Combined Physiotherapy and Cognitive Behavioral Therapy for Functional Movement Disorders

• DOI: 10.1001/jamaneurol.2024.2393
• Publication Date: 2024-08-05T15:25:27Z
• Authors: Daniel Macías-García; Marta Méndez-Del ...; Manuel Canal-Rivero; Laura Muñoz-Delgado; Astrid Adarmes-Gómez; Silvia Jesús; Elena Ojeda-Lepe; Fátima Carrillo-G...; Francisco J. Palomar; Francisco Javier ...; Juan Francisco Ma...; Benedicto Crespo-...; Miguel Ruiz-Veguilla; Pablo Mir
• Keywords: Movement Disorders; Functional movement

Importance Functional movement disorders (FMDs) are frequent and disabling neurological with a substantial socioeconomic impact. Few randomized studies have analyzed the effectiveness of combined physiotherapy psychotherapy in patients’ quality life. Objective To assess efficacy multidisciplinary treatment (physiotherapy plus cognitive behavioral therapy) FMDs. Design, Setting, Participants This was parallel, rater-blinded, single-center, clinical trial. Recruitment took place from June 2022 to April 2023, follow-up visits were performed at months 3 5, concluding October 2023. recruited national referral center for disorders: Movement Disorders Unit Hospital Universitario Virgen Rocio Seville, Spain. Patients had be 18 years or older confirmed FMD diagnosis capable giving consent participate. who did not meet eligibility criteria refused participate excluded. Any uncontrolled psychiatric disorder considered an exclusion criterion. Interventions randomly assigned, ratio 1:1 therapy), control intervention (psychological support intervention). Main Outcomes Measures Primary outcomes: between-group differences changes baseline month 5 life (EQ-5D-5L score: EQ Index visual analog scale [EQ VAS]; 36-Item Short-Form Survey Physical Component Summary [SF-36 PCS] SF-36 Mental [MCS]). Linear mixed models applied, controlling by severity applying Bonferroni correction. Results Of 70 patients screened FMD, 40 enrolled (mean [SD] age, 43.5 [12.8] years; age range, 18-66 32 female [80%]; mean onset, 38.4 [12.1] years), 38 completed all included analysis primary outcomes. Multidisciplinary improved PCS difference 4.23 points (95% CI, −0.9 9.4 points; P = .11) significant 5.62 2.3-8.9 < .001), after multiple-comparisons adjustment. There no other quality-of-life outcomes such as MCS months: 0.72 95% −5.5 7.0 .82 0.69 .83, respectively), VAS (9.34 −0.6 19.3 .07 13.7 −1.7 29.0 .09, respectively) (0.001 point; −0.1 0.1 .98 0.08 0-0.2 .13, respectively). At 42% 47% patients, respectively, group reported health using EQ-5D system, compared 26% 16% group. Conclusions Relevance show that effectively improves symptoms physical aspects Further must evaluate potential cost-effectiveness this approach FMD. Trial Registration ClinicalTrials.gov Identifier: NCT05634486