Oral Papers: Neuropsychiatry III: Screening & Intervention
Background/Significance: Functional neurological disorder (FND), also known as conversion or pseudoneurological disorder, is difficult to treat and costly, with few known effective interventions. Patients with FND often suffer from psychiatric comorbidities and abnormal illness behavior, and multimodal approaches are recommended. Interdisciplinary chronic pain rehabilitation programs (iCPRPs) are month-long multidimensional interventions suited to such complexity, effecting change through physical, medical, and psychological rehabilitation. The impact of iCPRP care on FND specifically has not been assessed. The purpose of this study was to assess the impact of iCPRP care on both subjective and objective measures of functioning amongst FND patients.
Methods: Data were examined retrospectively from an existing IRB-approved registry capturing admission and discharge data from all patients participating in the Cleveland Clinic iCPRP. Terms used to identify FND patients included: “functional neurological,” “conversion,” “functional movement,” “functional gait/tremor,” “psychogenic movement,” “pseudoneurological,” “pseudoseizures,” “psychogenic nonepileptic seizures,” and “paroxysmal nonepileptic events.” Subjective measures included depression, anxiety, and stress (Depression, Anxiety and Stress Scale – DASS) and disability (Pain Disability Index), whereas objective measures included physical functioning measures (timed up and go, stair climbing test, 6 minute walk test). Pre- and post-iCPRP measures were compared using a paired t-test approach.
Results: 63 patients with FND who participated in the iCPRP were identified between the years 2013 and 2017. Of these, 49 completed treatment in the program (14 were either discharged or left voluntarily). Mean age was 42.53 years, and most patients were female (67.3%), married (55.1%), and Caucasian (71.4%). All four subjective measures showed statistically significant improvements. Mean PDI scores decreased significantly from 46.40 to 20.91 (p < .001, d = 1.92). Mean depression scores decreased significantly from 20.38 to 4.81, (p < .001, d = 1.53). Mean anxiety scores decreased significantly from 15.09 to 6.29, (p < .001, d = 1.18). Mean stress scores decreased significantly from 21.96 to 9.70, (p < .001, d = 1.21). Similarly, all three objective measures showed statistically significant improvements. Mean timed up and go scores decreased from 15.96 to 8.87 seconds (p < .001, d = 0.86). Mean stair climbing test scores increased from 40.98 to 71.93 stairs (p < .001, d = -1.11). Mean 6 minute walk test scores increased from 0.21 to 0.30 miles, (p < .001, d = -0.68).
Discussion: While preliminary and based on a small patient sample, these findings support the use of interdisciplinary care models for treatment of FND. Strengths of the study include robustness of the clinical intervention, while limitations include retrospective nature.
Conclusion: There is broadening support for the effectiveness of interdisciplinary functional restoration programs/iCPRPs in many conditions beyond pain, and this extends this knowledge. Future clinical and investigational directions are discussed and considered.