Randomised feasibility study of physiotherapy for patients with functional motor symptoms
Open accessAbstract
OBJECTIVE: To determine the feasibility of conducting a randomised controlled trial of a specialist physiotherapy intervention for functional motor symptoms (FMS). METHODS: A randomised feasibility study was conducted recruiting patients with a clinically established diagnosis of FMS from a tertiary neurology clinic in London, UK. Participants were randomised to the intervention or a treatment as usual control. Measures of feasibility and clinical outcome were collected and assessed at 6 months. RESULTS: 60 individuals were recruited over a 9-month period. Three withdrew, leaving 29 intervention and 28 controls participants in the final analysis. 32% of patients with FMS met the inclusion criteria, of which 90% enrolled. Acceptability of the intervention was high and there were no adverse events. At 6 months, 72% of the intervention group rated their symptoms as improved, compared to 18% in the control group. There was a moderate to large treatment effect across a range of outcomes, including three of eight Short Form 36 (SF36) domains (d=0.46-0.79). The SF36 Physical function was found to be a suitable primary outcome measure for a future trial; adjusted mean difference 19.8 (95% CI 10.2 to 29.5). The additional quality adjusted life years (QALY) with intervention was 0.08 (95% CI 0.03 to 0.13), the mean incremental cost per QALY gained was £12 087. CONCLUSIONS: This feasibility study demonstrated high rates of recruitment, retention and acceptability. Clinical effect size was moderate to large with high probability of being cost-effective. A randomised controlled trial is needed. TRIAL REGISTRATION NUMBER: NCT02275000; Results.
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The prognosis of patients with FND who are misdiagnosed with MS may improve with more modern evidence-based treatment.
“Patients with FND who are misdiagnosed with MS have a prognosis similar to MS [2] but which may improve with more modern evidence-based treatment [3].”
From Functional neurological disorder and multiple sclerosis: a systematic review of misdiagnosis and clinical overlap (2022) · cites this paper as [3]
The Discussion reports improved symptoms after specialist physiotherapy for patients with functional motor symptoms, supporting the possibility that treatment may improve their outlook. The Participants section says patients had a clinically established functional motor diagnosis; the study does not establish treatment outcomes specifically for patients with FND misdiagnosed with MS. (LLM, conf=0.83)
Experimental — accuracy not yet measuredA randomized controlled trial of specialized physiotherapy for functional motor symptoms found that 72% of patients had improvements in mobility sustained at 6 month follow-up compared to 18% in a control arm having non-specialized physiotherapy.
“a randomized controlled trial of specialized physiotherapy for functional motor symptoms found that 72% of patient had improvements in mobility sustained at 6 month follow-up compared to 18% in a control arm having non-specialized physiotherapy [3].”
From Functional neurological disorder and multiple sclerosis: a systematic review of misdiagnosis and clinical overlap (2022) · cites this paper as [3]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThe type of physical rehabilitation developed for FND uses a transparent explanatory model that takes advantage of inconsistencies seen on examination and turns them into therapeutic opportunities during therapy.
“the type of physical rehabilitation that has been developed for FND uses a transparent explanatory model for the disorder which takes advantage of the inconsistencies seen on examination and turns them into therapeutic opportunities during therapy [3].”
From Functional neurological disorder and multiple sclerosis: a systematic review of misdiagnosis and clinical overlap (2022) · cites this paper as [3]
The Procedures section (page not specified) describes a physiotherapy programme that explains functional motor symptoms through an aetiological model and uses movement retraining. It does not say that inconsistencies observed on examination are used as therapeutic opportunities, so that specific part of the claim is unsupported. (LLM, conf=0.84)
Experimental — accuracy not yet measuredMisdiagnosis of MS or FND causes harm to patients, most generally in the form of a delay to diagnosis and initiation of proper treatment.
“Misdiagnosis of MS or FND causes harm to patients, most generally in the form of a delay to diagnosis and initiation of proper treatment.”
From Functional neurological disorder and multiple sclerosis: a systematic review of misdiagnosis and clinical overlap (2022) · cites this paper as [3]
The Participants section describes how FMS was diagnosed for this study, and the Discussion suggests that earlier physiotherapy might have been more effective. Neither passage addresses misdiagnosis of MS or FND or says that misdiagnosis delayed diagnosis and treatment; searches for those points found no supporting passage. Page numbers were unavailable in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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- Authors
- Nielsen, G., Buszewicz, M., Stevenson, F., Hunter, R., Holt, K., Dudziec, M., Ricciardi, L., Marsden, J., Joyce, E., & Edwards, M.
- Affiliations
- National Hospital for Neurology and Neurosurgery (GB)
- University College London (GB)
- St George's, University of London (GB)
- UCL Queen Square Institute of Neurology (GB)
- University of Plymouth (GB)
- Corresponding author
- Nielsen, G
- Venue
- Journal of Neurology, Neurosurgery & Psychiatry
- Publisher
- BMJ
- Published
- 2016-09-30
- Volume
- 88
- Issue
- 6
- Pages
- 484-490
- ISSN
- 0022-3050 (ISSN-L)
- 1468-330X
- OpenAlex
- W2526261005
- Cited by
- 246
- References
- 3
- Citations by year
- 2026: 18 · 2025: 14 · 2024: 28 · 2023: 31 · 2022: 40 · 2021: 25 · 2020: 31 · 2019: 25 · 2018: 20 · 2017: 14
- FWCI
- 17.47
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Neurology Neurosurgery & Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- St George's Online Research Archive (St George's University of London) (acceptedVersion)
- PEARL (University of Plymouth) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Research Trainees Coordinating Centre (CDRF-2013-04-034)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Keywords
- physiotherapy, feasibility, recruitment and retention, acceptability, SF-36 physical function, quality-adjusted life years, cost-effectiveness, neurological patients
- MeSH terms
- Motor Disorders, Intersectoral Collaboration, Adult, Combined Modality Therapy, Conversion Disorder, Disability Evaluation, Feasibility Studies, Female, Follow-Up Studies, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Quality of Life, Cognitive Behavioral Therapy, Outcome Assessment, Health Care, Quality-Adjusted Life Years, Physical Therapy Modalities, Interdisciplinary Communication
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