Page 119 - THE PERCEPT STUDY Illness Perceptions in Physiotherapy Edwin de Raaij

Discussion
In this case report, changes in IPs in a patient with secondary osteoarthritis of the right knee are reported. They changed in favourable directions. The question that should be asked is: due to which intervention?
The dysfunctional IPs were the starting point for the patient’s need for information. For instance, Concern scored high at baseline, accompanied by Causal attributions of injury and aging. Discussing these issues made it clear that she worried about more degeneration of her knee and that she thought exercise might damage the knee further. The patient also had a high score on Emotional Consequences at baseline, indicating a high level of distress Concerning her knee condition. The IPs of the patient gave direction to the communication and education about her OA. This approach may have led to a shift in IPs as shown in
Table 1. Conversely, it can also be argued that the applied co-interventions may have led to better physical function, thereby leading to a shift in IPs.
In a case report, no Causal attributions can be drawn. It is unclear whether the changes in IPs are responsible for the changes in outcome on pain intensity, ADL and knee impairments, or whether changes in these outcomes positively influenced IPs. What favours the idea that a change in IPs might be the driving factor for improved outcomes is the fact that the patientexperienced progressive pain and disability in the year prior to physical therapy, despite the advice of an orthopaedic surgeon to stay active. During physical therapy treatment in which her dysfunctional IPs were explicitly targeted, positive changes in health status were reported.
The body of knowledge in both OA related and non OA related literature suggests an association between IPs and activity limitations11,6,5. The study by Bijsterbosch et al5. shows a relation between increased dysfunctional IPs and progression in disability. They draw an important conclusion: “interventions aimed at changing illness perceptions can contribute to better functional outcome”. Findings in this case report are in line with their conclusion.
The physiotherapist in our case report can be classified as an expert based on the criteria mentioned by Jensen14. Knowledge and skills in areas of patient-centeredness, clinical reasoning, clinical assessment and commitment to patient preferences values are conditional. Physiotherapists should be taught the process of participatory decision making and to address IPs as an important attribute of patients’ health status.
A case report intervention study
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