people with ME/CFS do not advise CBT or GET, and the only recommended management strategy is pacing [ 34 ]. In the years between changes to these guidelines, the landmark PACE trial [ 35 ] was published in 2011. This large, randomised control trial (RCT; n = 639) compared pacing with CBT and reported GET and CBT were more effective than pacing for improving symptoms. Yet, this study has come under considerable criticism from patient groups and clinicians alike [ 36 , 37 , 38 , 39 ]. This may partly explain why NICE do not advise CBT or GET as of 2021, and only recommend pacing for symptom management people with ME/CFS [ 34 ]. There has been some controversy over best treatment for people with ME/CFS in the literature and support groups, potentially amplified by the ambiguity of evidence for pacing efficacy and how pacing should be implemented. As such, before pacing can be advised for people with long COVID, it is imperative previous literature concerning pacing is systematically reviewed. This is because a consensus is needed within the literature for implementing pacing so practitioners treating people with ME/CFS or long COVID can do so effectively. A lack of agreement in pacing implementation is a barrier to adoption for both practitioners and patients. Despite several systematic reviews concerning pharmacological interventions or cognitive behavioural therapy in people with ME/CFS [ 36 , 40 , 41 ], to date, there are no systematic reviews concerning pacing.

Despite the widespread use of pacing, the literature base is limited and includes clinical commentaries, case studies, case series, and few randomised control trials. Consequently, while a comprehensive review of the effects of pacing in ME/CFS is an essential tool to guide symptom management advice, the available literature means that effective pooling of data is not feasible [ 42 ] and therefore, a traditional systematic review and meta-analysis, with a tightly focussed research question would be premature [ 43 ]. Consequently, we elected to undertake a scoping review. This approach retains the systematic approach to literature searching but aims to map out the current state of the research [ 43 ]. Using the framework of Arksey and O'Malley [ 44 ], a scoping review aims to use a broad set of search terms and include a wide range of study designs and methods (in contrast to a systematic review [ 44 ]). This approach, has the benefit of clarifying key concepts, surveying current data collection approaches, and identifying critical knowledge gaps.

We aimed to provide an overview of existing literature concerning pacing in ME/CFS. Our three specific objectives of this scoping review were to (1) conduct a systematic search of the published literature concerning ME/CFS and pacing, (2) map characteristics and methodologies used, and (3) provide recommendations for the advancement of the research area.

Protocol and registration

The review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines [ 45 ] and the five-stage framework outlined in Arksey and O’Malley [ 44 ]. Registration is not recommended for scoping reviews.

Studies that met the following criteria were included in this review: (1) published as a full-text manuscript; (2) not a review; (3) participants with ME/CFS; (4) studies employed a pacing intervention or retrospective analysis of pacing or a case study of pacing. Studies utilising sub-analysis of the pacing, graded activity, and cognitive behaviour therapy: a randomised evaluation (PACE) trial were included as these have different outcome measures and, as this is not a meta-analysis, this will not influence effect size estimates. Additionally, due to the paucity of evidence, grey literature has also been included in this review.

Search strategy

The search strategy consisted of a combination of free-text and MeSH terms relating to ME/CFS and pacing, which were developed through an examination of published original literature and review articles. Example search terms for PubMed included: ‘ME/CFS’ OR ‘ME’ OR ‘CFS’ OR ‘chronic fatigue syndrome’ OR ‘PEM’ OR ‘post exertional malaise’ OR ‘pene’ OR ‘post-exertion neurogenic exhaust’ AND ‘pacing’ OR ‘adaptive pacing’. The search was performed within title/abstract. Full search terms can be found in Additional file 1 .

Information sources

Six electronic databases [PubMed, Scholar, ScienceDirect, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL)] were searched to identify original research articles published from the earliest available date up until 02/02/2022. Additional records were identified through reference lists of included studies. ‘Grey literature’ repositories including MEPedia, Action for ME, and ME Action were also searched with the same terms.

Study selection and data items

Once each database search was completed and manuscripts were sourced, all studies were downloaded into a single reference list (Zotero, version 6.0.23) and duplicates were removed. Titles and abstracts were screened for eligibility by two reviewers independently and discrepancies were resolved through discussion between reviewers. Subsequently, full text papers of potentially relevant studies were retrieved and assessed for eligibility by the same two reviewers independently. Any uncertainty by reviewers was discussed in consensus meetings and resolved by agreement. Data extracted from each study included sample size, participant characteristics, study design, trial registration details, study location, pacing description (type), intervention duration, intervention adherence, outcome variables, and main outcome data. Descriptions were extracted with as much detail as was provided by the authors. Study quality was assessed using the Physiotherapy Evidence Database (PEDro) scale [ 46 , 47 ].

Role of the funding source

The study sponsors had no role in study design, data collection, analysis, or interpretation, nor writing the report, nor submitting the paper for publication.

Study selection

After the initial database search, 281 records were identified (see Fig.  1 ). Once duplicates were removed, 177 titles and abstracts were screened for inclusion resulting in 22 studies being retrieved as full text and assessed for eligibility. Of those, five were excluded, and 17 articles remained and were used in the final qualitative synthesis.

Schematic flow diagram describing exclusions of potential studies and final number of studies. RCT = randomized control trial. CT = controlled trial. UCT = uncontrolled trial

Study characteristics

Study characteristics are summarised in Table 1 . Of the 17 studies included, three were randomised control trials (RCTs [ 35 , 48 , 49 ]); one was an uncontrolled trial [ 50 ]; one was a case series [ 51 ]; one was a retrospective observational study [ 52 ], two were prospective observational studies [ 53 , 54 ]; four were cross-sectional observational studies [ 25 , 55 , 56 ]; and five were cross-sectional analytical studies [ 57 , 58 , 59 , 60 , 61 ] including sub-analysis of the PACE trial [ 35 , 56 , 59 , 61 ]. Seven of the studies were registered trials [ 35 , 48 , 49 , 50 , 56 , 57 , 58 ]. Diagnostic criteria for ME/CFS are summarised in Table 2 .

Types of pacing

Pacing interventions.

Of the 17 studies included, five implemented their own pacing interventions and will be discussed in this section. Sample sizes ranged from n = 7 in an interventional case series [ 51 ] to n = 641 participants in the largest RCT [ 35 ]. The first of these five studies considered an education session on pacing and self-management as the ‘pacing’ group, and a ‘pain physiology education’ group as the control group [ 49 ]. Two studies included educational sessions provided by a therapist plus activity monitoring via ActiGraph accelerometers [ 51 ] and diaries [ 48 ] at baseline and follow-up. In the first of these two studies, Nijs and colleagues [ 51 ] implemented a ‘self-management program’ which asked patients to estimate their current physical capabilities prior to commencing an activity and then complete 25–50% less than their perceived energy envelope. They[ 51 ] did not include a control group and had a sample size of only n = 7. Six years later, the same research group [ 48 ] conducted another pacing study which utilised relaxation as a comparator group (n = 12 and n = 14 in the pacing and relaxation groups, respectively). The pacing group underwent a pacing phase whereby participants again aimed to complete 25–50% less than their perceived energy envelope, followed by a gradual increase in exercise after the pacing phase (the total intervention spanned three weeks, and it is unclear how much was allocated to pacing, and how much to activity increase). Therefore, it could be argued that Kos et al. [ 48 ] really assessed pacing followed by a gradual exercise increase as outcome measures were assessed following the graded activity phase. Another pacing intervention delivered weekly educational sessions for six weeks and utilised a standardised rehabilitation programme using the ‘activity pacing framework’ [ 50 ] in a single-arm, no comparator group feasibility study. Finally, the PACE trial adopted an adaptive pacing therapy intervention consisting of occupational therapists helping patients to plan and pace activities utilising activity diaries to identify activities associated with fatigue and staying within their energy envelope [ 35 ]. This study incorporated standard medical care, cognitive behavioural therapy (CBT) and graded exercise therapy (GET) as comparator groups [ 35 ]. It is worth noting that the pacing group and the CBT group were both ‘encouraged’ to increase physical activity levels as long as participants did not exceed their energy envelope. Although not all five intervention studies explicitly mentioned the “Energy Envelope Theory”, which dictates that people with ME/CFS should not necessarily increase or decrease their activity levels, but moderate activity and practice energy conservation [ 62 ], all intervention studies used language analogous to this theory, such as participants staying within limits, within capacity, or similar.

The interventions included in this review were of varying durations, from a single 30-min education session [ 49 ], a 3-week (one session a week) educational programme [ 51 ], a 3-week (3 × 60–90 min sessions/week) educational programme [ 48 ], a 6-week rehabilitation programme [ 50 ], to a 24-week programme [ 35 ]. Intervention follow-up durations also varied across studies from immediately after [ 49 ], 1-week [ 51 ], 3-weeks [ 48 ], 3-months [ 50 ], and 1-year post-intervention [ 35 ].

Observational studies of pacing

Eight studies were observational and, therefore, included no intervention. Observational study sample sizes ranged from 16 in a cross-sectional interview study [ 25 ] to 1428 in a cross-sectional survey [ 52 ]. One study involved a retrospective analysis of participants’ own pacing strategies varying from self-guided pacing or pacing administered by a therapist compared with implementation of CBT and GET [ 52 ]. Five involved a cross-sectional analysis of participants own pacing strategies which varied from activity adjustment, planning and acceptance [ 50 , 55 ], and the Energy Envelope method [ 58 , 60 ]. Two studies were prospective observational studies investigating the Energy Envelope theory [ 53 , 54 ]. Four studies [ 56 , 57 , 59 , 61 ] included in this review involved sub-analysis of results of the PACE trial [ 35 ].

Outcome measures

Quantitative health outcomes.

ME/CFS severity and general health status were the most common outcome measures across studies (16/17) [ 35 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 63 ]. Studies utilised different instruments, including the Short-Form 36 (SF-36; 8/16) [ 35 , 51 , 53 , 54 , 56 , 57 , 58 , 60 ], SF-12 (2/16) [ 50 , 63 ], ME symptom and illness severity (2/16) [ 52 , 55 ], Patient health (PHQ-15; 1/16) [ 59 ], DePaul symptom questionnaire (DSQ; 1/16) [ 58 ], and the Patient health questionnaire-9 (1/16) [ 50 ]. Additionally, some studies used diagnostic criteria for ME/CFS as an outcome measure to determine recovery [ 57 , 59 , 61 ].

Pain was assessed by most included studies (11/17) [ 35 , 49 , 50 , 51 , 53 , 54 , 55 , 57 , 59 , 60 , 61 , 63 ]. Two studies [ 59 , 61 ] included the international CDC criteria for CFS which contain five painful symptoms central to a diagnosis of CFS: muscle pain and joint pain. Other methods of assessment included Brief Pain Inventory (1/11) [ 53 ], Chronic Pain Coping Inventory (CPCI; 1/11) [ 49 ], Pain Self Efficacy Questionnaire (PSEQ; 1/11) [ 50 ], Tampa Scale for Kinesiophobia–version CFS (1/11) [ 49 ], algometry (1/11) [ 49 ], Knowledge of Neurophysiology of Pain Test (1/12) [ 49 ], Pain Catastrophizing Scale (1/11) [ 49 ], Pain Anxiety Symptoms Scale short version (PASS-20; 1/11) [ 50 ], Pain Numerical Rating Scale (NRS; 1/11) [ 63 ].

Fatigue or post-exertional malaise was assessed by 11 of the 17 studies [ 35 , 48 , 50 , 51 , 53 , 54 , 56 , 57 , 60 , 61 , 63 ]. Again, measurement instruments were divergent between studies and included the Chalder Fatigue Questionnaire (CFQ; 4/11) [ 35 , 50 , 57 , 63 ], Fatigue Severity Scale (2/11) [ 53 , 60 ], the Chronic Fatigue Syndrome Medical Questionnaire (1/11) [ 60 ], and Checklist Individual Strength (CIS; 2/11) [ 48 , 51 ].

Anxiety and depression were also common outcome measures, utilised by four studies (4/17) [ 50 , 53 , 59 , 63 ]. These were also assessed using different instruments including Hospital Anxiety and Depression Scale (HADS; 2/4) [ 59 , 63 ], Generalised Anxiety Disorder Assessment (1/4 [ 50 ]), Beck Depression Inventory (BDI-II; 1/4) [ 53 ], Beck Anxiety Inventory (BAI; 1/4) [ 53 ], and Perceived Stress Scale (PSS; 1/4) [ 53 ].

Outcome measures also included sleep (2/17) [ 53 , 59 ], assessed by The Pittsburgh Sleep Quality Index (1/2) [ 53 ] and Jenkins sleep scale (1/2) [ 59 ]; and quality of life (2/17) [ 50 , 53 ] as assessed by the EuroQol five-dimensions, five-levels (EQ-5D-5L; 1/2) [ 50 ] and The Quality-of-Life Scale (1/2) [ 53 ]. Self-Efficacy was measured in four studies [ 50 , 53 , 59 , 60 ], assessed by the Brief Coping Orientation to Problems Experienced Scale (bCOPE; 1/4) [ 60 ] and the Chronic Disease Self-Efficacy measure (3/4) [ 50 , 53 , 59 ].

Quantitative evaluation of pacing

Some studies (4/17) [ 25 , 50 , 52 , 63 ] included assessments of the participants’ experiences of pacing, using the Activity Pacing Questionnaire (APQ-28; 1/4 [ 50 ], APQ-38 (2/4) [ 25 , 63 ]), a re-analysis of the 228 question survey regarding treatment (1/4) [ 52 ] originally produced by the ME Association [ 55 ], and qualitative semi-structured telephone interviews regarding appropriateness of courses in relation to individual patient needs (1/4) [ 25 ]. The APQ-28 and -38 have been previously validated, but the 228-question survey has not. When outcome measures included physical activity levels (4/17), the Canadian Occupational Performance Measure (COPM) was used in two studies [ 48 , 51 ], and two studies used accelerometers to record physical activity [ 51 , 54 ]. Of these two studies, Nijs [ 51 ] examined accelerometery after a 3-week intervention based on the Energy Envelope Theory and Brown et al. [ 54 ] evaluated the Energy Envelope Theory of pacing over 12 months.

Other outcomes

Two [ 53 , 59 ] of the 17 studies included structured clinical interviews for the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) to assess psychiatric comorbidity and psychiatric exclusions. One study included a disability benefits questionnaire [ 55 ], and one study included employment and education questionnaire [ 55 ]. Additionally, satisfaction of primary care was also used as an outcome measure (2/17) [ 25 , 55 ] assessed using the Chronic Pain Coping Inventory (CPCI).

Efficacy of pacing interventions

The majority of studies (12/17) [ 25 , 48 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 58 , 60 , 63 ] highlighted improvements in at least one outcome following pacing (Fig.  2 ). When the effect of pacing was assessed by ME symptomology and general health outcomes, studies reported pacing to be beneficial [ 25 , 50 , 51 , 53 , 54 , 55 , 56 , 58 ]. It is worth noting however that pacing reportedly worsened ME symptoms in 14% of survey respondents, whilst improving symptoms in 44% of respondents [ 52 ]. Most studies using fatigue as an outcome measure reported pacing to be efficacious (7/10) [ 50 , 51 , 53 , 54 , 56 , 60 , 63 ]. However, one study reported no change in fatigue with a pacing intervention (1/10) [ 35 ], and 2/10 studies [ 53 , 63 ] reported a worsening of fatigue with pacing. Physical function was used to determine the efficacy of pacing in 11 studies [ 35 , 48 , 50 , 51 , 53 , 54 , 56 , 58 , 59 , 60 , 63 ]. Of these, the majority found pacing improved physical functioning (8/10) [ 48 , 50 , 51 , 53 , 54 , 56 , 58 , 60 ], with 1/10 [ 35 ] studies reporting no change in physical functioning, and 1/10 [ 59 ] reporting a worsening of physical functioning from pre- to post-pacing. Of the seven studies [ 35 , 49 , 50 , 51 , 53 , 54 , 60 ] which used pain to assess pacing efficacy, 4/7 [ 50 , 51 , 53 , 60 ] reported improvements in pain and 3/7 [ 35 , 51 , 53 ] reported no change in pain scores with pacing. All studies reporting quality of life (1/1) [ 53 ], self-efficacy (3/3) [ 50 , 53 , 59 ], sleep (2/2) [ 53 , 59 ], and depression and anxiety (4/4) [ 50 , 53 , 59 , 63 ], found pacing to be efficacious for ME/CFS participants.

Bubble plot displaying number of studies reporting each domain (x-axis) and the percentage of studies reporting improvement with pacing (y-axis), including a coloured scale of improvement from 0–100%. PEM = post-exertional malaise, 6MWT = 6-min walk time, CFS = chronic fatigue syndrome, DSQ = DePaul Symptom Questionnaire, PA = Physical Activity, HRQOL = Health-related quality of life, COPM = The Canadian Occupational Performance Measure

Participant characteristics

The majority of studies (10/17) [ 25 , 50 , 52 , 53 , 54 , 58 , 59 , 60 , 61 , 63 ] did not report age of the participants. For those which did report age, this ranged from 32 ± 14 to 43 ± 13 years. Where studies reported sex (11/17) [ 35 , 48 , 49 , 50 , 51 , 54 , 55 , 56 , 57 , 58 , 60 ], this was predominantly female, ranging from 75 to 100% female. Only six studies [ 35 , 54 , 56 , 57 , 58 , 60 ] reported ethnicity, with cohorts predominantly Caucasian (94–98%). Time since diagnosis was mostly unreported (12/17) [ 25 , 48 , 49 , 50 , 52 , 53 , 54 , 58 , 59 , 60 , 61 , 63 ] but ranged from 32 to 96 months, with a cross-sectional survey reporting 2% of the participants were diagnosed 1–2 years previously; 6% 3–4 years since diagnosis; 13% 3–4 years since diagnosis; 12% 5–6 years since diagnosis; 20% 7–10 years since diagnosis; 29% 11–21 years since diagnosis; 13% 21–30 years since diagnosis; and 5% > 30 years since diagnosis. Of the studies which reported comorbidities of the participants (6/17) [ 25 , 35 , 50 , 56 , 57 , 63 ], the comorbidities were chronic pain, depressive disorder, psychiatric disorder.

Study location

Of the 17 studies, 14 were from Europe [ 25 , 35 , 48 , 49 , 50 , 51 , 52 , 55 , 56 , 57 , 58 , 59 , 61 , 63 ], and three from North America [ 53 , 54 , 60 ]. Of the 14 studies[ 25 , 35 , 48 , 49 , 50 , 51 , 52 , 55 , 56 , 57 , 58 , 59 , 61 , 63 ] from Europe, ten [ 25 , 35 , 50 , 52 , 55 , 56 , 57 , 58 , 59 , 61 , 63 ] were conducted in the United Kingdom, three in Belgium [ 48 , 49 , 51 ], and one was a multicentred study between the United Kingdom and Norway [ 58 ].

Recruitment strategy

Of the 17 studies, three [ 53 , 54 , 60 ] used announcements in a newspaper and physician referrals to recruit participants, two [ 50 , 63 ] recruited patients referred by a consultant from a National Health Service (NHS) Trust following a pain diagnosis, two [ 52 , 55 ] concerned online platforms on the web, two [ 59 , 61 ] recruited from secondary care clinics, and two used the PACE trial databases [ 56 , 57 ]. Moreover, one study recruited from the hospital [ 58 ], one from physiotherapist referrals [ 25 ], two from specialist clinic centres [ 35 , 64 ], one from waiting list of rehabilitation centre [ 48 ], and one from medical files [ 49 ].

Study settings

Ten studies were carried out in hospital and clinic setting [ 25 , 35 , 48 , 49 , 50 , 51 , 58 , 59 , 61 , 63 ]. Two studies were performed on online platforms [ 52 , 55 ]. Three studies did not report study setting [ 53 , 54 , 60 ]. Two studies generated output from PACE trial databases [ 56 , 57 ]

Adherence and feasibility

All five intervention studies reported adherence rates (which they defined as number of sessions attended), which ranged from 4–44% (4% [ 49 ], 8% [ 35 ], 25% [ 48 ], 29% [ 51 ], and 44% [ 50 ]). One study reported the median number of rehabilitation programme sessions attended was five out of six possible sessions, with 58.9% [ 50 ] participants attending ≥ 5 sessions; 83.2% participants attending at least one educational session on activity pacing and 56.1% attending both activity pacing sessions.

This scoping review summarises the existing literature, with a view to aid physicians and healthcare practitioners better summarise evidence for pacing in ME/CFS and use this knowledge for other post-viral fatiguing conditions. Overall, studies generally reported pacing to be beneficial for people with ME/CFS. The exception to this trend is the controversial PACE trial [ 36 , 37 , 38 , 39 ], which we will expand on in subsequent sections. We believe information generated within this review can facilitate discussion of research opportunities and issues that need to be addressed in future studies concerning pacing, particularly given the immediate public health issue of the long COVID pandemic. As mentioned, we found some preliminary evidence for improved symptoms following pacing interventions or strategies. However, we wish to caution the reader that the current evidence base is extremely limited and hampered by several limitations which preclude clear conclusions on the efficacy of pacing. Firstly, studies were of poor to fair methodological quality (indicated by the PEDro scores), often with small sample sizes, and therefore unknown power to detect change. Moreover, very few studies implemented pacing, with most studies merely consulting on people’s views on pacing. This may of course lead to multiple biases such as reporting, recruitment, survivorship, confirmation, availability heuristic, to name but a few. Thus, there is a pressing need for more high-quality intervention studies. Secondly, the reporting of pacing strategies used was inconsistent and lacked detail, making it difficult to describe current approaches, or implement them in future research or symptom management strategies. Furthermore, outcome evaluations varied greatly between studies. This prevents any appropriate synthesis of research findings.

The lack of evidence concerning pacing is concerning given pacing is the only NICE recommended management strategy for ME/CFS following the 2021 update [ 34 ]. Given the analogous nature of long COVID with ME/CFS, patients and practitioners will be looking to the ME/CFS literature for guidance for symptom management. There is an urgent need for high quality studies (such as RCTs) investigating the effectiveness of pacing and better reporting of pacing intervention strategies so that clear recommendations can be made to patients. If this does not happen soon, there will be serious healthcare and economic implications for years to come [ 65 , 66 ].

Efficacy of pacing

Most studies (12/17) highlighted improvements in at least one outcome measure following pacing. Pacing was self-reported to be the most efficacious, safe, acceptable, and preferred form of activity management for people with ME/CFS [ 55 ]. Pacing was reported to improve symptoms and improve general health outcomes [ 25 , 50 , 52 , 58 , 63 ], fatigue and PEM [ 48 , 50 , 51 , 53 , 54 , 55 , 56 , 60 , 63 ], physical functioning [ 48 , 50 , 51 , 53 , 56 , 58 , 60 , 63 ], pain [ 25 , 50 , 55 , 63 ], quality of life [ 50 ], self-efficacy [ 50 , 53 ], sleep [ 53 , 55 ], and depression and anxiety [ 50 , 53 , 63 ]. These positive findings provide hope for those with ME/CFS, and other chronic fatiguing conditions such as long COVID, to improve quality of life through symptom management.

Conversely, some studies reported no effects of pacing on ME/CFS symptoms [ 52 ], fatigue, physical functioning [ 35 ], or pain scores [ 49 , 61 ]. Some studies even found pacing to have detrimental effects in those with ME/CFS, including a worsening of symptoms in 14% of survey participants recalling previous pacing experiences [ 52 ]. Furthermore, a worsening of fatigue [ 35 , 59 ], and physical functioning from pre- to post-pacing [ 35 , 57 , 59 , 61 ] was reported by the PACE trial and sub-analysis of the PACE trial [ 56 , 57 , 61 ]. The PACE trial [ 35 ], a large RCT (n = 639) comparing pacing with CBT and GET, reported GET and CBT were more effective for reducing ME/CFS-related fatigue and improving physical functioning than pacing. However, the methodology and conclusions from the PACE trial have been heavily criticised, mainly due to the authors lowering the thresholds they used to determine improvement [ 36 , 37 , 38 , 67 ]. With this in mind, Sharpe et al. [ 56 ] surveyed 75% of the participants from the PACE trial 1-year post-intervention and reported pacing improved fatigue and physical functioning, with effects similar to CBT and GET.

Lessons for pacing implementation

All pacing intervention studies (5/5) implemented educational or coaching sessions. These educational components were poorly reported in terms of the specific content and how and where they had been developed, with unclear pedagogical approaches. Consequently, even where interventions reported reduction in PEM or improved symptoms, it would be impossible to transfer that research into practice, future studies, or clinical guidance, given the ambiguity of reporting. Sessions typically contained themes of pacing such as activity adjustment (decrease, break-up, and reschedule activities based on energy levels), activity consistency (maintaining a consistently low level of activity to prevent PEM), activity planning (planning activities and rest around available energy levels), and activity progression (slowly progressing activity once maintaining a steady baseline) [ 35 , 48 , 49 , 50 , 51 ]. We feel it is pertinent to note here that although activity progression has been incorporated as a pacing strategy in these included studies, some view activity progression as a form of GET. The NICE definition of GET is “first establishing an individual's baseline of achievable exercise or physical activity, then making fixed incremental increases in the time spent being physically active” [ 34 ]. Thus, this form of pacing can also be considered a type of ‘long-term GET’ in which physical activity progression is performed over weeks or months with fixed incremental increases in time spent being physically.

Intervention studies attempted to create behaviour change, through educational programmes to modify physical activity, and plan behaviours. However, none of these studies detailed integrating any evidence-based theories of behaviour change [ 68 ] or reported using any frameworks to support behaviour change objectives. This is unfortunate since there is good evidence that theory-driven behaviour change interventions result in greater intervention effects [ 69 ]. Indeed, there is a large body of work regarding methods of behaviour change covering public health messaging, education, and intervention design, which has largely been ignored by the pacing literature. Interventions relied on subjective pacing (5/5 studies), with strategies including keeping an activity diary (3/5 studies) to identify links between activity and fatigue [ 35 , 48 , 50 ]. Given the high prevalence of ‘brain fog’ within ME/CFS [ 70 , 71 , 72 , 73 ], recall may be extremely difficult and there is significant potential for under-reporting. Other strategies included simply asking participants to estimate energy levels available for daily activities (2/5 studies [ 48 , 51 ]). Again, this is subjective and relies on participants’ ability to recall previous consequences of the activity. Other methods of activity tracking and measuring energy availability, such as wearable technology [ 74 , 75 , 76 , 77 , 78 ] could provide a more objective measure of adherence and pacing strategy fidelity in future studies. Despite technology such as accelerometers being widely accessible since well-before the earliest interventional study included in this review (which was published in 2009), none of the interventional studies utilised objective activity tracking to track pacing and provide feedback to participants. One study considered accelerometery alongside an activity diary [ 51 ]. However, accelerometery was considered the outcome variable, to assess change in activity levels from pre- to post-intervention and was not part of the intervention itself (which was one pacing coaching sessions per week for 3 weeks). Moreover, most research-grade accelerometers cannot be used as part of the intervention since they have no ability to provide continuous feedback and must be retrieved by the research team in order to access any data. Consequently, their use is mostly limited to outcome assessments only. As pacing comprises a limit to physical activity to prevent push-crash cycles, it is an astonishing observation from this scoping review that only two studies objectively measured physical activity to quantify changes to activity as a result of pacing [ 51 , 54 ]. If the aim of pacing is to reduce physical activity, or reduce variations in physical activity (i.e., push-crash cycles), only two studies have objectively quantified the effect pacing had on physical activity, so it is unclear whether pacing was successfully implemented in any of the other studies.

By exploring the pacing strategies previously used, in both intervention studies and more exploratory studies, we can identify and recommend approaches to improve symptoms of ME/CFS. These approaches can be categorised as follows: activity planning, activity consistency, activity progression, activity adjustment and staying within the Energy Envelope [ 50 , 53 , 60 , 63 ]. Activity planning was identified as a particularly effective therapeutic strategy, resulting in improvement of mean scores of all symptoms included in the APQ-28, reducing current pain, improvement of physical fatigue, mental fatigue, self-efficacy, quality of life, and mental and physical functioning [ 50 ]. Activity planning aligns with the self-regulatory behaviour change technique ‘Action Planning’ [ 79 ] which is commonly used to increase physical activity behaviour. In the case of ME/CFS, activity planning is successfully used to minimise rather than increase physical activity bouts to prevent expending too much energy and avoid PEM. Activity consistency, meaning undertaking similar amounts of activity each day, was also associated with reduced levels of depression, exercise avoidance, and higher levels of physical function [ 63 ]. Activity progression was associated with higher levels of current pain. Activity adjustment associated with depression and avoidance, and lower levels of physical function [ 63 ]. Staying within the Energy Envelope was reported to reduce PEM severity [ 53 , 60 ], improve physical functioning [ 53 , 60 ] and ME/CFS symptom scores [ 53 ], and more hours engaged in activity than individuals with lower available energy [ 53 ]. These results suggest that effective pacing strategies would include activity planning, consistency, and energy management techniques while avoiding progression. This data is, of course, limited by the small number of mostly low-quality studies and should be interpreted with some caution. Nevertheless, these are considerations that repeatedly appear in the literature and, as such, warrant deeper investigation. In addition, and as outlined earlier, most studies are relatively old, and we urgently need better insight into how modern technologies, particularly longitudinal activity tracking and contemporaneous heart-rate feedback, might improve (or otherwise) adaptive pacing. Such longitudinal tracking would also enable activities and other behaviours (sleep, diet, stress) to be linked to bouts of PEM. Linking would enable a deeper insight into potential PEM triggers and mitigations that might be possible.

The PACE trial

We feel it would be remiss of us to not specifically address the PACE trial within this manuscript, as five of the 17 included studies resulted from the PACE trial [ 35 , 56 , 57 , 59 , 61 ]. There has been considerable discussion around the PACE trial, which has been particularly divisive and controversial [ 37 , 38 , 39 , 59 , 67 , 80 , 81 ]. In the PACE trial, GET and CBT were deemed superior to pacing by the authors. Despite its size and funding, the PACE trial has received several published criticisms and rebuttals. Notably, NICE's most recent ME/CFS guideline update removed GET and CBT as suggested treatment options, which hitherto had been underpinned by the PACE findings. While we will not restate the criticisms and rebuttals here, what is not in doubt, is that the PACE trial has dominated discussions of pacing, representing almost a third of all the studies in this review. However, the trial results were published over a decade ago, with the study protocol devised almost two decades ago [ 82 ]. The intervening time has seen a revolution in the development of mobile and wearable technology and an ability to remotely track activity and provide real-time feedback in a way which was not available at that time. Furthermore, there has been no substantive research since the PACE trial that has attempted such work. Indeed, possibly driven by the reported lack of effect of pacing in the PACE trial, this review has demonstrated the dearth of progress and innovation in pacing research since its publication. Therefore, regardless of its findings or criticisms, the pacing implementation in the PACE trial is dated, and there is an urgent need for more technologically informed approaches to pacing research.

Limitations of the current evidence

The first limitation to the literature included in this scoping review is that not all studies followed the minimum data set (MDS) of patient-reported outcome measures (PROMs) agreed upon by the British Association of CFS/ME Professionals (BACME) (fatigue, sleep quality, self-efficacy, pain/discomfort, anxiety/depression, mobility, activities of daily living, self-care, and illness severity) [ 83 , 84 ]. All but one study included in this review measured illness severity, most studies included fatigue and pain/discomfort, and some studies included assessments of anxiety/depression. There was a lack of quantitative assessment of sleep quality, self-efficacy, mobility, activities of daily living, and self-care. Therefore, studies did not consistently capture the diverse nature of the symptoms experienced, with crucial domains missing from the analyses. The MDS of PROMs were established in 2012 [ 83 , 84 ] and therefore, for studies published out prior to 2012, these are not applicable [ 35 , 49 , 51 , 53 , 54 ]. However, for the 12 studies carried out after this time, the MDS should have been considered elucidate the effects of pacing on ME/CFS. Importantly, despite PEM being a central characteristic of ME/CFS, only two studies included PEM as an outcome measure [ 55 , 60 ]. This may be because of the difficulty of accurately measuring fluctuating symptoms, as PEM occurs multiple times over a period of months, and therefore pre- to post- studies and cross-sectional designs cannot adequately capture PEM incidence. Therefore, it is likely studies opted for measuring general fatigue instead. More appropriate longitudinal study designs are required to track PEM over time to capture a more representative picture of PEM patterns. Secondly, reporting of participant characteristics was inadequate, but in the studies that did describe participants, characteristics were congruent with the epidemiological literature and reporting of ME/CFS populations (i.e., 60–65% female) [ 85 ]. Therefore, in this respect, studies included herein were representative samples. However, the lack of reporting of participant characteristics limits inferences we can draw concerning any population-related effects (i.e. whether older, or male, or European, or people referred by a national health service would be more or less likely to respond positively to pacing). Thirdly, comparison groups (where included) were not ideal, with CBT or GET sometimes used as comparators to pacing [ 35 ], and often no true control group included. Penultimately, there is a distinct lack of high-quality RCTs (as mentioned throughout this manuscript). Finally, in reference to the previous section, inferences from the literature are dated and do not reflect the technological capabilities of 2023.

Recommendations for advancement of the investigative area

It is clear from the studies included in this scoping review for the last decade or more, progress and innovation in pacing research have been limited. This is unfortunate for several reasons. People with ME/CFS or long COVID are, of course, invested in their recovery. From our patient and public involvement (PPI) group engagement, it is clear many are ahead of the research and are using wearable technology to track steps, heart rate, and, in some cases, heart rate variability to improve their own pacing practice. While the lack of progress in the research means this is an understandable response by patients, it is also problematic. Without underpinning research, patients may make decisions based on an individual report of trial-and-error approaches given the lack of evidence-based guidance.

A more technologically-informed pacing approach could be implemented by integrating wearable trackers [ 77 , 78 , 86 , 87 ] to provide participants with live updates on their activity and could be integrated with research-informed messaging aimed at supporting behaviour change, as has been trialled in other research areas [ 88 , 89 , 90 , 91 ]. However, more work is needed to evaluate how to incorporate wearable activity trackers and which metrics are most helpful.

A more technologically-informed approach could also be beneficial for longitudinal symptom tracking, particularly useful given the highly variable symptom loads of ME/CFS and episodic nature of PEM. This would overcome reliance on assessments at a single point in time (as the studies within this review conducted). Similarly, mobile health (mHealth) approaches also allow questionnaires to be digitised to make it easier for participants to complete if they find holding a pen or reading small font problematic [ 92 ]. Reminders and notifications can also be helpful for patients completing tasks [ 77 , 93 , 94 , 95 ]. This approach has the added advantage of allowing contemporaneous data collection rather than relying on pre- to post-intervention designs limited by recall bias. Future work must try to leverage these approaches, as unless we collect large data sets on symptoms and behaviours (i.e. activity, diet, sleep, and pharmacology) in people with conditions like ME/CFS we will not be able to leverage emerging technologies such as AI and machine learning to improve the support and care for people with these debilitating conditions. The key areas for research outline in the NICE guidelines (2021 update) speaks to this, with specific mention of improved self-monitoring strategies, sleep strategies, and dietary strategies, all of which can be measured using mHealth approaches, in a scalable and labour-inexpensive way.

The potential for existing pacing research to address the long COVID pandemic

There is now an urgent public health need to address long COVID, with over 200 million sufferers worldwide [ 30 ]. Given the analogous symptomology between ME/CFS and long COVID, and the lack of promising treatment and management strategies in ME/CFS, pacing remains the only strategy for managing long COVID symptoms. This is concerning as the quality of evidence to support pacing is lacking. Given long COVID has reached pandemic proportions, scalable solutions will be required. In this context, we propose that technology should be harnessed to a) deliver, but also b) evaluate, pacing. We recently reported on a just-in-time adaptive intervention to increase physical activity during the pandemic [ 78 ]. However, this method could be adapted to decrease or maintain physical activity levels (i.e., pacing) in long COVID. This method has the advantage of scalability and remote data collection, reducing resource commitments and participant burden, essential for addressing a condition with so many sufferers.

This review highlights the need for more studies concerning pacing in chronic fatiguing conditions. Future studies would benefit from examining pacing’s effect on symptomology and PEM with objectively quantified pacing, over a longer duration of examination, using the MDS. It is essential this is conducted as an RCT, given that in the case of long COVID, participants may improve their health over time, and it is necessary to determine whether pacing exerts an additional effect over time elapsing. Future studies would benefit from digitising pacing to support individuals with varying symptom severity and personalise support. This would improve accessibility and reduce selection bias, in addition to improving scalability of interventions. Finally, clinicians and practitioners should be cognisant of the strength of evidence reported in this review and should exert caution when promoting pacing in their patients, given the varying methods utilised herein.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Activity Pacing Questionnaire

Beck Anxiety Inventory

Beck Depression Inventory

Brief Coping Orientation to Problems Experienced Scale

Canadian Occupational Performance Measure

Centers for disease control and prevention

Chalder Fatigue Questionnaire

Checklist Individual Strength

Chronic Pain Coping Inventory

Cognitive behavioural therapy

Cochrane Central Register of Controlled Trials

DePaul symptom questionnaire

EuroQol five-dimensions, five-levels questionnaire

Graded exercise therapy

Hospital Anxiety and Depression Scale

Myalgic encephalomyelitis/chronic fatigue syndrome

Pain Self Efficacy Questionnaire

Pain Anxiety Symptoms Scale short version

Pain Numerical Rating Scale

Patient health questionnaire

Patient reported outcome measures

Physiotherapy Evidence Database

Perceived Stress Scale

Post exertional malaise

Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews

Randomised control trial

McMurray JC, May JW, Cunningham MW, Jones OY. Multisystem Inflammatory Syndrome in Children (MIS-C), a post-viral myocarditis and systemic vasculitis-a critical review of its pathogenesis and treatment. Front Pediatr. 2020;8: 626182.

Article   PubMed   PubMed Central   Google Scholar  

Perrin R, Riste L, Hann M, Walther A, Mukherjee A, Heald A. Into the looking glass: post-viral syndrome post COVID-19. Med Hypotheses. 2020;144: 110055.

Article   PubMed   PubMed Central   CAS   Google Scholar  

Hayes LD, Ingram J, Sculthorpe NF. More than 100 persistent symptoms of SARS-CoV-2 (Long COVID): A scoping review. Front Med. 2021. https://doi.org/10.3389/fmed.2021.750378 .

Article   Google Scholar  

McLaughlin M, Cerexhe C, Macdonald E, Ingram J, Sanal-Hayes NEM, Hayes LD, et al. A Cross-sectional study of symptom prevalence, frequency, severity, and impact of long-COVID in Scotland: part I. Am J Med. 2023. https://doi.org/10.1016/j.amjmed.2023.07.009 .

Article   PubMed   Google Scholar  

McLaughlin M, Cerexhe C, Macdonald E, Ingram J, Sanal-Hayes NEM, Hayes LD, et al. A cross-sectional study of symptom prevalence, frequency, severity, and impact of long-COVID in Scotland: part II. Am J Med. 2023. https://doi.org/10.1016/j.amjmed.2023.07.009 .

Hayes LD, Sanal-Hayes NEM, Mclaughlin M, Berry ECJ, Sculthorpe NF. People with long covid and ME/CFS exhibit similarly impaired balance and physical capacity: a case-case-control study. Am J Med. 2023;S0002–9343(23):00465–75.

Google Scholar  

Jenkins R. Post-viral fatigue syndrome. Epidemiology: lessons from the past. Br Med Bull. 1991;47:952–65.

Article   PubMed   CAS   Google Scholar  

Sandler CX, Wyller VBB, Moss-Morris R, Buchwald D, Crawley E, Hautvast J, et al. Long COVID and post-infective fatigue syndrome: a review. Open Forum Infect Dis. 2021;8:440.

Carod-Artal FJ. Post-COVID-19 syndrome: epidemiology, diagnostic criteria and pathogenic mechanisms involved. Rev Neurol. 2021;72:384–96.

PubMed   CAS   Google Scholar  

Ballering AV, van Zon SKR, Olde Hartman TC, Rosmalen JGM. Lifelines corona research initiative. Persistence of somatic symptoms after COVID-19 in the Netherlands: an observational cohort study. Lancet. 2022;400:452–61.

Wong TL, Weitzer DJ. Long COVID and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)-a systemic review and comparison of clinical presentation and symptomatology. Medicina (Kaunas). 2021;57:418.

Sukocheva OA, Maksoud R, Beeraka NM, Madhunapantula SV, Sinelnikov M, Nikolenko VN, et al. Analysis of post COVID-19 condition and its overlap with myalgic encephalomyelitis/chronic fatigue syndrome. J Adv Res. 2021. https://doi.org/10.1016/j.jare.2021.11.013 .

Bonilla H, Quach TC, Tiwari A, Bonilla AE, Miglis M, Yang P, et al. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is common in post-acute sequelae of SARS-CoV-2 infection (PASC): results from a post-COVID-19 multidisciplinary clinic. medrxiv. 2022. https://doi.org/10.1101/2022.08.03.22278363v1 .

Twomey R, DeMars J, Franklin K, Culos-Reed SN, Weatherald J, Wrightson JG. Chronic fatigue and postexertional malaise in people living with long COVID: an observational study. Phys Ther. 2022;102:005.

Barhorst EE, Boruch AE, Cook DB, Lindheimer JB. Pain-related post-exertional malaise in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and fibromyalgia: a systematic review and three-level meta-analysis. Pain Med. 2022;23:1144–57.

Goudsmit EM. The psychological aspects and management of chronic fatigue syndrome [Internet] [Thesis]. Brunel University, School of Social Sciences; 1996 [cited 2022 Jan 20]. https://scholar.google.co.uk/scholar_url?url=https://bura.brunel.ac.uk/bitstream/2438/4283/1/FulltextThesis.pdf&hl=en&sa=X&ei=kNYjZdeuA4-8ywTAmKmADQ&scisig=AFWwaeZvdxcuHmzGL08L3jp-QwNn&oi=scholarr . Accessed 2 Aug 2022

Stussman B, Williams A, Snow J, Gavin A, Scott R, Nath A, et al. Characterization of post-exertional malaise in patients with myalgic encephalomyelitis/chronic fatigue syndrome. Front Neurol. 2020;11:1025.

Holtzman CS, Bhatia KP, Cotler J, La J. Assessment of Post-Exertional Malaise (PEM) in Patients with Myalgic Encephalomyelitis (ME) and Chronic Fatigue Syndrome (CFS): a patient-driven survey. Diagnostics. 2019. https://doi.org/10.3390/diagnostics9010026 .

Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A. The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med. 1994;121:953–9.

Carruthers BM, van de Sande MI, De Meirleir KL, Klimas NG, Broderick G, Mitchell T, et al. Myalgic encephalomyelitis: international consensus criteria. J Intern Med. 2011;270:327–38.

Carruthers JD, Lowe NJ, Menter MA, Gibson J, Eadie N, Botox Glabellar Lines II Study Group. Double-blind, placebo-controlled study of the safety and efficacy of botulinum toxin type A for patients with glabellar lines. Plast Reconstr Surg. 2003;112:1089–98.

Jason LA, Jordan K, Miike T, Bell DS, Lapp C, Torres-Harding S, et al. A pediatric case definition for myalgic encephalomyelitis and chronic fatigue syndrome. J Chronic Fatigue Syndrome. 2006;13:1–44.

Goudsmit EM, Nijs J, Jason LA, Wallman KE. Pacing as a strategy to improve energy management in myalgic encephalomyelitis/chronic fatigue syndrome: a consensus document. Disabil Rehabil. 2012;34:1140–7.

Antcliff D, Keenan A-M, Keeley P, Woby S, McGowan L. Engaging stakeholders to refine an activity pacing framework for chronic pain/fatigue: a nominal group technique. Musculoskeletal Care. 2019;17:354–62.

Antcliff D, Keeley P, Campbell M, Woby S, McGowan L. Exploring patients’ opinions of activity pacing and a new activity pacing questionnaire for chronic pain and/or fatigue: a qualitative study. Physiotherapy. 2016;102:300–7.

Yoshiuchi K, Cook DB, Ohashi K, Kumano H, Kuboki T, Yamamoto Y, et al. A real-time assessment of the effect of exercise in chronic fatigue syndrome. Physiol Behav. 2007;92:963–8.

Davenport TE, Stevens SR, Baroni K, Van Ness M, Snell CR. Diagnostic accuracy of symptoms characterising chronic fatigue syndrome. Disabil Rehabil. 2011;33:1768–75.

Nurek M, Rayner C, Freyer A, Taylor S, Järte L, MacDermott N, Delaney BC, Panellists D, et al. Recommendations for the recognition, diagnosis, and management of long COVID: a Delphi study. Br J Gen Pract. 2021. https://doi.org/10.3399/BJGP.2021.0265 .

Herrera JE, Niehaus WN, Whiteson J, Azola A, Baratta JM, Fleming TK, Kim SY, Naqvi H, Sampsel S, Silver JK, Gutierrez MV, Maley J, Herman E, Abramoff Benjamin, et al. Multidisciplinary collaborative consensus guidance statement on the assessment and treatment of fatigue in postacute sequelae of SARS-CoV-2 infection (PASC) patients. PM & R. 2021. https://doi.org/10.1002/pmrj.12684 .

Chen C, Haupert SR, Zimmermann L, Shi X, Fritsche LG, Mukherjee B. Global prevalence of post COVID-19 condition or long COVID: a meta-analysis and systematic review. J Infect Dis. 2022. https://doi.org/10.1093/infdis/jiac136 .

Office for National Statistics. Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK [Internet]. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk/7july2022 . Accessed 2 Aug 2022

Office for National Statistics. Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK [Internet]. [cited 2022 Apr 1]. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk/3march2022

Baker R, Shaw EJ. Diagnosis and management of chronic fatigue syndrome or myalgic encephalomyelitis (or encephalopathy): summary of NICE guidance. BMJ. 2007;335:446–8.

NICE. Overview | Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management | Guidance | NICE [Internet]. NICE; [cited 2022 Aug 22]. https://www.nice.org.uk/guidance/ng206 . Accessed 2 Aug 2022

White P, Goldsmith K, Johnson A, Potts L, Walwyn R, DeCesare J, et al. Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. The Lancet. 2011;377:823–36.

Article   CAS   Google Scholar  

Vink M. PACE trial authors continue to ignore their own null effect. J Health Psychol. 2017;22:1134–40.

Petrie K, Weinman J. The PACE trial: it’s time to broaden perceptions and move on. J Health Psychol. 2017;22:1198–200.

Stouten B. PACE-GATE: an alternative view on a study with a poor trial protocol. J Health Psychol. 2017;22:1192–7.

Agardy S. Chronic fatigue syndrome patients have no reason to accept the PACE trial results: response to Keith J Petrie and John Weinman. J Health Psychol. 2017;22:1206–8.

Kim D-Y, Lee J-S, Park S-Y, Kim S-J, Son C-G. Systematic review of randomized controlled trials for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). J Transl Med. 2020;18:7.

Twisk FNM, Maes M. A review on cognitive behavorial therapy (CBT) and graded exercise therapy (GET) in myalgic encephalomyelitis (ME) / chronic fatigue syndrome (CFS): CBT/GET is not only ineffective and not evidence-based, but also potentially harmful for many patients with ME/CFS. Neuro Endocrinol Lett. 2009;30:284–99.

PubMed   Google Scholar  

Mays N, Roberts E, Popay J. Synthesising research evidence. In: Fulop N, Allen P, Clarke A, Black N, editors. Studying the organisation and delivery of health services: research methods. London: Routledge; 2001. p. 188–220.

Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018;18:143.

Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8:19–32.

Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169:467–73.

de Morton NA. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother. 2009;55:129–33.

Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther. 2003;83:713–21.

Kos D, van Eupen I, Meirte J, Van Cauwenbergh D, Moorkens G, Meeus M, et al. Activity pacing self-management in chronic fatigue syndrome: a randomized controlled trial. Am J Occup Ther. 2015;69:6905290020.

Meeus M, Nijs J, Van Oosterwijck J, Van Alsenoy V, Truijen S. Pain physiology education improves pain beliefs in patients with chronic fatigue syndrome compared with pacing and self-management education: a double-blind randomized controlled trial. Arch Phys Med Rehabil. 2010;91:1153–9.

Antcliff D, Keenan A-M, Keeley P, Woby S, McGowan L. Testing a newly developed activity pacing framework for chronic pain/fatigue: a feasibility study. BMJ Open. 2021;11: e045398.

Nijs J, van Eupen I, Vandecauter J, Augustinus E, Bleyen G, Moorkens G, et al. Can pacing self-management alter physical behavior and symptom severity in chronic fatigue syndrome? A case series. J Rehabil Res Dev. 2009;46:985–96.

Geraghty K, Hann M, Kurtev S. Myalgic encephalomyelitis/chronic fatigue syndrome patients’ reports of symptom changes following cognitive behavioural therapy, graded exercise therapy and pacing treatments: Analysis of a primary survey compared with secondary surveys. J Health Psychol. 2019;24:1318–33.

Jason L, Muldowney K, Torres-Harding S. The energy envelope theory and myalgic encephalomyelitis/chronic fatigue syndrome. AAOHN J. 2008;56:189–95.

Brown M, Khorana N, Jason LA. The role of changes in activity as a function of perceived available and expended energy in non-pharmacological treatment outcomes for ME/CFS. J Clin Psychol. 2011;67:253.

Association ME. ME/CFS illness management survey results:‘“No decisions about me without me.” Part 1: Results and in-depth analysis of the 2012 ME association patient survey examining the acceptability, efficacy and safety of cognitive behavioural therapy, graded exercise therapy and pacing, as interventions used as management strategies for ME/CFS. 2015. https://www.meassociation.org.uk/wp-content/uploads/NO-DECISIONS-WITHOUT-ME-report.docx . Accessed 2 Feb 2022

Sharpe M, Goldsmith KA, Johnson AL, Chalder T, Walker J, White PD. Rehabilitative treatments for chronic fatigue syndrome: long-term follow-up from the PACE trial. The Lancet Psychiatry. 2015;2:1067–74.

White PD, Goldsmith K, Johnson AL, Chalder T, Sharpe M. Recovery from chronic fatigue syndrome after treatments given in the PACE trial. Psychol Med. 2013;43:2227–35.

O’connor K, Sunnquist M, Nicholson L, Jason LA, Newton JL, Strand EB. Energy envelope maintenance among patients with myalgic encephalomyelitis and chronic fatigue syndrome: Implications of limited energy reserves. Chronic Illn. 2019;15:51–60.

Dougall D, Johnson A, Goldsmith K, Sharpe M, Angus B, Chalder T, et al. Adverse events and deterioration reported by participants in the PACE trial of therapies for chronic fatigue syndrome. J Psychosom Res. 2014;77:20–6.

Brown AA, Evans MA, Jason LA. Examining the energy envelope and associated symptom patterns in chronic fatigue syndrome: does coping matter? Chronic Illn. 2013;9:302–11.

Bourke JH, Johnson AL, Sharpe M, Chalder T, White PD. Pain in chronic fatigue syndrome: response to rehabilitative treatments in the PACE trial. Psychol Med. 2014;44:1545–52.

Jason LA, Brown M, Brown A, Evans M, Flores S, Grant-Holler E, et al. Energy conservation/envelope theory interventions to help patients with myalgic encephalomyelitis/chronic fatigue syndrome. Fatigue. 2013;1:27–42.

Antcliff D, Campbell M, Woby S, Keeley P. Activity pacing is associated with better and worse symptoms for patients with long-term conditions. Clin J Pain. 2017;33:205–14.

Nijs T, Klein Y, Mousavi S, Ahsan A, Nowakowska S, Constable E, et al. The different faces of 4’-Pyrimidinyl-Functionalized 4,2’:6’,4"-Terpyridin es: metal-organic assemblies from solution and on Au(111) and Cu(111) surface platforms. J Am Chem Soc. 2018;140:2933–9.

Cutler DM, Summers LH. The COVID-19 pandemic and the $16 Trillion Virus. JAMA. 2020;324:1495–6.

Cutler DM. The costs of long COVID. JAMA Health Forum. 2022;3:e221809–e221809.

Geraghty K. ‘PACE-Gate’: when clinical trial evidence meets open data access. J Health Psychol. 2017;22:1106–12.

Davis R, Campbell R, Hildon Z, Hobbs L, Michie S. Theories of behaviour and behaviour change across the social and behavioural sciences: a scoping review. Health Psychol Rev. 2015;9:323–44.

Prestwich A, Sniehotta FF, Whittington C, Dombrowski SU, Rogers L, Michie S. Does theory influence the effectiveness of health behavior interventions? Meta-analysis Health Psychol. 2014;33:465–74.

Balinas C, Eaton-Fitch N, Maksoud R, Staines D, Marshall-Gradisnik S. Impact of life stressors on Myalgic encephalomyelitis/chronic fatigue syndrome symptoms: an Australian longitudinal study. Int J Environ Res Public Health. 2021;18:10614.

McGregor NR, Armstrong CW, Lewis DP, Gooley PR. Post-exertional malaise is associated with hypermetabolism, hypoacetylation and purine metabolism deregulation in ME/CFS cases. Diagnostics. 2019;9:70.

Nacul LC, Lacerda EM, Campion P, Pheby D, de Drachler M, Leite JC, et al. The functional status and well being of people with myalgic encephalomyelitis/chronic fatigue syndrome and their carers. BMC Public Health. 2011;11:402.

Deumer U-S, Varesi A, Floris V, Savioli G, Mantovani E, López-Carrasco P, et al. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): an overview. J Clin Med. 2021. https://doi.org/10.3390/jcm10204786 .

Düking P, Giessing L, Frenkel MO, Koehler K, Holmberg H-C, Sperlich B. Wrist-worn wearables for monitoring heart rate and energy expenditure while sitting or performing light-to-vigorous physical activity: validation study. JMIR Mhealth Uhealth. 2020;8: e16716.

Falter M, Budts W, Goetschalckx K, Cornelissen V, Buys R. Accuracy of apple watch measurements for heart rate and energy expenditure in patients with cardiovascular disease: cross-sectional study. JMIR Mhealth Uhealth. 2019;7: e11889.

Fuller D, Colwell E, Low J, Orychock K, Tobin MA, Simango B, et al. Reliability and validity of commercially available wearable devices for measuring steps, energy expenditure, and heart rate: systematic review. JMIR Mhealth Uhealth. 2020;8: e18694.

Mair JL, Hayes LD, Campbell AK, Sculthorpe N. Should we use activity tracker data from smartphones and wearables to understand population physical activity patterns? J Measur Phys Behav. 2022;1:1–5.

Mair JL, Hayes LD, Campbell AK, Buchan DS, Easton C, Sculthorpe N. A personalized smartphone-delivered just-in-time adaptive intervention (JitaBug) to increase physical activity in older adults: mixed methods feasibility study. JMIR Formative Res. 2022;6: e34662.

Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013;46:81–95.

Feehan SM. The PACE trial in chronic fatigue syndrome. The Lancet. 2011;377:1831–2.

Giakoumakis J. The PACE trial in chronic fatigue syndrome. The Lancet. 2011;377:1831.

White PD, Sharpe MC, Chalder T, DeCesare JC, Walwyn R, PACE trial group. Protocol for the PACE trial: a randomised controlled trial of adaptive pacing, cognitive behaviour therapy, and graded exercise, as supplements to standardised specialist medical care versus standardised specialist medical care alone for patients with the chronic fatigue syndrome/myalgic encephalomyelitis or encephalopathy. BMC Neurol. 2007;7:6.

Reuben DB, Tinetti ME. Goal-oriented patient care–an alternative health outcomes paradigm. N Engl J Med. 2012;366:777–9.

Roberts D. Chronic fatigue syndrome and quality of life. PROM. 2018;9:253–62.

Valdez AR, Hancock EE, Adebayo S, Kiernicki DJ, Proskauer D, Attewell JR, et al. Estimating prevalence, demographics, and costs of ME/CFS using large scale medical claims data and machine learning. Front Pediatr. 2019. https://doi.org/10.3389/fped.2018.00412 .

Greiwe J, Nyenhuis SM. Wearable technology and how this can be implemented into clinical practice. Curr Allergy Asthma Rep. 2020;20:36.

Sun S, Folarin AA, Ranjan Y, Rashid Z, Conde P, Stewart C, et al. Using smartphones and wearable devices to monitor behavioral changes during COVID-19. J Med Internet Res. 2020;22: e19992.

Hardeman W, Houghton J, Lane K, Jones A, Naughton F. A systematic review of just-in-time adaptive interventions (JITAIs) to promote physical activity. Int J Behav Nutr Phys Act. 2019;16:31.

Perski O, Hébert ET, Naughton F, Hekler EB, Brown J, Businelle MS. Technology-mediated just-in-time adaptive interventions (JITAIs) to reduce harmful substance use: a systematic review. Addiction. 2022;117:1220–41.

AhmedS A, van Luenen S, Aslam S, van Bodegom D, Chavannes NH. A systematic review on the use of mHealth to increase physical activity in older people. Clinical eHealth. 2020;3:31–9.

Valenzuela T, Okubo Y, Woodbury A, Lord SR, Delbaere K. Adherence to technology-based exercise programs in older adults: a systematic review. J Geriatric Phys Ther. 2018;41:49–61.

Bowling A. Mode of questionnaire administration can have serious effects on data quality. J Public Health. 2005;27:281–91.

Burns SP, Terblanche M, Perea J, Lillard H, DeLaPena C, Grinage N, et al. mHealth intervention applications for adults living with the effects of stroke: a scoping review. Arch Rehabil Res Clin Transl. 2021;3: 100095.

Vandelanotte C, Müller AM, Short CE, Hingle M, Nathan N, Williams SL, et al. Past, present, and future of eHealth and mHealth research to improve physical activity and dietary behaviors. J Nutr Educ Behav. 2016;48:219-228.e1.

Ludwig K, Arthur R, Sculthorpe N, Fountain H, Buchan DS. Text messaging interventions for improvement in physical activity and sedentary behavior in youth: systematic review. JMIR Mhealth Uhealth. 2018;6:e10799.

Download references

Acknowledgements

We have no acknowledgements to make.

Open access funding provided by Swiss Federal Institute of Technology Zurich. This work was supported by grants from the National Institute for Health and Care Research (COV-LT2-0010) and the funder had no role in the conceptualisation, design, data collection, analysis, decision to publish, or preparation of the manuscript.

Author information

Authors and affiliations.

Sport and Physical Activity Research Institute, School of Health and Life Sciences, University of the West of Scotland, Glasgow, UK

Nilihan E. M. Sanal-Hayes, Marie Mclaughlin, Lawrence D. Hayes, David Carless, Rachel Meach & Nicholas F. Sculthorpe

Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore

Jacqueline L. Mair

Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore

Long COVID Scotland, 12 Kemnay Place, Aberdeen, UK

Jane Ormerod

Physios for ME, London, UK

Natalie Hilliard

School of Education and Social Sciences, University of the West of Scotland, Glasgow, UK

Joanne Ingram

School of Health and Society, University of Salford, Salford, UK

Nilihan E. M. Sanal-Hayes

School of Sport, Exercise & Rehabilitation Sciences, University of Hull, Hull, UK

Marie Mclaughlin

You can also search for this author in PubMed   Google Scholar

Contributions

Authors’ contributions are given according to the CRediT taxonomy as follows: Conceptualization, N.E.M.S–H., M.M., L.D.H, and N.F.S.; methodology, N.E.M.S–H., M.M., L.D.H., and N.F.S.; software, N.E.M.S–H., M.M., L.D.H., and N.F.S.B.; validation, N.E.M.S–H., M.M., L.D.H, and N.F.S.; formal analysis, N.E.M.S–H., M.M., L.D.H., and N.F.S.; investigation, N.E.M.S–H., M.M., L.D.H., and N.F.S.; resources, L.D.H., J.O., D.C., N.H., J.L.M., and N.F.S.; data curation, N.E.M.S.-H., M.M., L.D.H., and N.F.S.; writing—original draft preparation, N.E.M.S.-H., M.M., L.D.H., and N.F.S.; writing—review and editing, N.E.M.S–H., M.M., L.D.H., J.O., D.C., N.H., R.M., J.L.M., J.I., and N.F.S.; visualisation, N.E.M.S–H. and M.M., supervision, N.F.S; project administration, N.E.M.S–H., M.M., L.D.H., and N.F.S.; funding acquisition, L.D.H., J.O., D.C., N.H., J.L.M., J.I., and N.F.S. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Jacqueline L. Mair .

Ethics declarations

Ethical approval and content to participate.

This manuscript did not involve human participants, data, or tissues, so did not require ethical approval.

Consent for publication

This paper does not contain any individual person’s data in any form.

Competing interests

We report no financial and non-financial competing interests.

Additional information

Publisher's note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Additional file 1..

Supplementary file 1. Full search string for databse searching.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Sanal-Hayes, N.E.M., Mclaughlin, M., Hayes, L.D. et al. A scoping review of ‘Pacing’ for management of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): lessons learned for the long COVID pandemic. J Transl Med 21 , 720 (2023). https://doi.org/10.1186/s12967-023-04587-5

Download citation

Received : 30 June 2023

Accepted : 03 October 2023

Published : 14 October 2023

DOI : https://doi.org/10.1186/s12967-023-04587-5

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Myalgic encephalomyelitis
• Chronic fatigue syndrome
• Post-exertional malaise

Journal of Translational Medicine

ISSN: 1479-5876

• Submission enquiries: Access here and click Contact Us
• General enquiries: [email protected]