Andy
Retired committee member
Full title: Subjective versus objective measures of distress, arousal and symptom burden in patients with functional seizures and other functional neurological symptom disorder presentations: A systematic review
Highlights
• Outcome measurement poses particular challenges in patients with PNES and FND.
• Objective/subjective measures of arousal and symptom burden rarely correlate.
• Subjective and objective measures yield complementary information.
• Change in subjective/objective discrepancies may be of particular interest in FND.
• The best outcome measure depends on the particular study objectives.
Abstract
Symptoms and functioning can be measured subjectively using self-report measures or objectively, based on physiological changes. This raises the question whether subjective and objective measures are closely correlated and – if not – whether one is more accurate or meaningful than the other, especially in patients with Functional Seizures (FS) or other Functional Neurological Symptom Disorders (FND), where subjective and objective observations may be thought particularly likely to deviate. This systematic review explores these questions focussing on measures of distress, arousal and symptom burden. Eighteen studies (12 FS, 6 other FND) capturing 396 FND patients were included. Eleven reported no correlation between subjective and objective measures. Only four studies reported significant correlations (r’s = −0.74–0.59, p’s < 0.05). The small number of studies and diverse methodologies do not provide conclusive answers to the questions posed. Given that subjective and objective measures capture different aspects of current state or function, a combination of measurement approaches is likely to provide optimal information about patients’ health state. In view of the attentional and perceptual alterations implicated in FND, the difference between objective and subjective measures may represent an interesting observation in its own right.
Open access, https://www.sciencedirect.com/science/article/pii/S2589986421000769
Highlights
• Outcome measurement poses particular challenges in patients with PNES and FND.
• Objective/subjective measures of arousal and symptom burden rarely correlate.
• Subjective and objective measures yield complementary information.
• Change in subjective/objective discrepancies may be of particular interest in FND.
• The best outcome measure depends on the particular study objectives.
Abstract
Symptoms and functioning can be measured subjectively using self-report measures or objectively, based on physiological changes. This raises the question whether subjective and objective measures are closely correlated and – if not – whether one is more accurate or meaningful than the other, especially in patients with Functional Seizures (FS) or other Functional Neurological Symptom Disorders (FND), where subjective and objective observations may be thought particularly likely to deviate. This systematic review explores these questions focussing on measures of distress, arousal and symptom burden. Eighteen studies (12 FS, 6 other FND) capturing 396 FND patients were included. Eleven reported no correlation between subjective and objective measures. Only four studies reported significant correlations (r’s = −0.74–0.59, p’s < 0.05). The small number of studies and diverse methodologies do not provide conclusive answers to the questions posed. Given that subjective and objective measures capture different aspects of current state or function, a combination of measurement approaches is likely to provide optimal information about patients’ health state. In view of the attentional and perceptual alterations implicated in FND, the difference between objective and subjective measures may represent an interesting observation in its own right.
Open access, https://www.sciencedirect.com/science/article/pii/S2589986421000769
