Page 128 - THE PERCEPT STUDY Illness Perceptions in Physiotherapy Edwin de Raaij

Chapter 7
disability9 and personalizing management of LBP might involve addressing these IPs. Dysfunc- tional IPs have shown to attribute to higher pain intensity and lower physical functioning and quality of life in a variety of conditions15. It is not known how this attribution unfolds during a matched-care physiotherapy treatment, whether, for instance, IPs act as a mediator or moder- ator for LBP outcomes. A mediator indicates a part of the causal pathway. The intervention ef- fect on the outcome goes through the mediator. A moderator on the other hand indicates that the intervention effect is different for different subgroups of the moderator23. This has not yet been researched in primary care physiotherapy, which is important in our health care system.
It is hypothesized IPs can mediate and/or moderate the association between intervention and outcome. To research the possible mediation and/or moderation effect of IPs on pain and disability, a multiple baseline Single Case Experimental Design (SCED) can be used to screen and measure patients’ individual prognostic factors for recovery before, during and after an intervention. In this study we use matched-care physiotherapy as the intervention for patients with persistent LBP and dysfunctional levels of IPs. In order to analyze the results from our experiment in this study, we pose the following three research questions:
1. Do pain intensity, physical function and pain interference change significantly during and after matched-care physiotherapy treatment?
2. Do Illness Perceptions mediate the effect of matched-care physiotherapy on pain intensi- ty, physical function and pain interference?
3. Do baseline Illness Perceptions moderate the effect of matched-care physiotherapy on pain intensity, physical function and pain interference?
Methods
This study is designed according to The Single-Case Reporting Guideline In Behavioural Inter- ventions (SCRIBE) checklist38 and six primary care physiotherapy practices in The Netherlands participated. After a recruitment call on social media and within the professional network of the lead author (EdR), a group of physiotherapists signed up for a two day course, six hours/ day. Within the course, the aim of the study, the design and lay-out of the matched-care in- tervention (treatment package see paragraph 2.3) were addressed. After this course, six eligi- ble physiotherapists, each from different primary care physiotherapy practice, were included in the study after signing an informed consent. They had access to videos that summarized the discussed topics. The lead author was available at any time during the research period for support on the implementation of the project.
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