Page 146 - THE PERCEPT STUDY Illness Perceptions in Physiotherapy Edwin de Raaij

Chapter 7
Appendix B
Intervention
The intervention is based on usual care following the low back pain guideline of the Royal Dutch Physiotherapy Association16 and will target patients whom are classified in ‘patient profile 3’. This means that this study includes patients that have an abnormal course with dominant presence of psychosocial factors impeding recovery.
The intervention is considered to be delivered as proposed in the guideline, with an additional matched-care treatment package. This package focusses on patients’ specific Illness Perception (IPs) regarding his or her low back pain. This means if IPs are considered to be dysfunctional before and during treatment, these IPs will be seen as prognostic factor for poor recovery of pain intensity and physical function. The aim is to alter dysfunctional IPs to more functional perceptions by the advised strategies for consistent (back) pain 5,8,15,17. These cognitive, exposure and respondent strategies will be response guided at the beginning and during each intervention session.
The additional treatment package will be matched with the scores of the IPs before each treatment session. Patients whose score are within the 4th-quartile range (Box 1), are seen as indicative for dysfunctional IPs, will be challenged to rethink their perception by a combination of the three proposed strategies. This means that the physiotherapist together with the patient must decide on which strategy to start with and when to switch to another strategy. This decision-making process is an essential part of the intervention and will be shaped by shared decision-making2 and can be seen as a response guided intervention.
This treatment approach can be seen more as reflective than as descriptive. Meaning the patient guides her or his own meaningful and safe strategies to cope with their pain condition. The physiotherapist is more a reflective, instead of a problem-solving practitioner.
Treatment package
Each strategy within the treatment package consists of a diagnostic- and a treatment-phase. The diagnostic-phase determines if the strategy is indicated to be used and if so, the treatment phase will then deliver the treatment as intended within this specific strategy.
The cognitive-based strategy
Pain neuroscience education has been proven to be useful for reducing pain, improving patient knowledge of pain, improving function and lowering disability, reducing psychosocial factors, enhancing movement, and minimizing healthcare utilization 9.
• Diagnostic-phase
The revised neuro physiology pain questionnaire will be used for assessing patients’ baseline knowledge of pain physiology1. The outcome of this questionnaire, together with The Brief-IPQ-DLV baseline scores will be determining the content of
144