Outcomes of an Integrated Multidisciplinary Clinic for People with Functional Neurological Disorder 2023 Palmer et al

Andy

Andy

Retired committee member
Background

Functional neurological disorder (FND) is a disabling condition which has poor prognosis without treatment. This study aimed to evaluate the effectiveness of an outpatient integrated multidisciplinary intervention for the condition.

Objectives
This study aimed to assess the outcomes of a pilot integrated multidisciplinary treatment clinic for FND with motor symptoms.

Methods
Patients were seen simultaneously by a neurology doctor, a physiotherapist, a clinical psychologist, and sometimes a psychiatrist. The primary endpoint was change in quality of life measured by Short Form-36 (SF-36). Secondary outcomes were change in work and social participation measured by the Work and Social Adjustment Scale (WSAS), ability to participate in full-time or part-time employment, self-rated understanding of FND, and self-rated agreement with the diagnosis of FND. Over the year, 13 patients were recruited to the clinic, and 11 agreed to participate in the outcome study.

Results
Statistically significant improvements in quality of life were seen across seven out of eight domains of the SF-36, with improvements in individual domains of between 23 and 39 points (of a possible 100). Mean Work and Social Adjustment Scale score halved from 26 to 13 (worst possible is 40). Of the 12 patients treated, one began to work again after complete unemployment, and two who had been working reduced hours due to disability resumed full time work. No patients had worsened occupational status.

Conclusions
This intervention is associated with substantial improvements in quality of life and function, and may be more amenable to delivery at non-specialist centers than other described interventions for FND.

Paywall, https://movementdisorders.onlinelibrary.wiley.com/doi/10.1002/mdc3.13757
 
Methods
Patients were seen simultaneously by a neurology doctor, a physiotherapist, a clinical psychologist, and sometimes a psychiatrist.
...
Conclusions
This intervention is associated with ...
Click to expand...

What intervention?

So this is a treatment study, but there's no treatment described in the abstract. I doubt being seen simultaneously by 3 or 4 people constitutes treatment unless they have magic eyes.
 
Andy said:
Over the year, 13 patients were recruited to the clinic, and 11 agreed to participate in the outcome study.
Click to expand...
13 patients in one year!!

Andy said:
Of the 12 patients treated, one began to work again after complete unemployment, and two who had been working reduced hours due to disability resumed full time work.
Click to expand...
Not sure where the extra patient came from, considering only 11 agreed to participate.
 
So, if they're evaluating the work they do at this clinic now, this means that what they are doing at the clinic has no evidence. If you do something with real people, then evaluate it after the fact, you have essentially experimented on people.

Again they're just describing what they do as if it's valid in itself, simply by the fact that they are doing it. All knowing that any details about "the intervention" get lost, no one even knows what they did because it'll all get scrambled alongside a bunch of other biased studies generally labeled as "non-pharmaceutical".

Anyway this is exactly what every other alternative medicine provider does. They do a thing. They think it helps and get paid for it. They can show you evidence that it helps. Well, not so much evidence as they think it does and they have some cherry-picked quotes for you if you want any.

We went from snake oil merchants to "memories of snake oil" merchants. No need for snake oil anymore, there is simply no need for substance.
 
"Seeing a doctor", "seeing a therapist","seeing whomever", in everyday language and understanding means some kind of action is taking place. The implication is it's useful, helpful action.

However, to write this up as a scientific paper without the actual methods in the abstract, other than saying practitioners are "seeing" study subjects, is not the accepted process.

In addition, 11 participants is too small a study.
 
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