Psychologically informed physiotherapy as part of a multidisciplinary rehabilitation program for children & adolescents with [FND], 2020, Kasia et al

[Andy]

Full title: Psychologically informed physiotherapy as part of a multidisciplinary rehabilitation program for children and adolescents with functional neurological disorder: Physical and mental health outcomes

Aim

Children and adolescents with functional neurological disorder (FND) present with physical impairment and mental health comorbidities. Specialist physiotherapy programs for treating FND have been developed over the last two decades. This article reports outcome data from three cohorts of children treated with a multidisciplinary rehabilitation intervention – the Mind–Body Program – in which a psychologically informed physiotherapy intervention, known as the wellness approach to physiotherapy, was a key component.

Methods
For three cohorts of children (n = 57, n = 60 and n = 25, respectively) treated in the Mind–Body Program, data about functional impairment and mental health concerns were collected at presentation and at follow‐up (4 years, 12 months and 18 months, respectively).

Results
Outcome data show that FND symptoms resolved in 54/57 (95%), 51/60 (85%) and 22/25 (88%) of children in the three cohorts, and that 31/57 (61%), 32/60 (53%) and 13/25 (52%) of children returned to full health and to full‐time school attendance. Changes in Global Assessment of Function (GAF) were significant (t(54) = 21.60, P < 0.001; t(55) = 9.92, P < 0.001; t(24) = 6.51, P < 0.001). Outcomes were less favourable for children with chronic FND symptoms at presentation; those whose comorbid mental health disorders or other (comorbid) functional somatic symptoms did not resolve; and those who subsequently developed chronic mental health problems.

Conclusions
Implementation of a multidisciplinary rehabilitation intervention – with psychologically informed physiotherapy as one of the key treatment components – resulted in resolution of FND symptoms and return to health and well‐being in the large majority of patients.

Paywall, https://onlinelibrary.wiley.com/doi/abs/10.1111/jpc.15122
Sci hub, unable to access via at time of posting.

 

[Sean]

From Wikipedia:

The Global Assessment of Functioning (GAF) is a numeric scale used by mental health clinicians and physicians to rate subjectively the social, occupational, and psychological functioning of an individual, e.g., how well one is meeting various problems in living. Scores range from 100 (extremely high functioning) to 1 (severely impaired).

The scale was included in DSM-IV, but replaced in DSM-5 with the WHODAS (WHO Disability Assessment Schedule), a survey or interview with detailed items. The WHODAS is supposed to be more detailed and objective than a single global impression. The main advantage of the GAF would be its brevity.

So, a single outdated outcome measure, of (as far as I can tell) the clinician's subjective assessment of the patient's status (not self-report by the patient), and – in this study – uncontrolled.

Yep, the usual crap.

 

[Snowdrop]

With this group of researchers it is their POV that informs any conclusions anyway.

There is no science here. They can call it research, they can get it printed up in a journal--
but regardless this is no more than opinion, thinly disguised, based on preconceptions they cannot prove. I think they believe they have 'proved' them but they use the same non-science methods and thinking to create proof.

This group of FND, MUS researchers seem to lack the capacity to understand the patient experience of illness always viewing symptoms through the lens of their preconceptions.

Currently the exposure of this wrong thinking can be found in the many people who are getting ill with long-covid who were taught to believe in the crap this group spouts. When faced with symptoms that yield no unusual lab results yet affect their lives profoundly they finally realise what the experience is and that it isn't amenable to the trite solutions that have been proffered.

These researchers just don't know what they are talking about. And I'm not even sure they know how completely they are making this stuff up.

I also think it's part of the cult of (here I'm not sure I know the right words) but a sort of 'life is good /positivity / push to make the most or best of everything. This means thinking their job is super ultra important to the point of making the sick person their project and failure is not an option because that would be negative and not lead to job satisfaction. And job satisfaction is what is the really important bit when the patient leaves.

That bit might sound strange but I have read stuff (not research but articles) where they comment as much cheer-leading for each other (metaphorical high fives) and feelings of a sense of belonging and accomplishment. I'm not saying this type of feeling is only found among this group just that it seems to interfere with clarity of thought with regard to the actual outcomes of their efforts.

But then again it's enough to put it down to the lack of scientific rigour at any rate.

 

[rvallee]

More copy-paste research from the clown factory. This exact kind of experiment has been done hundreds of times, probably thousands. That this is still getting funding and approval is by now a massive failure of the regulatory process and fiscal responsibility, wasting resources on pet projects of no scientific merit.

The approval board, the funders, the reviewers, the journal, the oversight, everyone is failing massively at upholding their responsibility. All the funding wasted on this should be returned, out of the respective departments' future budgets if need be. Accountability is badly needed here, there simply isn't any at all.

 

[NelliePledge]

Clown factory scamming a living - nauseating

 

[Amw66]

Kids.
The amount of harm this kind of thing can do should be the subject of a study.

 

[rvallee]

Kids.
The amount of harm this kind of thing can do should be the subject of a study.

How to breed mistrust of experts 101. This is a large part of why some people distrust experts, when "expertise" falls completely on its face. Accountability. Now.

Being exposed to blatant charlatanism like that will wreck anyone's perspective of the very idea of expertise. And all for damn nothing, just to keep the clown show going.

 

[Hutan]

This exact kind of experiment has been done hundreds of times,

The thing is, this isn't actually an experiment. It's propaganda.

There's no controls, so no one has any idea how many of these children would have got better over time without the 'psychologically informed physiotherapy'. The fact that outcomes were less favourable for those children whose symptoms were already chronic is completely in line with a recovery pattern that looks a lot like that found in the Dubbo study (i.e. high rates of recovery in the first year, with recovery rates tailing off after that).

and those who subsequently developed chronic mental health problems.

This is the bit that bothers me the most. From the abstract, it appears that the authors assume that 'development of chronic mental health problems causes failure to recover despite our great treatment'. I think it's far more likely that those children who didn't recover were, at least partly as a result of the treatment, left feeling as though they had failed and were psychologically inadequate. and such feelings contributed to depression and anxiety. Also, some of the children might have felt angry about the illness model that was being pushed on them, and expressions of that anger may have been classified as a 'mental health problem'.

 

[Mithriel]

Children feel massive distress when they think they have failed their parents. As adults it is difficult to not feel guilty when you have been assured you will be well if you follow their programme correctly but don't improve so to put this pressure on kids is appalling.