Physiotherapy management of functional movement disorders: the patient perspective 2023 Zeun and Hunter

[Andy]

Abstract

Purpose
People with functional movement disorders (FMD) are commonly seen in neurology clinics. Despite a recent increase in research, no standardised treatment pathway across the UK exists. Currently only a few qualitative studies in FMD with a focus on psychological aspects and diagnosis have been published. This study aimed to understand people with FMD perceptions of their physiotherapy treatment.

Method
Qualitative web-based interviews were conducted with seven participants and an interpretive phenomenological approach was used to identify themes from the data.

Results
Four themes were identified; 1) my brain, mind and body are all me, 2) physiotherapy; what helps and what doesn’t, 3) what recovery is to me, and 4) barriers to treatment. Participants desired a combination of psychological and physical approaches, which were holistic, individualised, and delivered by experienced physiotherapists. Limited availability and funding of specialist treatments were barriers to recovery.

Conclusion
Holistic management combining psychological and physiological systems seems to be crucial for effective management of FMD. Large variations in physiotherapy treatment exist across the UK. It is hoped that increasing the understanding, amongst healthcare professionals will lead to the development of timely and appropriate pathways for patients that otherwise find themselves lost between medical specialities.

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  IMPLICATIONS FOR REHABILITATION
• Patients report more positive experiences when a combined and detailed psychological and physiological explanation to their symptoms is given.
  
  
• An individualised approach working with the patient on activities they find challenging is more preferable than group exercise or impairment based (e.g., strengthening/stretching) treatments.
  
  
• Having a physiotherapist who is experienced in treating functional movement disorders or prepared to learn and understand them helped with adherence to treatment.
  

Open access, https://www.tandfonline.com/doi/full/10.1080/09638288.2023.2272709

 

[Andy]

Theme 1a. Giving me knowledge

Participants commonly perceived a separation of their physical symptoms and associated psychological explanations from clinicians, whether at the initial diagnosis or during treatment sessions. However, when the psychological and physiological approaches were combined, particularly in treatment sessions, they found it beneficial for the understanding of their symptoms.

The psychologists explained that you know, my body was shutting down trying to protect itself from any sort of thing that it perceived as a threat. So, if my body felt a little bit tired or a little bit achy from doing something physical that it was the similar sensation to what I’d experienced after [the accident] then my body went into protect mode … just knowing that helped how we go forward with my physical therapy. Billy

So something perfectly safe to tell anybody with ME/CFS who has been misdiagnosed then....

All the participants discussed how important it was to gain an understanding of FMD when receiving the diagnosis and during their treatment. However, most participants stated they had a negative experience of this.

I didn’t get a good explanation of what it meant basically and so it’s a bit confusing, I was also told that although like it was positive because he said you should make some improvement like, he also said there was nothing else that could be done. So that was like really difficult. And there was no time scale on like how long it would take to get better… and I think you feel a bit of despair because they say that it’s, it’s a software problem like it’s a good thing and, and you’re still left sitting in a wheelchair. Delia

A common topic was that participants wanted a more in-depth scientific explanation linking psychological triggers, physiological symptoms, and brain functioning, rather than simply being told that there was no structural cause. They wanted the information to be at an appropriate intellectual level as they found some of the discussions and resources condescending.

It helped an enormous amount for me personally to understand the amygdala to the CNS link and the, the jumbling of the signals and so on and being able to understand how I get twitches in the hand. The educational part, the way it was structured together we had the initial session with [psychologist and physiotherapist] they explained in some detail the neural pathway through the body in the fight and flight and freeze versus rest and digest…. All of these things together make great sense. So, when we came to the rather more practical matter of first learning to just stand up. I can’t tell you what a boost it was. Adam

Shame that any 'scientific' explanation given to them will be merely wishful thinking on behalf of the professional.

 

[DokaGirl]

Physiotherapists are not qualified mental health workers. If in fact, physios are officially sanctioned to provide psychological counselling, along with their usual therapies, this is concerning.

The default perspective always seems to be that mental health issues are interfering with normal functioning, whatever that is defined as.

Any physiological health issue that practitioners can't be bothered to investigate or learn about, is deemed a mental health issue.

"Just go to the gym, and you'll get better."

ETA: punctuation corrected

 

[rvallee]

There sure is an awful lot of therapist perspective in those patients' perspectives as reported by therapists. The themes are clearly so.

It's basically the same old: if professionals tell stories to patients, most patients will believe some of the stories. Does that count as professional health care? In my opinion it does not. It cheapens the very idea of professionals, building up on "trust us, we're experts", then using that expertise to simply tell stories that, if we are being honest, are more reassuring to the therapists than the patients, who are not getting any real help in the end.

Any business run like this would go bankrupt. If you run focus groups where you get the answers you want, you will get beat in the market by people who are smarter about this, and want to know what people really need and want, not simply create a theatre-like production where they can boast about customers repeating the company motto "totally naturally" and totally breaking out singing and dancing the company's jingle.