A multidisciplinary approach integrating specialized physiotherapy with cognitive-behavioral therapy significantly improves the symptoms and physical aspects of quality of life for patients with functional movement disorders, according to a new randomized clinical trial. The study, published in JAMA Neurology, highlights the efficacy of combining physical and psychological therapies to address this challenging condition.
The research, led by Daniel Macías García and Pablo Mir Rivera from HUVR-IBiS/CIBERNED and the University of Seville, involved a team of specialists in physiotherapy, psychiatry, psychology, and neurology. The trial is the first to demonstrate the benefits of this integrated approach in a controlled setting.
Study Design and Results
The study involved patients diagnosed with functional movement disorders at the Hospital Universitario Virgen del Rocío – IBiS Movement Disorders Unit. Participants were randomly assigned to either a multidisciplinary treatment group, receiving outpatient physiotherapy and brief cognitive-behavioral therapy, or a control group, receiving non-specific supportive psychological therapy.
Results showed that patients in the multidisciplinary group experienced a greater than 50% improvement in the severity of their motor symptoms at a five-month follow-up, compared to the control group. This improvement had a positive impact on the physical aspects of their quality of life. Furthermore, nearly 60% of patients in the multidisciplinary group perceived clear improvements from the therapy by the end of the treatment. This led to the social and occupational reincorporation of up to 20% of those who were previously unemployed or on sick leave due to their symptoms.
Functional Movement Disorders: A Complex Condition
Functional movement disorders are neurological conditions characterized by a loss of movement control due to nervous system malfunction, rather than structural damage or disease. These disorders can manifest as excessive movement, such as tremors or abnormal postures, or as a lack of movement, such as weakness or gait disorders. They often appear in younger patients, typically between the ages of 20 and 40, and can be associated with various risk factors.
Implications for Clinical Practice
Despite being a common pathology in neurology, there are often no established care plans or multidisciplinary units for these patients within public health systems. This study provides evidence supporting the implementation of integrated approaches, combining specialized physiotherapy and psychological therapies, to improve patient outcomes.
"For the first time in a controlled study, this randomized clinical trial demonstrates that an integrated approach involving physiotherapy plus cognitive behavioral therapy can improve the quality of life and symptoms of patients with functional movement disorders, compared to a similar diagnostic and non-specific supportive approach," the researchers noted. "This confirms the evidence previously found by other research groups in neuropsychiatry and could serve as support for generating a model of multidisciplinary units in the national health system offering this type of approach in hospitals."
The study also opens avenues for future research, including investigating the therapy's impact on brain circuits involved in functional movement disorders and evaluating the cost-effectiveness of this approach in healthcare settings.
