Neurological Institute, Cleveland Clinic, Cleveland, OH.
Department of Psychology, Louisiana State University, Baton Rouge, LA.
Psychosomatics. 2019 Nov-Dec;60(6):556-562. doi: 10.1016/j.psym.2019.07.002. Epub 2019 Jul 10.
Functional neurological disorder (FND) is difficult to treat and costly. Interdisciplinary chronic pain rehabilitation programs (iCPRPs) are multidimensional functional restoration interventions for pain; their impact on FND specifically has not been assessed.
The purpose of this study was to assess iCPRP's impact on functioning in FND.
Data were examined retrospectively from an Institutional Review Board-approved registry capturing admission and discharge data from patients participating in an outpatient iCPRP. Subjective measures included pain-related disability, depression, anxiety, and stress scores, whereas objective measures included physical functioning measures (timed up and go, stair climbing test, and 6-min walk test). Pre-iCPRP and post-iCPRP measures were compared using a paired t-test approach.
Forty-nine FND patients completed care and showed pre-measures and postmeasures. Statistically significant reductions in subjective measures of pain-related disability (46.40-20.91; P < 0.001, d = 1.92), depression (20.38-4.81; P < 0.001, d = 1.53), anxiety (15.09-6.29; P < 0.001, d = 1.18), and stress (21.96-9.70; P < 0.001, d = 1.21) scores were observed. Statistically significant changes in objective measures of mean timed up and go scores (decreased from 15.96 to 8.87 s), stair climbing test scores (increased from 40.98 to 71.93 steps), and mean 6-minute walk test scores (increased from 0.21 to 0.30 miles) were also observed across the group.
While preliminary and based on a small patient sample, these findings support the use of interdisciplinary care models for FND treatment. Clinical and investigational implications are explored.
功能性神经障碍（FND）难以治疗且费用高昂。跨学科慢性疼痛康复计划（iCPRPs）是针对疼痛的多维功能恢复干预措施；但其对 FND 的具体影响尚未得到评估。
本研究旨在评估 iCPRP 对 FND 功能的影响。
对一项机构审查委员会批准的注册研究的数据进行回顾性分析，该研究从参加门诊 iCPRP 的患者中捕获入院和出院数据。主观测量包括与疼痛相关的残疾、抑郁、焦虑和压力评分，而客观测量包括身体功能测量（起立行走测试、爬楼梯测试和 6 分钟步行测试）。使用配对 t 检验方法比较 iCPRP 前后的测量值。
49 例 FND 患者完成了治疗，并提供了治疗前和治疗后的测量值。与疼痛相关的残疾（46.40-20.91；P<0.001，d=1.92）、抑郁（20.38-4.81；P<0.001，d=1.53）、焦虑（15.09-6.29；P<0.001，d=1.18）和压力（21.96-9.70；P<0.001，d=1.21）的主观测量值均显著降低。平均起立行走测试评分（从 15.96 秒降至 8.87 秒）、爬楼梯测试评分（从 40.98 步增至 71.93 步）和平均 6 分钟步行测试评分（从 0.21 英里增至 0.30 英里）的客观测量值也发生了显著变化。
尽管初步研究结果且基于小样本患者，但这些发现支持将跨学科护理模式用于 FND 治疗。探讨了临床和研究意义。
