TY - JOUR
T1 - In Patients with Functional Movement Disorders, Is Specialized Physical Therapy Effective in Improving Motor Symptoms?
T2 - A Critically Appraised Topic
AU - Callister, Marcus N.
AU - Stonnington, Cynthia B.
AU - Cuc, Andrea
AU - Alcott, Sally B.
AU - Driver-Dunckley, Erika D.
AU - Mehta, Shyamal H.
AU - Hasan, Shemonti
AU - Marks, Lisa A.
AU - Wingerchuk, Dean M.
AU - O'Carroll, Cumara B.
N1 - Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/3/20
Y1 - 2022/3/20
N2 - Background: Functional movement disorders (FMD, aka psychogenic movement disorders) are very common and frequently chronic and disabling. Despite this, there is a paucity of evidence-based treatment to manage and alleviate these conditions. Specialized physical therapy (PT), involving sequential motor relearning and redirecting attention, has shown promise as a therapeutic intervention for motor symptoms. Methods: The objective of this study was to critically assess current evidence regarding specialized PT compared with usual care in improving motor symptoms among patients with FMD. This was addressed through the development of a structured critically appraised topic. This included a clinical scenario with a clinical question, literature search strategy, critical appraisal, results, evidence summary, commentary, and bottom-line conclusions. Participants included consultant and resident neurologists, a medical librarian, and content experts in the fields of physical medicine and rehabilitation, physical and occupational therapy, psychiatry, and psychology. Results: A randomized controlled feasibility trial was identified and selected for critical appraisal. This study randomized 60 patients with FMD to a 5-day specialized outpatient PT program or to general outpatient PT referral, and measured patient-reported and clinician-measured outcomes. At 6 months, 72% of patients in the intervention group had a good outcome compared with 18% of control group patients. Patients in the specialized outpatient PT program had significantly better outcomes in 3 Short-Form 36 (SF36) domains (d=0.46 to 0.79) and multiple other scales of physical and social function as well as clinician-measured outcomes. The intervention resulted in 0.08 additional quality-adjusted life years in a cost-effective manner. Conclusions: Current evidence suggests that in patients with FMD, specialized PT improves motor symptoms in a clinically significant, sustained, and cost-effective manner. This promising intervention warrants further investigation and replication.
AB - Background: Functional movement disorders (FMD, aka psychogenic movement disorders) are very common and frequently chronic and disabling. Despite this, there is a paucity of evidence-based treatment to manage and alleviate these conditions. Specialized physical therapy (PT), involving sequential motor relearning and redirecting attention, has shown promise as a therapeutic intervention for motor symptoms. Methods: The objective of this study was to critically assess current evidence regarding specialized PT compared with usual care in improving motor symptoms among patients with FMD. This was addressed through the development of a structured critically appraised topic. This included a clinical scenario with a clinical question, literature search strategy, critical appraisal, results, evidence summary, commentary, and bottom-line conclusions. Participants included consultant and resident neurologists, a medical librarian, and content experts in the fields of physical medicine and rehabilitation, physical and occupational therapy, psychiatry, and psychology. Results: A randomized controlled feasibility trial was identified and selected for critical appraisal. This study randomized 60 patients with FMD to a 5-day specialized outpatient PT program or to general outpatient PT referral, and measured patient-reported and clinician-measured outcomes. At 6 months, 72% of patients in the intervention group had a good outcome compared with 18% of control group patients. Patients in the specialized outpatient PT program had significantly better outcomes in 3 Short-Form 36 (SF36) domains (d=0.46 to 0.79) and multiple other scales of physical and social function as well as clinician-measured outcomes. The intervention resulted in 0.08 additional quality-adjusted life years in a cost-effective manner. Conclusions: Current evidence suggests that in patients with FMD, specialized PT improves motor symptoms in a clinically significant, sustained, and cost-effective manner. This promising intervention warrants further investigation and replication.
KW - conversion disorder
KW - critically appraised topic
KW - evidence-based medicine
KW - functional motor disorder
KW - functional movement disorder
KW - functional neurological disorder
KW - functional neurological symptom disorder
KW - occupational therapy
KW - physical therapy
KW - psychogenic disorder
UR - http://www.scopus.com/inward/record.url?scp=85124140784&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85124140784&partnerID=8YFLogxK
U2 - 10.1097/NRL.0000000000000408
DO - 10.1097/NRL.0000000000000408
M3 - Article
C2 - 35051971
AN - SCOPUS:85124140784
SN - 1074-7931
VL - 27
SP - 82
EP - 88
JO - Neurologist
JF - Neurologist
IS - 2
ER -