@Maxwhd highlighted this on Twitter. Then @dxrevisionwatch found some more info.
The NIHR along with the MRC are the two main ways UK taxpayers' money is spent on health and medical research
http://www.nets.nihr.ac.uk/projects/hta/142608
The NIHR along with the MRC are the two main ways UK taxpayers' money is spent on health and medical research
http://www.nets.nihr.ac.uk/projects/hta/142608
HTA - 14/26/08: Medically unexplained symptoms(MUS): primary care intervention
Project title Medically unexplained symptoms(MUS): primary care intervention
Research type Evidence Synthesis
Status Waiting to start
Start date September 2015
Publication date
September 2017
Cost £ 200,008.00
Chief Investigator Dr Joanna Leaviss
Co-investigators Dr Andrew Booth (University of Sheffield), Dr Marta Buszewicz (University College London), Ms Sarah Davis (University of Sheffield), Professor Rona Moss-Morris (King's College London),Professor Glenys Parry (University of Sheffield), Dr Alison Scope (University of Sheffield), Mrs Andrea Shippam (University of Sheffield), Professor Matt Stevenson (University of Sheffield),Miss Anthea Sutton (University of Sheffield), Professor Peter White (Queen Mary University of London), Dr Shijie Ren (University of Sheffield)
Contractor University of Sheffield
Plain English summary
Individuals who often present to their GP with symptoms that can not easily be explained even after physical examination and tests may be referred to as having 'medically unexplained symptoms' (MUS). These symptoms can vary from individual to individual in terms of their number and severity, and some patients report 'clusters' of symptoms which have been given a variety of names such as fibromyalgia, irritable bowel syndrome, or chronic fatigue syndrome. Diagnosis can be made by a range of diagnostic criteria or by the GP expertise. MUS are a key feature of somatoform disorders, which must meet specific diagnostic criteria. There is variation in the usage of the term MUS. For the purposes of our review, we will use the term MUS to refer to all of the above diagnoses. Patients with MUS may place a large burden on the health services, with annual costs to the NHS estimated at £3.1 billion. This is due to increased GP visits and referrals for specialist tests or treatments. Current treatments include pharmacological, psychological or physical interventions. Reviews of the existing evidence for the effectiveness of these interventions tend to focus on the 'syndromes' (clusters of symptoms). Evidence of effectiveness is mixed, with some reviews showing small to moderate improvements in physical symptoms and functioning, and some showing no effect. These differing results may be due to factors such as the way the intervention is delivered, e.g. by a specialist or GP, in a group or individually, or by the way the condition is defined, e.g. as specific syndromes or 'MUS' in general. The most common interventions delivered in primary care tend to be psychological therapies such as cognitive behavioural therapy or reattribution therapy, or physical exercise therapies, or behaviour therapies. Many of these therapies aim to change problem behaviours of the individual that may be making their symptoms worse. There are benefits of these therapies being delivered in primary care. Sometimes people with MUS do not want to be referred to psychological services, as they feel that this means their symptoms are not being taken seriously. Therefore patients may be more ready to engage with these therapies if they are delivered within the primary care setting. There is no clear evidence about whether these therapies are effective when they are delivered in primary care. However, it has been suggested that the doctor-patient relationship plays an important role in their effectiveness. We propose a systematic review of the evidence of the effectiveness of such treatments, and an analysis of whether they offer good value. We will also look at how acceptable they are to patients. We will use rigorous methodology to conduct searches for all the evidence relating to behavioural modification intervention that are delivered in a primary care or community based setting. We will extract information about whether the intervention improves symptoms, functioning and health related quality of life, and what the barriers and facilitators to its effectiveness might be. We will then statistically analyse the data to obtain an overall effect. We will also conduct cost-effectiveness analyses to determine whether or not these interventions offer good value.
Scientific summary
The term MUS is used to cover a wide range of symptoms which cannot clearly be explained by a general medical condition, even after a thorough examination and any relevant investigations. A UK MUS prevalence rate of 18% of consecutive attenders to UK GP practices has been estimated (Taylor et al 2012). MUS costs the UK NHS in excess of £3.1 billion per annum and taking into account quality of life and sickness absence, wider costs to the economy reach £14 billion annually (Bermingham et al. 2010). A range of pharmacological, psychological and physical therapies have been implemented in the treatment of MUS. Behavioural Modification Interventions such as Cognitive Behavioural Therapy (CBT), Graded Exercise Therapy (GET), and behaviour therapies are commonly delivered in primary care. We will conduct a systematic review, using rigorous methods, of the evidence on the clinical, cost-effectiveness and acceptability of behavioural modification interventions for MUS in primary care and community-based settings. Search strategy: we will conduct a comprehensive search of bibliographic databases, combining terms for MUS and related synonyms and primary care setting. Searches will not be limited by intervention as we anticipate overlap between interventions and inconsistencies in labels and definitions. Methodological search filters will be applied to identify systematic reviews, RCTs, and qualitative research and cost-effectiveness where appropriate. Inclusion criteria: Intervention interventions that aim to modify behaviour will be included. These include CBT, GET, behaviour therapies. Where the intervention is not explicitly behaviour modification, we will adopt a broad inclusion criteria, with studies included if i) at least one primary outcome is a functional or behavioural change measure, or ii) the stated explicit aim of the intervention is to change behaviour. Population studies of populations meeting the criteria for MUS, MUPS, or somatoform disorders. Functional somatic syndromes will be included. Setting studies in primary care or community-based settings. Design Randomised Controlled Trials. Comparator usual care, treatment as usual, or wait list, trials with a placebo control. We will also include head to head trials. Outcomes improvement in symptoms, functioning and/or health related quality of life; use of healthcare resources. Quantitative synthesis: a random effects network meta-analysis will be used, providing the relevant RCTs form a network of evidence. The random effects pairwise comparison will allow heterogeneity in treatment effects across studies. Random effects pairwise meta-analysis will be performed when data do not form a network. Qualitative synthesis: A realist synthesis will be conducted to provide added value to the quantitative synthesis by indicating patient and service provider issues around the acceptability of interventions. Thematic synthesis will be used to aggregate the findings. Cost-effectiveness: evidence on cost-effectiveness will be identified by conducting a systematic review of existing economic analyses, and undertaking a de novo model based evaluation where there is a lack of relevant existing analyses. Costs will be evaluated from an NHS and personal social services perspective. Health benefits will be estimated using quality-adjusted life years (QALYS) gained. Future costs will be discounted at 3.5% in line with NICE s current guidance.
Documents
Protocol http://www.nets.nihr.ac.uk/__data/assets/pdf_file/0016/150181/PRO-14-26-08.pdf (PDF File - 118.5 KB)