Page 114 - THE PERCEPT STUDY Illness Perceptions in Physiotherapy Edwin de Raaij

Chapter 6
Case description
Patient history
The patient was a 45-year-old female with post-traumatic secondary osteoarthritis of the lateral patella-femoral cartilage of the right knee based on magnetic resonance imaging (MRI). The treatment by the orthopaedic surgeon consisted of non-steroid anti-inflammatory drugs and advice to stay active. After one year,because of on-going pain and activity limitations the patient consulted a physiotherapist.
Examination
At baseline the patient’s (weight 86.5 kg, height 176 cm, no comorbidity), signs and symp- toms were recorded (Table 1, Figure 1)21.
Tests and measures.
At baseline IPs, activity limitations, knee pain, knee flexion and extension strength, passive flexion and extension mobility and the use of medication were recorded. Also the algo-func- tional indices for hip and knee osteoarthritis were administered and recorded as part of the Dutch Osteoarthritis knee-hip Guideline 16,22.
The IPs were assessed using the Brief Illness Perception Questionnaire Dutch Language Version (Brief IPQ-DLV)19. The Brief IPQ-DLV covers all IP dimensions and has nine items. Eight of these items are rated using a 0-10 Numeric Rating Scale (NRS) of which five items assess cognitive illness perceptions: Consequences (Item 1), Timeline (Item 2), Personal Control (Item 3), Treatment Control (Item 4), and Identity (Item 5). Two of the items assess emotional perceptions: Concern (Item 6) and emotions (Item 8) and one item assesses illness Coherence (Item 7). The ninth item assesses Causal perception, which asks the patient to list the three most important Causal factors in their illness and is rated as an open-ended response (Item 9). The Brief IPQ-DLV has a Smallest Detectable Change (SDC) of 3 points for items 1-8 for individual evaluation purpose. Reliability has a Kappa of K =0.57-0.75 19. Responses to the Causal item (item 9) can be grouped into 4 categories:
1. psychological attribution 2. risk factors
3. immunity
4. accident or chance
Activity limitations were assessed by using the Patient Specific Functional Scale (PSFS)4. The SDC of the PSFS is 2.5 points. The PSFS is known to be reliable3. Present knee pain was
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