Institute of Epidemiology & Health Care


Mental Health Seminar 10.05.18

Title: A randomised feasibility study of specialist physiotherapy for functional motor disorder

Speaker: Glenn Nielsen - Specialist Physiotherapist, St George's University of London (Previously UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery)

Abstract: Functional motor disorder (FMD), also known as conversion disorder, is a diagnosis characterised by neurological symptoms affecting movement that are not caused by a structural disease process. It is a common cause of disability and distress amongst patientsreferred to NHS neurology and physiotherapy clinics. Patients typically present with one or a combination of weakness, tremor, jerks, dystonia and/or an abnormal gait pattern.  A recent systematic review of long term follow up studies found that 40% of patientswere either unchanged or worse at an average of seven years follow up. Historically we have understood FMD predominantly from a psychological point of view. Correspondingly, psychological intervention has traditionally been considered the treatment of choice. More recently, physical based interventions, informed by a biopsychosocial understanding of FMD, have emerged as a promising treatment for FMD, but there is a lack of controlled trials and few descriptions of how physical interventions should be carried outin patients with FMD. As the prevalence of FMD is thought to be similar to that of Multiple Sclerosis this work is of direct relevance to primary care practitioners who may be involved in the care of such patients.

This talk will present a body of work aimed at developing a specialised physiotherapy treatment for patients with FMD. The work was undertaken as part of a NIHR Clinical Doctoral Research Fellowship for Glenn Nielsen, under the supervision of Dr Marta Buszewicz, Dr Fiona Stevenson and Professor Mark Edwards. In addition, Rachael Hunter provided support for health economic analysis. As part of the PhD fellowship, a randomised feasibility study of the specialist physiotherapy intervention was conducted. Sixty patients with FMD were recruited from outpatient neurology clinics and randomised to the study intervention or treatment as usual (a referral to community physiotherapy suitable for someone with neurological symptoms). Embedded in the feasibility study was a longitudinal qualitative study, with semi-structured interviews used to explore the beliefs, perceptions and experiences of a sample of 11 participants randomised to the intervention group. Leading on from this study, an NIHR Health Technology Assessment grant application was put together in collaboration with Priment Clinical Trials Unit and several UK experts in FMD. The application was successful and in September 2018 we will start recruiting for a multicentre RCT of specialist physiotherapy for FMD. The FMD patient community are very supportive of this work and keen that GPs and primary care teams should be well informed about this condition and potential effective treatments.