Page 27 - THE PERCEPT STUDY Illness Perceptions in Physiotherapy Edwin de Raaij

Cross-cultural adaptation and measurment properties
Introduction
Ever since the introduction of Engel’s Biopsychosocial Model7 emotions, thoughts, beliefs and behaviors are more and more accepted as important factors of health1. Understanding the patient’s subjective experience can be an essential contributor to accurate diagnosis and treatment3. In the field of manual and physical therapy a call for research including not only biomedical measurements but also psychosocial measurements is emerging18,22.
Illness perceptions (IPs), or patients’ personal thoughts about the symptoms they experience can be seen as one of the psychosocial factors by which variance in physical functioning in patients can be explained11. Illness perceptions are well recognized as target for treatment19,10,17. Nijs et al. recently discussed the importance of assessing IPs in this journal. They suggested the use of IPs in tailoring an educational program for patients with unexplained chronic musculoskeletal pain21.
IPs belong to the core concepts in the Common-Sense Model of Self-Regulation (CSM), developed by Leventhal16. The CSM is based on a parallel processing model,describing behavior in response to health threats. In this model, a health threat is theorized to generate both cognitive representations(danger control) and emotional states of fear and distress (fear control). Based on initial clinical research evidence15, five dimensions of illness perceptions 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
The assessment of illness perceptions has evolved from interviews to validated questionnaires13, three questionnaires can be discerned: IPQ, IPQ-R and Brief IPQ30. Weinman et al. (1996) published the Illness Perception Questionnaire (IPQ) in 1996 which explicitly assesses the five dimensions of illness perceptions. Empirical research with the IPQ20 made clear that some concepts needed to be assessed with additional subscales (e.g. Coherence). Therefore the IPQ was adapted and labeled as Revised Illness Perception Questionnaire (IPQ-R)20. In the IPQ-R, the Control dimension was split into the Personal Control dimension and Treatment Control dimension. The Timeline dimension was complemented with the Cyclical timeline
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