Multidisciplinary inpatient rehabilitation for Functional Movement Disorders: A prospective study with long term follow up

Abstract

IntroductionFunctional Movement Disorders (FMDs) are challenging to treat. We assessed the effect of multidisciplinary inpatient rehabilitation, involving motor retraining, psychotherapy and psychotropic medication on FMD patient function and maintenance of improvement after one year. MethodsFMD patients in a movement disorders clinic were referred for inpatient rehabilitation. Baseline, discharge and one year follow-up measures included: Clinical Global Impression (CGI-severity, CGI-change); Depression and Somatic Symptom Scale (DSSS); Generalized Anxiety Disorder-7 (GAD-7); Patient Health Questionnaire-9 (PHQ-9); Post-traumatic stress disorder check-list for DSM-5 (PCL-5). Outcomes were analyzed with non-parametric models. ResultsSeventeen patients completed rehabilitation. Thirteen completed one-year follow-up. Median CGI-severity was “markedly ill.” At discharge, movement disorder improved in 93% (median CGI-change = 2, “much improved”) as assessed by neurologist and patient. Psychiatrist ratings showed improvement among 86.7%; physiatrist and psychologist ratings were 66.7% and 53.3%, respectively. Symptoms improved on DSSS (Wilcoxon Z = −2.914, p ≤ 0.004); GAD-7 (Z = −3.045, p ≤ 0.002); PHQ-9 (Z = −3.415, p ≤ 0.01) but not PCL-5 (Z = −1.506, p = 0.132). At 1 year, 54% maintained at least minimal improvement by neurologist rating and 77% by patient rating (median CGI-change = 3, “minimally improved”). Improvement was not maintained for DSSS (Wilcoxon Z = −0.385. p = 0.701), GAD-7 (Z = −0.943, p = 0.357) or PHQ-9 (Z = −0.55, p = 0.582). ConclusionsMultidisciplinary inpatient rehabilitation improved FMD patient function, depression, anxiety and somatic symptoms. One-year follow-up demonstrated minimal sustained improvement and worsening psychopathology, reflecting chronic debility despite initial rehabilitative success.