Effect of inpatient therapy on quality of life, general and psychosocial functioning, psychological impairment, and symptoms severity for patients with functional neurological disorders
Creators: name: Steinauer, Manuela
Publisher: name: ZHAW Zürcher Hochschule für Angewandte Wissenschaften
Year: 2023
Subjects: 616.8: Neurologie und Krankheiten des Nervensystems

description: Functional neurological disorders (FND) are characterized by the presence of symptoms not caused by a classic neurological disorder. FND are among the most common causes of neurological disability and long-term outcome is poor. Treatment involves multidisciplinary care, including psychoeducation, psychological therapy, or physiotherapy. Since 2021, the Psychosomatic Medicine at Inselspital Bern offers the first specialized inpatient program for FND patients in Switzerland. This study evaluates the treatment effectiveness of this three weeks multidisciplinary inpatient therapy for FND patients, using patient-reported outcome measures (PROMs) and clinical data, providing a comprehensive assessment of therapy impact on quality of life (QOL), general and psychosocial functioning, psychological impairment, and symptom severity.
In a first step, a scoping review was conducted to identify studies on therapy programs for FND patients and to analyse the corresponding outcomes measures. In a second step, the data of patients, attending the three weeks multidisciplinary inpatient therapy at the Psychosomatic Medicine at Inselspital between July 2021 and April 2023, was analysed.
The study included 43 adult patients with FND and collected data at three individual timepoints: at the beginning of therapy (entry), at the end of therapy (exit), and at a three months follow-up. The therapy consisted of physiotherapy, individual psychotherapy, medical consultations, and occupational therapy.
Significant improvement was found in clinical symptoms but no clear significant improvements in PROMs. QOL did not significantly improve across all patients, although there was a significant improvement in QOL at exit compared to entry for patients who were assessed at all three timepoints. General and psychosocial functioning did not show significant differences overall, but there was a significant reduction in impairment from entry to exit. Psychological impairment did not significantly change across all patients, but there was a significant decrease in mean depression scores from entry to exit and a significant increase again at follow-up compared to exit. Compared to the PROMs, the objectively assessed clinical data showed a significant improvement in symptoms at exit and follow-up over all patients.
The study found that clinical outcomes, as assessed by clinicians, did not align with PROMs. While clinical measures showed an improvement, patients did not report a corresponding increase in PROMs. This might suggest that patients have different expectations than clinicians, with patients focusing more on subjective feeling and coping with the disease. The findings indicate that PROMs were less sensitive to change over time compared to clinician-rated assessments. While previous literature on PROMs showed inconsistent results, literature on clinical outcome measures consistently demonstrated a reduction in symptoms. Thus, the findings of this study align with previous research, emphasizing the effectiveness of therapy in reducing symptoms of FND. However, this study must be replicated in a larger sample size, and incomplete data must be avoided to reduce a potential selection bias. Furthermore, FND subtypes and outpatient therapy must be considered. Overall, the study emphasizes the need to explore different outcome measures and the long-term effects of treatment for FND patients.