Review Characteristics of collaborative care networks in functional disorders: A systematic review, 2023, Mamo, Rosmalen et al

Highlights

• Collaborative care networks in functional disorders are heterogeneous.
• Most networks are outpatient, secondary-care based, with two to 19 team members.
• Networks provide a wide range of treatments reflecting a biopsychosocial approach.
• Collaboration is documented as more common in diagnostics than in treatment.
• Local context impacts the structure and processes of such networks.

Abstract
Objective
Functional disorders (FD) are complex conditions, for which multidisciplinary involvement is often recommended. Collaborative care networks (CCN) may unlock the potential of the multidisciplinary team (MDT) in FD care. To understand what characteristics should be part of CCNs in FD, we studied the composition and characteristics of existing CCNs in FD.

Methods
We performed a systematic review following PRISMA guidelines. A search of PubMed, WebofScience, PsycInfo, SocINDEX, AMED and CINAHL was undertaken to select studies describing CCNs in FD. Two reviewers extracted characteristics of the different CCNs. Characteristics were classified as relating to structure and processes of networks.

Results
A total of 62 studies were identified representing 39 CCNs across 11 countries. Regarding structural characteristics, we found that most networks are outpatient, secondary-care based, with teams of between two and 19 members. Medical specialists were most commonly involved and the typical team leads as well as main patient contacts were general practitioners (GPs) or nurses. Regarding processes, collaboration was demonstrated mostly during assessment, management and patient education, less often during rehabilitation and follow-up, mostly using MDT meetings. CCNs provided a wide range of treatment modalities, reflecting a biopsychosocial approach, including psychological therapies, physiotherapy and social and occupational therapy.

Conclusion
CCNs for FD are heterogeneous, showing a wide variety of structures as well as processes. The heterogeneity of results provides a broad framework, demonstrating considerable variation in how this framework is applied in different contexts. Better development of network evaluation, as well as professional collaboration and education processes is needed.

Open access, https://www.sciencedirect.com/science/article/pii/S0022399923002143

 

They are careful to avoid explaining in the paper what they count as functional disorders, so they tuck their search terms away on a separate document found at https://osf.io/usc7a

("dizziness")
("bodily distress")
("CFS")
("chemical sensitivity")
("chronic benign pain syndrome")
("chronic fatigue")
("chronic back pain")
("chronic low back pain")
("chronic pain")
("chronic pelvic pain syndrome")
( "conversion disorder*")
("somatisation")
("somatization")
("fatigue syndrome")
("fibromyalgi*")
("functional abdominal pain")
("functional bowel disorder")
("functional constipation")
("functional disease*")
("functional disorder*")
("functional dyspepsia")
("functional gastrointestinal")
("functional illness")
("functional neurologic*")
(“functional motor”)
("functional pain*")
("functional seizure*")
(("functional motor") OR ("functional movement") OR ("functional gait") OR
("functional paralysis") OR ("functional tremor") OR ("functional dystonia") OR
("functional weakness"))
(("functional*") AND ("somatic*") AND ("syndrom*"))
("Gulf Syndrome")
("Gulf War Syndrome")
("hypochondri*")
("IBS")
("interstitial cystitis")
("irritable bowel")
("medically unexplained")
("multiple chemical sensitivity syndrome")
("myalgic encephalitis")
("myalgic encephalomyelitis")
("neurastheni*")
("non cardiac chest pain")
("non cardiac pain")
("non specific chest pain")
("non specific headache")
("noncardiac chest pain")
("noncardiac pain")
("non-organic")
("nonspecific chest pain")
("nonspecific headache")
("nonspecific complaint*")
("non-specific complaint*")
("nonspecific sympt*")
("non-specific sympt*")
("pain disorder")
("pelvic pain")
("persistent pain")
("persistent physical symptom*")
("persistent somatic symptom*")
("phantom pain")
("PNES")
("post-viral fatigue")
("premenstrual syndrome")
("psychogenic nonepileptic seizures")
("psychogenic non-epileptic seizures")
("psychophysiologic disorder*”) (“psychosomatic disorder”)
("somatic symptom disorder")
("somatic symptom distress")
("somatoform disorder*")
("subjective health complaint*")
("subjective pain")
("temporomandibular dysfunction")
(("tension") AND ("headache*"))
("unexplained complaint*")
("unexplained disease*")
( "unexplained health symptom*")
( "unexplained illness*")
("unexplained medical symptom*")
("unexplained physical complaint*")
("unexplained physical symptom*")
("unexplained somatic complaint*")
("unexplained somatic symptom*")
("unexplained symptom*")

 

She really is on a psychosomatic publication spree, isn't she.

To me the main objective of these papers seems to be cementing the perception of "functional disorders" as an actual entity, and one they are authoritative in.

 

People with back pain must be getting quite irritated about this as well.

 

Thanks Andy, I just wanted to check that. Great you found a source.

What a list. (As usual) quite the nerve treating Gulf War Syndrome, hypochondria, PMS, ME/CFS, hysteria and pain as a collective entity.

Also, I just spoke to someone today whose pain syndrome recently turned out to be something that could actually be treated in hospital, after six years getting psychosomatic diagnoses. (She's going to get treatment soon, very happy for her, but she's understandably livid.)

It should also be noted that this list boils down to ME/CFS and anything pain-related, neurological or intestinal that is (yet) undiagnosed (usually because examination & tests are discouraged), while it's also ignoring known pathology. And balling it together as hysteria. Not in the mood to look it up, but also I'd be surprised if they had taken into account endometriosis, ovarian cysts, MS and a bunch of other things that are well-known to be diagnosed with much delay.

 

Also:

So telling.

 

The Rosmalen paradox.

I want to secure funding but unfortunately for me it is biomedical research: ME/CFS isn't a FND.
I want to do my day to day research: ME/CFS is a FND.