illness perceptions? ‘the patient’s (hi)story’. behavior explanation interpretation,...
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Illness perceptions? ‘The Patient’s (hi)story’
BehaviorExplanation
Interpretation, Representation
Ideas, Beliefs, Cognitions
about illness
Importance of ideas and perceptions regarding the illness
Patient
Leventhal’s Common Sense Selfregulation Model
Symptoms Perception Coping Appraisal
Representation of the illness
Action planning
Monitoring succes or failure
Nerenz & Leventhal 1983Leventhal 2003
This model identifies factors involved in the processing of information regarding the illness, how this information is integrated to provide a view of the illness and how this view guides behavior Hagger & Orbel 2003
Low back pain
It is a hernia
CopingPerception
MRI, avoid bending
The pain stays!l
Appraisal
CO
GN
ITIO
NS
Leventhal’s Common Sense Selfregulation Model
Low back pain
It is a hernia
I am sad and will not go out tonight
This is terrible
MRI, avoid bending
The pain stays!l
It is not going better
COGNITIONS
PERCEPTIONS
Illness Perception Questionnaire – RevisedThis IPQ-R should be adapted to the illness
Weinman 1996, Moss-Morris 2002
Components of illness perceptions
1. Illness identity (symptoms)
2. Beliefs Timeline Consequences Curability/controllability Coherence Emotional representation
3. Causal domain (causes)
IPQ-R
Leysen et al, Manual Therapy 2015
Importance of assessing illness perceptions in patients?
It determines the behavior of the patients!!!
1600 patients with LBP Questionnaire assessment during visit general practicioner
IPQ-R, pain catastrophizing, …. Follow-up after 6 months
Patients who expected their back problem to last a long time,
Patients who perceived serious consequences,
Patients who held weak beliefs in the controllability of their back problem
were more likely to have poor clinical outcomes 6 months after they consulted their doctor.
Foster et al, Pain, 2008
Low Back Pain
Observation of history taking during the first consultation of patients with LBP
Audiotaping & transcription of first consultation◦ Therapists not aware of purpose of the study◦ Illness perceptions mentioned during the interview were
inventoried afterwards using an observational instrument
Patients were asked to fill in the IPQ-R◦ To quantify the illness perceptions of the patients.
Roussel et al, Disability & Rehabilitation, 2015
Observation of subjective evaluation of 34 physiotherapists treating LBP
PTs assess◦Illness identity: pain, numbness, strength
◦Causes and controllability
PTs do not assess◦Timeline◦Consequence◦Coherence◦Emotional representation
Roussel et al, Disability & Rehabilitation, 2015
Observation of subjective evaluation of 34 physiotherapists treating LBP
These had a prognostic factor!!!
Negative illness perceptions are predictors of disability
But Belgian physiotherapists mainly question bio-medically oriented illness perceptions
They do not sufficiently address psychosocially oriented illness perceptions as recommended in low back pain guidelines
Roussel et al, Disability & Rehabilitation, 2015
Conclusion
Foster et al, Pain, 2008
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