Medically Unexplained Symptoms Clinical Trial
— PsySomOfficial title:
Psychosomatic Therapy, Feasibility and Cost Analysis, a Pilot Randomised Trial
Medically unexplained symptoms (MUS) are a common and important problem in primary care.
Patients repeatedly presenting MUS to their general practitioner (GP) suffer from their
symptoms, are functionally impaired, and are at risk of unnecessary and possibly harmful
tests, referrals and treatment. Evidence indicate that specific interventions for patients
with MUS, such as reattribution therapy and cognitive behavioural therapy are of limited
help. According to experts in this field a multi-component approach is most helpful for
these patients.
This pilot trial aims to test the systematic identification of eligible patients, to assess
the acceptability of the intervention and to estimate potential treatment effects for a
larger trial.
It's a randomised pilot study consisting of patients with MUS in primary care. Patients will
be randomized to intervention (usual care and additional psychosomatic therapy) or control
condition (usual care alone). Patients will be followed for one year.
Participants are patients consulting their GP more than once with MUS and in which the GP
presumes that psychosocial distress is an underlying cause.
The intervention is the psychosomatic therapy delivered by a psychosomatic therapist,
consists of a combination of information and education, relaxation therapy and mindfulness,
cognitive approaches and activating therapy. This multi-component approach is captured into
a protocol in which therapists are able to modify the treatment in order to deliver a
tailor-made treatment for patients with MUS.
Primary outcome measures are: the number of patients identified and recruited, perceived
symptom severity, measured on a Visual Analogue Scale (VAS) and patients' self-rated
symptoms of distress, depression, anxiety and somatization (4DSQ: The Four Dimensional
Symptom Questionnaire). Other primary outcome measures are the time needed to include the
eligible patients, the number of withdrawals in the intervention and control group,
compliance in the therapy group and the number of patients who complete the questionnaires.
Secondary outcome measures are: symptoms of hyperventilation (NHL: Nijmegen Hyperventilation
List), physical and mental health status and quality of life (SF-36), and level of
functioning (MAF: measure of general functioning). Patient satisfaction with the received
therapy is rated on a 5-point Likert-type scale. Medical consumption will be measured by the
Cost Diary for medical consumption.
Status | Completed |
Enrollment | 42 |
Est. completion date | February 2015 |
Est. primary completion date | December 2014 |
Accepts healthy volunteers | No |
Gender | Both |
Age group | 18 Years to 80 Years |
Eligibility |
Inclusion Criteria: patients with medical unexplained symptoms who consulting the general practitioner more than once for one or more of the 12 most common symptoms: - stomach-/abdominal pain, - back/neck/shoulder pain, - pain in arms/legs/joints, - headache, chest pain, - dizziness, - fainting spells, - palpitations of the heart, - shortness of breath, - nausea/indigestion, - feeling tired, - sleeping disorder and psychosocial distress Exclusion Criteria: - patients wich chronic diseases, - palliative care, - severe psychiatric disorders, - long-lasting injury treatment - patients who are not able to speak, read and write Dutch |
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
Country | Name | City | State |
---|---|---|---|
Netherlands | General Practitioner, Douwes Dekker | Albergen | Overijssel |
Netherlands | General Practitioner, Hesselink | Borne | Overijssel |
Netherlands | M. Oijevaar | Borne | |
Netherlands | General Practitioner,Tuijnenburg | Enschede | Overijssel |
Netherlands | General Practitioner, Kleissen | Haaksbergen | Overijssel |
Netherlands | General Practitioner, van der Waart | Hengelo | Overijssel |
Netherlands | D.J. Jansen | Julianadorp | |
Netherlands | General Practitioner, Van Rijn | Vriezenveen | Overijssel |
Lead Sponsor | Collaborator |
---|---|
Radboud University |
Netherlands,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Medical consumption | Medical consumption will be measured by the Cost Diary for medical consumption. | at baseline, at 3, 6 and 12 months | No |
Other | Baseline characteristics of the participants | Patient satisfaction with the received therapy is rated on a 5-point Likert-scale | at baseline, at 3, 6 and 12 months | No |
Primary | The number of patients identified and recruited | The number of patients identified and recruited by the GP | one year | No |
Primary | The time needed to include the eligible patients | The time needed to include the eligible patients by the GPs | one year | No |
Primary | The number of withdrawals in both groups | the number of patients that withdraw from the study in both groups | one year | No |
Primary | Perceived symptom severity | Perceived symptoms severity by patients | one year | No |
Primary | Patients' self-rated symptoms of distress, depression, anxiety and somatization | Patients' self-rated symptoms of distress, depression, anxiety ansd somatization measured with the Four Dimensional Symptom Questionnaire (4DSQ) | one year | No |
Secondary | Symptoms of hyperventilation | symptoms of hyperventilation measured by the NHL (Nijmegen Hyperventilation List) according to patients | at baseline, at 3, 6 and 12 months | No |
Secondary | Physical and mental status and quality of life | Physical and mental health status and quality of life according to patients are measured by the SF-36 | at baseline, at 3, 6 and 12 months | No |
Secondary | Level of functioning | Level of functioning according to patients are measured by the MAF (measure of general functioning) | at baseline, at 3, 6 and 12 months | No |
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