Effective group training for patients with unexplained physical symptoms: a randomized controlled trial with a non-randomized one-year follow-up.
BACKGROUND: Although 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...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2012-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC3413637?pdf=render |
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| author | Lyonne N L Zonneveld Yanda R van Rood Reinier Timman Cornelis G Kooiman Adriaan Van't Spijker Jan J V Busschbach |
| author_facet | Lyonne N L Zonneveld Yanda R van Rood Reinier Timman Cornelis G Kooiman Adriaan Van't Spijker Jan J V Busschbach |
| author_sort | Lyonne N L Zonneveld |
| collection | DOAJ |
| description | BACKGROUND: Although 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 FINDINGS: The 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/SIGNIFICANCE: The 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 REGISTRATION: TrialRegister.nl NTR1609 <rctview.asp?TC = 1609> |
| first_indexed | 2024-12-13T06:28:42Z |
| format | Article |
| id | doaj.art-e6a5c46fba4748ada7696c63437619bb |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-13T06:28:42Z |
| publishDate | 2012-01-01 |
| publisher | Public Library of Science (PLoS) |
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| spelling | doaj.art-e6a5c46fba4748ada7696c63437619bb2022-12-21T23:56:41ZengPublic Library of Science (PLoS)PLoS ONE1932-62032012-01-0178e4262910.1371/journal.pone.0042629Effective group training for patients with unexplained physical symptoms: a randomized controlled trial with a non-randomized one-year follow-up.Lyonne N L ZonneveldYanda R van RoodReinier TimmanCornelis G KooimanAdriaan Van't SpijkerJan J V BusschbachBACKGROUND: Although 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 FINDINGS: The 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/SIGNIFICANCE: The 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 REGISTRATION: TrialRegister.nl NTR1609 <rctview.asp?TC = 1609>http://europepmc.org/articles/PMC3413637?pdf=render |
| spellingShingle | Lyonne N L Zonneveld Yanda R van Rood Reinier Timman Cornelis G Kooiman Adriaan Van't Spijker Jan J V Busschbach Effective group training for patients with unexplained physical symptoms: a randomized controlled trial with a non-randomized one-year follow-up. PLoS ONE |
| title | Effective group training for patients with unexplained physical symptoms: a randomized controlled trial with a non-randomized one-year follow-up. |
| title_full | Effective group training for patients with unexplained physical symptoms: a randomized controlled trial with a non-randomized one-year follow-up. |
| title_fullStr | Effective group training for patients with unexplained physical symptoms: a randomized controlled trial with a non-randomized one-year follow-up. |
| title_full_unstemmed | Effective group training for patients with unexplained physical symptoms: a randomized controlled trial with a non-randomized one-year follow-up. |
| title_short | Effective group training for patients with unexplained physical symptoms: a randomized controlled trial with a non-randomized one-year follow-up. |
| title_sort | effective group training for patients with unexplained physical symptoms a randomized controlled trial with a non randomized one year follow up |
| url | http://europepmc.org/articles/PMC3413637?pdf=render |
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