MOVING FORWARD: Towards a proactive, integrated and blended care intervention in patients with moderate medically unexplained physical symptoms

Abstract

Most people at times experience physical symptoms such as pain, fatigue or dizziness. Surveys show that approximately 90% of the Dutch general population experienced at least one physical symptom in the past two weeks. While in most cases symptoms disappear spontaneously, in certain cases symptoms persist for a few weeks or even months without having an identifiable underlying explanation. Such Medically Unexplained Physical Symptoms (MUPS) can have a high impact on quality of life and daily functioning, impairing social, physical and psychological functioning. Whether people visit their general practitioner with concerns about these symptoms is strongly related to the impact on daily life and ideas about these symptoms. Developing MUPS is more common when patients are concerned and develop negative catastrophizing beliefs. MUPS can be regarded on a continuum with a spectrum ranging from mild to moderate and then persisting or chronic MUPS. This dissertation focused on patients with moderate MUPS and preventing chronicity in this patient group. The moderate MUPS population has a high prevalence in primary care, yet little research has been done on preventing chronicity. Furthermore, there is not yet an appropriate treatment to reduce the burden for these patients, straining healthcare professionals and incurring high healthcare and societal costs.

Given the ambitions to provide the right care, for the right patient, in the right place, at the right time, we find a combination of early identification of patients with moderate MUPS and a preventive intervention integrating eHealth (blended care) a move forward. What lies ahead is to tailor such interventions, rather than offer a one-size-fits-all treatment. Increasing insights into self-management skills and movement behavior during treatment can aid the tailoring of interventions, as can early identification of patients’ needs, motivation, and the requested use of eHealth. As this way of treatment differs from usual care, healthcare professionals should be coached more on their changing role from treating patients to coaching patients.