Specialist physiotherapy for functional motor disorder in England and Scotland (Physio4FMD): a pragmatic, multicentre, phase 3 randomised controlled trial.

Functional motor disorder, a condition causing movement problems not explained by typical neurological disease, is often disabling and hard to treat, so researchers wanted to know whether a specialised physiotherapy programme could do better than standard community physiotherapy. This trial, run across 11 hospitals in England and Scotland, randomly assigned adults with a confirmed diagnosis to either a structured nine-session specialist physiotherapy programme or usual local physiotherapy care. On the main measure, physical functioning a year later, there was no statistically significant difference between the two groups. Some participants given specialist physiotherapy did report feeling their motor symptoms had improved and described better mental health, but these were secondary, self-reported findings rather than the trial's main result.

A notable limitation is that COVID-19 disrupted treatment for many participants, and these cases were excluded from the main analysis, which affected the two groups unevenly and complicates interpreting the comparison.

If you or someone you know has functional motor disorder, a condition where the body's movement signals go wrong without a clear structural cause, you might wonder whether a specialised physiotherapy approach works better than standard physiotherapy. This trial compared the two directly in adults diagnosed by a neurologist, assigning people by chance to one or the other. After a year, physical functioning scores, the main thing the study measured, did not differ in a way that reached statistical significance between the two groups.

Interestingly, more people who had the specialist programme said their symptoms felt improved and reported feeling better mentally, but these were separate, more subjective measures, not the study's main yardstick. An important caveat is that the COVID-19 pandemic interrupted treatment for a substantial number of participants, and those people were left out of the main results, unevenly affecting the two groups. Both approaches appeared to be valued by at least some patients, but this trial does not show specialist physiotherapy clearly outperforming usual care on physical functioning.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This trial addresses whether a protocolised specialist physiotherapy intervention for functional motor disorder produces better physical functioning outcomes than standard community neurological physiotherapy, a question with direct relevance to referral and treatment triage decisions. On the pre-specified primary outcome, SF36 physical functioning at 12 months, no statistically significant difference was detected between groups (adjusted mean difference 3.5, 95% CI -2.3 to 9.3, p=0.23), based on a modified intention-to-treat complete-case analysis of 241 of 355 randomised participants. Secondary findings showed more participants assigned specialist physiotherapy self-rated their motor symptoms as improved and reported better subjective mental health scores, but these are self-reported, secondary measures that do not establish superiority on the primary functional outcome, and could partly reflect differences in therapist contact or expectation given neither arm was blinded or sham-controlled.

Serious adverse events occurred in similar proportions in both groups (17.0% each), with one death by suicide in the specialist physiotherapy arm considered unrelated to the intervention; non-serious adverse events were not described in the abstract. A key limitation is that 89 participants, disproportionately from the treatment-as-usual group (62 versus 27), were excluded from the primary analysis because COVID-19 disrupted their treatment, which may bias the comparison and limits how confidently these results generalise to usual-care delivery outside pandemic disruption.