Hedwig Neels

Physical therapists should integrate illness perceptions in their assessment in patients with chronic musculoskeletal pain; a qualitative analysis

In the past decade, scientific evidence has shown that the biomedical model falls short in the treatment of patients with musculoskeletal pain. To understand musculoskeletal pain and a patients health behavior and beliefs, physical therapists should assess the illness perceptions of their patients. In this quantitative study, we audiotaped the assessments of 19 primary care physical therapists on 27 patients and analyzed if and how illness perceptions were assessed. The Common Sense Model was used as the theoretical framework. We conclude that some of the domains of the Common Sense Model were frequently asked for (identity, causes and consequences), while others (timeline, treatment control, coherence, emotional representation) were used less frequently or seldom mentioned. The overall impression was that the assessments of the physical therapists were still bio-medically oriented in these patients with chronic musculoskeletal pain.

Knowledge of the pelvic floor in nulliparous women

[Purpose] Proper pelvic floor function is important to avoid serious dysfunctions including incontinence, prolapse, and sexual problems. The current study evaluated the knowledge of young nulliparous women about their pelvic floor and identified what additional information they wanted. [Subjects and Methods] In this cross-sectional survey, a validated, 36 item questionnaire was distributed to 212 nulliparous women. The questionnaire addressed demography, pelvic floor muscles, pelvic floor dysfunction, and possible information sources. Descriptive statistics were generated for all variables. Stability and validity testing were performed using Kappa statistics and intra class correlation coefficients to define agreement for each question. The study was approved by the ethics Committee (B300201318334). [Results] Using a VAS scale (0 to 10), the women rated their knowledge about the pelvic floor as a mean of 2.4 (SD 2.01). A total of 93% of the women were insufficiently informed and requested more information; 25% had concerns about developing urinary incontinence, and 14% about fecal incontinence. Many of the women were unaware what pelvic floor training meant. [Conclusion] There was a significant lack of knowledge about pelvic floor function among nulliparous women. The majority of nulliparous women expressed a need for education, which might offer a way to reduce dysfunction.

History taking by physiotherapists with low back pain patients: are illness perceptions addressed properly?

Abstract 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 Leventhal’s 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 Rehabilitation Belgian 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 physiotherapist’s 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.

Knowledge of the pelvic floor in menopausal women and in peripartum women

[Purpose] Pelvic floor dysfunction is an important health-care issue, with pregnancy, childbirth, and menopause as the most important risk factors. Insufficient knowledge about pelvic floor dysfunction is the largest barrier to seeking care. The aim of this study was to investigate the level of knowledge and information on pelvic floor dysfunction in peripartum and menopausal women. [Subjects and Methods] The present study was a cross-sectional survey. A valid and reliable questionnaire of 48 items was distributed to 402 women who were pregnant or had recently given birth and to 165 postmenopausal women. All answers were analyzed and interpreted. The study was approved by an ethics committee (B300201318334). [Results] On a VAS scale of 0 to 10, the mean ratings of the peripartum and postmenopausal women concerning their knowledge were 4.38 (SD 2.71) and 4.92 (SD 2.72). Peripartum women held significantly more pessimistic perceptions about the occurrence of postpartum pelvic floor dysfunction. The results showed that 75% of the peripartum women and 68% of the postmenopausal women felt insufficiently informed or want to get better informed. [Conclusion] The results reveal sparse knowledge about the pelvic floor among women of all ages and that a major proportion of them would be interested in more information. Amelioration of common knowledge could improve help-seeking behavior in women.

Do Illness Perceptions in Patients with Fibromyalgia Differ Across Countries? A Comparative Study

Abstract Objective: Illness perceptions, i.e. how patients think about their illness in terms of identity, cause and consequences, are important, as negative illness perceptions are associated with maladaptive illness behavior, more dysfunctioning, poor treatment adherence and treatment outcome. As illness perceptions are influenced by cultural background, former experiences and provided information, the aim of this study was to compare illness perceptions of patients with fibromyalgia syndrome [FMS] living in different countries. Methods: Dutch speaking participants from two countries were recruited in this international comparative study. In total, 114 Belgian [Flemish] and 283 Dutch FMS patients completed the Illness Perception Questionnaire for Fibromyalgia-Dutch Language version [IPQ-R FM-Dlv]. The Mann–Whitney U test for non-parametric data was used to compare data between the patient groups. Pearson’s chi-squared test was used to compare proportions. Results: Significant differences in illness perceptions were observed. Belgian patients reported a higher variety of symptoms and believed more strongly that these symptoms are related with their illness. They had more negative beliefs concerning the consequences of their illness and reported more external attributed factors to be the cause of their illness. Dutch patients demonstrated a better understanding and controllability. They indicated more internal attributed factors as a cause. Conclusions: These findings suggest that illness perceptions in patients with FMS are prone to local influences, including small differences in the health care system. Future studies are advised to measure mood, psychopathology, medical co-morbidity and socio-demographic factors and include them in a multivariate analysis.

Does pelvic floor muscle contraction early after delivery cause perineal pain in postpartum women

OBJECTIVE Pelvic floor muscle training is effective and necessary in the prevention and treatment of pelvic floor dysfunction during pregnancy and after childbirth. But because of the high prevalence of perineal pain observed in women after childbirth, many women and caregivers fear to start pelvic floor muscle training immediately after childbirth. However, it is unknown whether pelvic floor muscle contractions (PFMC) provoke perineal pain in women shortly after childbirth. Therefore, the main objective is to study whether PFMC performed immediately after childbirth is painful or not. STUDY DESIGN Observational longitudinal study. Perineal pain was assessed (1-6 days and 9 weeks postpartum) using a visual analogue scale (VAS 0-10) during PFMC and during several activities of daily living (ADL), during micturition and defecation. Descriptive statistics, Wilcoxon and McNemar tests were used. RESULTS A total of 233 women participated (148 primiparous and 85 multiparous). Immediately postpartum the prevalence and intensity of pain during ADL (73%; VAS 4.9 (±2.3)), micturition (47%; VAS 3.4 (±1.7)) and defecation (19%; VAS 3.6 (±2.2)) were significantly higher (all p<0.000) than during PFMC (8%; VAS 2.2 (±0.9)). At 9 weeks postpartum, 30% experienced perineal pain during sexual intercourse (VAS 4.6 +/- 2.3) and 18% during defecation (VAS 4.7 +/- 2.3), but none during PFMC. CONCLUSION Perineal pain is highly prevalent immediately after childbirth during ADL, micturition and defecation, but not during PFMC (only 8%). In case perineal pain occurs during PFMC, the intensity of pain is low (VAS 2). These results show that fear of perineal pain should not discourage women to start pelvic floor muscle training shortly after childbirth.

Vaginal wind: A literature review

OBJECTIVE In the medical literature, there is little known about vaginal wind, though from clinical expertise, it turns out to be a consistent and underreported problem. The aim of this review was to collect the available literature about the different aspects of vaginal wind. STUDY DESIGN A systematic literature search was conducted using three databases until December 2015. The search strategy was built using relevant synonyms of vaginal wind. Study characteristics were extracted. Risk of bias, the quality of the relevant studies and the level of evidence was judged. RESULTS Eleven studies met the inclusion criteria. Vaginal wind occurs on random movements and during or after coitus. The prevalence ranges from one to 69%. The pathophysiology is unclear and the incidence unknown. Known risk factors are vaginal delivery and urinary incontinence. Provoking factors are coitus, digital stimulation, cunnilingus and exercising. Female sexual function is decreased. The sexual function of male partners with vaginal wind is not influenced. Overall vaginal wind leads to a decrease in the quality of live and can have cause social isolation. The treatment is related to the cause and mainly not successful. Tampons can be used for treatment as well as prevention. CONCLUSION Vaginal wind is an underestimated health issue with a severe impact on sexual functioning. Adequate research is needed regarding the influence of sexual activity, weight, age, parity, the underlying pathophysiological mechanisms, prevention and treatment.