Prevalence of medically unexplained symptoms in adults who are high users of health care services: a systematic review and meta-analysis protocol

Jadhakhan, Ferozkhan; Lindner, Oana C; Blakemore, Amy; Guthrie, Elspeth

doi:10.1136/bmjopen-2018-027922

Cited by 20 publications

(24 citation statements)

References 23 publications

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“…A calibration exercise using the first 10–15 consecutive studies will be undertaken to pilot test and refine our data extraction form adapted from Jadhakhan et al [ 68 ] [see Additional file 3 ]. For each study, pairs of reviewers will independently extract data and reach consensus through discussion.…”

Section: Methodsmentioning

confidence: 99%

Adverse childhood experience and adult persistent pain and disability: protocol for a systematic review and meta-analysis

et al. 2020

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Background A growing body of research highlights the pervasive harms of adverse childhood experiences (ACEs) on health throughout the life-course. However, findings from prior reviews and recent longitudinal studies investigating the association between types of ACEs and persistent pain have yielded inconsistent findings in the strength and direction of associations. The purpose of this review is to appraise and summarize evidence on the relationship between ACEs and persistent pain and disability outcomes in adulthood. The specific aims are (1) to determine whether there is a relationship between exposure to ACE and persistent pain and disability in adults and (2) to determine whether unique and cumulative ACEs exposures (number and type) increase the risk of developing persistent pain and disability in adulthood. Method A systematic review and meta-analysis of observational studies will be conducted. Our eligibility criteria are defined following a PECOS approach: population, adults with persistent (≥ 3 months) musculoskeletal and somatoform painful disorders exposed to single or cumulative direct ACEs alone (i.e., physical, sexual, emotional abuse or neglect) or in combination to indirect types of ACE (e.g., parental death, exposure to domestic violence) in the first 18 years of life; comparators, unexposed individuals; outcomes, measurements for persistent pain (≥ 3 months) and disability using discrete and/or continuous measures; and settings, general population, primary care. A comprehensive search of MEDLINE (Ovid) and nine other pertinent databases was conducted from inception to 29 August 2019 using a combination of key words and MeSh terms (the search will be updated prior to conducting the analyses). Pairs of reviewers will independently screen records and full text articles, and a third reviewer will be consulted in cases of disagreement. Data will be extracted using Endnote and Covidence and a meta-analysis will be conducted using Review Manager (RevMan) Version 5.3. The Scottish Intercollegiate Guidelines Network (SIGN) and the Joanna Briggs Institute (JBI) checklists will be used to assess the quality of the included studies. If heterogeneity is high, the findings will be presented in narrative form. Discussion The present review will help consolidate knowledge on persistent pain and disability by evaluating whether frequency and type of adverse childhood experiences produces the most harm. Findings may help inform practitioners and policy-makers who endeavor to prevent and/or mitigate the consequences of ACEs and promote healthy development and well-being of children, youth, and families. Systematic review registration PROSPERO CRD42020150230

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Section: Methodsmentioning

confidence: 99%

Adverse childhood experience and adult persistent pain and disability: protocol for a systematic review and meta-analysis

et al. 2020

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“…Persistent physical symptoms (PPS) -also known as medically unexplained symptoms (MUS) [1,2] -is the umbrella term given to chronic physical symptoms common to physical and mental health conditions that have unclear or contested cause [3,4]. PPS is common, though prevalence estimates vary greatly.…”

Section: Introductionmentioning

confidence: 99%

“…In general, patients with PPS, relative to those without PPS, are more likely to: have impaired physical and mental health functioning [6]; receive excessive health care [7]; have higher annual health care costs [2,6]; consult their physicians more frequently [3,4,8]; have longer visits to doctors for treatment of chronic conditions, such as diabetes [9]; receive "disease/symptom-based care" leading to unnecessary laboratory testing/treatment [2,6,7]; experience iatrogenic complications [10]; have greater dependency on medical care [10,11].…”

Section: Introductionmentioning

confidence: 99%

Interrelationships between symptom burden and health functioning and health care utilization among veterans with persistent physical symptoms

et al. 2020

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Background: Between 10 and 50% of primary care patients present with persistent physical symptoms (PPS). Patients with PPS tend to utilize excessive or inappropriate health care services, while being stuck in a deleterious cycle of inactivity, deconditioning, and further worsening of symptoms and disability. Since military deployment (relative to non-deployment) is associated with greater likelihood of PPS, we examined the interrelationships of health care utilization, symptom burden and functioning among a sample of recently deployed Veterans with new onset persistent physical symptoms. Methods: This study analyzed a cohort of 790 U.S. soldiers who recently returned from deployment to Iraq or Afghanistan. Data for this analysis were obtained at pre-and post-deployment. We used moderation analyses to evaluate interactions between physical symptom burden and physical and mental health functioning and four types of health care utilization one-year after deployment, after adjusting for key baseline measures. Results: Moderation analyses revealed significant triple interactions between physical symptom burden and health functioning and: primary care (F = 3.63 [2, 303], R 2 Δ = .02, p = 0.03), specialty care (F = 6.81 [2, 303] R 2 Δ =0.03, p < .001), allied therapy care (F = 3.76 [2, 302], R 2 Δ = .02, p = 0.02), but not mental health care (F = 1.82 [1, 303], R 2 Δ = .01, p = .16), one-year after deployment. Conclusions: Among U.S. Veterans with newly emerging persistent physical symptoms one-year after deployment, increased physical symptom burden coupled with decreased physical and increased mental health functioning was associated with increased medical care use in the year after deployment. These findings support whole health initiatives aimed at improving health function/well-being, rather than merely symptom alleviation.

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“…In the case, if non-English studies will be selected for inclusion in the review, Google Translate will be used to translate into English. [18][19][20] Moreover, to avoid errors, the studies will be rechecked by official translators and then assessed for the final selection. Students from the Peking University will also provide support in translating non-English articles.…”

Section: Study Selection and Data Extractionmentioning

confidence: 99%

Prevalence of acute liver injury and hypertransaminemia in patients with COVID-19: a protocol for a systematic review

Xu²,

Yang

et al. 2020

BMJ Open

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IntroductionCOVID-19 has spread rapidly in China and around the world. Published studies have revealed that some patients with COVID-19 had abnormal liver function in laboratory tests. However, the results were inconsistent and the analysis of epidemiological data stratified by the severity of COVID-19 was not available in previous meta-analyses. Furthermore, these meta-analyses were suspected of overestimating the incidence of liver injury in patients with COVID-19 because some studies considered transaminase elevation as liver injury, which might partially result from cardiac and muscle injury. This systematic review aims to enrol published literatures related to COVID-19 without language restriction, analyse the data based on the severity of the COVID-19 and explore the impact of varied definitions of liver injury on the incidence of liver injury.Methods and analysisWe have conducted a preliminary search on PubMed and Excerpta Medica Database on 13 April 2020, for the studies published after December 2019 on the prevalence of acute liver injury and hypertransaminemia in patients with COVID-19. Two reviewers will independently screen studies, extract data and assess the risk of bias. We will estimate the pooled incidence of hypertransaminemia and acute liver injury in patients with COVID-19 by using the random-effects model. The I² test will be used to identify the extent of heterogeneity. Publication bias will be assessed by funnel plot and performing the Begg’s and Egger’s test if adequate studies are available. We will perform a risk of bias assessment using the Joanna Briggs Institute’s critical appraisal checklist.Ethics and disseminationSince this study will be based on the published data, it does not require ethical approval. The final results of this study will be published in a peer-reviewed journal.PROSPERO registration numberCRD42020179462.

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Prevalence of medically unexplained symptoms in adults who are high users of health care services: a systematic review and meta-analysis protocol

Cited by 20 publications

References 23 publications

Adverse childhood experience and adult persistent pain and disability: protocol for a systematic review and meta-analysis

Adverse childhood experience and adult persistent pain and disability: protocol for a systematic review and meta-analysis

Interrelationships between symptom burden and health functioning and health care utilization among veterans with persistent physical symptoms

Prevalence of acute liver injury and hypertransaminemia in patients with COVID-19: a protocol for a systematic review

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