Clinical outcomes from The BodyMind Approach™ in the treatment of patients with medically unexplained symptoms in primary health care in England: Practice-based evidence

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Synchronous, effortful movement together in a circle has been shown to reduce pain and act as a way to increase group cohesion.

“Participants are engaged in synchronous, effortful movement together in a circle (accompanied by music or not) which has been shown to reduce pain and act as a way to increase group cohesion (Tarr, Launay, Cohen, Dunbar, 2015).”

• cites Tarr et al., 2015 sourcePartly supported

  The Results report that synchrony and exertion increased pain threshold and in-group prosociality, supporting the pain and cohesion effects. The Methods > Procedure confirms that participants moved in a circle, but they danced to instrumental music in every condition; the study does not establish the same effects without music. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

May combine two claims.

For GPs, benefits from TBMA included reduced attendance at GPs and/or hospitals and reduced costs of medication.

“For GPs the benefits included reduced attendance at GPs and/or hospitals and reduced costs of medication.”

• cites Payne & Stott 2010 sourcePartly supported

  The Discussion (page unavailable) reports reduced GP visits and medication use after BMA, supporting part of the claimed benefit. Our copy does not report reduced hospital attendance or measure a reduction in medication costs; reduced use alone does not establish the stated cost outcome. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Only 10%-15% of the 14 common physical symptoms seen in half of GP consultations over 12 months were found to be caused by an organic illness, resulting in 85-90% being of unknown biological aetiology.

“only 10% -15% of the 14 common, physical symptoms seen in half of GP consultations over 12 months were found to be caused by an organic illness (Morriss, Dowrick, Salmon, 2007), resulting in 85-90% being of unknown biological aetiology.”

• cites Morriss et al., 2007 sourceCould not verify

  The introduction says medically unexplained symptoms are common in primary care, but it gives none of the claimed figures. The Results and Possible methodological limitations sections describe this trial’s patients, not 14 symptoms across GP consultations over 12 months. Searches for the 10–15% organic-cause figure and the resulting 85–90% figure found no supporting passage in our copy; page numbers were unavailable. (LLM, conf=0.73)

  Experimental — accuracy not yet measured

May combine two claims.

The indicative outcomes are very positive, are consistent with a previous pilot study conducted at the University of Hertfordshire, and may be transferable.

“However, the indicative outcomes which are very positive are consistent with a previous pilot study conducted at the University of Hertfordshire (Payne & Stott 2010) and may be transferable.”

• cites Payne & Stott 2010 sourcePartly supported

  The Abstract and Discussion report positive outcomes from a pilot study, supporting the comparison with a previous positive pilot. The Methodology mentions Hertfordshire research oversight, but does not establish that this study was conducted at the University of Hertfordshire. The Conclusions propose testing the approach in a wider locality rather than showing that its outcomes are transferable; that latter suggestion may be the citing authors’ own inference. (LLM, conf=0.82)

  Experimental — accuracy not yet measured

May combine two claims.

From the proof of concept pilot study, patient benefits from TBMA intervention were improved wellbeing and activity levels; decreased symptom/anxiety/depression levels; improved self-management of symptoms; and lower or stabilized medication levels.

“From these earlier research studies, specifically the proof of concept pilot study (Payne & Stott 2010), patient benefits from TBMA intervention were improved wellbeing and activity levels; decreased symptom/anxiety/depression levels; improved self-management of symptoms; and lower or stabilized medication levels.”

• cites Payne & Stott 2010 sourceSupported

May combine two claims.

Improvements made at post group are sustained at three months post group and patients report continued improvement at six month stage.

“An important trend shown in the six month follow up data analysis is that the improvements made at post group are not only sustained at three months post group, as in the previous pilot research study, but patients report continued improvement at the six month stage.”

May combine two claims.

From the PEF, patients said they had benefited from the group experience and had no hesitation in recommending it to friends and family.

“From the PEF, they said that they had benefited from the group experience having no hesitation in recommending it to friends and family.”

Probably not a substantial claim: may not pass S3 (load-bearing).

There were 26 different symptoms for the whole cohort of 16 patients completing the programme to follow up.

“Types of symptoms: There were 26 different symptoms for the whole cohort of 16 patients completing the programme to follow up.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The majority of patients were in the moderate or mild categories for anxiety.

“The majority of patients were in the moderate or mild categories for anxiety which is broadly consistent with the literature which states that at least two thirds of patients with MUS will have anxiety (Grover et al 2014).”

• cites Grover et al., 2014 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The majority of patients were women.

“The majority of patients were women, a finding consistent with the literature (Speckens, VanHemert, Bolk, Rooijmans & Hengeveld, 1996).”

• cites Speckens et al., 1996 sourceNot checked — no full text of the source

May combine two claims.

The courses helped GP practices to conserve costs by reducing consultation time, and increasing capacity.

“Furthermore, we know from patient self-reporting that the courses helped GP practices to conserve costs by reducing consultation time, and increasing capacity crucial in these times of low GP recruitment in the NHS in England.”

The quote only partly states this claim.

Depression scores decreased from pre to post group for 13/16 patients.

“13/16 of patients reported feeling less depressed after attending the group intervention.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Participants in this project were from a variety of backgrounds and ages.

“However, participants in this project were from a variety of backgrounds and ages.”

May combine two claims.

8/14 patients showed large improvement in overall MYMOP2 score at follow up; 5/14 worsened; 1/14 no change.

“8/14 patients showed a large improvement in their overall MYMOP2 score, whilst 5/14 got worse only 1/14 showed no change when compared to the improvement shown in the postgroup score.”

May combine two claims.

10/14 patients improved or maintained global functioning at follow up; 4/14 worsened.

“10/14 patients either improved still further from their post group scores or maintained their improvement whilst only 4/14 patients reported feeling worse at follow up than at post group.”

May combine two claims. The quote only partly states this claim.

22/27 symptoms improved or no change in symptom severity distress at follow up; 5/27 worsened.

“Hence approximately 22/27 of patients reported either improvement or the same levels of symptom severity distress.”

May combine two claims.

Patients appear to have found the programme acceptable and were committed to attend the groups.

“Patients appear to have found the programme acceptable and were committed to attend the groups.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Some patients develop new symptoms.

“Interestingly, some patients develop new symptoms.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Employment status of the sample was: 5/16 retired (one due to ill health), 7/16 in full-time employment, two in part-time employment, one unemployed, and one a student.

“Employment status: 5/16 retired, one of which was due to ill health.7/16 patients were in full-time employment; two in part time employment; one was unemployed and one a student.”

May combine two claims.

Social support improved for 7/16 patients post group and increased for 9/16 patients following attendance post group.

“social support collected by a questionnaire post group showed improvement for 7/16 of patients (Table 1) and this increased for 9/16 patients following attendance post group.”

May combine two claims.

Patients with MUS have very limited pathways for supporting their wellbeing in primary care and are high health utilizers.

“These patients have very limited pathways for supporting their wellbeing in primary care and are high health utilizers (Bermingham, Cohen, Hague, Parsonage, 2010).”

• cites Bermingham et al., 2010Not checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In 2008-9 approximately £3 billion was spent on patients with MUS in the NHS (11% of total budget), rising to £18 billion including the cost to the wider economy through lost productivity.

“In 2008-9 approximately £3 billion was spent on patients with MUS in the NHS (11% of total budget) rising to £18 billion including the cost to the wider economy through lost productivity (Bermingham et al, 2010).”

• cites Bermingham et al., 2010Not checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

For chronic back pain, there was insufficient evidence to determine the effectiveness of self-management programmes.

“For chronic back pain, there was insufficient evidence to determine the effectiveness of self-management programmes.”

• cites Du et al., 2011Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

The small sample size (N=16) and the lack of a control arm mean that the outcomes cannot be generalised with any confidence.

“The small sample size (N=16) and the lack of a control arm means that the outcomes cannot be generalised with any confidence.”

Probably not a substantial claim: may not pass S3 (load-bearing).

MUS patients use many resources, accounting for as many as one in five new consultations.

“Furthermore, they use many resources accounting for as many as one in five new consultations (Bridges & Goldberg, 1985).”

• cites Bridges & Goldberg, 1985 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

A mindful relationship to the body and symptoms helps patients become less attached to or identified with their symptoms and less reactive to them, which diminishes their experience of them.

“This mindful relationship to the body and symptoms helps patients become less attached to/identified with their symptoms as well as less reactive to them which diminishes their experience of them.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The change to SSD removes the diagnostic problem of having to distinguish between medically explained and unexplained symptoms.

“this change removes the diagnostic problem of having to distinguish between medically explained and unexplained symptoms (Creed, et al 2010).”

• cites Creed et al., 2010 sourceNot checked — no full text of the source

May combine two claims.

CBT is unacceptable to this patient population; they require an accessible and integrated approach which acknowledges their bodily based physical experience whilst exploring this at emotional and cognitive levels.

“Thus it seems CBT is unacceptable to this patient population, they require an accessible and integrated approach which acknowledges their bodily based physical experience whilst exploring this at emotional and cognitive levels.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Practice-based evidence is complementary to the quantitative, and dominant, randomised control trial-based approach to evidence.

“Practice-based evidence is described by Guy, Thomas, Stephenson, and Loewenthal (2011) as complementary to the quantitative, and dominant, randomised control trial-based approach to evidence.”

• cites Guy et al., 2011Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

The term MUS defines the illness by what it is not, implying no organic cause, which is not necessarily accurate and limits treatment.

“The term defines the illness by what it is not: i.e. it implies no organic cause which is not necessarily accurate and limits treatment.”

Probably not a substantial claim: may not pass S3 (load-bearing).

CBT with relaxation and/or graded exercise has some effectiveness for some symptoms.

“Cognitive Behaviour Therapy (CBT) with relaxation and/or graded exercise has some effectiveness for some symptoms (Whiting, Bagnall, Sowden, Cornell, Mulrow, 2001).”

• cites Whiting et al., 2001 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

No serious medical cause was the diagnosis in 25%-50% of all primary care visits.

“No serious medical cause was the diagnosis in 25% -50% of all primary care visits (Barsky & Borus, 1995)”

• cites Barsky & Borus, 1995Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The shortcomings of the MUS category are the mind-body dualism present in the unreliable classification of complaints as medically explained or not and the random categorisation into different somatoform disorders.

“The shortcomings of the MUS category is the mind-body dualism present in the unreliable classification of complaints as medically explained or not (Creed 2009;Sharpe, Mayou & Walker, 2006) and the random categorisation into different somatoform disorders (Leiknes, Finset, Moum & Sandanger, 2006).”

• cites Creed 2009 sourceNot checked — no full text of the source
• cites Sharpe et al., 2006 sourceNot checked — no full text of the source
• cites Leiknes et al., 2006Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

A previous health economic analysis of TBMA compared with CBT showed that cost savings would be large in primary care but even greater in secondary care.

“Furthermore, a previous health economic analysis of TBMA compared with CBT showed that the cost savings would be large in primary care but that secondary care they would be even greater (Payne & Fordham, 2008) the findings of which are supported by a report from the DH (2012).”

• cites Payne & Fordham, 2008Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites DH, 2012Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

The term SSD is thought to be more useful than MUS in primary care.

“The term is thought to be more useful than that of MUS in primary care (Creed, Guthrie, Fink, Henningsen, Rief, 2010).”

• cites Creed et al., 2010 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.

Mind-body dualism in the MUS category reinforces GP training to address physical rather than mental health issues and the patient's perception that their symptom is purely physical.

“This dualism reinforces the GP training to address physical rather than mental health issues and the patient's perception that their symptom is purely physical because of the sensory experience.”

Probably not a substantial claim: may not pass S2 (checkable).

The subjective experiencing body is the fundamental basis for all feelings, sensations, perceptions or object manipulation, which in turn actively underlies cognition and meaning-making.

“The subjective experiencing body (Gallagher & Zahavi, 2007), whether engaging with the world's affordances (Gibson, 1979) through the tactile sense, movement or in stillness, is the fundamental basis for all feelings, sensations, perceptions or object manipulation which in turn actively underlies cognition and meaning-making (Merleau-Ponty, 1962& 1965;Dewey, 1991).”

• cites Gallagher & Zahavi, 2007 sourceNot checked — no full text of the source
• cites Gibson, 1979Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Merleau-Ponty, 1962 & 1965Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

For non-specific low back pain, moderate-quality evidence shows that self-management has small effects on pain and disability, which challenges the endorsement of self-management in treatment guidelines.

“In a more recent review (Oliveira, Ferreira, Maher, Pinto, Refshauge, 2012) for non-specific low back pain results showed moderate-quality evidence that self-management has small effects on pain and disability which challenge the endorsement of self-management in treatment guidelines.”

• cites Oliveira et al., 2012 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

TBMA can be seen as one solution to the problem of patients with MUS.

“TBMA can be seen as one solution to the problem of patients with MUS.”

Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing).

A UKCP report suggests that practitioners and service users need to be given a voice, acknowledging that they have direct knowledge and experience of what works and what needs to change, and how.

“A United Kingdom Council for Psychotherapy (UKCP) report (Ryan & Morgan, 2004, cited in Thomas, Stephenson, & Loewenthal, 2006) suggests that practitioners and service users need to be given a voice, acknowledging that they have direct knowledge and experience of what works and alternatively what needs to change, and how.”

• cites Ryan & Morgan, 2004Not checked — no full text of the source
• cites Thomas et al., 2006Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Although psychological treatment may work in some cases, this does not reflect that the symptoms are necessarily psychological.

“Although psychological treatment may work in some cases this does not reflect that the symptoms are necessarily psychological (Creed, Henningsen & Fink, 2011).”

• cites Creed et al., 2011Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

MUS patients frequently have high cost referrals to secondary care for tests and scans and usually present with anxiety and/or depression.

“They frequently have high cost referrals to secondary care for tests and scans and usually present with anxiety and/or depression, which is understandable (Simon, VonKorff, Piccinelli, Fullerton, Ormel, 1999;Aguara, 2010).”

• cites Simon et al., 1999 sourceNot checked — no full text of the source
• cites Aguara, 2010Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Only a third of MUS patients with varied symptoms attend CBT, probably due to their physical explanation for their symptoms and the stigma attached to mental health services.

“However, only a third of MUS patients with varied symptoms attend this treatment (Hague, 2008), probably due to their physical explanation for their symptoms and the stigma attached to mental health services.”

• cites Hague, 2008Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

MUS is defined as a clinical and social predicament including a broad spectrum of presentations and difficulty accounting for symptoms based on known pathology.

“Edwards, Stern, Clarke, Ivbijaro, and Kasney (2010) define MUS as 'a clinical and social predicament, includes broad spectrum of presentations, difficulty accounting for symptoms based on known pathology' (ibid p 1).”

• cites Edwards et al., 2010Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

None of the mindfulness approaches address the lived bodily felt sensory experience from a phenomenological perspective or address the importance of body awareness as a vehicle for change.

“Nevertheless none of these approaches address the lived bodily felt sensory experience from a phenomenological perspective or address the importance of body awareness as a vehicle for change.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Although MUS/somatoform disorders are common, health professionals seeing such patients have considerable confusion regarding diagnostic terminology and a reluctance to use these diagnostic labels.

“Dimsdale, Sharma and Sharpe (2011) showed that although MUS/somatoform disorders are common, for those health professionals seeing such patients there is considerable confusion regarding the diagnostic terminology and a reluctance to use these diagnostic labels.”

• cites Dimsdale et al., 2011 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S4 (based).

TBMA differs significantly from CBT in that it focuses on the physical symptom within an experiential inquiry-led learning framework to support patients to live well and cope better in a more meaningful way.

“TBMA differs significantly from CBT in that it focuses on the physical symptom within an experiential inquiry-led learning framework to support patients to live well and cope better in a more meaningful way.”

May combine two claims.

Despite feeling less well overall in terms of general wellbeing and more depressed than at post group, patients were still able to continue to maintain and even increase their engagement in activity.

“Consequently, despite feeling less well overall in terms of general wellbeing and more depressed than at post group patients were still able to continue to maintain and even increase their engagement in activity perhaps as result of increased global functioning, reduced symptom distress and anxiety levels experienced at follow up.”

Probably not a substantial claim: may not pass S2 (checkable).

With this practice-based methodology and its evaluation using qualitative and quantitative patient feedback and standardised psychological assessment tools, there is an opportunity to build an evidence base rooted in routine service delivery.

“With this practice-based methodology and its evaluation using qualitative and quantitative patient feedback and the standardised psychological assessment tools there is an opportunity to build an evidence base rooted in routine service delivery.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Most patients with MUS have mild to moderate depression.

“The literature (Lowe, Spitzer, Williams, Mussell, Schellberg, 2008) states most patients with MUS will have mild to moderate depression consequently this sample of patients were more or less in a similar category in this regard.”

• cites Lowe, Spitzer, Williams, Mussell, Schellberg, 2008 sourceNot checked — no full text of the source

May combine two claims.

The majority of patients had maintained their improvement post group or had continued to improve still further to the six month follow up stage.

“Once again the majority of patients had maintained their improvement post group or had continued to improve still further to the six month follow up stage.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The number of group sessions attended per patient ranged from 8 to 11.

“The number of group sessions attended per patient ranged from 8-11.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Attendance figures were 67% for Group 1, 86% for Group 2, and 90% for Group 3.

“Attendance figures: Group 1 had 67%, Group 2 86% and for Group 3 it was 90%.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

There is no alternative treatment available and appealing for patients with MUS.

“There is no alternative treatment available and appealing.”

• AssumptionRests on an assumption: Patients do not see the more widely offered CBT as relevant because most have a physical explanation rather than a psychological one for their symptoms.
• AssumptionRests on an assumption: The stigma attached to psychological interventions means that patients feel unable to access such therapy.

May combine two claims.

First indications from the delivery of TBMA in primary care suggest that it can benefit patients with MUS and the health service by encouraging coping strategies which promote patient self-management thereby reducing the demand for and cost of services.

“First indications from the delivery of TBMA in primary care suggest that it can benefit patients with MUS and the health service by encouraging coping strategies which promote patient self-management thereby reducing the demand for and cost of services.”

• AssumptionRests on an assumption: Patients with MUS are extremely high utilizers of health resources.

May combine two claims.

Two patients withdrew in the 6 month post group to follow up assessment period, leaving 14 patients.

“There are now 14 patients because two patients withdrew in the 6 month post group to follow up assessment period”

May combine two claims.

TBMA is acceptable to patients and provides more patient and GP choice of treatment for MUS.

“In addition, it is acceptable to patients and provides more patient and GP choice of treatment for MUS.”