illness perceptions? ‘the patient’s (hi)story’. behavior explanation interpretation,...

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

Contact

Nathalie.Roussel@uantwerpen.be