Page 153 - THE PERCEPT STUDY Illness Perceptions in Physiotherapy Edwin de Raaij

General discussion
The overall aim of the research presented in this thesis is to explore the contribution of Illness Perceptions (IPs) for the management of patients with musculoskeletal pain in primary physiotherapy care. IPs, or patients’ personal idea’s and thoughts about the symptoms they experience can be seen as one of the psychosocial factors by which variance in health related outcome in patients can be explained17,18 and are recognized as target for treatment15,24,27. For example, it is suggested that educating patients on dysfunctional IPs about musculoskeletal pain (MSP) is associated with better physical and somatic outcomes and lower pain levels3,6.
Musculoskeletal conditions are one of the main contributors to Global Burden of Diseases causing many years lived with disability 4,39. Disability-adjusted life years for musculoskeletal disorders rose between 2006-2016 with 61.6 percent 4. In health-care systems, primary care practitioners, including physiotherapists are important providers of care in treating patients with musculoskeletal disorders.
As a result of the ongoing burden of MSP, management of musculoskeletal conditions evolved from a traditional mechanical/structural approach to a more biopsychosocial approach 5,12,19,22,29,31. This shift also implies incorporating patient’s perceptions about their condition and possible treatments. For example, exploring patients’ fear avoidance is well-documented in literature, and recently it is proposed to see this as a patients’ common-sense Response to deal with low back pain. 8,11. This makes IPs an interesting field for physiotherapists to explore.
IPs belong to the core concepts in the Common Sense Model of self-regulation of health and Illness (CSM), developed by Leventhal21. The CSM is based on a parallel processing model, de- scribing behavior in Response to health threats. In this model, a health threat is hypothesized to generate both cognitive representations (danger and/or control) and emotional states of fear and distress (fear control). Based on initial clinical research evidence, five IP dimensions have been identified.
1. Identity : the label or name given to the illness by patients and the symptoms that are perceived to go with it
2. Timeline : how long the patient believes the illness or symptoms will last
3. Consequences : how strong the impact of the patient’s illness is on, for example, pain
or physical function
4. Causal : the patient’s beliefs about what causes the illness
5. Control : the patient’s beliefs about how to control or recover from the illness
General discussion
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