Page 147 - THE PERCEPT STUDY Illness Perceptions in Physiotherapy Edwin de Raaij

the treatment-phase.
• Treatment-phase
By a number of tools, the patients’ knowledge and perceptions about their pain condition will be discussed. Important part of the intervention will be pain neuroscience education. Main message will be that pain mainly is about being a symptom that is formed from past experiences, sensory input and contextual circumstances14, not about tissue damage alone.
The Operant-based strategy
Is based on the Operant Learning Theory (OLT) introduced by Fordyce for managing chronic pain3. The use of OLT has been shown to be useful4, treatment is advised to be customized to the bio-psych-social needs of the patient12.
• Diagnostic-phase
The Phoda will be used to rate the level of patients’ fear related avoidance of daily activities. The outcome of this method, 3-5 most highly feared daily activities, together with The Brief-IPQ-DLV baseline scores will be selected to be expose the feared activities with movement/exercise related OLT.
• Treatment-phase
Exposure with movement will be used to adjust patients’ fear and beliefs about the harmfulness of the daily activity. There will be no upfront defined route of ‘graded exposure’ before the treatment session. The start of the exposure will always be aimed on the least feared activity first but might be directly followed with the most feared activity, depending on the pace in which patients’ fear and beliefs are responding.
The respondent-based strategy
Is based on safety behaviour expression, such as propping with hands and avoiding loading painful body part13.
• Diagnostic-phase
The diagnostics is primarily done via observation by the physiotherapist during interview, examination and treatment. These observations will focus on safety and communication behaviors and sympathetic responses.
• Treatment-phase
Cited from O’sullivan 2018: “These observations then form the basis of a series of guided behavioral experiments. These guided experiments explicitly seek to reduce sympathetic responses and abolish safety and communicative behaviors (via relaxed diaphragmatic breathing, body relaxation, awareness, and control), prior to and while gradually exposing individuals to their feared, avoided, and painful tasks.”
A multiple baseline single-case experimental design
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