Summary of findings 2. Psychological therapy compared with enhanced or structured care for somatoform disorders and medically unexplained physical symptoms.
| Patient or population: somatoform disorders and medically unexplained physical symptoms Settings: all settings Intervention: psychological therapies Comparison: enhanced or structured care | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Enhanced or structured care | Psychological therapies | |||||
| Severity of somatic symptoms at end of treatment | ‐ | The mean severity of somatic symptoms at end of treatment in the intervention groups was 0.19 standard deviations lower (0.43 lower to 0.04 higher) | ‐ | 624 (5 studies1) | ⊕⊕⊕⊝ low2, 11 | 95% CI excluded large effect (> 0.5 SMD) |
| Acceptability 1 ‐ proportion of participants withdrawing during treatment | 904 per 1000 | 841 per 1000 (787 to 904) | RR 0.93 (0.87 to 1) | 679 (5 studies3) | ⊕⊕⊕⊝ moderate4 | ‐ |
| Dysfunctional cognitions, emotions, or behaviours at end of treatment Whitely Index (different forms) | ‐ | The mean dysfunctional cognitions, emotions, or behaviours at end of treatment in the intervention groups was 0.09 standard deviations lower (0.29 lower to 0.1 higher) | ‐ | 499 (4 studies5) | ⊕⊕⊕⊝ moderate6 | 95% CI excluded clinically relevant effect |
| Treatment response at end of treatment | Study population | Not estimable | 0 (0) | See comment | No studies reported on this outcome (see text) | |
| See comment | See comment | |||||
| Moderate | ||||||
| ‐ | ‐ | |||||
| Functional disability/quality of life at end of treatment Various instruments | ‐ | The mean functional disability/quality of life at end of treatment in the intervention groups was 0.13 standard deviations higher (0.05 lower to 0.3 higher) | ‐ | 497 (4 studies7) | ⊕⊕⊕⊝ moderate6 | 95% CI excluded clinically relevant effect |
| Healthcare use within 1 year after treatment | ‐ | The mean healthcare use within 1 year after treatment in the intervention groups was 0.24 standard deviations lower (0.46 to 0.01 lower) | ‐ | 319 (2 studies8) | ⊕⊕⊝⊝ low9,10 | ‐ |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio; SMD: standardised mean difference. | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 Analysis 2.1. 2 I2 = 53% 3 Analysis 2.4. 4 Quality of evidence downgraded by one point as studies not blinded. As acceptability and loss to follow‐up are interrelated, we decided not to downgrade the evidence for loss to follow‐up. 5 Analysis 2.8. 6 Assessment of quality of evidence downgraded by one point as studies were not blinded. 7 Analysis 2.11. 8 Analysis 2.15. 9 In addition to both studies not being blinded, high loss to follow‐up in one study. We therefore downgraded our assessment of the quality of the evidence by two points. 10 Only 2 studies with < 400 analysed participants.
11 No blinding (all studies) and >20% loss to follow up (2 studies)