Trial Report Cost Utility of Specialist Physiotherapy for Functional Motor Disorder (Physio4FMD), 2025, Hunter, Stone, Carson, Edwards et al

That makes sense! It probably makes it harder to ignore.

 

yes. If you throw everything at them, they can answer something and ignore key points. This way, there’s only one point.

 

Seems like quality of life as measured by the EuroQoL EQ5D-5L did not show a significant difference.


In the supplementary material it also seems that employment dropped from 41% to 29% after specialist physiotherapy.

 

I wonder how that is cost effective.. Good catch! 12 pctp decrease compared to 9 pctp in tau.

 

Looking at healthcare use and welfare payments, the difference do not seem large. The main difference driving costs is time spent caring by family members which was $2668 more expensive per participant for the control group.

This is an enormous difference given that the cost of treatment was only $646. The amount of $17,867 per participant in the control group for 'Family and close others-time spent caring' dwarfs any of the medical costs and is probably also bigger than costs of lost employment or increased benefits.

I think the researchers should have done a sensitivity analysis excluding this cost to see if their results and conclusion still holds.

 

Made this quick overview of costs for the control group based on Table 2 in the paper:





I think it's important to value the unpaid care that family members give to patients, but assigning it 50% of all costs including welfare payments, productivity losses, medications, healthcare use, etc. seems like a bit much?

 

Also note that the difference in costs on family spent caring in itself was not statistically significant between groups. But because these costs were estimated to be enormous, this difference (which could have occurred by chance) determines the economic analysis and make the intervention look cost effective.

 

That's a major omission from the paper. I checked all 3 papers and none mention it. This is egregious, especially considering this:

These quacks get away with things like this because no one in the entire academic process seems bothered by such facts. You can bet your life savings that had they shown an improvement they would not only have emphasized it front and center, they would have even argued that it's a better outcome since it's more objective than self-reports.

As usual the problem isn't even with the ideologues. They make basic mistakes that are supposed to get caught at multiple stages in the process. But instead their sewage is allowed to go through unfiltered, straight in the clean water supply. Absurd.

 

Yes, but they used that non-statistically significant difference of .03 to calculate the cost-effectiveness

 

They've also rejected my request for a correction:

Hello Dr. Tuller,

Thank you for your concern regarding this article. We appreciate you taking the time to reach out and share your thoughts. Please know that our Editor-in-Chief, as well as the Editor of Neurology Clinical Practice, have both carefully reviewed the matter. After careful consideration, we have determined that no corrections are necessary, and we will not be making any changes to the published content. We will not reconsider this decision.

You are welcome to submit a Letter to the Editor to comment on the methodology, results, or conclusions featured in this article. However, please note that we cannot guarantee publication acceptance.

 

Given the low employment rates, how can they justify such low 'productivity losses'? When someone is unemployed because they are disabled it's a 100% loss of productivity, and of income. They set this up at 5K. This is fantasy.

 

Disappointing but probably expected? I’m assuming it’s not customary to share the reasoning?