Page 162 - THE PERCEPT STUDY Illness Perceptions in Physiotherapy Edwin de Raaij

Chapter 8
intensity, physical functioning or global perceived effect. Accordingly, no recommendations can be given for the preferred use of the 4DSQ or the Brief IPQ-DLV to assess psychological factors. One could argue that the level of patient and administrative burden is in favor of the 9-item Brief IPQ-DLV in with respect to 50-item 4DSQ 1.
The role of IPs as possible mediator has still to be researched. We recommend future re- search with suitable designs that can look at changeability and possible effectiveness of high IPs in patients with musculoskeletal pain.
Discussion
Most IPs did not show an added predictive value on poor recovery. The increase of explained variance is small and most of the variance remains unexplained. This is also seen in the in- crease of the Area Under the Curve: just 2-3 percent after adding the IPs. Furthermore, from our data a higher score on Treatment Control (hypothesized as higher chance for poor re- covery) showed lower odds for poor recovery. This is not in line with research in patients attending a general physician, an inpatient rehabilitation program or an acupuncturist for low back pain reporting higher scores on IPs to be predictive for more limitations in phys- ical functioning in low back pain3,10,15,16. We researched outpatients receiving usual physical therapy care for a wide range of MSP, which makes comparison of results difficult. Looking at the difference between good and poor clinical recovery of Treatment Control scores we see very small differences. This means that, although Treatment Control has an added predictive value, the clinical implication of our research on poor recovery prediction related to this IP is limited.
Methodological considerations
Our data originates from a convenient sample of patients who were treated in primary care by physiotherapists undergoing a 3-year master program at the University of Applied Scienc- es Utrecht. In this cohort study we looked at which patients, undergoing physiotherapy treat- ment, could be identified at baseline as being at risk for poor outcome. This means that we assumed that the physiotherapy treatment would have an effect on changing dysfunctional perceptions and improve treatment outcomes, although we did not have control on the con- tent of the treatment delivered (usual care). Within our design, we did not have consecutive datapoints in time in order to address a mediation effect. We advise future studies on the effect of physiotherapy to address the possible mediation effect of IPs in an effect study with a repeated measure design.
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