Effective Group Training for Patients with Unexplained Physical Symptoms: A Randomized Controlled Trial with a Non-Randomized One-Year Follow-Up

Zonneveld, Lyonne N. L.; Rood, Yanda R. van; Timman, Reinier; Kooiman, Cornelis G.; Spijker, Adriaan van’t; Busschbach, Jan J. V.

doi:10.1371/journal.pone.0042629

Cited by 28 publications

(24 citation statements)

References 70 publications

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“…Apart from chronic pain, arthritis and digestive diseases were also significant physical disorders. Pain disorders and gastrointestinal complaints have been described as some of the most frequent somatic symptoms among the attendees of specialty clinics and are particularly likely to remain unexplained (41), resulting in increasing disability and a higher utilization of health care, which is commonly unsatisfactory (42). The self-perceived health disability of digestive diseases was the highest among all disorders considered herein at the individual level, dropping to fifth in the rank at the societal level due to the low prevalence of these disorders.…”

Section: Discussionmentioning

confidence: 99%

Days out-of-role due to common physical and mental health problems: Results from the São Paulo Megacity Mental Health Survey, Brazil

Andrade¹,

Baptista²,

Alonso³

et al. 2013

Clinics

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OBJECTIVES:To investigate the relative importance of common physical and mental disorders with regard to the number of days out-of-role (DOR; number of days for which a person is completely unable to work or carry out normal activities because of health problems) in a population-based sample of adults in the São Paulo Metropolitan Area, Brazil.METHODS:The São Paulo Megacity Mental Health Survey was administered during face-to-face interviews with 2,942 adult household residents. The presence of 8 chronic physical disorders and 3 classes of mental disorders (mood, anxiety, and substance use disorders) was assessed for the previous year along with the number of days in the previous month for which each respondent was completely unable to work or carry out normal daily activities due to health problems. Using multiple regression analysis, we examined the associations of the disorders and their comorbidities with the number of days out-of-role while controlling for socio-demographic variables. Both individual-level and population-level associations were assessed.RESULTS:A total of 13.1% of the respondents reported 1 or more days out-of-role in the previous month, with an annual median of 41.4 days out-of-role. The disorders considered in this study accounted for 71.7% of all DOR; the disorders that caused the greatest number of DOR at the individual-level were digestive (22.6), mood (19.9), substance use (15.0), chronic pain (16.5), and anxiety (14.0) disorders. The disorders associated with the highest population-attributable DOR were chronic pain (35.2%), mood (16.5%), and anxiety (15.0%) disorders.CONCLUSIONS:Because pain, anxiety, and mood disorders have high effects at both the individual and societal levels, targeted interventions to reduce the impairments associated with these disorders have the highest potential to reduce the societal burdens of chronic illness in the São Paulo Metropolitan Area.

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Section: Discussionmentioning

confidence: 99%

Days out-of-role due to common physical and mental health problems: Results from the São Paulo Megacity Mental Health Survey, Brazil

Andrade¹,

Baptista²,

Alonso³

et al. 2013

Clinics

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“…The data for this study came from a randomized controlled trial on the effectiveness of cognitive-behavioral group training (CBT) for patients with UPS [22]. Patients with UPS were randomized either to CBT or to a waiting list after they had completed the baseline measurement (T0).…”

Section: Methodsmentioning

confidence: 99%

“…In the present study, the PCS was chosen as outcome measurement, because patients reported the quality of life in the physical domain as most burdensome. The group training significantly improved quality of life in the physical domain, and this positive effect was maintained during the entire one-year follow-up period [30]. …”

Section: Methodsmentioning

confidence: 99%

Predicting the outcome of a cognitive-behavioral group training for patients with unexplained physical symptoms: a one-year follow-up study

Zonneveld

Rood

Kooiman³

et al. 2012

BMC Public Health

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BackgroundAlthough Cognitive-Behavioral Therapy (CBT) is effective for Unexplained Physical Symptoms (UPS), some therapists in clinical practice seem to believe that CBT outcome will diminish if psychiatric comorbidity is present. The result is that patients with a psychiatric comorbidity are redirected from treatment for UPS into treatment for mental health problems. To explore whether this selection and allocation are appropriate, we explored whether CBT outcomes in UPS could be predicted by variables assessed at baseline and used in routine-practice assessments.MethodsPatients (n=162) with UPS classified as undifferentiated somatoform disorder or chronic pain disorder were followed up until one year after they had attended a CBT group training. The time-points of the follow-up were at the end of CBT (immediate outcome), three months after CBT (short-term outcome), and one year after CBT (long-term outcome).CBT outcome was measured using the Physical Component Summary of the SF-36, which was the primary outcome measure in the randomized controlled trial that studied effectiveness of the CBT group training. Predictors were: 1.) psychological symptoms (global severity score of SCL-90), 2.) personality-disorder characteristics (sum of DSM-IV axis II criteria confirmed), 3.) psychiatric history (past presence of DSM-IV axis I disorders), and 4.) health-related quality of life in the mental domain (mental component summary of SF-36). The effect of this predictor set was explored using hierarchical multiple regression analyses into which these predictors had been entered simultaneously, after control for: a.) pretreatment primary outcome scores, b.) age, c.) gender, d.) marital status, and e.) employment.ResultsThe predictor set was significant only for short-term CBT outcome, where it explained 15% of the variance. A better outcome was predicted by more psychological symptoms, fewer personality-disorder characteristics, the presence of a psychiatric history, and a better quality of life in the mental domain.ConclusionsAs the predictors do not seem to predict CBT outcome consistently over time, the need for selection and allocation of patients for CBT is doubtful. It seems that this would unnecessarily deprive patients of effective treatment.Trial registrationNederlands Trial Register, NTR1609

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“…Based on previous findings, we aim to detect a clinically relevant effect size of 0.4. This effect size was previously shown to be feasible in a similar population [18]. The clinically relevant difference on the PCS ranges from 3 to 5 points [51].…”

Section: Methodsmentioning

confidence: 99%

The CIPRUS study, a nurse-led psychological treatment for patients with undifferentiated somatoform disorder in primary care: study protocol for a randomised controlled trial

Sitnikova

Leone

Zonneveld

et al. 2017

Trials

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BackgroundUp to a third of patients presenting medically unexplained physical symptoms in primary care may have a somatoform disorder, of which undifferentiated somatoform disorder (USD) is the most common type. Psychological interventions can reduce symptoms associated with USD and improve functioning. Previous research has either been conducted in secondary care or interventions have been provided by general practitioners (GPs) or psychologists in primary care. As efficiency and cost-effectiveness are imperative in primary care, it is important to investigate whether nurse-led interventions are effective as well. The aim of this study is to examine the effectiveness and cost-effectiveness of a short cognitive behavioural therapy (CBT)-based treatment for patients with USD provided by mental health nurse practitioners (MHNPs), compared to usual care.MethodsIn a cluster randomised controlled trial, 212 adult patients with USD will be assigned to the intervention or care as usual. The intervention group will be offered a short, individual CBT-based treatment by the MHNP in addition to usual GP care. The main goal of the intervention is that patients become less impaired by their physical symptoms and cope with symptoms in a more effective way. In six sessions patients will receive problem-solving treatment. The primary outcome is improvement in physical functioning, measured by the physical component summary score of the RAND-36. Secondary outcomes include health-related quality of life measured by the separate subscales of the RAND-36, somatization (PHQ-15) and symptoms of depression and anxiety (HADS). Problem-solving skills, health anxiety, illness perceptions, coping, mastery and working alliance will be assessed as potential mediators. Assessments will be done at 0, 2, 4, 8 and 12 months. An economic evaluation will be conducted from a societal perspective with quality of life as the primary outcome measure assessed by the EQ-5D-5L. Health care, patient and lost productivity costs will be assessed with the Tic-P.DiscussionWe expect that the intervention will improve physical functioning and is cost-effective compared to usual care. If so, more patients might successfully be treated in general practice, decreasing the number of referrals to specialist care.Trial registrationDutch Trial Registry, identifier: NTR4686, Registered on 14 July 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-1951-2) contains supplementary material, which is available to authorized users.

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Effective Group Training for Patients with Unexplained Physical Symptoms: A Randomized Controlled Trial with a Non-Randomized One-Year Follow-Up

Cited by 28 publications

References 70 publications

Days out-of-role due to common physical and mental health problems: Results from the São Paulo Megacity Mental Health Survey, Brazil

Days out-of-role due to common physical and mental health problems: Results from the São Paulo Megacity Mental Health Survey, Brazil

Predicting the outcome of a cognitive-behavioral group training for patients with unexplained physical symptoms: a one-year follow-up study

The CIPRUS study, a nurse-led psychological treatment for patients with undifferentiated somatoform disorder in primary care: study protocol for a randomised controlled trial

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