Physiotherapy management of functional movement disorders: the patient perspective 2023 Zeun and Hunter

Abstract

Purpose
People with functional movement disorders (FMD) are commonly seen in neurology clinics. Despite a recent increase in research, no standardised treatment pathway across the UK exists. Currently only a few qualitative studies in FMD with a focus on psychological aspects and diagnosis have been published. This study aimed to understand people with FMD perceptions of their physiotherapy treatment.

Method
Qualitative web-based interviews were conducted with seven participants and an interpretive phenomenological approach was used to identify themes from the data.

Results
Four themes were identified; 1) my brain, mind and body are all me, 2) physiotherapy; what helps and what doesn’t, 3) what recovery is to me, and 4) barriers to treatment. Participants desired a combination of psychological and physical approaches, which were holistic, individualised, and delivered by experienced physiotherapists. Limited availability and funding of specialist treatments were barriers to recovery.

Conclusion
Holistic management combining psychological and physiological systems seems to be crucial for effective management of FMD. Large variations in physiotherapy treatment exist across the UK. It is hoped that increasing the understanding, amongst healthcare professionals will lead to the development of timely and appropriate pathways for patients that otherwise find themselves lost between medical specialities.

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  IMPLICATIONS FOR REHABILITATION
• Patients report more positive experiences when a combined and detailed psychological and physiological explanation to their symptoms is given.
  
  
• An individualised approach working with the patient on activities they find challenging is more preferable than group exercise or impairment based (e.g., strengthening/stretching) treatments.
  
  
• Having a physiotherapist who is experienced in treating functional movement disorders or prepared to learn and understand them helped with adherence to treatment.
  

Open access, https://www.tandfonline.com/doi/full/10.1080/09638288.2023.2272709

 

Theme 1a. Giving me knowledge

So something perfectly safe to tell anybody with ME/CFS who has been misdiagnosed then....

Shame that any 'scientific' explanation given to them will be merely wishful thinking on behalf of the professional.

 

Physiotherapists are not qualified mental health workers. If in fact, physios are officially sanctioned to provide psychological counselling, along with their usual therapies, this is concerning.

The default perspective always seems to be that mental health issues are interfering with normal functioning, whatever that is defined as.

Any physiological health issue that practitioners can't be bothered to investigate or learn about, is deemed a mental health issue.

"Just go to the gym, and you'll get better."

ETA: punctuation corrected

 

There sure is an awful lot of therapist perspective in those patients' perspectives as reported by therapists. The themes are clearly so.

It's basically the same old: if professionals tell stories to patients, most patients will believe some of the stories. Does that count as professional health care? In my opinion it does not. It cheapens the very idea of professionals, building up on "trust us, we're experts", then using that expertise to simply tell stories that, if we are being honest, are more reassuring to the therapists than the patients, who are not getting any real help in the end.

Any business run like this would go bankrupt. If you run focus groups where you get the answers you want, you will get beat in the market by people who are smarter about this, and want to know what people really need and want, not simply create a theatre-like production where they can boast about customers repeating the company motto "totally naturally" and totally breaking out singing and dancing the company's jingle.