Self-Help for Medically Unexplained Symptoms: A Systematic Review and Meta-Analysis

Gils, Anne van; Schoevers, Robert A.; Bonvanie, Irma J.; Gelauff, Jeannette M.; Roest, Annelieke M.; Rosmalen, Judith

doi:10.1097/psy.0000000000000325

Cited by 44 publications

(31 citation statements)

References 44 publications

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“…This minimal intervention did not seem potentially effective and a more intensive intervention is required. This contradicts findings reported by van Gils et al who concluded that self-help was associated with a significant reduction in symptom severity and improvement in quality of life for people with MUS [ 20 ].…”

Section: Discussioncontrasting

confidence: 81%

“…A systematic review and meta-analysis published by van Gils et al (2013) concluded that self-help (designed to be conducted independently from healthcare workers) compared with usual care or waiting list, was associated with lower symptom severity and higher QoL directly post treatment, irrespective of amount of therapist content for adults with MUS [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

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Integrated GP care for patients with persistent physical symptoms: feasibility cluster randomised trial

et al. 2020

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Background Patients continue to suffer from medically unexplained symptoms otherwise referred to as persistent physical symptoms (PPS). General practitioners (GPs) play a key role in the management of PPS and require further training. Patients are often frustrated with the care they receive. This study aims to assess the acceptability of an ‘integrated GP care’ approach which consists of offering self-help materials to patients with PPS and offering their GPs training on how to utilise cognitive behavioural skills within their consultations, as well as assessing the feasibility of conducting a future trial in primary care to evaluate its benefit. Methods A feasibility cluster randomised controlled trial was conducted in primary care, South London, UK. GP practices (clusters) were randomly allocated to ‘integrated GP care plus treatment as usual’ or ‘treatment as usual’. Patients with PPS were recruited from participating GP practices before randomisation. Feasibility parameters, process variables and potential outcome measures were collected at pre-randomisation and at 12- and 24-weeks post-randomisation at cluster and individual participant level. Results Two thousand nine hundred seventy-eight patients were identified from 18 GP practices. Out of the 424 patients who responded with interest in the study, 164 fully met the eligibility criteria. One hundred sixty-one patients provided baseline data before cluster randomisation and therefore were able to participate in the study. Most feasibility parameters indicated that the intervention was acceptable and a future trial feasible. 50 GPs from 8 GP practices (randomised to intervention) attended the offer of training and provided positive feedback. Scores in GP knowledge and confidence increased post-training. Follow-up rate of patients at 24 weeks was 87%. However estimated effect sizes on potential clinical outcomes were small. Conclusions It was feasible to identify and recruit patients with PPS. Retention rates of participants up to 24 weeks were high. A wide range of health services were used. The intervention was relatively low cost and low risk. This complex intervention should be further developed to improve patients’/GPs’ utilisation of audio/visual and training resources before proceeding to a full trial evaluation. Trial registration NCT02444520 (ClinicalTrials.gov).

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Section: Discussioncontrasting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Integrated GP care for patients with persistent physical symptoms: feasibility cluster randomised trial

et al. 2020

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“…Third, developing effective dissemination strategies to actually reach patients with evidence-based approaches. Innovative examples addressing both clinicians and patients include mental health consultations in primary care, self-help, e-health interventions, and networks facilitating referral (11, 12). A central conclusion from our discussion was that individuals with PSS appear to be a non-identified patient group within many European health care systems: They rarely reach specialized care, but are widely treated by other health care providers and probably seek help outside the medical health care system (e.g., complementary and alternative medicine).…”

Section: Discussionmentioning

confidence: 99%

Health Care for Persistent Somatic Symptoms Across Europe: A Qualitative Evaluation of the EURONET-SOMA Expert Discussion

2018

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Background: Persistent somatic symptoms (PSS), referred to as somatoform disorders and lately somatic symptom disorders, are frequent but often remain under-recognized and under-treated. Although European guidelines overlap, presumably, there is large diversity in their practical use and in the actual health care situation. The aim of this qualitative evaluation was to compare health care for PSS across 9 European countries, to illustrate commonalities and differences, and to discuss challenges for a pan-European research agenda.Methods: A case vignette fulfilling ICD-10 criteria of undifferentiated somatization disorder was presented to 24 experts from 9 European countries, who completed a semi-structured assessment regarding the routine management including diagnostic procedures, treatment recommendations, and country-specific health care aspects. A qualitative evaluation was conducted using the video-transcripts of the presentations. Results were validated by additional expert interviews.Results: Across all countries, primary care physicians serve as the gate keeper for further diagnostic and treatment procedures. Apart from this commonality, there is a large variability in health care routines. Experts concluded that individuals with PSS appear to be a non-identified patient group within many European health care systems. To overcome the gap between evidence-based guidelines and clinical reality needs, three key challenges were identified: (1) Defining a clinically useful, acceptable, and non-stigmatizing diagnostic term, (2) implementing guideline recommendations into routine care, (3) developing effective dissemination strategies.Conclusions: The results advocate for more research on the actual European health care situation. A systematic European research agenda with unified goals and interdisciplinary collaboration that integrates all stakeholders could answer this challenge.

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“…The estimation of the necessary sample size was based on power calculations and evidence from previous studies. The effect sizes of interventions for persistent somatic symptoms have a wide range and depend on the condition of intervention, that is, somatic symptom reduction in functional somatoform syndromes in guided iCBT with effect sizes from d=0.1095 to d=1.21,96 aggregated effect sizes of self-help interventions in general (Hedge’s g=0.58)15 or of face-to-face CBT (d=0.38) 12. Based on these findings, a moderate effect size of d=0.50 is expected.…”

Section: Methodsmentioning

confidence: 99%

“…A growing body of evidence suggests the effectiveness of cognitive behavioural therapy (CBT) in SSDs with small-to-medium effect sizes,11 12 while the evidence for peripheral interventions (eg, medication, injections, operations) is controversial 13 14. Furthermore, self-help interventions have been shown to be effective in various somatoform disorders 15…”

Section: Introductionmentioning

confidence: 99%

Efficacy of a guided internet-based intervention (iSOMA) for somatic symptoms and related distress in university students: study protocol of a randomised controlled trial

Hennemann¹,

Böhme²,

Baumeister

et al. 2018

BMJ Open

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IntroductionPersistent and distressing somatic symptoms are common in younger age cohorts such as university students. However, the majority does not receive adequate psychosocial care. Internet-based and mobile-based interventions may represent low threshold and effective extensions to reduce somatic and associated mental symptom severity. The planned study aims to investigate the feasibility and efficacy of an internet-based intervention in reducing somatic and psychological symptoms in an international population of university students with somatic symptom burden.Methods and analysisThis parallel two-armed randomised controlled trial evaluates an 8-week guided intervention, including web-based consecutive modules based on cognitive behavioural therapy (CBT) principles against a waitlist control group. Guidance will be provided by trained psychologists with weekly written supportive feedback. As part of the ‘Studicare’ project, the present study aims to recruit n=154 university students indicating somatic symptom burden at baseline in German-speaking universities. Self-report assessments will take place at baseline and after intervention completion (8, 16 weeks after randomisation). The primary outcome will be the severity of somatic symptoms and associated mental distress. Secondary outcomes include depression, (health) anxiety, disability, intervention satisfaction and adherence.Ethics and disseminationEthics approval has been granted. Results from this study will be published in peer-reviewed journals and presented at international conferences.Trial registration numberDRKS00014375; Pre-results.

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Self-Help for Medically Unexplained Symptoms: A Systematic Review and Meta-Analysis

Abstract: Self-help is associated with a significant reduction in symptom severity and improvement of QoL. The methodological quality of included studies was suboptimal, and further research is needed to confirm the findings of this meta-analysis.

Cited by 44 publications

References 44 publications

Integrated GP care for patients with persistent physical symptoms: feasibility cluster randomised trial

Integrated GP care for patients with persistent physical symptoms: feasibility cluster randomised trial

Health Care for Persistent Somatic Symptoms Across Europe: A Qualitative Evaluation of the EURONET-SOMA Expert Discussion

Efficacy of a guided internet-based intervention (iSOMA) for somatic symptoms and related distress in university students: study protocol of a randomised controlled trial

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