EIPQ-R or brief IPQ: Can we safely use it in patients with musculoskeletal disorders?   January 1st, 2015

In November 2015 a short summary of our review in Manual Therapy (Leysen et al. 2015) will be published in FysioPraxis (Fysiopraxis Nov. 2015, p39), the monthly magazine of physiotherapy in the Netherlands. 

The article addresses the Illness Perception Questionnaire Revised (IPQ-R) and the Brief Illness Perception Questionnaire (Brief IPQ). Both are questionnaires to explore the illness perceptions in patients. According to Leventhal's Common Sense Model, patients develop cognitions about their illness, based on former experiences, interpretation of symptoms and provided information. These cognitions are often referred to as illness perceptions.

These illness perceptions have been studied in several pathologies (e.g. cardiovascular disorders, respiratory disorders, musculoskeletal disorders). In a large prospective study with acute, sub-acute and chronic low back pain patients, negative illness perceptions were better predictors of disability at 6 months than fear avoidance, catastrophizing or depression (Foster et al. 2008Foster et al. 2010). In chronic pain patients, negative illness perceptions are associated with maladaptive illness behaviour, dysfunction, poor treatment adherence and treatment outcome (Spinhoven et al. 2004Edwards et al. 2006).

In order to evaluate the illness perceptions, the IPQ-R and Brief IPQ were developed. The IPQ-R consists of 3 domains: 

  1. Illness identity: subjective symptoms and their perceived relation to the pathology. 
  2. Beliefs domain: 38 statements about the beliefs and emotions of the patient regarding their pathology. 
  3. Causal domain: the perceived causes of the pathology. 
The Brief IPQ only consists of 9 questions and covers the same domains. 
Since the IPQ-R and Brief IPQ are general questionnaires, they can be adapted to target different pathologies. The causal and identity scales can be modified to suit particular illnesses, cultural settings or populations. 
Information on the clinimetric properties of the (adapted) questionnaires are scarce. Therefore we conducted a systematic literature search concerning the clinimetric properties of the IPQ-R and the Brief IPQ in patients with musculoskeletal pain. 
Results show that overall the IPQ-R is a reliable questionnaire. The internal consistency is good, except for the causal domain. This might be due to the variety of pathologies and the nature of this domain. 
The factor structure of the IPQ-R is unstable. Again, the variety of pathologies and changes made to the questionnaire can be an important issue. Furthermore, known group validity was assessed. There is a significant difference between chronic and acute patients on all dimensions. 
The Brief IPQ shows moderate test-retest reliability. The smallest detectable change is 42. Therefore, care must be taken when using the Brief IPQ to track changes. No articles were found about the validity of the Brief IPQ in patients with musculoskeletal pain. 
We demonstrated that the IPQ-R can be safely used to explore the illness perceptions of patients with musculoskeletal pain. More research is necessary concerning the clinimetric properties of the Brief IPQ in these patients. 

Marijke Leysen 

Who am I? I am currently making a joined PhD at the University of Antwerp and Brussels. This research project is under supervision of Dr. Nathalie Roussel (UAntwerpen), Dr. Jo Nijs (VUB) and Dr. C. Paul Van Wilgen (VUB) and is focusing on the illness beliefs regarding low back pain in patients and health care professionals. In addition to the research pillar, I am involved in the educational program of students physiotherapy at the faculty of medicine and health sciences in Antwerp, Belgium. 
2015 Pain in Motion

References and further reading: 

  • Leysen M, Nijs J, Meeus M, Paul van Wilgen C, Struyf F, Vermandel A, Kuppens K, Roussel NA. Clinimetric properties of illness perception questionnaire revised (IPQ-R) and brief illness perception questionnaire (Brief IPQ) in patients with musculoskeletal disorders: A systematic review. Man Ther. 2015 Feb; 20(1):10-7.
  • Moss-Morris, R, Weinman, J, Petrie, KJ, Horne, R, Cameron, LD, Buick, D. The revised illness perception questionnaire (IPQ-R). Psychology and Health 2002; 17(1): 1-16.
  • Broadbent, E, Petrie, KJ, Main, J, Weinman, J. The brief illness perception questionnaire. J Psychosom Res 2006; 60(6): 631-7. 
  • Leventhal H, Cameron LD. The self-regulation of health and illness behavior. Psychology Press. 2003
  • Foster, NE, Bishop, A, Thomas, E, Main, C, Horne, R, Weinman, J, Hay, E. Illness perceptions of low back pain patients in primary care: what are they, do they change and are they associated with outcome? Pain 2008; 136(1-2): 177-87.
  • Foster, NE, Thomas, E, Bishop, A, Dunn, KM, Main, CJ. Distinctiveness of psychological obstacles to recovery in low back pain patients in primary care. Pain 2010; 148(3): 398-406.
  • Spinhoven, P, Ter Kuile, M, Kole-Snijders, AM, Hutten Mansfeld, M, Den Ouden, DJ, Vlaeyen, JW. Catastrophizing and internal pain control as mediators of outcome in the multidisciplinary treatment of chronic low back pain. Eur J Pain 2004; 8(3): 211-9
  • Edwards, RR, Bingham, CO, 3rd, Bathon, J, Haythornthwaite, JA. Catastrophizing and pain in arthritis, fibromyalgia, and other rheumatic diseases. Arthritis Rheum 2006; 55(2): 325-32.
  • http://www.uib.no/ipq/ for different versions of the IPQ

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