Physiotherapy for functional disorders is potentially highly effective in selected patients

In their JNNP publication, Nielsen et al1 present data from a randomised controlled trial of 57 patients with functional (psychogenic) motor disorders, such as limb weakness, gait disorder, tremor and dystonia. They are a leading cause of neurological disability at all ages. They may be isolated but more commonly co-occur with other physical and psychological comorbidities such as fatigue, pain and anxiety. Randomised trials are scarce.

The active group had just five consecutive days of twice daily physiotherapy, designed specifically for functional motor disorders,2 delivered as an outpatient. At 6 months, despite symptom duration of 6 years prior to treatment, 72% of the intervention group rated their symptoms as improved compared to 18% of the control group. There were large treatment effects on physical and social functioning. This kind of data is not a one off; previous studies in London, Mayo Clinic, Glasgow and Norway3 ,4 also found remarkable outcomes from physical therapy. Similar improvements in disorders such as multiple sclerosis or stroke would be considered worthy of vast expenditure and reorganisation of care.

In the 19th century physiotherapy was regarded as essential component of treatment. Gowers …