Outpatient Physical Therapy for [FND]: A Preliminary Feasibility and Naturalistic Outcome Study in a U.S. Cohort, 2019, Maggio et al

Paywall, https://neuro.psychiatryonline.org/doi/10.1176/appi.neuropsych.19030068
Sci hub, https://sci-hub.se/10.1176/appi.neuropsych.19030068

 

I tried and can't find how they actually assessed "being asymptomatic". It mentions somewhere that among limitations are lack of self-reported outcomes, but then I have no idea how "being asymptomatic" is otherwise measured.

The other "marked improvement" is not particularly helpful, a 10-meter walking test only means that it's possible to practice and improve for that very short test. It's possible to train paraplegics to climb a few stairs on their ass. Being able to demonstrate that is very far from that being a reasonable solution in real life or that it actually means an improvement to the paralysis itself.

Drop-outs were 13/50, so 26%. That's very high for a short trial and it's not clear how impaired they were. Selection was based on DSM criteria for psychogenic motor problems, which are untestable so it's not really clear who those participants actually are. "Improvement" rates are 17/50, or 24%, though there is no objective outcome of what improvement means.

The authors do note how unreliable assessment of "improvement" is, which does not prevent the usual conclusions of an "association" with short-term improvement.

So it's hard to define improvement, but it may have occurred in some. As always. Literally, this is always the same damn recipe. The same trials done over and over again. The same conclusion despite the same lack of specific reliable data supporting the conclusion.

 

Like all these trials they have found that people who were able to finish the course were not so ill as people who were not. The more of the sessions you could do the less sick you were at the end, though as usual the set up is so ill defined that in reality it is difficult to say if they fond anything at all.

Taking their results at face value the patients were all keen to do something that might help them get better so motivation to get well is high in FND (the same could be said about ME patients in things like PACE). However a quarter were physically unable to complete the course despite their motivation.

At the end of the trial, exercise classes had helped a little bit but not enough to make a real world difference so, basically, the most you can say is that some patients with the diagnosis of FND can gain some fitness by physical therapy if they can mange to do it.