Page 113 - THE PERCEPT STUDY Illness Perceptions in Physiotherapy Edwin de Raaij

Introduction
Osteoarthritis (OA) is the most common joint disease in The NetherlandsActivities in daily life (ADL)22 are negatively affected by OA. Limitations in ADL as a consequence of osteoarthritis cannot be explained by biomedical or sociodemographic factors alone. Ever since the intro- duction of Engel’s Biopsychosocial Model9 emotions, thoughts, beliefs and behaviours are more and more accepted as important factors of health1. The suggestion has been made that interventions on these factors should be part of physical therapy treatment8.
In the literature Illness Perceptions (IPs) are seen as an important psychological factor. Perceptions about increased Consequences, chronic Timeline and negative emotions are predictive for more limitations in ADL after 6 years in patients with OA11,5. IPs belong to the core concepts in the Common-Sense Model of Self-Regulation (CSM)17. In this model, a health threat is theorized to generate both cognitive representations (danger control) and emotional states of fear and distress (fear control). Five dimensions of illness perceptions 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
IPs can be seen as dysfunctional if they lead to limitations in ADL. An example is when a patient thinks that physical activity is harmful, but findings from physical assessment do not underscore such belief.
Changing patients’ dysfunctional IPs can be seen as a patient centred approach in which communication is the most important pathway 2. This means that communication plays an important role in changing IPs. In this case report, discussing dysfunctional IPs with the patient was the main intervention. A participatory decsion making (PDM) model by Epstein 10 was used as a design by which the dysfunctional IPs were discussed.
PDM is associated with better outcomes in patients with a chronic illness such as diabe- tes23,13,12.
This case report describes the process and outcome of an intervention study. Dysfunctional IPs were targeted and it was hypothesized that changing dysfunctional IPs would reduce limitations in ADL.
A case report intervention study
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