Page 164 - THE PERCEPT STUDY Illness Perceptions in Physiotherapy Edwin de Raaij

Chapter 8
Discussion
Changing dysfunctional IPs was the starting point for each treatment session, this shaped the communication and pointed out the direction to patient’s need for information. For instance, Concern scored high at baseline, accompanied by Causal attributions of injury and aging. Discussing these issues made it clear that she worried about more degeneration of her knee and that she thought exercise might damage the knee further. The patient also had a high score on Emotional Response and Consequences at baseline, indicating a high level of distress concerning her knee condition. The IPs gave direction to the communication and education about her Osteo Arthritis. This may have led to a shift in IPs. Conversely, it can also be argued that the applied co-interventions, i.e. exercise may have led to better physical functioning, thereby leading to a shift in IPs. The Causal pathway led to better functioning cannot be given.
Methodological considerations
The physiotherapist in our case report can be classified as an expert based on the criteria mentioned by Jensen et al20. Knowledge and skills in areas of patient-centeredness, clinical reasoning, clinical assessment and commitment to patient preferences and values are con- ditional. Physiotherapists should be taught in applying the process of participatory decision making and in addressing IPs as an attribute of patients’ health status.
Practical implications
The implications from this case report for physiotherapy management are limited, but our result stimulate further research on the possible attribution on changing dysfunctional IPs. Its mediation or moderation effect on health outcome is relevant for understanding pathways of the effect of IPs on outcomes. A better understanding of this pathway gives direction on how to interpret the importance of changing dysfunctional IPs for better health related outcomes.
2. Illness Perceptions mediate and moderate the effect of matched-care physiotherapy in patients with disabling persistent low back pain:
a multiple Single-Case Experimental Design in chapter 7.
Research questions:
• Do pain intensity, physical functioning and pain interference change significantly during
and after matched care physiotherapy treatment?
• Do Illness Perceptions mediate the relation between matched care physiotherapy with
pain intensity, physical functioning and pain interference?
• Do baseline Illness Perceptions moderate the effect of Illness Perceptions on pain inten-
sity, physical functioning and pain interference?
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