Page 60 - THE PERCEPT STUDY Illness Perceptions in Physiotherapy Edwin de Raaij

Chapter 3
cancer) and outcome measures on depression, anxiety, and quality of life. This means that the strength of the observed relations of illness perceptions with pain intensity and physical function in this review is comparable to those found in other studies on this topic.
Prognosis is the probable course and outcome of a health condition over time, and in explanatory prognostic research, 3 phases can be identified 20 : phase 1, identifying associations; phase 2, testing independent associations; and phase 3, understanding prognostic pathways. The authors identified no phase 3 studies, 9 phase 2 studies2,10,12,13,16,27,28,31,51,and 20 phase 1 studies4 .This means for phase 1 studies that illness perceptions, as prognostic factors, were reported without controlling for other prognostic factors. Therefore, the interpretation of reported associations and prognoses should be treated with caution.
This is the first review to the authors’ knowledge that focuses on the relationship between illness perceptions and pain intensity and physical function in individuals with musculoskeletal pain. The search strategy was designed in collaboration with a librarian information specialist (J.M.). It is known that the contribution of a librarian information specialist in designing a search strategy for systematic reviews is highly correlated with the quality of the reported search strategy47. Therefore, the authors consider their search strategy a strong element of the study. The risk-of-bias assessment was performed according to the recommendation of Hayden et al22, and led to determination of high risk of bias for all studies but 1.
A cutoff point of 9 on a 15-item scale (60%) as indicating a low-risk-of-bias study, while the present study did not employ a total score to indicate overall study quality. As a result, this assessment of risk of bias may be called stric The quality of the studies included in this review is not in line with the reported study quality found in another review on prognostic factors of musculoskeletal pain1. After performing a sensitivity analysis, that study used t, a characteristic that should be considered when interpreting conclusions about the quality of each individual study included in this review.
There are several limitations of this systematic review to be considered. First, the diversity of musculoskeletal pain condi- tions included may have influenced this synthesis. However, despite this diversity, the direction of the association is consistent throughout the included studies. Second, the strength of the association could not be assessed in a meta-analysis; therefore, a qualitative analysis of the data was performed. Because of this limitation, the authors cannot report on the strength of the pooled association or prognostic factor. The association of illness perceptions with prognosis for pain intensity and physical function, though small in strength for cross-sectional studies and limited in evidence for longitudinal
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