Palmer David D G, Gamble Mary, Higgins Matthew, Maley Jenny, Watson Eloise
Department of Neurology Capital and Coast District Health Board Wellington New Zealand.
ORA Wellington Inpatient Physiotherapy Team Capital and Coast District Health Board Wellington New Zealand.
Mov Disord Clin Pract. 2023 May 5;10(6):967-973. doi: 10.1002/mdc3.13757. eCollection 2023 Jun.
Functional neurological disorder (FND) is a disabling condition which has poor prognosis without treatment. This study aimed to evaluate the effectiveness of an outpatient integrated multidisciplinary intervention for the condition.
This study aimed to assess the outcomes of a pilot integrated multidisciplinary treatment clinic for FND with motor symptoms.
Patients were seen simultaneously by a neurology doctor, a physiotherapist, a clinical psychologist, and sometimes a psychiatrist. The primary endpoint was change in quality of life measured by Short Form-36 (SF-36). Secondary outcomes were change in work and social participation measured by the Work and Social Adjustment Scale (WSAS), ability to participate in full-time or part-time employment, self-rated understanding of FND, and self-rated agreement with the diagnosis of FND. Over the year, 13 patients were recruited to the clinic, and 11 agreed to participate in the outcome study.
Statistically significant improvements in quality of life were seen across seven out of eight domains of the SF-36, with improvements in individual domains of between 23 and 39 points (of a possible 100). Mean Work and Social Adjustment Scale score halved from 26 to 13 (worst possible is 40). Of the 12 patients treated, one began to work again after complete unemployment, and two who had been working reduced hours due to disability resumed full time work. No patients had worsened occupational status.
This intervention is associated with substantial improvements in quality of life and function, and may be more amenable to delivery at non-specialist centers than other described interventions for FND.
功能性神经障碍（FND）是一种致残性疾病，未经治疗预后较差。本研究旨在评估门诊综合多学科干预对该疾病的有效性。
本研究旨在评估一个针对有运动症状的FND的试点综合多学科治疗诊所的治疗效果。
患者同时由神经科医生、物理治疗师、临床心理学家诊治，有时还有精神科医生参与。主要终点是通过简短健康调查问卷（SF-36）测量的生活质量变化。次要结果包括通过工作和社会适应量表（WSAS）测量的工作和社会参与度变化、参与全职或兼职工作的能力、对FND的自评理解以及对FND诊断的自评认同。在这一年中，13名患者被招募到该诊所，11名同意参与结果研究。
SF-36的八个领域中有七个领域的生活质量有统计学意义的改善，各个领域的改善幅度在23至39分（满分100分）之间。工作和社会适应量表的平均得分从26分降至13分，减半（最差为40分）。在接受治疗的12名患者中，一名完全失业后重新开始工作，两名因残疾而减少工作时间的患者恢复了全职工作。没有患者的职业状况恶化。
这种干预与生活质量和功能的显著改善相关，并且与其他已描述的FND干预措施相比，可能更适合在非专科中心实施。
