Trial Report Which factors predict outcome from specialist physiotherapy for functional motor disorder?... 2025, Nielsen, Stone, Carson, Edwards et al

One trial has resulted in three papers. As well as this paper, there is:

• the main paper, which found a null result:

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

• an economic analysis, which found an economic benefit

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


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Which factors predict outcome from specialist physiotherapy for functional motor disorder? Prognostic modelling of the Physio4FMD intervention, 2025, Nielsen, Carson, Edwards, Stone, et al

Highlights

• We explored predictors of self-reported outcome from the Physio4FMD trial.
• A greater perception of control over recovery predicted self-reported improvement.
• A greater perception of symptom permanence predicted lack of improvement.
• Older age predicted lack of self-reported improvement.
• Many variables that we expected to predict poor outcome were not significant.

Abstract

Objectives
Physiotherapy is considered part of first line treatment for functional motor disorder (FMD) although not all patients benefit. Predictors of treatment outcome may help to inform triage decisions. We aimed to determine which baseline variables predicted treatment outcome in the pragmatic multicentre Physio4FMD randomised controlled trial of specialist physiotherapy for FMD.

Methods
Participants randomised to the specialist physiotherapy arm of the trial were included in the analysis. Treatment outcome was dichotomised into improvement vs no improvement, based on two measures, Short Form 36 Physical Functioning (SF36 PF) and participant-rated Clinical Global Impression Scale of Improvement (CGI-I). Predictors of outcome were selected from baseline variables. Univariate logistic regression was used to calculate the odds ratio of improvement for each variable. Variables associated with improvement at p < 0.1 were considered for inclusion in a multiple logistic regression model.

Results
A greater perception of having control over recovery predicted improvement on the CGI-I (OR 1.18, 95 % CI 1.07, 1.31). Predictors of lack of improvement were an increased perception of the permanence of symptoms, predicting lack of improvement on the SF36 PF (OR 0.91, 95 % CI 0.84, 0.99) and older age, predicting lack of improvement on the CGI-I (OR 0.97, 95 % CI 0.95, 0.998).

Conclusions
Age and perceptions of symptom control were weak predictors of outcome from specialist physiotherapy. In contrast, a number of factors commonly believed to predict poorer treatment response, including illness duration and levels of pain and fatigue, were not related to the outcomes measured in this study.

Open access

 

It’s probably the number of papers published, the number of citations and the authors’ bank balances.

They are positively correlated with the making of this study.

 

There’s something hidden in that last para on conclusions. Factors and demographics making people more naive and coercable potentially