Page 165 - THE PERCEPT STUDY Illness Perceptions in Physiotherapy Edwin de Raaij

Summary of main findings
Nine patients with persistent back pain were included by six different primary care physio- therapists. These patients were measured several times before, during and after treatment, resulting in 196 data points. For all three primary outcomes (pain intensity, physical function- ing and pain interference in daily life) there was a significant treatment effect during treat- ment which continued after treatment. Adjustment for fear of movement, catastrophizing, avoidance, somberness and sleep slightly attenuated the results. Overall, the effect of all 3 primary outcomes during treatment did not wash-out within 3-months post treatment and all three primary outcomes maintained a clinical meaningful improvement of ≥ 30% from baseline.
Regarding the mediation effect of IPs, expressed as percentage of the total effect of the inter- vention on the three outcomes our data showed the following results: for the IP dimensions Consequences (45-56%), Personal Control (11-19%), Identity (41-60%), Concern (15-34%) and Emotional Response (12-38%).
As for the moderating effect of IPs on the three outcomes, Personal Control acted as a moder- ator for all three primary outcomes, with clinically relevant changes 3-months post treatment (≥30% improvement from baseline).
Discussion
The findings of this study might be heuristic for future research to focus on how targeting a treatment on dysfunctional IPs could potentially influence pain and physical functioning. This SCED study was especially designed to match a patient’s needs to specific treatment strate- gies and treatment modalities. To apply such strategies requires a physiotherapist who is able to address patients’ specific needs and is able to choose relevant strategies for intervention that matches these needs. These needs can be found in dysfunctional IPs. For instance, a patient with safety behaviors may avoids certain movements such as bending forward based on dysfunctional IPs on the dimensions of Consequences, Personal Control, Identity, Concern and Emotional Response. The physiotherapist has to reason by which strategy (cognitive, exposure or respondent) this patient is best managed in order to change the dysfunctional IPs. This suggests that physiotherapists need a variety of competences in order to be able to deliver such approach and this may not be present without specific education.
Methodological considerations
In the paper several issues were already discussed. Here we would like to address additional considerations. For instance, the decision of the therapist to apply a certain cognitive, ex-
General discussion
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