Illness perceptions? ‘The Patient’s (hi)story’

Behavior Explanation Interpretation, Representation Ideas, Beliefs, Cognitions about illness Importance of ideas and perceptions regarding the illness Patient

Leventhal’s Common Sense Selfregulation Model Representation of the illness Action planning Monitoring succes or failure Nerenz & Leventhal 1983 Leventhal 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

COGNITIONS

Leventhal’s Common Sense Selfregulation Model COGNITIONS PERCEPTIONS Illness Perception Questionnaire – Revised This 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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