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

Glenn Nielsen; Teresa Lee; Louise Marston; Alan Carson; Mark Edwards; Laura Goldstein; Rachael Hunter; Kate Holt; Jon Marsden; Markus Reuber; Jon Stone; Irwin Nazareth

doi:10.1016/j.jpsychores.2025.112056

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

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

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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.

Original language	English
Article number	112056
Journal	Journal of Psychosomatic Research
Volume	190
DOIs	https://doi.org/10.1016/j.jpsychores.2025.112056
Publication status	Published - 13 Feb 2025

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Nielsen, G., Lee, T., Marston, L., Carson, A., Edwards, M., Goldstein, L., Hunter, R., Holt, K., Marsden, J., Reuber, M., Stone, J., & Nazareth, I. (2025). Which factors predict outcome from specialist physiotherapy for functional motor disorder? Prognostic modelling of the Physio4FMD intervention. Journal of Psychosomatic Research, 190, Article 112056. https://doi.org/10.1016/j.jpsychores.2025.112056

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title = "Which factors predict outcome from specialist physiotherapy for functional motor disorder? Prognostic modelling of the Physio4FMD intervention",

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.",

author = "Glenn Nielsen and Teresa Lee and Louise Marston and Alan Carson and Mark Edwards and Laura Goldstein and Rachael Hunter and Kate Holt and Jon Marsden and Markus Reuber and Jon Stone and Irwin Nazareth",

note = "Publisher Copyright: {\textcopyright} 2025 The Author(s)",

year = "2025",

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doi = "10.1016/j.jpsychores.2025.112056",

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Nielsen, G, Lee, T, Marston, L, Carson, A, Edwards, M , Goldstein, L, Hunter, R, Holt, K, Marsden, J, Reuber, M, Stone, J & Nazareth, I 2025, 'Which factors predict outcome from specialist physiotherapy for functional motor disorder? Prognostic modelling of the Physio4FMD intervention', Journal of Psychosomatic Research, vol. 190, 112056. https://doi.org/10.1016/j.jpsychores.2025.112056

TY - JOUR

T1 - Which factors predict outcome from specialist physiotherapy for functional motor disorder? Prognostic modelling of the Physio4FMD intervention

AU - Nielsen, Glenn

AU - Lee, Teresa

AU - Marston, Louise

AU - Carson, Alan

AU - Edwards, Mark

AU - Goldstein, Laura

AU - Hunter, Rachael

AU - Holt, Kate

AU - Marsden, Jon

AU - Reuber, Markus

AU - Stone, Jon

AU - Nazareth, Irwin

PY - 2025/2/13

Y1 - 2025/2/13

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85217438348&partnerID=8YFLogxK

U2 - 10.1016/j.jpsychores.2025.112056

DO - 10.1016/j.jpsychores.2025.112056

M3 - Article

SN - 0022-3999

VL - 190

JO - Journal of Psychosomatic Research

JF - Journal of Psychosomatic Research

M1 - 112056

ER -

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

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