Factors Influencing Triage to Rehabilitation in Functional Movement Disorder.

Autor: Gilmour GS; Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, Canada.; Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada.; Division of Neurology, Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada., Langer LK; KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada., Bhatt H; Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, Canada.; KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.; Integrated Movement Disorders Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada., MacGillivray L; Integrated Movement Disorders Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.; Centre for Mental Health, University Health Network and Department of Psychiatry, University of Toronto, Toronto, ON, Canada., Lidstone SC; Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, Canada.; Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada.; KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.; Integrated Movement Disorders Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
Jazyk: angličtina
Zdroj: Movement disorders clinical practice [Mov Disord Clin Pract] 2024 May; Vol. 11 (5), pp. 515-525. Date of Electronic Publication: 2024 Feb 22.
DOI: 10.1002/mdc3.14007
Abstrakt: Background: Treatment of functional movement disorder (FMD) should be individualized, yet factors determining rehabilitation engagement have not been evaluated. Subspecialty FMD clinics are uniquely poised to explore factors influencing treatment suitability and triage.
Objectives: To describe our approach and explore factors associated with triage to FMD rehabilitation.
Methods: We conducted a retrospective chart review of 158 consecutive patients with FMD seen for integrated assessment by movement disorders neurology and psychiatry, with the purpose of triage to rehabilitation. Demographic and clinical variables were compared between patients triaged to therapy versus no therapy, and logistic regression was used to explore factors predictive of triage outcome. Change in primary outcome scores were analyzed.
Results: Sixty-six patients (42%) were triaged to FMD therapy from July 2019 to December 2021. Patients triaged to therapy were more likely to have a constant movement disorder, gait disorder and/or tremor, hyperarousal, readiness for change, and people pleasing traits. Patients triaged to no therapy demonstrated persistent diagnostic disagreement, an inability to appreciate motor symptom inconsistency, low self-agency, a propensity to dissociate, and cluster B traits. 90% of patients triaged to rehabilitation had improved outcomes.
Conclusions: The ability to "opt-in" to FMD rehabilitation relies on different factors than those relevant to establishing a diagnosis. Unlike many other neurological disorders, a triage and treatment planning step is recommended to identify those likely to meaningfully engage at that time. Holistic assessment through a transdisciplinary lens, and working collaboratively with the patient is essential to prioritize symptoms, determine engagement, and identify treatment targets.
(© 2024 The Authors. Movement Disorders Clinical Practice published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.)
Databáze: MEDLINE
Externí odkaz: