Mobiele menu

Course of medically unexplained physical symptoms (MUPS) and underlying mechanisms, a long term follow-up study

Projectomschrijving

Aanhoudende lichamelijke klachten (ALK)

Aanhoudende lichamelijke klachten (ALK) komen vaak voor. Gelukkig gaan de klachten meestal vanzelf over. Sommige patiënten ontwikkelen echter langdurige klachten, dit kan leiden tot hoge ziektelast en ernstige beperkingen in het functioneren.

Verder onderzoek naar het beloop van ALK

Bij de behandeling wordt gebruik gemaakt van verschillende theorieën over in stand houdende mechanismen (zoals vicieuze cirkels in gedachten en gedrag). Het bewezen effect van deze behandelingen is echter beperkt. Een gebrek aan kennis over het beloop van ALK speelt hierbij een rol. Wie loopt risico op chronische klachten, en welke van de mechanismen spelen een rol bij het in stand houden van klachten?

Doel en verwachte opbrengst

De PROSPECTS-studie is een van de grootste ALK cohortstudies, gestart in 2013. Tot nu toe zijn de ongeveer 300 deelnemers 3 jaar gevolgd. Met de toegekende subsidie kan de totale follow-up verlengd worden tot 5 jaar. Dit levert unieke informatie op over het beloop van ALK op de lange termijn en de mechanismen die hierbij een rol spelen.

Producten

Titel: Fluctuations in persistent somatic symptoms: a patient perspective.
Auteur: Barends H, Walstock E, Botman F, de Kruif A, Claaassen N, van der Wouden H, olde Hartman T, Dekker J, van der Horst H.
Titel: Coordination of care when somatic symptoms persist: a patient's perspective.
Auteur: Barends H, Botman F, Walstock E, Claassen N, van der Wouden H, olde Hartman T, Dekker J, van der Horst H.
Titel: Potentially traumatic events, social support and symptom burden in patients with persistent somatic symptoms: a longitudinal study.
Auteur: H. Barends, N. Claassen-van Dessel, J. van der Wouden, J. Twisk, H. van der Horst, J. Dekker
Titel: Five-year trajectories of symptom severity, physical and mental functioning in patients with persistent somatic symptoms. A Latent Class Growth Model Analysis of the PROSPECTS cohort study.
Auteur: Barends H, van der Horst HE, van der Wouden JC, Claassen-van Dessel N, Dekker J, Hoekstra T.
Titel: Beloop en mechanismen van Aanhoudende Lichamelijke Klachten (ALK)
Auteur: Barends H
Titel: Impact of symptom focusing and somatosensory amplification on persistent physical symptoms: a three-year follow-up study.
Auteur: Barends H, Claassen-van Dessel N, van der Wouden JC, Twisk JWR, Terluin B, van der Horst HE, Dekker J.
Titel: Course of Medically Unexplained Symptoms (MUS) and underlying mechanisms, a long term follow up study: PROSPECTS cohort study.
Auteur: Barends H, Claassen-van Dessel N, van der Wouden JC, Dekker J, van der Horst HE
Titel: Fluctuations in persistent somatic symptoms: a patient perspective.
Auteur: Barends H, Walstock E, Botman F, de Kruif A, Claassen N, van der Wouden H, olde Hartman T, Dekker J, van der Horst H.
Titel: Somatosensory amplification in relation to symptom severity and functioning in patients with persistent physical symptoms: a cross-sectional analysis.
Auteur: Barends H, Claassen-van Dessel N, van der Wouden JC, Dekker J, van der Horst HE
Titel: Patients’ experiences with the course and fluctuations of persistent physical symptoms: a qualitative study
Auteur: Barends H, Walstock E, Botman F, de Kruif A, Claassen N, van der Wouden H, olde Hartman T, Dekker J, van der Horst H.
Titel: Potentially traumatic events, social support and burden of persistent somatic symptoms
Auteur: Barends H, van der Wouden JC, Claassen-van Dessel N, Twisk JWR, van der Horst HE, Dekker J.
Magazine: Journal of Psychosomatic Research
Titel: Lost in fragmentation - care coordination when somatic symptoms persist
Auteur: Barends H, Botman F, Walstock E, Claassen-van Dessel N, van der Wouden JC, Olde Hartman T, Dekker J, van der Horst HE
Magazine: British Journal of General Practice
Titel: Impact of symptom focusing and somatosensory amplification on persistent physical symptoms: A three-year follow-up study
Auteur: Barends H, Claassen-van Dessel N, van der Wouden JC, Twisk JWR, Terluin B, van der Horst HE, Dekker J
Magazine: Journal of Psychosomatic Research
Link: https://pubmed.ncbi.nlm.nih.gov/32473411/
Titel: Nieuw onderzoek naar beloop van SOLK
Auteur: Barends H
Magazine: Huisarts & Wetenschap
Titel: Patients' experiences with fluctuations in persistent physical symptoms: a qualitative study
Auteur: Barends H, Walstock E, Botman F, de Kruif A, Claassen N, van der Wouden JC, Olde Hartman T, Dekker J, van der Horst H
Magazine: BMJ Open
Titel: Head-to-head comparison of somatic symptom scales: The Patient Health Questionnaire (PHQ-15) and the somatization scale of the Four-Dimensional Symptom Questionnaire (4DSQ-S)
Auteur: Terluin B, Barends H, van der Horst HE, Dekker J, van der Wouden JC
Magazine: Journal of Psychosomatic Research

Verslagen


Samenvatting van de aanvraag

In all health care settings, patients frequently present with physical symptoms, such as fatigue, dizziness and pain, for which no sufficient somatic explanation is found after adequate medical examination. Such symptoms are called medically unexplained physical symptoms (MUPS). In most cases, the symptoms are self-limiting. However, when MUPS persist, they can be severe and disabling. Persistent MUPS is associated with a high risk of functional impairment and psychological distress, and extensive use of health care resources. Little is known about the long-term course of MUPS, the most prevalent course types, and the mechanisms underlying these course types. Such knowledge may help physicians to actively engage with their MUPS patients at an early stage in order consider possible interventions. Recent evidence from Cochrane systematic reviews has shown that various treatment modalities are available. It would be a waste of resources to offer treatment to MUPS patients when their symptoms are self-limiting or to offer a treatment that is not suited for that particular patient. Conversely, treatment should preferably be offered to those MUPS patients who are likely to have persistent symptoms or who deteriorate. Hence, providing physicians with tools to identify subgroups of MUPS patients that are prone to have persistent symptoms or to deteriorate will help to use health care resources more appropriately and efficiently. Several theoretical models have been proposed to explain the development and/or persistence of MUPS. However, testing these models in an empirical dataset has to the best of our knowledge not taken place so far. In addition to testing existing theoretical models, exploring the patients' perspective may also provide valuable insights into mechanisms that contribute to persistence or deterioration of MUPS. For the proposed study, our aims are threefold. First, we plan to extend the follow-up of an ongoing cohort study of MUPS patients, in order to gain insight in factors predicting the long-term course of MUPS symptoms (prognosis). Second, we will test several theoretical models that have been proposed explaining the mechanisms underlying the course of MUPS. Finally, we aim to assess the patients' perspective on the factors associated with an unfavourable course of their MUPS symptoms. The PROSPECTS observational cohort study started in 2012, and recruited 325 MUPS patients in primary, secondary and tertiary care settings. Inclusion and baseline measurements took place between July 2013 and February 2014, follow-up measurements took place 6, 12, 24 and 36 months after baseline. The last measurements at 36 months will take place in February 2017. The data collection mainly consisted of questionnaires assessing background characteristics, nature, duration and severity of MUPS symptoms, health care use and a large number of psychological characteristics (e.g. personality and coping). Besides, study participants provided saliva samples at baseline and after 12 months to determine the cortisol awakening response. Extending the follow-up of the PROSPECTS cohort with another 2 years, i.e. 5 years instead of 3 years follow-up, is a unique and efficient opportunity to provide insight into the long-term course of MUPS. We propose to test the value of three theoretical models in explaining the course of MUPS. These models are the somatosensory amplification model; the strength versus burden model; and the individual developmental model. We selected these models because of their popularity and the availability of empirical data in our cohort. Finally, in order to assess the patients’ perspective on factors associated with unfavourable courses of MUPS, we will perform a qualitative study, interviewing patients with unfavourable courses (i.e. long-term persistence or deterioration). Using the constant comparative method, 10-20 interviews will be held until saturation will be reached. We expect the interviews to provide valuable new insights in factors that have not been included in previously proposed theoretical models. In conclusion, the proposed study will provide empirical data enabling a detailed insight into the long-term course of MUPS, test three popular theoretical models and assess the patients’ perspective on factors associated with persistence and deterioration.

Kenmerken

Projectnummer:
839110018
Looptijd: 83%
Looptijd: 83 %
2018
2025
Gerelateerde subsidieronde:
Projectleider en penvoerder:
dr. J.C. van der Wouden PhD
Verantwoordelijke organisatie:
Amsterdam UMC Locatie VUmc
Afbeelding

Onderzoek naar huisartsgeneeskunde door aioto’s

Om de behandeling van patiënten te verbeteren, financieren we onderzoek naar wetenschappelijke vragen uit de dagelijkse praktijk. Doordat de onderzoeken worden uitgevoerd door artsen in opleiding tot onderzoeker dragen ze ook bij aan de academisering van de opleidingen. Lees meer over deze onderzoeken.