Trial Report Specialist physiotherapy for functional motor disorder in England and Scotland (Physio4FMD):... 2024 Stone, Carson, Edwards et al

Full title: Specialist physiotherapy for functional motor disorder in England and Scotland (Physio4FMD): a pragmatic, multicentre, phase 3 randomised controlled trial

Summary

Background
Functional motor disorder—the motor variant of functional neurological disorder—is a disabling condition that is commonly associated with poor health outcomes. Pathophysiological models have inspired new treatment approaches such as specialist physiotherapy, although evidence from large randomised controlled trials is absent. We aimed to assess the clinical effectiveness of a specialist physiotherapy intervention for functional motor disorder compared with treatment as usual.

Methods
In this pragmatic, multicentre, phase 3 randomised controlled trial at 11 hospitals in England and Scotland, adults with a clinically definite diagnosis of functional motor disorder, diagnosed by a neurologist, were included. Participants were randomly assigned (1:1, stratified by site) using a remote web-based application to either specialist physiotherapy (a protocolised intervention of nine sessions plus follow-up) or treatment as usual (referral to local community neurological physiotherapy). Individuals working on data collection and analysis were masked to treatment allocation. The primary outcome was the physical functioning domain of the 36-item short form health questionnaire (SF36) at 12 months after randomisation. The primary analysis followed a modified intention-to-treat principle, using a complete case approach; participants who were unable to receive their randomised treatment due to the suspension of health-care services during the COVID-19 pandemic were excluded from the primary analysis. This trial is registered with the International Standard Randomised Controlled Trial registry, ISRCTN56136713, and is completed.

Findings
Recruitment occurred between Oct 19, 2018, and March 11, 2020, pausing during the COVID-19 lockdown, and resuming from Aug 3, 2021, to Jan 31, 2022. Of 355 participants who were enrolled, 179 were randomly assigned to specialist physiotherapy and 176 to treatment as usual. 89 participants were excluded from the primary analysis due to COVID-19 interruption to treatment (27 were assigned to specialist physiotherapy and 62 to treatment as usual). After accounting for withdrawals (n=11) and loss to follow-up (n=14), the primary analysis included data from 241 participants (138 [91%] assigned specialist physiotherapy and 103 [90%] assigned treatment as usual). Physical functioning, as assessed by SF36, did not differ significantly between groups (adjusted mean difference 3·5, 95% CI –2·3 to 9·3; p=0·23). There were no serious adverse events related to the trial interventions. 35 serious adverse events were recorded in the specialist physiotherapy group by 24 participants (17·0%), and 24 serious adverse events were recorded in the treatment as usual group by 18 participants (17·0%); one death occurred in the specialist physiotherapy group (cause of death was recorded as suicide). All were considered unrelated to specialist physiotherapy.

Interpretation
Although more participants who were assigned specialist physiotherapy self-rated their motor symptoms as improved and had better scores on subjective measures of mental health, the intervention did not result in better self-reported physical functioning at 12 months. Both the specialist and community neurological physiotherapy appeared to be a safe and a valued treatment for selected patients with functional motor disorder. Future research should continue to refine interventions for people with functional motor disorder and develop evidence-based methods to guide treatment triage decisions.

Open access, https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(24)00135-2/

 

They clearly didn't work hard enough on their placebo effect.

 

Just looked up who carried out the trial FMD | Physio4fmd

Safe?!

The following are some references from the Timeline I've been creating.

2009

Berk M, Parker G. The Elephant on the Couch: Side-Effects of Psychotherapy. Australian & New Zealand Journal of Psychiatry. 2009;43(9):787-794. doi:10.1080/00048670903107559

The Elephant on the Couch: Side-Effects of Psychotherapy - Michael Berk, Gordon Parker, 2009 (sagepub.com)

This article is long read. The Osheroff case settled out of the court.

Psychiatry wars: the lawsuit that put psychoanalysis on trial | Psychiatry | The Guardian 11 Oct 2022

28 Feb 2023

The Montreux Charter on Patient Safety galvanizes action to address avoidable harm in health care (who.int)

11 Oct 2022

This article is long read. The Osheroff case settled out of the court.

Psychiatry wars: the lawsuit that put psychoanalysis on trial | Psychiatry | The Guardian


22 Jan 2008

Nutt DJ, Sharpe M. Uncritical positive regard? Issues in the efficacy and safety of psychotherapy. Journal of Psychopharmacology. 2008;22(1):3-6. doi:10.1177/0269881107086283

Uncritical positive regard? Issues in the efficacy and safety of psychotherapy - PubMed (nih.gov)


Did the ‘pink card’ harms reporting suggestion made in this paper by Bristol and Edinburgh ever take off?


March 2007

Lilienfeld, S. O. (2007). Psychological Treatments That Cause Harm. Perspectives on Psychological Science, 2(1), 53-70. https://doi.org/10.1111/j.1745-6916.2007.00029.

Psychological Treatments That Cause Harm - PubMed (nih.gov)


1983

Crown S. Contraindications and Dangers of Psychotherapy. British Journal of Psychiatry. 1983;143(5):436-441. doi:10.1192/bjp.143.5.436

Contraindications and Dangers of Psychotherapy | The British Journal of Psychiatry | Cambridge Core published online 2018

 

0 = 0 = effective = give us more money.

The scam equation.

Imagine being in any other job and doing a lot of work, to then show your boss that you did no better than something that you were already doing and lacks evidence of efficacy and concluding that they should spend resources on both and give you more money to try the same thing again. Do you get laughed at before you get fired? Or do you get fired and then they laugh at you once you leave the room?

Not here. Here they will give more money for this, after having already given you money for the same thing before. Two of the biggest names in the field, so this is the "best of the best" that they can do. And they best they can do is... nothing is no worse than nothing.

I follow a lot of politics. It fascinates me. There is so much bullshit in politics. Exactly as much as in psychosomatic ideology. It's completely absurd. Almost everything plays out the same way.