Page 45 - THE PERCEPT STUDY Illness Perceptions in Physiotherapy Edwin de Raaij
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Introduction
Musculoskeletal pain is a common global condition. The prevalence of this condition is high, and musculoskeletal pain causes many years lived with disability. For instance, global prevalence for low back pain (LBP) is 9.4%, and LBP ranks first among causes of years lived with disability41,58. Musculoskeletal pain also poses an economic burden on society. Direct health care costs, social compensation, retirement pensions, and other indirect costs contribute to this load3,60. To reduce this burden, effective management of pain and physical function for individuals with musculoskeletal pain is a challenge to society and clinicians.
Emotions, thoughts, beliefs, behaviors, and perceptions are increasingly accepted as important elements in the management of musculoskeletal pain39. Illness perceptions are the organized rep- resentations patients have about their illness and belong to the core concepts of the Common-Sense Model of Self-Regulation of Health and Illness (CSM). The CSM is based on a parallel-processing model that describes behavior in Response to health threats. In this model, a health threat is theorized to generate both cognitive representations (danger control) and emotional states of fear and distress (fear control)33. Based on initial clinical research, 5 illness perception dimensions have been identified.
1. Identity : the label or name given to the illness by patients and the symptoms that are perceived to go with it
2. Timeline : how long the patient believes the illness or symptoms will last
3. Consequences : how strong the impact of the patient’s illness is on, for example, pain
or physical function
4. Causal : the patient’s beliefs about what causes the illness
5. Control : the patient’s beliefs about how to control or recover from the illness
Ongoing research has explored and added the dimensions of Timeline-cyclical (periodic changes in symptoms), Coherence (making sense of the illness), Emotional Response (impact on emotional level), and Concern (anxiousness about the illness) to the CSM6,43. Recent research shows that illness perceptions have associations with several outcomes in acute and chronic illness, including self-management behaviors and quality of life35. These perceptions are associated with outcomes in a variety of diseases19. Although promising, the literature is not unambiguous. For instance, the illness perception dimensions of Timeline- chronic, Consequences, and Personal and Treatment Control have been recognized as prognostic factors for limitation in physical function in patients with LBP12,40. But, other studies have shown different perception dimensions to be associated with outcomes of LBP2,15.
A systematic literature review
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