Integrated model of care for functional movement disorder: targeting brain, mind and body
Haseel Bhatt, Lindsey MacGillivray, Gabriela S. Gilmour, Keschey Marcelle, Laura Langer, Sarah C. Lidstone
Abstract
Purpose To describe the therapy approaches and clinical outcomes of an integrated care model for patients with functional movement disorder (FMD).Materials and Methods A retrospective chart review was conducted for all treated individuals with a primary diagnosis of FMD between January 2020 and July 2022. Patients received time-limited integrated therapy (n = 21) (i.e., simultaneous therapy delivered by psychiatry, neurology and physiotherapy), physiotherapy (n = 18) or virtual physiotherapy alone (n = 9). Primary outcomes included the Simplified-Functional Movement Disorders Rating Scale (S-FMDRS) and Clinical Global Impression-Improvement scale (CGI-I) collected at baseline and post-intervention.Results Forty-eight patients completed treatment (42% male; mean age, 48.5 ± 16.6 years, median symptom duration 30 months). The most common presentations were gait disorder, tremor and mixed hyperkinetic FMD. Common comorbidities included pain and fatigue. Three-quarters of patients had a comorbid psychiatric diagnosis. There was a significant reduction in S-FMDRS score following therapy (71%, p < 0.0001) and 69% had “much” or “very much” improved on the CGI-I. There was no difference between therapy groups. Attendance rates were high for both in-person (94%) and virtual (97%) visits.Conclusions These findings support that a time-limited integrated model of care is feasible and effective in treating patients with FMD.