Phenomena associated with sick leave among primary care patients with Medically Unexplained Physical Symptoms: A systematic review

Abstract

Objective. To explore and synthesize the literature on phenomena associated with sick leave among patients with Medically Unexplained Physical Symptoms (MUPS). Design. A systematic review of the literature was undertaken in three phases: (1) a search of the following databases: Medline, Embase, Psych Info, Cochrane Collaboration Library, Digital Dissertations, DiVA, SweMed +, NORART, and ISI Web of Science, (2) selection of studies based on pre-specified inclusion criteria was undertaken, extracting study design and results, (3) quality assessment was undertaken independently by two reviewers. Due to heterogeneity in study designs, populations, interventions, and outcome measures, a mixed research synthesis approach was used. Results were assessed in a pragmatic and descriptive way; textual and numerical data were extracted from the included studies, and classified into patient- and doctor-related factors. Results. Sixteen studies were included. With regard to patients, an association was found between sick leave and psychiatric comorbidity as well as total symptom burden. With regard to doctors, knowledge of the patient, sympathy, and trust appeared to increase the probability of the patient being sick-listed. None of the interventions in the educational programmes aiming to improve doctors’ management of MUPS patients succeeded in lowering sick leave. Implications. Despite MUPS being a leading cause of sickness absence, the review identified only a small number of studies concerning phenomena associated with sick leave. The authors did not identify any studies regarding the impact of the working conditions on sick leave among MUPS patients. This is an important area for further studies.

Key Words::

• General practice
• medically unexplained symptoms
• Norway
• review
• sick leave
• somatoform disorder

Acknowledgement

The authors would like to thank medical librarians Regina Küfner Lein and Hilde Strøm for search advice, Lillebeth Larun (PT,PhD) for methodological advice, and Brona Fullen (PT, PhD) for linguistic advice.

Declaration of interest

The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.

Source of funding

Fund for research in general practice, Norwegian Medical Association.