Page 115 - THE PERCEPT STUDY Illness Perceptions in Physiotherapy Edwin de Raaij

assessed using an NRS. The NRS varies from zero indicating no pain to 10 the worst pain imaginable Reliability, validity and responsiveness have been shown14. The SDC is 2 points18.
Knee extension strength was measured using the MicorFET2 (MF2 Hoggan Health Industries) hand-held dynamometer. The SDC for knee extension strength is 21.5 N 20. The passive flexion/ extension range of motion of the knee was measured using the Microfet5 digital goniometric measurement instrument7.
Measurements were taken before every treatment session. In addition, in the last session the patient was asked to rate the Global Perceived Effect (GPE) by rating the change between baseline and the last session, on a 6 point Likert scale.
At baseline, the patient presented with significant pain and limitations in ADL on the PFSF. A decrease was shown in muscle strength of the right quadriceps and hamstrings, with no decrease in range of motion of her knee. The Brief IPQ DLV questions 1, 2, 4, 5, 6, 7, 8 showed a high score and question 3 a low score (Table 1).
The scores on the Brief IPQ DLV may well be indicative for dysfunctional IPs. Patient’s IPs of her OA on Consequences, Timeline, Identity, Concern and emotional Consequences could be associated with baseline outcome on the PFSF. It was hypothesized that changing her dysfunctional IPs would result in fewer limitations as measured by the PFSF. The patient was monitored six times from baseline within a 3-month period. Changes on measurements smaller than the SDC will reject the hypothesis.
Intervention
Physical therapy treatment was in accordance with the Dutch knee-hip Osteoarthritis guideline. Informing, advising and instructing the patient to keep engaged in normal ADL are considered to be major treatment modalities22. The intervention consisted of targeting dysfunctional IPs. The IPs were discussed in relation to limitations in ADL in each treatment session using the steps of the PDM-model (Box 1). For example, if the patient pointed out (step 1 & 2) to be highly Concerned about the progress of her OA over time (‘I think my knee will have to be replaced within a few years’), the physiotherapist communicated evidence about the actual progression of OA22 (step 3). Information about the slow progression of OA over time, and the fact that symptoms may well be minor during this process was given (step 4). After providing this information, checking for understanding and agreement was part of each treatment session (step 5). Co-interventions, like regular active and passive exercise therapy were given22. No other medical interventions, besides medication, took place.
A case report intervention study
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