Cross-sectional evaluation of health resource use in patients with [FND]s referred to a tertiary neuroscience centre 2024 O'Mahony, Edwards et al

Abstract

Introduction
Functional neurological disorder (FND) is a common cause of referral to neurology services. FND has been shown to lead to significant healthcare resource use and is associated with significant disability, comorbidity and distress. This leads to substantial direct, indirect and intangible costs to the patient and society.

Methods
We recruited consecutive patients with FND referred to a tertiary FND specialist clinic. We assessed health and social care resource use in the 6 months preceding their consultation through a modified version of the Client Service Receipt Inventory in the form of a postal questionnaire. The total cost was estimated by combining the number and frequency of health resource use with standard national unit costs. We also assessed indirect costs such as informal care and loss of income.

Results
We collected data on 118 subjects. Patients with comorbid anxiety or depression had higher costs in the preceding 6 months, as did patients who had a longer duration of FND symptoms. Indirect costs were higher than the already substantial direct costs and a large proportion of patients with FND were receiving government support.

Conclusion
This study highlights the high cost of FND to both patients and health systems. Adequate reform of the patient pathway and reorganisation of services to make diagnoses and initiate treatment more quickly would likely reduce these costs.

Open access, https://neurologyopen.bmj.com/content/6/1/e000606

 

"The FND of movement and sensation has a prevalence of roughly 50 per 100 000 population and an incidence of 4–12 per 100 000 population per year. FS contributes a further 1.5–4.9 per 100 000 population per year, with a prevalence of 2–33 per 100 000 population.5 Patients with FND make up 9% of neurology admissions6 and 16% of neurology clinic referrals.7 "

 

Aside from FND not being a cause, it's literally the label used when they don't know what causes illness, this study is totally useless. Sick people seek health care resources, which are thoroughly lacking and inadequate, and this leads to higher costs, but obviously, no, you can't just wing it to make it better when the whole thing is a bunch of pseudoscience. It's not as if a full century of failing at that can serve as some sort of information here...

Trying to optimize pseudoscience-informed ineffective care is like multiplying zero by whatever number you want. You can work your ass off to multiply by a billion and you'll still get zero. But after decades of having done that, they still can't even acknowledge that they've been multiplying by zero the whole time, and can only think of different ways to get a different number to multiply by zero. Maybe with a different font. Or a different paper. Maybe some chalk?

The whole thing is like building a large rain dancing department in a time of drought. You could employ 10% of your population doing rain dances and it still wouldn't bring any rain. Unless you're willing to do the hard work of either moving, or getting water from elsewhere, nothing will ever happen. But you can always suggest that having more, or fewer, rain dancers do different moves and use different costumes all you want, it's just not going to do anything other than paying people to do nothing useful.

You want the result of work? You gotta do the work. You'd rather clown around instead? For decades? While millions suffer needlessly? Then you don't get the result of the work, because you refused to do it. Children can understand it, but somehow getting this basic information across to medical doctors is basically as effective as dancing for rain, or chanting for sunlight, or tilting at windmills.

 

@dave30th
This old nugget again (16%)
↵

1. Stone J,
2. Carson A,
3. Duncan R, et al

. Who is referred to neurology Clinics?—The diagnoses made in 3781 new patients. Clin Neurol Neurosurg 2010;112:747–51. doi:10.1016/j.clineuro.2010.05.01

 

Thanks. I was alerted about that new paper. I'll tweet about it at least. and blog. Not sure it's worth writing to the journal. Edwards was a co-author of the NeuroImage: Clinical paper that we responded to, and he was a co-author of the response to our letter, but I took that response as them basically saying they'd do the same again. So there it is.

 

"Adequate reform of the patient pathway and reorganisation of services to make diagnoses and initiate treatment more quickly would likely reduce these costs."

But, but, but the 'treatment' has to be real world effective..... And there is no evidence of this.

CODES trial did not find positive outcome for patients with NEAD one favourite of the FND crowd.

Lumping all sorts of 'dunno' together makes it even less likely anyone with get to 'know' the underlying mechanisms and causation.

Lumping all FND together and then confusing the issue of 'feeling a bit better' (massive success for FND folks) versus 'being better' (as in real world meaningful return to functioning, ability to return to work (or equivalent), be active part of family / society etc, etc.... which is of course what patients, their doctors etc and family want.

More of the same.

I predict multiple trials with subjective outcome measures coming soon. With some 'wonderful' acronyms to make it all jolly