Methods of Tertiary Prevention such as the type and stage of disease, the type of injury, and available methods of treatment. This chapter discusses DISEASE, ILLNESS, DISABILITY, AND DISEASE PERCEPTIONS 206 pportunities for tertiary prevention and provides specific clinical examples of disability limitation and rehabilitation IL. OPPORTUNITIES FOR TERTIARY PREVENTION 206 IlL. DISABILITY LIMITATION 207 207 . Risk Factor Modifie I. DISEASE, ILLNESS, DISABILITY, 2. Therapy 208 AND DISEASE PERCEPTIONS 3. Symptomatic Stage Prevention 208 B. Dyslipidemia 20 Although sometimes used interchangeably, there are impor- Assessment 209 tant distinctions among disease, disability, and illness. Typi 2. Therapy and Symptomatic Stage Prevention 210 cally, disease is defined as the medical condition or diagnosis C. Hypertension 210 itself (e. g, diabetes, heart disease, chronic obstructive lung 1. Assessment 210 disease). Disability is the adverse impact of the disease on 2. Therapy and Symptomatic Stage Prevention 210 objective physical, psychological, and social functioning. For D. Diabetes Mellitus 2lI example, although stroke and paralytic polio are different IV, REHABILITATION diseases, both can result in the same disability: weakness of one leg and inability to walk. Illness is the adverse impact of B. Coronary Heart Disease 212 a disease or disability on how the patient feels. One way te Rehabilitation for Other Diseases 214 distinguish these terms is to specify that disease refers to the Categories of Disability 214 medical diagnosis, disability to the objective impact on the patient, and illness to the subjective impact. V. SUMMARY 214 Disability and illness obviously derive from the medical REVIEW QUESTIONS, ANSWERS, AND EXPLANATIONS disease. However, illness is also powerfully influenced by atients' perceptions of their disease, its duration and sever ity, and their expectations for a recovery; together, these beliefs are called illness perceptions. Disease and illness In practice, tertiary prevention resembles treatment of estab- interact; a patient's illness perceptions strongly predict lished disease. The difference is in perspective. Whereas recovery, loss of work days, adherence, and health care utili treatment Is sly about"fixing what is wrong, tertiary zation. To be successful, tertiary prevention and rehabilita prevention looks ahead to potential progression and compl tion must not only improve patients' physical functioning, cations of disease and aims to forestall them. Thus, although but also influence their illness perceptions. Although there treatment and tertiary prevention often share methods, their is some evidence of effective psychological interventions on motives and goals diverge illness perceptions, a recent systematic review of interven Methods of tertiary prevention are designed to limit the tions of illness perceptions in cardiovascular health found physical and social consequences of disease or injury after it too much heterogeneity among studies to allow for general has occurred or become symptomatic. There are two basic conclusions. Despite the mixed quality of the data, the prac- categories of tertiary prevention. The first category, disabil- ticing clinician should consider the patients' illness percep ity limitation, has the goal of halting the progress of the tions, if only to understand which patients are at high risk disease or limiting the damage caused by an injury. Thi of poor outcomes. ategory of tertiary prevention can be described as the " pre ention of further impairment. The second categ rehabilitation, focuses on reducing the social disability pro duced by a given level of impairment. It aims to strengther l. OPPORTUNITIES FOR the patient's remaining functions and to help the patient TERTIARY PREVENTION learn to function in alternative ways. Disability limitation ind rehabilitation usually should be initiated at the same The first sign of an illness provides an excellent opportunity time (i.e, when the disease is detected or the injury occurs), to initiate methods of tertiary prevention. The sooner dis- but the emphasis on one or the other depends on factors ability limitation and rehabilitation are begun, the greater 206