Understanding patient-reported outcomes in functional movement disorder: Association with clinical measures and change following integrative treatment.

BACKGROUND

Functional movement disorder (FMD), characterized by abnormal movements and motor weakness, represents a common manifestation within the spectrum of functional neurological disorders (FND). Integrative therapy, comprising specialised physiotherapy, psychotherapy, and patient education, has demonstrated efficacy in improving motor function and quality of life. To assess symptom severity and treatment response, both patient-reported outcome measures (PROMs) and clinician-rated outcome measures (CROMs) can be employed.

METHODS

In a preliminary analysis of an ongoing transdisciplinary treatment study, we examined the association between the 'Simplified FMD Rating Scale' (S-FMDRS, CROM) and the 'FMD Questionnaire' (FMDQ, PROM) during integrative therapy and explored their suitability for monitoring treatment-related changes over time.

RESULTS

Twenty-six patients contributed 60 paired longitudinal assessments. Linear mixed-effects modelling demonstrated significant associations between clinician-rated motor severity (S-FMDRS) and patient-reported total FMDQ scores as well as all functional domains. In the subgroup with complete pre-post data (n = 15), both S-FMDRS and FMDQ scores improved significantly during treatment (S-FMDRS: p = .003, r = 0.76; FMDQ: p = .012, r = 0.65). Concordance in MCID-based responder classification was partial, with 53% agreement between instruments.

CONCLUSION

Clinician- and patient-reported measures in FMD are significantly associated but not interchangeable at the individual level, supporting their complementary use in treatment evaluation.