eTable 3. Active treatment measures (selection): results at conclusion of treatment compared with control groups. based on recent systematic reviews.
| Intervention | Systematic review |
Main study result [95% confidence interval] |
Number of studies (patients) |
Evidence level (EL)/study quality (SQ) |
Signs of lacking acceptance or tolerance |
|
| (Simple) interventions to enhance self-efficacy | ||||||
| Functional somatic symptoms in general |
Self-help interventions |
(7) | SMD 0.58 [0.32; 0.84) (reduced symptom severity) |
17 (1894) | SQ: low | No data |
| Chronic unspecific back pain |
Education | (e106) | RR 1.02 [0.78; 1.33) (back pain prevalence) |
3 (938) | EL: strong | No data |
| Chronic unspecific back pain |
Mindfulness-based stress reduction (MBSR) |
(e107) | SMD −0.46 [−0.70; −0.22) (pain reduction) |
2 (266) | SQ: unclear | Yes*1 |
| Activating procedures | Pain reduction (if not otherwise specified) |
|||||
| Chronic unspecific back pain |
Exercise interventions | (e108) | SMD −0.32 [−0.44; −0.19) | 39 (4109) | SQ: unclear | No data |
| Fibromyalgia syndrome |
Aerobic exercise | (10) | SMD −0.40 [−0.55; −0.26) | 23 (1085) | SQ: moderate | Yes |
| Fibromyalgia syndrome |
Hydrotherapy | (e100) | SMD −0.42 [−0.61; −0.24) | 8 (462) | SQ: unclear | No |
| Chronic fatigue syndrome |
Exercise therapy | (9)*5 | SMD −0.73 [−1.10; −0.37)*2 (reduced fatigue) |
8 (1518) | EL: moderate | No |
| (Outpatient/inpatient) multimodal treatment |
Pain reduction (if not otherwise specified) |
|||||
| Fibromyalgia syndrome |
Multimodal treatment | (11) | SMD −0.42 [−0.58; −0.25) | 14 (927) | SQ: unclear | No |
| Chronic unspecific back pain | Multidisciplinary ‧biopsychosocial ‧rehabilitation | (e110) | SMD 0.54 [0.43; 1.04]*3 | 18 (3430) | SQ: high | No data |
| (Outpatient) psychotherapy | Pain reduction (if not otherwise specified) |
|||||
| Functional somatic symptoms in general | Short-term psychotherapy | (e113) | SMD 0.49 (no data; p < 0.05)*4 (reduced physical symptoms) |
12 (1019) | SQ: low/moderate | No data |
| Fibromyalgia syndrome |
Cognitive behavioral therapy | (18) *5 | SMD −0.29 [−0.47; −0.11] | 20 (1382) | EL: weak | No |
| Guided imagery/hypnosis | (e114) | RD 0.18 [0.02; 0.35] | 7 (387) | EL: weak | No data | |
| Irritable bowel syndrome | Psychological therapies | (23) | SMD 0.69 [0.52; 0.86] _(symptom severity) | 41 (2290) | SQ: unclear | No data |
*1 Predominantly minor and transient adverse effects without study discontinuation in all conditions examined
*2 Own analysis
*3 Median and interquartile range of effect sizes in the studies included. absolute effect size without comparison with a comparator
*4 Estimated from difference between effect sizes on basis of differences before and after the compared interventions
*5 Review from the Cochrane Database of Systematic Reviews
Bold: statistically significant effect size
No data: the review either does not report this information or states that the source trials did not report it.
The tables represent a selection of frequently employed. well established interventions for commonly occurring functional somatic symptoms. Whenever multiple reviews of the same intervention had been published since the previous edition of the guidelines. the most recent review was selected. In the event of publication of two or more reviews in the same year. the review with the largest number of patients and/or the best study quality was chosen. The complete evidence base can be found in the long version of the guidelines (3).
Notes on tabulation of evidence
- The effect sizes given in the tables depend on the study selection and mode of conduct of the systematic review and on the operationalization of the chosen criterion of success in the review. While the quality of the first two items was checked by the guideline group and only high-quality studies were used. the third item depends on the authors of the respective source review. The effect sizes can therefore be used to show the efficacy of a method. but cannot necessarily be compared among various systematic reviews. particularly if these cover different forms of disorders.
- With significant results the direction of the treatment effects is always in favor of the intervention investigated. unless otherwise stated.
- The diagnostic classifications of functional symptoms follow the deliberations of the authors of the systematic reviews. under consideration of recognized (research) diagnostic criteria.
- Whenever possible. the following data were used for assessment of tolerance and acceptance: percentage drop-out rates in the active treatment group and control group; percentage rates of subjectively relevant adverse effects or severe adverse effects.
Empirically significant results regarding efficacy that were not associated with a recommendation because of downgrading are given in italic.
MD/MD(w). Mean difference/mean difference (weighted); OR. odds ratio; RD. risk difference; RR. relative risk; SMD. standardized mean difference: effect size on the basis of validated psychometric instruments