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Which factors predict outcome from specialist physiotherapy for functional motor disorder? Prognostic modelling of the Physio4FMD intervention

Nielsen, G; Lee, TC; Marston, L; Carson, A; Edwards, MJ; Goldstein, LH; Hunter, RM; ... Nazareth, I; + view all (2025) Which factors predict outcome from specialist physiotherapy for functional motor disorder? Prognostic modelling of the Physio4FMD intervention. Journal of Psychosomatic Research , 190 , Article 112056. 10.1016/j.jpsychores.2025.112056. (In press). Green open access

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Abstract

Objectives: Physiotherapy is considered part of first line treatment for functional motor disorder (FMD) although not all patients benefit. Predictors of treatment outcome may help to inform triage decisions. We aimed to determine which baseline variables predicted treatment outcome in the pragmatic multicentre Physio4FMD randomised controlled trial of specialist physiotherapy for FMD. Methods: Participants randomised to the specialist physiotherapy arm of the trial were included in the analysis. Treatment outcome was dichotomised into improvement vs no improvement, based on two measures, Short Form 36 Physical Functioning (SF36 PF) and participant-rated Clinical Global Impression Scale of Improvement (CGI-I). Predictors of outcome were selected from baseline variables. Univariate logistic regression was used to calculate the odds ratio of improvement for each variable. Variables associated with improvement at p < 0.1 were considered for inclusion in a multiple logistic regression model. Results: A greater perception of having control over recovery predicted improvement on the CGI-I (OR 1.18, 95 % CI 1.07, 1.31). Predictors of lack of improvement were an increased perception of the permanence of symptoms, predicting lack of improvement on the SF36 PF (OR 0.91, 95 % CI 0.84, 0.99) and older age, predicting lack of improvement on the CGI-I (OR 0.97, 95 % CI 0.95, 0.998). Conclusions: Age and perceptions of symptom control were weak predictors of outcome from specialist physiotherapy. In contrast, a number of factors commonly believed to predict poorer treatment response, including illness duration and levels of pain and fatigue, were not related to the outcomes measured in this study.

Type: Article
Title: Which factors predict outcome from specialist physiotherapy for functional motor disorder? Prognostic modelling of the Physio4FMD intervention
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.jpsychores.2025.112056
Publisher version: https://doi.org/10.1016/j.jpsychores.2025.112056
Language: English
Additional information: © 2025 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Keywords: FND, Functional neurological disorder, Physiotherapy, Predictors, Prognosis, Rehabilitation
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Applied Health Research
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Primary Care and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/10204913
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