Page 140 - THE PERCEPT STUDY Illness Perceptions in Physiotherapy Edwin de Raaij

Chapter 7
withdrawal of safety behavior strategy is justified20. Secondly, within the model of Illness Representations by Leventhal it is hypothesized that dysfunctional perceptions affect pain and limitations in physical functioning. The use of an IP threshold as an inclusion criterion implies good diagnostics for creating a window of opportunity to improve pain and physical functioning by altering IPs. Thirdly, this study is a good example of how to include physiother- apists’ clinical relevant decisions for avoiding problems concerning “reference class forecast- ing”. Such forecasting relies on prediction from past reference classes, a model which may not be the most suitable because of the large variability in clinical signs and symptoms in patients with low back pain. In our study we explicitly incorporated psycho-social elements which were relevant for that patient as was shown in their ‘risk-profile’.
Practical implications
The use of a matched-care physiotherapy treatment is accompanied by a decrease of pain and physical function related health problems in patients with persistent low back pain. This type of research, looking at treatments that incorporate a dynamic and cyclical process is a reproduction of daily physiotherapy practice. We would like to encourage this way of working and researching the effectiveness of physiotherapy.
In earlier research, we concluded based on a longitudinal study with two timepoints that baseline IPs did not predict poor recovery on pain and/or physical function after three months. The results of this study are not in line with these findings. For instance, dysfunctional baseline IP Personal control scores (7-10) moderate the effect significantly, meaning that physiotherapists could consider to use item 3 of the Brief IPQ-DLV for the baseline assessment of patients’ perceptions on controllability of their condition. A specific intervention targeting this dysfunctional perception might than be appropriate. Further, it can be considered to evaluate the change in the IPs dimension Consequences, Personal control, Identity, Concern and Emotional response during treatment because our results showed a mediating effect of change in these perceptions. If one of these perceptions does not change during treatment there might still be room for improvement by specifically targeting these perceptions with interventions. Thereby, applying the principles of matched-care treatment.
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