In this thesis, a Dutch version of the Brief IPQ is presented to assess IPs in daily physiotherapy practice in The Netherlands. Further, a literature overview of the existing associations and prognosis of IPs on MSP and functioning is presented, and these associations in primary physiotherapy care in The Netherlands are explored. The impact of a matched care physiotherapy package, matched to dysfunctional IPs, and MSP and physical functioning is studied. In this thesis, three themes (ie. measurement, association / prediction and treatment) are explored for their contribution to physiotherapy management of MSP in general, and especially for low back pain
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Purpose: Despite the increasing evidence that illness perceptions should be addressed in patients, there is a lack of studies evaluating whether physiotherapists question illness perceptions. This study, using a mixed-methods design, investigates the integration of illness perceptions during the first consultation of physiotherapists treating patients with low back pain (LBP). Methods: Thirty-four physiotherapists performed usual history taking in a patient with non-specific LBP. The interview was audiotaped and illness perceptions were indexed using an observational instrument, based on the domains of Leventhals Common Sense Model. Patients were also asked to fill in the Illness Perception Questionnaire-Revised for LBP. Results: Physiotherapists assessed the illness identity, also perceptions regarding the (physical) cause and controllability of LBP were evaluated. Illness perceptions, such as timeline, consequences, coherence and emotional representation, were poorly assessed. Results of the questionnaire reveal that LBP-patients report overuse, workload and bad posture as primary cause. Patients held positive beliefs about the controllability and have high illness coherence. Conclusion: Belgian physiotherapists mainly question bio-medically oriented illness perceptions, e.g. physical symptoms and causes, but do not sufficiently address psychosocially oriented illness perceptions as recommended in LBP guidelines.Implications for RehabilitationBelgian physiotherapists mainly question biomedical oriented illness perceptions (illness identity, provoking factors and treatment control) in patients with low back pain (LBP) during the history taking (i.e. the first consultation).From a bio-psycho-social view psychosocially oriented illness perceptions should be incorporated in the daily routine of physiotherapists to comply with the bio-psycho-social treatment guidelines for LBP.Continuing education is mandatory in order to improve physiotherapists knowledge regarding the use of all dimensions of illness perceptions in the assessment of patients with LBP.
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Introduction: Illness Perceptions (IPs) may play a role in the management of persistent low back pain. The mediation and/or moderation effect of IPs on primary outcomes in physiotherapy treatment is unknown. Methods: A multiple single-case experimental design, using a matched care physiotherapy intervention, with three phases (phases A-B-A’) was used including a 3 month follow up (phase A’). Primary outcomes: pain intensity, physical functioning and pain interference in daily life. Analyzes: linear mixed models, adjusted for fear of movement, catastrophizing, avoidance, sombreness and sleep. Results: Nine patients were included by six different primary care physiotherapists. Repeated measures on 196 data points showed that IPs Consequences, Personal control, Identity, Concern and Emotional response had a mediation effect on all three primary outcomes. The IP Personal control acted as a moderator for all primary outcomes, with clinically relevant improvements at 3 month follow up. Conclusion: Our study might indicate that some IPs have a mediating or a moderating effect on the outcome of a matched care physiotherapy treatment. Assessing Personal control at baseline, as a relevant moderator for the outcome prognosis of successful physiotherapy management of persistent low back pain, should be further eplored.
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