RCT in neurology outpatients (Scotland)

Sharpe et al (2011)

Project: Medical Research Council funded randomised controlled study. ‘Functional’ symptoms are physical symptoms such as pain, weakness and dizziness that do not have a cause and are therefore named as medically unexplained. Such symptoms are frequently reported in neurology clinics and just like diagnosed physical symptoms can cause great distress. This study added the use of guided CBT based self-help (GSH-CBT) to the usual care received within two neurology services in the UK.

Target group: Patients with medically unexplained symptoms

Settings: Outpatients attending neurology clinics in in Glasgow and Edinburgh.

Intervention: Treatment as usual was compared with treatment as usual plus GSH-CBT. GSH-CBT comprised of the Five Areas self-help manual ‘Overcoming Functional Neurological Symptoms.’ The manual explains functional symptoms, how they are diagnosed, along with self-management techniques to reduce unhelping thinking, and coping with symptoms.

Support offered: 4 half an hour guidance sessions from a nurse trained in offering support for the approach.

Outcomes: Participants who were allocated to the usual care group plus GHS-CBT reported greater improvement and although not statistically significant at 6 months, symptom improvement and physical function was reported. The study concluded that GSH-CBT is feasible to implement and efficacious.

What else? The manual is available here. The Study has influenced Scottish health policy and the book is one of the recommended step 2 interventions in Scotland for this patient group.

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