Routine outcomes and evaluation of an 8-week outpatient multidisciplinary rehabilitative therapy program for FND 2023 Guy et al

[Andy]

Abstract

Objectives

We report routinely collected outcome data from an 8-week outpatient rehabilitative therapy program. The aims of the intervention were to (1) reduce symptom severity and (2) improve functional mobility in adults with functional neurological disorder (FND).

Methods
The program delivered individual physiotherapy, cognitive behavioral therapy (CBT) and self-management sessions, group physiotherapy, and psychoeducation. Outcome measures included the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-II), Work and Social Adjustment Scale (WSAS), 10-Meter Walk Test (10MWT), Timed Up and Go (TUG), and Berg Balance Scale (BBS). Data were analyzed retrospectively in accordance with routine service evaluation. Wilcoxon signed-rank tests assessed changes in outcomes between weeks 1 and 8 for all patients completing treatment (n = 45). For patients who attended the 3-month follow-up (n = 31), Friedman’s ANOVA assessed overall change in outcomes over time. Post hoc Wilcoxon signed-rank tests compared pairs of time-points (Weeks 1, 8, and 3-month follow-up).

Results
Analyses of patients completing the program revealed significant improvements in scores between week 1 and week 8. Excluding the BBS, there were statistically significant improvements in all outcomes between weeks 1 and 8 and between weeks 1 and 3-month follow-up.

Discussion
This outpatient therapy program provided effective treatment for FND. Patients reported reduced anxiety, depression, and functional impairment, as well as improved performance on most physiotherapy measures.

Open access, https://link.springer.com/article/10.1007/s00415-023-12111-4

 

[Andy]

Looks like possibly another for you @dave30th ?

"Functional neurological disorder (FND) refers to genuinely experienced neurological symptoms that cause significant distress or disruption, without evidence of an underlying neurological, psychiatric or other medical explanation [1, 2]. FND has an estimated incidence of 4–12 per 100,000 population per year [3], with women representing 60–75% of the FND population [4]. Functional symptoms are amongst the most common presentations in neurology outpatient settings, at approximately 15–16% of patients seen [5, 6]."

 

[Andy]

"The themes of these sessions included: behavioral activation and gradually increasing activity, managing ‘boom-and-bust’ patterns, goal setting, strategies to overcome worry, managing anxiety, sleep hygiene and fatigue management, communication styles, volunteering, and relapse prevention planning."

"Patients were also given psycho-educational sessions relating to pain and the benefits of exercise. Graded exercise and pacing were the primary strategies implemented to manage fatigue and pain."

"At baseline, the symptoms most commonly reported for all patients (n = 50) were motor symptoms such as involuntary movements, dystonia, tremor and balance difficulties (64%), and weakness (70%), particularly left lower limb weakness (58%). Pain (72%), fatigue (64%), functional seizures (38%), and sensory symptoms were also common (e.g., visual symptoms, dizziness, numbness and tingling sensations, 48%)."

"Pain and fatigue were amongst the most common symptoms reported at baseline, indicating that these symptoms are important to address through the MDT [multidisciplinary team] approach."

 

[Tilly]

"The themes of these sessions included: behavioral activation and gradually increasing activity, managing ‘boom-and-bust’ patterns, goal setting, strategies to overcome worry, managing anxiety, sleep hygiene and fatigue management, communication styles, volunteering, and relapse prevention planning."

"Patients were also given psycho-educational sessions relating to pain and the benefits of exercise. Graded exercise and pacing were the primary strategies implemented to manage fatigue and pain."

"At baseline, the symptoms most commonly reported for all patients (n = 50) were motor symptoms such as involuntary movements, dystonia, tremor and balance difficulties (64%), and weakness (70%), particularly left lower limb weakness (58%). Pain (72%), fatigue (64%), functional seizures (38%), and sensory symptoms were also common (e.g., visual symptoms, dizziness, numbness and tingling sensations, 48%)."

"Pain and fatigue were amongst the most common symptoms reported at baseline, indicating that these symptoms are important to address through the MDT [multidisciplinary team] approach."

How do you manage to find this stuff and how do they get funding for this? The merry go round of managing 'bloom and bust'

 

[Andy]

How do you manage to find this stuff

I use a service called Stork, https://www.storkapp.me/main.php, which finds me papers newly published that match certain keywords every day. I would be more than happy not to have to monitor what the FND folk are publishing but I believe that they present a real danger to our patient community.

how do they get funding for this?

Because the funders believe that there is value in this sort of thing.

For this study in particular, the only funding revealed is for the corresponding author, who declares "SP was supported by the Medical Research Council (Grant MR/V032771/1).". Interestingly, that grant is for Funding award: Novel approaches to the investigation of psychobiological mechanisms in functional neurological disorder, Chalder, Pick and Hotopf

 

[rvallee]

62% follow-up data. No controls or randomization, in fact there is a selection process. Retrospective evaluation. They're basically working around the most basic requirements of EBM by simply framing this as routine service evaluation from an existing clinic that assumes the treatments are effective.

Any alternative medicine clinic, whether they offer healing hands therapy or chug-this-beer therapy would report similar "improvements" if they were allowed to use this methodology. This is nothing but pseudoscience paid for by research funds.

 

[Amw66]

GIGO

 

[Sean]

Excluding the BBS, there were statistically significant improvements in all outcomes between weeks 1 and 8 and between weeks 1 and 3-month follow-up.

Did any of them reach clinical significance?

 

[Joan Crawford]

High drop out rate resulting in likely distortion of the results which are all subjective questionnaire type.

I've not had time to read the article so only my impressions from the abstract.

A lot of the wording suggests picking and choosing from pain management programme material. The aim in pain management is for patients to be living as best they can despite having ongoing pain and other debilitating conditions/symptoms. There is no expectation of cure or recovery. This has been twisted by the above. Also, no obvious attempt at 6 min walk test or sit to stand or similar and comparison to healthy controls without FND.

Looking very much like spin.

 

[bobbler]

62% follow-up data. No controls or randomization, in fact there is a selection process. Retrospective evaluation. They're basically working around the most basic requirements of EBM by simply framing this as routine service evaluation from an existing clinic that assumes the treatments are effective.

Any alternative medicine clinic, whether they offer healing hands therapy or chug-this-beer therapy would report similar "improvements" if they were allowed to use this methodology. This is nothing but pseudoscience paid for by research funds.

I read the retrospective analysis bit and instead of shock thought ‘yawn’ - which in itself should be shocking

then read then saying ‘of those who attended 3month follow up’

and of course we know what happens to those it doesn’t work for or gets worse: patient blaming, gaslighting and shsme that means they don’t dare ‘admit it’ anymore and even if that didn’t get them the message us clear there won’t be a chance they are heard if they report it to them. Then of course you hear of people being discharged if they can’t make it or find it doesn’t help.

sadly in these designs they only analyse those who turn up instead of the ones who they should do if you had good intentions where you care about harm or deterioration: focus on those who get worse and make that input bith accessible to those who get worse, and heard.

Oh what a difference if there were yellow card reporting, and given the symptoms and huge gamut of things (treatments) thrown at these people it seems unjustifiable (to claim it is 'therapy-based so is not required to be regulated) even if it was anyway as a loophole: this isn't 'a trial' in that circumstance but actually ‘apes’ clinical care whilst not REALLY having a follow-up if they depend on you being well enough to pass the bad of attending the office?

How is it that something can both pretend to be the clinical care for a condition, whilst also claiming that loophole of not needing yellow card reporting, whilst also then being used as a retrospective really badly having got rid of anyone it doesn't work for to claim data?