1. Click here to sign the "Publish the NICE ME/CFS Guideline Now" petition.
    Dismiss Notice
  2. Guest, the 'News in Brief' for the week beginning 13th September 2021 is here.
    Dismiss Notice
  3. Welcome! To read the Core Purpose and Values of our forum, click here.
    Dismiss Notice

Physiotherapy for functional motor disorders: a consensus recommendation, 2015, Nielsen et al

Discussion in 'PsychoSocial ME/CFS Research' started by Hutan, Sep 13, 2021.

  1. Hutan

    Hutan Moderator Staff Member

    Messages:
    15,997
    Location:
    New Zealand
    Open access: https://jnnp.bmj.com/content/86/10/1113

    Glenn Nielsen, Jon Stone, Audrey Matthews, Melanie Brown, Chris Sparkes, Ross Farmer, Lindsay Masterton, Linsey Duncan, Alisa Winters, Laura Daniell, Carrie Lumsden, Alan Carson, Anthony S David, Mark Edwards

    Abstract
    Background Patients with functional motor disorder (FMD) including weakness and paralysis are commonly referred to physiotherapists. There is growing evidence that physiotherapy is an effective treatment, but the existing literature has limited explanations of what physiotherapy should consist of and there are insufficient data to produce evidence-based guidelines. We aim to address this issue by presenting recommendations for physiotherapy treatment.

    Methods A meeting was held between physiotherapists, neurologists and neuropsychiatrists, all with extensive experience in treating FMD. A set of consensus recommendations were produced based on existing evidence and experience.

    Results We recommend that physiotherapy treatment is based on a biopsychosocial aetiological framework. Treatment should address illness beliefs, self-directed attention and abnormal habitual movement patterns through a process of education, movement retraining and self-management strategies within a positive and non-judgemental context. We provide specific examples of these strategies for different symptoms.

    Conclusions Physiotherapy has a key role in the multidisciplinary management of patients with FMD. There appear to be specific physiotherapy techniques which are useful in FMD and which are amenable to and require prospective evaluation. The processes involved in referral, treatment and discharge from physiotherapy should be considered carefully as a part of a treatment package.
     
    Last edited: Sep 13, 2021
  2. Hutan

    Hutan Moderator Staff Member

    Messages:
    15,997
    Location:
    New Zealand
    It's interesting that they felt that there was not enough data to produce an evidence-based guideline. But they'll present some recommendations anyway, with the Methods section summarised as 'We had a meeting and we decided this seems about right'.
    They go on to note that their etiological framework is the BPS model, but yes, although phrases like 'emotional disorder' and 'personality traits' get thrown around freely, they suggest they are moving away from a 'purely psychological model'.
    This is the evidence they cite:
    1. Jordbru et al
    Psychogenic gait disorder: a randomized controlled trial of physical rehabilitation with one-year follow-up. J Rehabil Med 2014
    3. Nielsen, Stone, EdwardsPhysiotherapy for functional (psychogenic) motor symptoms: a systematic review. J Psychosom Res 2013


    I thought the paragraphs about exercise and management of pain and fatigue were particularly interesting given the issue we are having with the Royal Colleges right now:
    You can see how a NICE guideline that specifically says that GET should not be used for chronic fatigue syndrome throws a rather large spanner in the works.

     
  3. Peter Trewhitt

    Peter Trewhitt Senior Member (Voting Rights)

    Messages:
    2,042
  4. Peter Trewhitt

    Peter Trewhitt Senior Member (Voting Rights)

    Messages:
    2,042
    There is also a parallel piece on for Occupational Therapists

    Nicholson C, Edwards MJ, Carson AJ, et al. Occupational therapy consensus
    recommendations for functional neurological disorder. J Neurol Neurosurg Psychiatry
    2020;91:1037–45.

    https://jnnp.bmj.com/content/jnnp/91/10/1037.full.pdf
     
  5. Daisybell

    Daisybell Moderator Staff Member

    Messages:
    2,504
    Location:
    New Zealand
  6. MSEsperanza

    MSEsperanza Senior Member (Voting Rights)

    Messages:
    1,969
    Location:
    betwixt and between
    Yes, interesting and concerning. At least the article is in the rubric "Viewpoint".

    Whereas... -- not sure if this RCP journal's "practical review" from January 2021 has been posted already elsewhere on the forum:

    A practical review of functional neurological disorder (FND) for the general physician
    Karina Bennett, Clare Diamond, Ingrid Hoeritzauer, Paula Gardiner, Laura McWhirter, Alan Carson, Jon Stone
    Clinical Medicine Jan 2021, 21 (1) 28-36; DOI: 10.7861/clinmed.2020-0987
     
  7. Peter Trewhitt

    Peter Trewhitt Senior Member (Voting Rights)

    Messages:
    2,042
    The links to this article cited above

    A practical review of functional neurological disorder (FND) for the general physician
    https://www.rcpjournals.org/content/clinmedicine/21/1/28/tab-article-info

    and the full text as a pdf
    https://www.rcpjournals.org/content/clinmedicine/21/1/28.full.pdf?download=true
     
  8. Trish

    Trish Moderator Staff Member

    Messages:
    35,720
    Location:
    UK
    I know nothing about functional motor disorders and what sort of treatment people with them find helpful, but I am very wary of assuming fatigue suffered by people with these disorders has anything to do with ME/CFS.

    If there were such a big overlap as to warrant the inclusion of ME/CFS in this paper, surely the reverse would be true, and research on ME/CFS would list functional motor disorders as a common co-morbidity. As far as I know that's not the case.

    It looks to me more like huge assumptions being made here on the basis that everything the BPS people get involved in ends up with the same theory of false beliefs and phobias and past traumas, and the same GET/CBT being prescribed.
     
  9. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

    Messages:
    9,784
    We recommend that physiotherapy treatment is based on a biopsychosocial aetiological framework.

    This is just bad medicine. In modern medicine we do not base treatment on theoretical frameworks.
    We base it on evidence of safety and efficacy.

    It is salutary to compare this statement with what is in the draft NICE guideline. The latter says nothing about basing treatment on theoretical frameworks and specifically recommends against frameworks such as deconditioning.
     
    Last edited: Sep 13, 2021
  10. MSEsperanza

    MSEsperanza Senior Member (Voting Rights)

    Messages:
    1,969
    Location:
    betwixt and between
    Forum thread here.

    Thread on the related editorial here.
     
    alktipping and Peter Trewhitt like this.
  11. MSEsperanza

    MSEsperanza Senior Member (Voting Rights)

    Messages:
    1,969
    Location:
    betwixt and between
    Unless they think motor fatigue belongs to the same type of disorder ... -- but maybe they do?
     
  12. chrisb

    chrisb Senior Member (Voting Rights)

    Messages:
    3,871
    Ah, but is that in the pre-publication draft? He asks, innocently.
     
  13. rvallee

    rvallee Senior Member (Voting Rights)

    Messages:
    7,280
    Location:
    Canada
    This is completely self-contradictory.

    High school essays have higher requirements of not being self-contradictory.
     
  14. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

    Messages:
    9,784
    It's in what counts, he said innocently.
     

Share This Page