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

Esther12

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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.
 

paddygirl

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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.
 

Dolphin

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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

Training General Practitioners in the Treatment of Functional Somatic Symptoms: Effects on Patient Health in a Cluster-Randomised Controlled Trial (the Functional Illness in Primary Care Study)
Tomas Tofta, Marianne Rosendalb, Eva rnbla, Frede Olesenb, Lisbeth Frostholma, Per Finka

aResearch Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, and
bResearch Unit for General Practice, Aarhus University, Aarhus, Denmark
 

Dolphin

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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

Br J Psychiatry. 2007 Dec;191:536-42.

Cluster randomised controlled trial of training practices in reattribution for medically unexplained symptoms.

Morriss R, Dowrick C, Salmon P, Peters S, Dunn G, Rogers A, Lewis B, Charles-Jones H, Hogg J, Clifford R, Rigby C, Gask L.

Division of Psychiatry, School of Community Health Sciences, University of Nottingham, South Block, A Floor, Queen's Medical School, Nottingham, NG7 2UH, UK. richard.morriss@nottingham.ac.uk

Abstract

BACKGROUND:
Reattribution is frequently taught to general practitioners (GPs) as a structured consultation that provides a psychological explanation for medically unexplained symptoms.

AIMS:
To determine if practice-based training of GPs in reattribution changes doctor-patient communication, thereby improving outcomes in patients with medically unexplained symptoms of 3 months' duration.

METHOD:
Cluster randomised controlled trial in 16 practices, 74 GPs and 141 patients with medically unexplained symptoms of 6 hours of reattribution training v. treatment as usual.

RESULTS:
With training, the proportion of consultations mostly consistent with reattribution increased (31 v. 2%, P=0.002).

Training was associated with decreased quality of life (health thermometer difference -0.9, 95% CI -1.6 to -0.1; P=0.027) with no other effects on patient outcome or health contacts.

CONCLUSIONS:
Practice-based training in reattribution changed doctor-patient communication without improving outcome of patients with medically unexplained symptoms.
 

Sean

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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.
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.
 

Esther12

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Was there a thread collecting BPS spin? I couldn't remember where it was, but just found this thread from five (long) years ago, and thought I'd bump it, as it's funny.