Page 85 - THE PERCEPT STUDY Illness Perceptions in Physiotherapy Edwin de Raaij

First, if dysfunctional IPs contribute to the burden of MSP, screening for these in patients with acute or sub-acute MSP might be advised and could be done by using validated questionnaires19,5,8. Second, considering IPs could be a supplementary procedure to the use of risk stratification tools, such as the Keele STarT MSK Tool or STarT Back Screenings Tool16,3 for predicting poor recovery from MSP. In this way, the assessment of IPs might contribute to the identification of possible relevant psychosocial risk factors for poor recovery from MSP.
Illness perceptions and pain intensity
The IP dimensions Consequences, Identity and Coherence explained an additional 13.3% to the initially-explained variance for pain intensity. As this is a rather substantial increase, this might imply that these IPs could potentially be relevant for the management of these patients. For instance, if a patient with MSP shows dysfunctional IPs, such as ‘My condition has a high impact on my daily life’ or ‘I don’t understand where my pain comes from’, these IPs could be risk factors for poor recovery and therefore should be assessed. Also, identifying dysfunctional IPs opens opportunities for treatment options in trying to change these perceptions. To our knowledge, no studies have to date researched associations of IPs with pain intensity, or the changing of dysfunctional IPs, within primary physiotherapy care8. Consequently, we recommend further research to explore the possibilities of identifying IPs as risk factors and to study the feasibility of changing dysfunctional IPs.
Illness perceptions and limitations in physical functioning
For physical functioning, the additional explained variance of the IP dimensions Consequences, Timeline, Personal Control, Identity and Emotional Response was 26.5%. This could mean that these IPs are potentially important for clinical practice. This is in line with the results from a RCT for persistent low back pain. A total of 10 – 14 hours of cognitive treatment of IPs by occupational therapists resulted in statistically-significant and clinically- relevant improvements in patient-relevant physical activities at 18 weeks25. Included were patients with persistent LBP of, on average, more than one year’s duration. We know of no intervention studies targeting high IP scores within a population having less than one year’s MSP. We recommend further exploration of the feasibility of changing IPs by physiotherapists for improving patients’ physical functioning, not only for persistent LBP but also for acute and sub-acute LBP.
Limitations and strengths
First, the cross-sectional design prevents a causal interpretation of the findings. The main aim of this study, however, was to explore whether IPs and, if so, which IPs were associated with pain intensity and physical functioning. Secondly, despite the large and geographically wide-
A cross-sectional study
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