Multidisciplinary inpatient rehabilitation for Functional Movement Disorders: A prospective study with long term follow up
| Autor: | Jay M. Behel, Ravi Kasi, Katie Kompoliti, Charles Hebert, Gian Pal |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male 0301 basic medicine medicine.medical_specialty Movement disorders medicine.medical_treatment Anxiety Severity of Illness Index Young Adult 03 medical and health sciences 0302 clinical medicine Outcome Assessment Health Care Tremor mental disorders Humans Medicine Prospective cohort study Conversion disorder Gait Disorders Neurologic Depression (differential diagnoses) Aged Inpatients Movement Disorders Rehabilitation Depression business.industry Neurological Rehabilitation Middle Aged medicine.disease 030104 developmental biology Conversion Disorder Neurology Clinical Global Impression Physical therapy Female Neurology (clinical) Geriatrics and Gerontology medicine.symptom business 030217 neurology & neurosurgery Follow-Up Studies Psychopathology |
| Zdroj: | Parkinsonism & Related Disorders. 82:50-55 |
| ISSN: | 1353-8020 |
| Popis: | Introduction Functional 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. Methods FMD 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. Results Seventeen 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). Conclusions Multidisciplinary 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. |
| Databáze: | OpenAIRE |
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