title: Blended care; development of a day treatment program for medically unexplained physical symptoms (MUPS) in the Dutch Armed Forces.
abstract: BACKGROUND
  A subgroup of servicemen can be identified that seek a disproportionally amount of health care in comparison to diagnostic and therapeutic perspectives. This group can be identified on the basis of an absence of a structural medical explanation for their symptoms. The symptoms manifest predominantly as fatigue and pain, and are often chronic. Patients with medical unexplained medical symptoms (MUPS) often have multiple and complex problems that would be best treated by a multidisciplinary team of medical specialists and paramedics. The military is characterized by high loyalty towards peers and leadership, leading to neglect for personal care.
  
  
  OBJECTIVE
  While consensus on the biological basis for these complaints is lacking, awareness on the need for effective treatments for this patient group is high.
  
  
  METHODS
  Based on reviews, expert recommendations and clinical demand, a specialized treatment program for soldiers with MUPS has recently been developed and implemented in the system of health care in the Netherlands Armed Forces. We developed a functional rehabilitation program with blended care elements of cognitive behavioral therapy (CBT), physical therapy, case management, and psychoeducation, embedded in a day treatment setting.
  
  
  RESULTS
  The program received high scores on participant as well as team satisfaction. The program is illustrated by two clinical vignettes.
  
  
  CONCLUSIONS
  The blended care program for MUPS that focused on allostatic load awareness offered a more holistic and preventive approach that contributed to a reduction of unnecessary medical consumption, and increased job participation. We recommend that the development of guidelines for diagnoses and treatment of these complaints in military settings will improve the quality of patient care, reduce disability, facilitate reintegration, and encourage scientific research.
authors.affiliation: Department of Defense, Central Military Hospital, Utrecht, The Netherlands.
authors.forename: M M P
authors.initials: MM
authors.lastname: Zeylemaker
authors.affiliation: Department of Defense, Central Military Hospital, Utrecht, The Netherlands.
authors.forename: F H H
authors.initials: FH
authors.lastname: Linn
authors.affiliation: Department of Defense, Military Mental Health Research, Utrecht, The Netherlands Department Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Vermetten
mesh_terms: D000328:Adult; D000069537:Adult Day Care Centers / Q000379:methods*; D019090:Case Management; D015928:Cognitive Behavioral Therapy / Q000379:methods; D005221:Fatigue / Q000150:complications / Q000209:etiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D008889:Military Personnel / Q000523:psychology*; D009426:Netherlands; D010146:Pain / Q000150:complications / Q000209:etiology; D010817:Physician-Patient Relations; D013001:Somatoform Disorders / Q000150:complications* / Q000523:psychology* / Q000628:therapy; D016896:Treatment Outcome
keywords: Multiple unexplained physical symptoms (MUPS); allostatic load; assessment; blended care; functional impairment; holistic approach; multidisciplinary