Discrepancies between patient-reported and physician-reported severity & disability in functional & non-functional movement disorders, 2026,Vermeulen+

[SNT Gatchaman]

Discrepancies between patient-reported and physician-reported severity and disability in functional and non-functional movement disorders

Spoiler: Authors

Olof Cb Vermeulen; Tjerk J Lagrand; Jeannette Gelauff; Marjolein Brusse-Keizer; Alexander Lehn; Marina A J Tijssen

BACKGROUND
Functional movement disorder (FMD) is a common cause of debilitating symptoms in neurology patients. Due to the stigma that is associated with FMD, it is possible that discrepancies between patient and physician judgements of severity and disability are more pronounced in FMD compared with non-FMD. A patient-physician discrepancy in judgement may be explained by associated comorbid non-motor symptoms.

METHODS
In the prospective TASMAN study, 171 FMD and 294 non-FMD patients were recruited from the Netherlands and Australia. Patient characteristics included non-motor symptoms: depression, anxiety, dissociation, pain and fatigue. Patient-reported and physician-reported severity and disability were collected using seven-point Likert scales. A quantitative measure of discrepancies was calculated by subtracting the physician’s score from the patient’s score. Associations between non-motor symptoms and disability were analysed using linear regression.

RESULTS
Patients reported significantly higher severity and disability compared with physicians in both groups. Patient-physician discrepancies in both severity and disability outcomes were not statistically different between FMD and non-FMD. FMD patients scored significantly higher on all non-motor symptoms compared with non-FMD. Patient-reported, but not physician-reported, disability was associated with increased pain and fatigue in both the FMD and non-FMD groups. In FMD, dissociation was associated with disability in both patient-reported and physician-reported outcomes. In non-FMD, depression was associated with disability in both patient-reported and physician-reported outcomes.

CONCLUSIONS
Our results do not support notions of ongoing FMD-specific stigmatisation in physicians. Similar patient-physician discrepancies regarding severity and disability exist in both FMD and non-FMD patients. Patient-physician discrepancies in disability in all movement disorder patients might be in part explained by different appreciation of the importance of non-motor symptoms.

Web | DOI | PDF | Journal of Neurology, Neurosurgery & Psychiatry | Paywall

 

[SNT Gatchaman]

Functional movement disorder (FMD) is the motor dominant subtype of functional neurological disorder (FND) and encompasses different phenotypes, including tremor, dystonia and weakness. The diagnosis should be based on positive clinical signs, such as Hoover’s sign and entrainment. These tests reveal a problem in the brain’s signal function rather than structural damage.

Guys, you're behind the times.

Despite its prevalence in movement disorder clinics, FMD is still widely stigmatised. Even healthcare providers may contribute to this stigma by, for example, dismissing FMD patients, holding prejudices and acting as if these patients are not deserving of care.

This is a secondary analysis of a prospective cohort study comparing the patient-assessed and physician-assessed disability and severity of FMD and non-FMD. The data used were originally collected as part of the international multi-centre prospective TASMAN study.3

[3] is Positive signs from the history as an aid for early diagnosis in functional movement disorders: The prospective TASMAN study (2025)

That study looked at people referred for, but prior to, their neurological clinic assessment to look back at who ultimately received an FND diagnosis. They developed a model with 88% accuracy.

Shockingly they found "Distinguishing factors amongst these groups included age at onset, gender, history or family history of a functional and psychiatric disorder, sudden onset, specific triggers, fluctuation patterns throughout the day and over an extended period, pain, fatigue, depression, anxiety and dissociation."

Back to this paper, which notes in methods on dissociation —

Dissociation was measured using the Somatoform Dissociation Questionnaire 5 (SDQ-5). This five-item questionnaire results in a score ranging from 5 to 25 points. A score of over 8 points indicates significant somatoform dissociation.

5 point Likert + "Is the physical cause known?" for:

I have pain while urinating
My body, or a part of it, are insensitive to pain
I see things around me differently than usual (for example, as if looking through a tunnel, or merely seeing part of an object)
It is as if my body, or part of it, has disappeared
I cannot speak (or only with great effort) or I can only whisper

(1&5 could easily score highly in severe ME/CFS.)

The patient characteristics are presented in table 1. This study was performed using a cohort of 171 patients with FMD and 294 patients with non-FMD. Of the 294 patients with nonFMD, most patients were diagnosed with PD (n=76); focal dystonia (n=40); essential tremor (ET) (n=37) and parkinsonism (n=27).

In this study, both patients with FMD and with other movement disorders (without FMD) rated the severity and disability of their condition significantly higher than their physicians did. However, no statistical differences in patient-physician discrepancy were found between the two groups. Therefore, these results do not support the hypothesis that physicians specifically underestimate the severity or disability of FMD, a bias that is often linked to the stigma that is associated with the disorder.

(Relaxing, safe in the knowledge that we stigmatise all our patients, equally.)

Non-motor symptoms were more prevalent in the FMD group and different nonmotor symptoms were associated with disability in FMD and in the other movement disorder control group. In both groups, pain and fatigue were associated with disability.