Multidisciplinary approach improves quality of life in functional movement disorders

The research team of the Neurology Department Movement Disorders Unit at the Virgen del Rocío University Hospital and the Movement Disorders group of the Institute of Biomedicine of Seville – IBiS, in collaboration with researchers from the Mental Health Clinical Management Unit and the Translational Psychiatry group coordinated by Benedicto Crespo Facorro (HUVR-IBiS/CIBERSAM), has published a randomized clinical trial demonstrating for the first time that a multidisciplinary approach integrating specific physiotherapy and cognitive-behavioral therapy is effective in improving the symptoms and physical aspects of the quality of life of patients with functional movement disorders.

The study, published in the journal JAMA Neurology, was led by Daniel Macías García (HUVR-IBiS/CIBERNED) and Pablo Mir Rivera (HUVR-IBiS/CIBERNED, University of Seville), and involved a multidisciplinary team that included specialists in disciplines such as physiotherapy (Marta Méndez Del Barrio), psychiatry (Miguel Ruiz Veguilla) and psychology (Manuel Canal Rivera), as well as specialists in neurology.

The study (a randomised clinical trial) shows that a therapeutic approach integrating specialised physiotherapy with cognitive-behavioural therapy is effective in improving the severity of symptoms and physical aspects of the quality of life of patients affected by functional movement disorders. Furthermore, the study suggests this approach could be cost-effective in terms of social and health care for patients with this type of neurological disorder.

In this study, we addressed the care of a group of patients with functional movement disorders, after being diagnosed in the Hospital Universitario Virgen del Rocío – IbiS Movement Disorders Unit. They were randomly assigned to treatment with a multidisciplinary approach integrating an outpatient physiotherapy program plus brief cognitive-behavioral therapy or non-specific supportive psychological therapy. Compared to patients in the control group, the severity of their motor symptoms in the patients assigned to the multidisciplinary approach improved by more than 50% at 5-month follow-up, with a positive impact on physical aspects of their quality of life. Nearly 60% of patients in the multidisciplinary group perceived clear improvements from therapy at the end of treatment and this had an impact on the social and occupational reincorporation of up to 20% of those who were unemployed or on sick leave due to their symptoms.

Functional movement disorder: interface between neurology and psychiatry

Such neurological disorders, a frequent reason for consultations in neurology departments, cause patients to lose their ability to control movement due to an alteration in the functioning of the nervous system rather than due to injury, inflammation or degeneration of the nervous system. Clinically, functional movement disorders may present with excess movement (tremor, shaking, abnormal postures, among others) or lack of movement (weakness, gait disorder), such functional neurological disorder being caused by a malfunction of the nervous system (brain circuits involved in the production, perception and control of movement). They usually appear in young patients, with an age of onset between the third and fourth decade of life, and with the existence of a series of risk and predisposing factors, which are not always present in all patients.

Despite being a common pathology in neurology, there are no care plans or multidisciplinary units for these patients in the national public health systems. Clinical research studies point to improvements in at least one subgroup of these patients with specialised physiotherapy approaches and various psychological therapies. In particular, there is evidence from multidisciplinary units in other countries of possible clinical benefits for patients from interdisciplinary approaches, but there have been no randomised clinical trials to evaluate the efficacy of such approaches until now.

Relevance

For the first time in a controlled study, this randomized clinical trial demonstrates that an integrated approach involving physiotherapy plus cognitive behavioral therapy can improve the quality of life and symptoms of patients with functional movement disorders, compared to a similar diagnostic and non-specific supportive approach. This confirms the evidence previously found by other research groups in neuropsychiatry and could serve as support for generating a model of multidisciplinary units in the national health system offering this type of approach in hospitals. It also opens up new lines of research, such as the impact of the therapy on the brain circuits involved in the origin of functional movement disorders or evaluation of the cost-efficiency of this approach in health care.

The work was funded by the Caser Foundation – IV Programme of aid for social and health research and by the Carlos III Health Institute (ISCIII).