http://repub.eur.nl/res/aut/25415/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/38948/ 2013-02-27T00:00:00Z Unexplained Physical Symptoms (UPS) are physical symptoms that cannot be fully explained by a known medical condition. This definition can be refined with supplements such as a minimum number and/or duration of physical symptoms, and/or a certain level of functioning. Depending on these supplements, the estimated prevalence of UPS ranges from 20 to 74% in primary care [85], and from 30 to 52% in secondary care [83; 112; 123; 161]. UPS is more prevalent in women than in men [14; 68; 86; 112; 135; 165] and women in their forties seem to run the highest risk [38; 58; 79; 86; 135]. The comorbidity of DSM-IV Axis I and II disorders in patients with UPS is high: 26 to 58% of patients have a comorbid depressive and/or anxiety disorder [14; 38; 99] and 37 to 88,6% have a comorbid personality disorder [37; 56; 57; 66; 76; 95; 100; 114; 127; 157]. The number of comorbid anxiety and depression disorders in patients with UPS is higher than that in ‘comparable’, organically explained diseases, for example irritable bowel syndrome versus inflammatory bowel disease or fibromyalgia versus rheumatoid arthritis [67]. The number of comorbid personality disorders in patients with UPS is higher than that in patients with a mood and/or anxiety disorder [56]. Also, the number of comorbid somatic disorders in patients with UPS is significantly higher than that in general primary-care patients [14; 165]. http://repub.eur.nl/res/pub/28356/ 2010-11-01T00:00:00Z The prevalence of unexplained physical symptoms (UPS) in primary care is at least 33%. Cognitive behavioural therapy has shown to be effective. Within cognitive behavioural therapy, three models can be distinguished: reattribution model, coping model and consequences model. The consequences model, labelling psychosocial stress in terms of consequences rather than as causes of UPS, has high acceptance among patients and is effective in academic medical care. This acceptance is lost when applied in primary care. To increase acceptance of the consequences model among patients in primary care, we tailor this model to patient's perspective by approaching the model from bottom-up instead of top-down. Subsequently, we use this tailored model in an easily accessible group training. We illustrate our approach using two illustrative cases. http://repub.eur.nl/res/pub/20859/ 2009-07-01T00:00:00Z Abstract: BACKGROUND: In primary care, up to 74% of physical symptoms is classified as unexplained. These symptoms can cause high levels of distress and healthcare utilization. Cognitive behavioral therapy has shown to be effective, but does not seem to be attractive to patients. An exception herein is a therapy based on the consequences model, which distinguishes itself by its labeling of psychosocial distress in terms of consequences rather than as causes of physical symptoms. In secondary care, 81% of the patients accepts this therapy, but in primary care the outcome is poor. We assume that positive outcome can also be reached in primary care, when the consequences model is modified and used bottom-up in an easily accessible group training, in which patients are relieved of being blamed for their symptoms. Our aim is to investigate the (cost-)effectiveness of this training. METHODS AND DESIGN: A randomized controlled trial is designed. One hundred patients are randomized to either the group training or the waiting list. Physicians in general practices and outpatients clinics of general hospitals refer patients. Referral leads to inclusion if patients are between 18 and 65 years old, understand Dutch, have no handicaps impeding participation and the principal DSM-IV-TR classification is undifferentiated somatoform disorder or chronic pain disorder. In contrast to other treatment effect studies, the co-morbidity of a personality disorder does not lead to exclusion. By this, we optimize the comparability between the study population and patients in daily practice enlarging the generalization possibilities. Also in contrast to other effect studies, we chose quality of life (SF-36) instead of physical symptoms as the primary outcome measure. The SF-6D is used to estimate Quality Adjusted Life Years (QALYs). Costs are measured with the Trimbos/iMTA Questionnaire for Costs associated with Psychiatric Illness. Measurements are scheduled at baseline, after the training or waiting list, three and twelve months after the training. The differences between measurements are analyzed according to the intention-to-treat principle. The cost-effectiveness is expressed as costs per QALY, using multiple sensitivity analyses on the basis of a probabilistic model of the trial. DISCUSSION: If we show that our group training is (cost-)effective, more patients could be served, their quality of life could be improved while costs might be reduced. As the training is investigated in a heterogeneous patient group in the daily practice of a mental healthcare institution, its transfer to practice should be relatively easy. TRIAL REGISTRATION: Nederlands Trial Register, NTR1609.