Article Text

PDF
Research paper
Randomised feasibility study of physiotherapy for patients with functional motor symptoms
  1. G Nielsen1,2,
  2. M Buszewicz3,
  3. F Stevenson3,
  4. R Hunter3,
  5. K Holt2,4,
  6. M Dudziec2,
  7. L Ricciardi1,
  8. J Marsden5,
  9. E Joyce1,
  10. MJ Edwards1,4
  1. 1Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
  2. 2Therapy Services Department, National Hospital for Neurology and Neurosurgery, London, UK
  3. 3Research Department of Primary Care and Population Health, University College London, London, UK
  4. 4Institute of Cardiovascular and Cell Sciences, St Georges University of London, London, UK
  5. 5School of Health Professions, Peninsula Allied Health Centre, University of Plymouth, Plymouth, UK
  1. Correspondence to Glenn Nielsen, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, P.O. Box 146, Queen Square, London WC1N 3BG, UK; g.nielsen{at}ucl.ac.uk

Abstract

Objective To determine the feasibility of conducting a randomised controlled trial of a specialist physiotherapy intervention for functional motor symptoms (FMS).

Methods A randomised feasibility study was conducted recruiting patients with a clinically established diagnosis of FMS from a tertiary neurology clinic in London, UK. Participants were randomised to the intervention or a treatment as usual control. Measures of feasibility and clinical outcome were collected and assessed at 6 months.

Results 60 individuals were recruited over a 9-month period. Three withdrew, leaving 29 intervention and 28 controls participants in the final analysis. 32% of patients with FMS met the inclusion criteria, of which 90% enrolled. Acceptability of the intervention was high and there were no adverse events. At 6 months, 72% of the intervention group rated their symptoms as improved, compared to 18% in the control group. There was a moderate to large treatment effect across a range of outcomes, including three of eight Short Form 36 (SF36) domains (d=0.46–0.79). The SF36 Physical function was found to be a suitable primary outcome measure for a future trial; adjusted mean difference 19.8 (95% CI 10.2 to 29.5). The additional quality adjusted life years (QALY) with intervention was 0.08 (95% CI 0.03 to 0.13), the mean incremental cost per QALY gained was £12 087.

Conclusions This feasibility study demonstrated high rates of recruitment, retention and acceptability. Clinical effect size was moderate to large with high probability of being cost-effective. A randomised controlled trial is needed.

Trial registration number NCT02275000; Results.

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.