Factors Influencing Triage to Rehabilitation in Functional Movement Disorder

• Published in: Movement disorders clinical practice (Hoboken, N.J.) Vol. 11; no. 5; pp. 515 - 525
• Main Authors: Gilmour, Gabriela S., Langer, Laura K., Bhatt, Haseel, MacGillivray, Lindsey, Lidstone, Sarah C.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.05.2024; Wiley Subscription Services, Inc
• Subjects: Adult; Aged; Female; functional movement disorder; functional neurological disorder; Humans; Male; Middle Aged; Movement disorders; Movement Disorders - diagnosis; Movement Disorders - rehabilitation; multidisciplinary treatment; Rehabilitation; Retrospective Studies; Treatment Outcome; triage; Triage - methods; rehabilitation; functional neurological disorder; multidisciplinary treatment; functional movement disorder; triage
• ISSN: 2330-1619; 2330-1619
• DOI: 10.1002/mdc3.14007

ABSTRACT 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.