哪些因素可预测功能性运动障碍专科物理治疗的结果？Physio4FMD干预的预后模型。

Which factors predict outcome from specialist physiotherapy for functional motor disorder? Prognostic modelling of the Physio4FMD intervention.

作者信息

Nielsen Glenn, Lee Teresa C, Marston Louise, Carson Alan, Edwards Mark J, Goldstein Laura H, Hunter Rachael Maree, Holt Kate, Marsden Jon, Reuber Markus, Stone Jon, Nazareth Irwin

机构信息

Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St. George's University of London, London SW17 0RE, UK; Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St. George's University of London, London SW17 0RE, UK.

Department of Primary Care and Population Health, University College London, London, NW3 2PF, UK; Department of Primary Care and Population Health, University College London, London, NW3 2PF, UK; PRIMENT Clinical Trials Unit, University College London, London, NW3 2PF, UK; Department of Statistical Science, University College London, London WC1E 7HB, UK.

出版信息

J Psychosom Res. 2025 Mar;190:112056. doi: 10.1016/j.jpsychores.2025.112056. Epub 2025 Feb 10.

DOI:10.1016/j.jpsychores.2025.112056

PMID:39952010

Abstract

OBJECTIVES

Physiotherapy is considered part of first line treatment for functional motor disorder (FMD) although not all patients benefit. Predictors of treatment outcome may help to inform triage decisions. We aimed to determine which baseline variables predicted treatment outcome in the pragmatic multicentre Physio4FMD randomised controlled trial of specialist physiotherapy for FMD.

METHODS

Participants randomised to the specialist physiotherapy arm of the trial were included in the analysis. Treatment outcome was dichotomised into improvement vs no improvement, based on two measures, Short Form 36 Physical Functioning (SF36 PF) and participant-rated Clinical Global Impression Scale of Improvement (CGI-I). Predictors of outcome were selected from baseline variables. Univariate logistic regression was used to calculate the odds ratio of improvement for each variable. Variables associated with improvement at p < 0.1 were considered for inclusion in a multiple logistic regression model.

RESULTS

A greater perception of having control over recovery predicted improvement on the CGI-I (OR 1.18, 95 % CI 1.07, 1.31). Predictors of lack of improvement were an increased perception of the permanence of symptoms, predicting lack of improvement on the SF36 PF (OR 0.91, 95 % CI 0.84, 0.99) and older age, predicting lack of improvement on the CGI-I (OR 0.97, 95 % CI 0.95, 0.998).

CONCLUSIONS

Age and perceptions of symptom control were weak predictors of outcome from specialist physiotherapy. In contrast, a number of factors commonly believed to predict poorer treatment response, including illness duration and levels of pain and fatigue, were not related to the outcomes measured in this study.

摘要

目的

物理治疗被视为功能性运动障碍（FMD）一线治疗的一部分，尽管并非所有患者都能从中受益。治疗结果的预测因素可能有助于指导分诊决策。我们旨在确定在针对FMD的专科物理治疗的实用多中心Physio4FMD随机对照试验中，哪些基线变量可预测治疗结果。

方法

纳入随机分配至试验专科物理治疗组的参与者进行分析。基于两项指标，即简明健康状况调查量表36项身体功能维度（SF36 PF）和参与者评定的临床总体印象改善量表（CGI-I），将治疗结果分为改善与未改善。从基线变量中选择结果的预测因素。采用单因素逻辑回归计算每个变量改善的比值比。将p<0.1时与改善相关的变量纳入多因素逻辑回归模型。

结果

对恢复有更强的控制感预示着CGI-I评分改善（比值比1.18，95%置信区间1.07，1.31）。未改善的预测因素包括对症状持续性的感知增加，预示着SF36 PF评分未改善（比值比0.91，95%置信区间0.84，0.99），以及年龄较大，预示着CGI-I评分未改善（比值比0.97，95%置信区间0.95，0.998）。