title: Brief multimodal psychosomatic therapy in patients with medically unexplained symptoms: feasibility and treatment effects.
abstract: Patients repeatedly presenting with medically unexplained symptoms (MUS) to their GPs, suffer from their symptoms. Experts in the field suggest a multicomponent approach for these patients. Brief multimodal psychosomatic therapy (BMPT) is such an intervention.
  
  
  
  To test the systematic identification of eligible patients, acceptability of BMPT and potential treatment effects of BMPT.
  
  
  
  The participants in this randomized pilot trial, patients consulting their GPs more than once with MUS, were randomized to intervention [usual care (UC) and additional BMPT] or control condition (UC alone).We monitored the number of patients identified and recruited, trial recruitment and retention. Potential treatment effects were measured with perceived symptom severity [Visual Analogue Scale (VAS)]; patients' self-rated symptoms of distress, depression, anxiety and somatization [Four-Dimensional Symptom Questionnaire (4DSQ)]; symptoms of hyperventilation [Nijmegen Hyperventilation List (NHL)]; physical and mental health status and quality of life [Short-Form Health Survey-36 items (SF-36)]; and level of functioning (measure of general functioning). Follow-up was 1 year.
  
  
  
  A total of 42 patients could be included in the trial. Four patients withdrew after randomization and two patients were lost to follow-up, resulting in 36 patients (86%). During the 12-month follow-up after BMPT, there was an improvement in perceived symptom severity [adjusted mean difference -2.0, 95% confidence interval (CI) -3.6 to -0.3], in somatization (adjusted mean difference -4.4, 95% CI -7.5 to -1.4) and in symptoms of hyperventilation (adjusted mean difference -5.7, 95% CI -10.5 to -0.8).
  
  
  
  This randomized pilot study shows that a larger trial studying the effectiveness of BMPT in patients with MUS in primary care is feasible and useful.
authors.affiliation: Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Department of Exercise Therapy, ACHIEVE - Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, m.s.h.wortman@hva.nl.
authors.forename: Margreet S H
authors.initials: MS
authors.lastname: Wortman
authors.affiliation: Department of Primary and Community Care, Radboud University Medical Center, Nijmegen.
authors.forename: Peter L B J
authors.initials: PL
authors.lastname: Lucassen
authors.affiliation: Department of Psychiatry, Radboud University Medical Center, Nijmegen and.
authors.forename: Hiske J
authors.initials: HJ
authors.lastname: van Ravesteijn
authors.affiliation: Department of Primary and Community Care, Radboud University Medical Center, Nijmegen.
authors.forename: Hans
authors.initials: H
authors.lastname: Bor
authors.affiliation: Department of Primary and Community Care, Radboud University Medical Center, Nijmegen.
authors.forename: Pim J J
authors.initials: PJ
authors.lastname: Assendelft
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Cees
authors.initials: C
authors.lastname: Lucas
authors.affiliation: Department of Primary and Community Care, Radboud University Medical Center, Nijmegen.
authors.forename: Tim C
authors.initials: TC
authors.lastname: Olde Hartman
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology*; D003863:Depression / Q000523:psychology*; D015444:Exercise; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D000071896:Medically Unexplained Symptoms; D008875:Middle Aged; D009426:Netherlands; D010865:Pilot Projects; D011320:Primary Health Care; D011602:Psychophysiologic Disorders / Q000628:therapy*; D011614:Psychotherapy, Brief / Q000379:methods*; D011788:Quality of Life; D011795:Surveys and Questionnaires
keywords: Medically unexplained symptoms; physical activity/exercise; primary health care; psychosomatic therapy; somatoform disorders.