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Researchers can now document the effectiveness of a conversational tool in general practice for a vulnerable and often stigmatised patient group.

New study gives hope to patients with medically unexplained physical symptoms

A newly developed communication tool, specifically designed for use in primary care, has reduced sick leave and increased the quality of life for patients.

Medically Unexplained Physical Symptoms (MUPS) are characterised by persistent bodily symptoms and functional impairment that lack an explanation through known medical condition or pathology.

Former studies have shown that the general practitioner (GP) often struggles to treat these patients without a defined diagnosis.

It is estimated that up to 40 per cent of all consultations in primary care in Norway involve patients presenting with MUPS and make up a considerable proportion of people on long-term sick leave and on disability.

This often leads to frustration for both patients and physicians, with patients experiencing dissatisfaction with their medical treatment, feelings of stigmatisation, and a sense of not being taken seriously.

GP Cathrine Abrahamsen has through her PhD work at the Department of General Practice, University of Oslo, developed and tested a new communication tool. It turns out to have a positive impact on patients with MUPS.

The patient finds their own solutions 

The approach helps patients find solutions themselves. It offers hope for improved quality of life and a quicker return to work.

“As far as we are aware, this is the first primary care intervention with a structured communication tool with a work-focused cognitive-behavioural therapy approach, to show such significant results," Abrahamsen says.

Although CBT has demonstrated effectiveness in specialised settings, its efficiency in primary care has been relatively limited.

103 GPs from across Norway were recruited for the study. Half of the GPs were trained in using the newly developed approach ICIT- Individual Challenge Inventory Tool.

The GPs recruited a total of 541 patients who met the inclusion criteria, 238 of these were treated with ICIT.

“What makes this study unique is that it is specifically tailored to assist GPs in efficiently managing patients with MUPS. It is the GP who treats, and patients are selected based on those who have booked an appointment with the doctor,” Abrahamsen explains.

Sick leave reduced by 27 per cent

The results of the study are significant. 76 per cent of the people in the intervention group reported an improvement in quality of life, compared to 38 per cent in the usual care group. 

After 11 weeks, the patients in the intervention group had a 27 per cent reduction in sick leave, compared to 4 per cent in the control group.

“The foremost aim of the study is to empower patients, helping them enhance their coping skills in both their daily lives and work settings. Patients with MUPS frequently experience psychological distress, social isolation, and a decline in their overall quality of life, resulting in high healthcare utilisation and costs associated with sick leave,” Abrahamsen says.


Abrahamsen et al.  The effects of a structured communication tool in patients with medically unexplained physical symptoms: a cluster randomized trialThe Lancet, 2023. DOI: 10.1016/j.eclinm.2023.102262

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