Improvement in motor symptoms, physical fatigue, and self-rated change perception in functional motor disorders: a prospective cohort study of a 12-week telemedicine program

Abstract

Background Functional motor disorders (FMDs) are highly disabling conditions associated with long-term disability, poor quality of life, and economic burden on health and social care. While multidisciplinary 5-days rehabilitation programs have been shown to reduce motor and non-motor symptoms, long-term management and monitoring in FMDs remain an unmet need. Aim To compare a 12-weeks telemedicine program against a 12-weeks self-management program after a 5-days rehabilitation program for improving motor, non-motor symptoms, quality of life, and perception of change in patients with FMDs. Methods The study population was 64 consecutive patients with a definite diagnosis of FMDs who underwent a 5-days in-person rehabilitation program followed by either a self-management (the first 32 patients) or a telemedicine program (the latter 32 patients). Validated measures of motor and non-motor symptoms such as fatigue and pain, quality of life, perception of change, gait, and postural control were recorded before (T0), after completion of rehabilitation (T1), and then again at 3 months (T2). Results Improvement at 3-month follow-up assessment of motor symptoms (p < 0.001), physical fatigue (p = 0.028), and self-rated change perception (p = 0.043) was greater in the telemedicine group. No different between-groups effect was found on other dimensions of fatigue, pain, physical and mental health, and gait and postural control. Conclusions Long-term management and expert monitoring of patients with FMDs via telemedicine may enhance long-term outcomes in motor symptoms and physical fatigue, with a positive long-term impact on self-rated health perception of change.

Pain and functional neurological disorder: a systematic review and meta-analysis

“…Patients with functional movement disorders (n=64) who received home-based physical exercises from a physiotherapist did not show improvements in the Brief Pain Inventory compared with those in the self-management group. 35 A randomised feasibility study of physiotherapy for patients with functional motor disorders (n=57) found no significant changes in SF-36 bodily pain, despite improvements in physical and social function. 29 Likewise, a pilot study of tailored psychotherapy for 63 patients with functional neurological symptoms identified global improvements in the SF-36 but not in bodily pain.…”

Functional Overlay Model of Persistent Post-Concussion Syndrome

“…Further research should also elucidate if the perception of persistent PCS patients of themselves and their illness would be a factor in influencing or evaluating the physiological and psychological outcomes following holistic treatment, as it was suggested that selfperception and expectations related to the disease could at least partly change the treatment and recovery outcomes in FNDs and other chronic neurological disorders [96][97][98].…”

How Does Postural Control in Patients with Functional Motor Disorders Adapt to Multitasking‐Based Immersive Virtual Reality?

“…FMDs are involuntary but learnt altered movement patterns caused by abnormal self‐directed attention and movement prediction, resulting in a movement generated without a normal sense of agency 1,3,17–19 . Within this perspective, multidisciplinary intensive rehabilitation, supported by telemedicine, is a widely recognized strategy for the PwFMD management 20–23 . Retraining movement through diverted attention and changing maladaptive symptoms‐related behaviors can reduce disability and improve patients’ quality of life 20–23 .…”

“… 1 , 3 , 17 , 18 , 19 Within this perspective, multidisciplinary intensive rehabilitation, supported by telemedicine, is a widely recognized strategy for the PwFMD management. 20 , 21 , 22 , 23 Retraining movement through diverted attention and changing maladaptive symptoms‐related behaviors can reduce disability and improve patients’ quality of life. 20 , 21 , 22 , 23 Future research directions require developing interventions for treating specific functional symptoms based on the pathophysiological features of FMDs, such as the altered focus of attention, sense of agency, and belief/expectations.…”

“… 20 , 21 , 22 , 23 Retraining movement through diverted attention and changing maladaptive symptoms‐related behaviors can reduce disability and improve patients’ quality of life. 20 , 21 , 22 , 23 Future research directions require developing interventions for treating specific functional symptoms based on the pathophysiological features of FMDs, such as the altered focus of attention, sense of agency, and belief/expectations. 1 , 3 , 15 , 23 , 24 , 25 Some techniques for specific symptoms to normalize movement have been recommended, mainly focusing on weakness, gait disturbances, tremors, and dystonia.…”