Abstract
BackgroundAlthough cognitive-behavioral therapy for Unexplained Physical Symptoms (UPS) is effective in secondary care, studies done in primary care produced implementation problems and conflicting results. We evaluated the effectiveness of a cognitive-behavioral group training tailored to primary care patients and provided by a secondary community mental-health service reaching out into primary care.Methodology/Principal FindingsThe effectiveness of this training was explored in a randomized controlled trial. In this trial, 162 patients with UPS classified as undifferentiated somatoform disorder or as chronic pain disorder were randomized either to the training or a waiting list. Both lasted 13 weeks. The preservation of the training's effect was analyzed in non-randomized follow-ups, for which the waiting group started the training after the waiting period. All patients attended the training were followed-up after three months and again after one year. The primary outcomes were the physical and the mental summary scales of the SF-36. Secondary outcomes were the other SF-36-scales and the SCL-90-R. The courses of the training's effects in the randomized controlled trial and the follow-ups were analyzed with linear mixed modeling. In the randomized controlled trial, the training had a significantly positive effect on the quality of life in the physical domain (Cohen's d = 0.38;p = .002), but this overall effect was not found in the mental domain. Regarding the secondary outcomes, the training resulted in reporting an improved physical (Cohen's d = 0.43;p = 0.01), emotional (Cohen's d = 0.44;p = .0.01), and social (Cohen's d = 0.36;p = 0.01) functioning, less pain and better functioning despite pain (Cohen's d = 0.51;p = <0.001), less physical symptoms (Cohen's d = −.23;p = 0.05) and less sleep difficulties (Cohen's d = −0.25;p = 0.04) than time in the waiting group. During the non-randomized follow-ups, there were no relapses.Conclusions/SignificanceThe cognitive-behavioral group training tailored for UPS in primary care and provided by an outreaching secondary mental-health service appears to be effective and to broaden the accessibility of treatment for UPS.Trial RegistrationTrialRegister.nl NTR1609 <rctview.asp?TC = 1609>
Highlights
The estimated prevalence of Unexplained Physical Symptoms (UPS) ranges from 18 to 74% in primary care [1,2,3], and from 30 to 52% in secondary care [4,5,6,7]
The follow-up ended in December 2009; one year after the intervention group of the last randomization had completed the training
Interpretation The effect of a cognitive-behavioral group training on the quality of life was studied in patients with UPS
Summary
The estimated prevalence of Unexplained Physical Symptoms (UPS) ranges from 18 to 74% in primary care [1,2,3], and from 30 to 52% in secondary care [4,5,6,7]. UPS is more prevalent in women than in men [7,8,9,10] and women in their forty’s seem to run a higher risk [2,10]. Cognitive-behavioral therapy for Unexplained Physical Symptoms (UPS) is effective in secondary care, studies done in primary care produced implementation problems and conflicting results. We evaluated the effectiveness of a cognitive-behavioral group training tailored to primary care patients and provided by a secondary community mental-health service reaching out into primary care
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