Outcomes of specialist physiotherapy for functional motor disorder: the Physio4FMD RCT.

Functional motor disorder causes persistent, disabling symptoms, and while physiotherapy is often recommended, there has been little solid evidence to confirm it helps. This trial compared specialist physiotherapy designed specifically for functional motor disorder against usual community neurological physiotherapy in 355 adults, following them for 12 months. On the main measure, how well people could physically function day to day, there was no statistically significant difference between the two treatments. However, several other measures, including how much people felt they had improved, mental health scores, and confidence in their diagnosis, favoured specialist physiotherapy at six and twelve months.

The economic analysis also suggested specialist physiotherapy was likely a better use of healthcare resources. A key limitation is that most outcomes relied on participants' own reports, which could be influenced by knowing which treatment they received, and nearly a quarter of those randomised were excluded from the main analysis due to COVID-19 disruptions to treatment.

If you live with functional motor disorder, you may know that treatment options are limited and physiotherapy is often suggested, but until now there wasn't strong evidence proving which type of physiotherapy actually helps. This study compared a specialist form of physiotherapy, built specifically around understanding functional motor disorder, against standard physiotherapy for neurological conditions, in 355 adults followed over a year. The main result, looking at physical functioning like walking and climbing stairs, showed no clear difference between the two treatments.

However, people who received specialist physiotherapy were more likely to say they felt improved, and they reported somewhat better mental health and more confidence in their diagnosis. The specialist approach also appeared to offer better value for money.

It's worth keeping in mind that these more positive results come from people's own ratings, which can be shaped by knowing which treatment they got, and a notable portion of participants couldn't be included in the main analysis because the pandemic interrupted their treatment.

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

This trial addresses a genuine gap in evidence for how physiotherapists should approach functional motor disorder, specifically whether specialist, condition-informed physiotherapy offers advantages over standard community neurological physiotherapy. On the primary, prespecified outcome, the SF-36 Physical Functioning domain at 12 months, no statistically significant between-group difference was detected (adjusted mean difference 3.5, 95% CI -2.3 to 9.3), so this trial does not establish superiority on physical function as defined here. Secondary and exploratory outcomes, which should be interpreted with more caution than the primary result, showed differences favouring specialist physiotherapy at 6 and 12 months, including participant-reported improvement (59% versus 38%), SF-36 Mental Health, confidence in diagnosis, and specific illness-perception subscales.

These are patient-reported measures in an unblinded trial, so expectation or attention effects linked to treatment allocation cannot be ruled out. The health economic analysis suggested a high probability (86%) of cost-effectiveness at a £20,000 per quality-adjusted life-year threshold, which may be clinically relevant for service planning even without a primary outcome difference. Importantly, 89 of 355 randomised participants were excluded from the primary analysis due to COVID-19 treatment disruption, and the abstract notes treatment-as-usual participants waited longer to start physiotherapy, affecting the interval between treatment completion and outcome assessment.

No adverse events related to physiotherapy were reported. The authors themselves call for better outcome measures and identification of who benefits most, underscoring that this trial informs rather than settles clinical decision-making for this population.