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Training General Practitioners in the Treatment of Functional Somatic Symptoms...

Discussion in 'Latest ME/CFS Research' started by Esther12, Jul 31, 2010.

  1. Esther12

    Esther12 Senior Member

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    I can't get over how happily they spin their results:

    http://content.karger.com/ProdukteD...howAbstract&ArtikelNr=313691&ProduktNr=223864

    Background: Patients with medically unexplained or functional somatic symptoms (FSS) are prevalent in primary care. In this pragmatic cluster-randomised controlled trial we aimed to test the effect of a training programme (The Extended Reattribution and Management model) for general practitioners (GPs) in the treatment of FSS. Methods: 38 participating GPs were randomised to the control group or the training group. The GPs included consecutive 18- to 65-year-old patients presenting during a 3-week period for new health complaints. We assessed a stratified subsample with the psychiatric interview Schedules of Clinical Assessment in Neuropsychiatry. Of 701 patients interviewed, 350 fulfilled the diagnostic criteria for any ICD-10 somatoform disorder (SD) and 111 presented FSS without fulfilling these criteria (sub-threshold SD). Patients completed questionnaires at baseline and after 3, 12 and 24 months. The questionnaires included assessment of health status (36-item Medical Outcomes Study Short Form; SF-36), health anxiety (Whiteley-7) and physical symptoms (Symptom Check List-90, somatization subscale). Results: Patients with SD consulting trained GPs improved more on our primary outcome of physical functioning than patients consulting control GPs at the 3-month follow-up (p = 0.004), but the improvement was not statistically significant at later follow-up. We found no significant differences in improvement between patients with SD and those with sub-threshold SD. Results for other SF-36 subscales, physical symptoms and health anxiety only showed statistically significant differences between the intervention and control groups for patients with SD; patients consulting trained GPs had less improvement in vitality, health anxiety and physical symptoms at 24 months compared with the control group. Conclusions: GP training may accelerate improvement in physical functioning for patients with SD. However, the effect is small and may not be clinically significant.
  2. paddygirl

    paddygirl Senior Member

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    Are they saying that half those patients had SD? The arrogance of it. I wonder did it occur to them that the reason there was not much improvement in the group was that these people had genuine problems.
  3. Dolphin

    Dolphin Senior Member

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    Firstly, the full text is available for free at that link if anyone is interested.

    Good point. I know Fink is a "hardliner".

    Vol. 79, No. 4, 2010
    Regular Article

  4. Dolphin

    Dolphin Senior Member

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    There was also an unsuccessful trial of re-attribution training in the UK

    This used to be listed on the CFS/ME page of the Medical Research Council (MRC) in the UK as I recall.

    Full free text at: http://bjp.rcpsych.org/cgi/content/full/191/6/536

  5. Sean

    Sean Senior Member

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    How the hell did that get through peer review? By any fair standard it should have read something like:

    Conclusions: Active intervention in the form of GP training produced a worse outcome than in the untreated control arm. The implications of this need further investigation.

    Preferably by researchers with no vested interest in the outcome.

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