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



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.



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.



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.



NCT02275000; Results.
Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK.|Therapy Services Department, National Hospital for Neurology and Neurosurgery, London, UK.
G
G
Nielsen
Research Department of Primary Care and Population Health, University College London, London, UK.
M
M
Buszewicz
Research Department of Primary Care and Population Health, University College London, London, UK.
F
F
Stevenson
Research Department of Primary Care and Population Health, University College London, London, UK.
R
R
Hunter
Therapy Services Department, National Hospital for Neurology and Neurosurgery, London, UK.|Institute of Cardiovascular and Cell Sciences, St Georges University of London, London, UK.
K
K
Holt
Therapy Services Department, National Hospital for Neurology and Neurosurgery, London, UK.
M
M
Dudziec
Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK.
L
L
Ricciardi
School of Health Professions, Peninsula Allied Health Centre, University of Plymouth, Plymouth, UK.
J
J
Marsden
Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK.
E
E
Joyce
Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK.|Institute of Cardiovascular and Cell Sciences, St Georges University of London, London, UK.
M J
MJ
Edwards
D000328:Adult; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003291:Conversion Disorder / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D004185:Disability Evaluation; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033183:Interdisciplinary Communication; D000070516:Intersectoral Collaboration; D008297:Male; D008875:Middle Aged; D000068079:Motor Disorders / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care / Q000523:psychology; D026741:Physical Therapy Modalities; D011788:Quality of Life / Q000523:psychology; D019057:Quality-Adjusted Life Years