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#3031 Outcome and evaluation of an outpatient multidisciplinary group-based rehabilitative therapy programme for functional neurological disorder
  1. Lisette Guy,
  2. Sean Gorman,
  3. Jennifer Wilson,
  4. Temeika Jackson,
  5. Demelza Petty,
  6. Simon Harrison,
  7. Susannah Pick
  1. FND Programme, South London and Maudsley NHS Foundation Trust, London, UK
  2. *Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK

Abstract

Aims We report findings from an eight-week rehabilitative therapy programme, delivered in a neuropsychiatric outpatient setting, with co-primary aims to (1) reduce symptom severity, and (2) improve functional mobility, in selected adults with a diagnosis of Functional Neurological Disorder (FND). Effectiveness of the programme was assessed in regard to outcome data routinely collected throughout the programme, and at three-month follow-up.

Method Following appropriate referral, criteria screening and initial assessment, suitable individuals attended as day patients for two days per week over an eight-week period, and a follow-up session provided at three months. The programme comprised individual sessions of Physiotherapy (PT), Cognitive Behavioural Therapy (CBT) and self-management, as well as group physiotherapy workshops and psycho-educational sessions. Outcome measures included the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-ii), Work and Social Adjustment Scale (WSAS), and clinician-rated observation of mobility-aid requirement. Mobility-aid requirement was categorised as follows: unaided, walking-aid, and wheelchair user. Analyses included only data from individuals completing both treatment and follow-up (n = 31). Friedmans ANOVA assessed overall change in outcome measure scores over time. Dunn-Bonferroni post-hoc tests were used to compare pairs of time-points (Weeks 1, 8, three-month follow-up).

Results There were statistically significant overall improvements on the BAI,χ2(2) = 15.35, p <.001,BDI-ii,χ2(2) = 24.61, p <.001,WSAS,χ2(2) = 24.61, p =.001, and in category of mobility-aid requirement, χ2(2) = 19.50, p <.001.Descriptive statistics indicated that 45% of patients could mobilise unaided prior to programme attendance, with 84%able to mobilise unaided at follow-up. Post-hoc Dunn-Bonferroni tests indicated that reductions in scores were significant between Week 1 and Week 8 for the BAI, p =.004, BDI-ii, p <.001, and WSAS, p =.004, and between Week 1 and three-month follow-up for the BAI, p =.002, BDI-ii, p =.001, and WSAS, p =.006.

Conclusions These findings suggest that an outpatient rehabilitative therapy programme can be a beneficial treatment approach, as patients reported reduced symptom severity in terms of anxiety, depression, and functional impairment, as demonstrated by scores on the BAI, BDI-ii and WSAS, and displayed improvements in mobility, as determined by reduced mobility-aid requirement. Although further evaluation would be encouraged to address limitations of these findings, they serve as a positive indication of an effective alternative to inpatient treatment.

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