Authors' objectives: 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.

Project Status: Completed

URL for project: http://www.nets.nihr.ac.uk/projects/hta/142608

Year Published: 2020

URL for published report: http://www.nets.nihr.ac.uk/projects/hta/142608

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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