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Cochrane Database of Systematic Reviews

Enhanced care by generalists for functional somatic symptoms and disorders in primary care

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Information

DOI:
https://doi.org/10.1002/14651858.CD008142Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 07 October 2009see what's new
Type:
  1. Intervention
Stage:
  1. Protocol
Cochrane Editorial Group:
  1. Cochrane Common Mental Disorders Group

Copyright:
  1. Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Marianne Rosendal

    Correspondence to: Research Unit for General Practice, Institute of Public Health, Aarhus University, Århus, Denmark

    [email protected]

  • Chris Burton

    Community Health Sciences, General Practice Section, Edinburgh, UK

  • Annette H Blankenstein

    Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, Netherlands

  • Per Fink

    Research Clinic for Functional Disorders and Psychosomatics, Århus University Hospital, Århus, Denmark

  • Kurt Kroenke

    Department of Medicine and Regenstrief Institute, Indiana University, Indianapolis, USA

  • Michael Sharpe

    Department of Psychiatry, University of Oxford, Oxford, UK

  • Morten Frydenberg

    Department of Biostatistics, Institute of Public Health, Århus University, Århus, Denmark

  • Richard Morriss

    Psychiatry, University of Nottingham, Nottingham, UK

Contributions of authors

Marianne Rosendal and Chris Burton wrote the protocol draft, other authors contributed with critical feedback and discussions of methods. All authors accepted the final version of the protocol.

Sources of support

Internal sources

  • Research Unit for General Practice, Århus, Denmark.

  • Community Health Sciences, General Practice Section, University of Edinburgh, UK.

  • Department of General Practice, EMGO Instituut (VU), Amsterdam, Netherlands.

  • The Research Clinic for Functional Disorders and Psychosomatics, Århus University Hospital, Denmark.

  • Department of Medicine and Regenstrief Institute, Indiana University, USA.

  • School of Molecular & Clinical Medicine, University of Edinburgh, UK.

  • Department of Biostatistics, Institute of Public Health, University of Århus, Denmark.

  • Department of Psychiatry, University of Nottingham, UK.

External sources

  • No sources of support supplied

Declarations of interest

Marianne Rosendal has been actively participating in the evaluation of RCTs cited in this review and is currently involved in the development of treatment guidelines for Danish primary care. The working hours spent on this Cochrane review has been part of standard employment at the Research Unit for General Practice. No other conflicts of interest known.

Chris Burton: no conflicts of interest known.

Nettie Blankenstein has been the primary researcher in one of the RCTs on reattribution cited in this review. Currently, she is involved in the development of a multi‐disciplinary treatment guideline on somatoform symptoms and disorders for Dutch primary and secondary health care. She has contributed to the development of a training course for general practitioners on cognitive‐behavioural treatment for functional symptoms. Her contribution to this Cochrane review is part of her employment at the department of general practice of the VU university medical center. No further conflicts of interest known.

Per Fink has been involved in RCTs on treatment of medically unexplained symptoms in primary care and is currently participating in the development of treatment guidelines for Danish primary care. No other conflicts of interest known.

Kurt Kroenke has had research support from Eli Lilly and Pfizer and honoraria from them plus Forest in relation to research in depression. No other conflicts of interest known.

Michael Sharpe: no conflicts of interest known.

Morten Frydenberg: no conflicts of interest known.

Richard Morriss has been the chief investigator of one of the RCTs cited in this review as well as a previous non‐randomised treatment trial. No other conflicts of interest known.

Version history

Published

Title

Stage

Authors

Version

2013 Oct 18

Enhanced care by generalists for functional somatic symptoms and disorders in primary care

Review

Marianne Rosendal, Annette H Blankenstein, Richard Morriss, Per Fink, Michael Sharpe, Christopher Burton

https://doi.org/10.1002/14651858.CD008142.pub2

2009 Oct 07

Enhanced care by generalists for functional somatic symptoms and disorders in primary care

Protocol

Marianne Rosendal, Chris Burton, Annette H Blankenstein, Per Fink, Kurt Kroenke, Michael Sharpe, Morten Frydenberg, Richard Morriss

https://doi.org/10.1002/14651858.CD008142

Keywords

MeSH

Medical Subject Headings Check Words

Adult; Humans;

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Table 1. Instruments for the assessment and sampling of functional somatic symptoms and disorders (preliminary overview)

Type of instrument

Name

references

Questionnaire

Abridged criteria

Escobar 1989

 

PHQ‐15

Kroenke 2002

 

SCL‐som

Derogatis 1977

 

Whiteley‐7

Fink 1999

Interview

SCAN

World Health Organisation 1998 

 

DIS

Eaton 2000; Robins 1989

 

CIDI

Andrews 1995; World Health Organisation 1990

Health care use

Frequent attendance

Blankenstein 2001; Katon 1992;Portegijs 1996; Schilte 2001

The table may be supplemented by specific instruments for functional somatic syndromes

The final review will also include a table of names and classification terms

Figures and Tables -
Table 1. Instruments for the assessment and sampling of functional somatic symptoms and disorders (preliminary overview)
Table 2. Data extraction form

Rubric

Reviewer 1

Reviewer 2

Conclusion

Author name

 

 

 

Title of paper

 

 

 

Name of study

 

 

 

Personal notes (e.g. name of disorder used)

 

 

 

Reason for exclusion

 

 

 

Study characteristics

 

 

 

 

Assessment of methods (table 2)

 

 

 

 

Setting of the study (the primary care organisation)

 

 

 

 

Level of randomisation and measures of clustering

 

 

 

 

The risk of contamination (control patients receiving intervention unintentional or vice versa)

 

 

 

 

Doctor characteristics and sampling (previous training, years in practice, GP age)

 

 

 

 

Patient characteristics (inclusion, exclusion, ethnicity, diagnosis, symptom duration, psychiatric co‐morbidity) and sampling (population screening, waiting room screening, GP assessment, diagnostic instruments used)

 

 

 

 

Intervention* in active group

 

 

 

 

Intervention in control group

 

 

 

 

Outcome measure and instrument for assessment (primary outcome, secondary outcome, subgroups)

 

 

 

 

Length of maximum follow‐up

 

 

 

 

Results

 

 

 

* Interventions

  • Training (duration, content, skills training, supervision)

  • Treatment model: reattribution and how close it is to the original, psychosocial interventions other than reattribution). To which degree does the model for patients stipulate that physical symptoms are secondary to psychosocial distress.

  • Clinicians (GP, nurse, other)

  • Organisation (flagging of patients, consultation duration, number of consultations, no changes)

Figures and Tables -
Table 2. Data extraction form