ORCID

Abstract

Background and ObjectivesFunctional motor disorder (FMD), a motor-dominant variant of functional neurologic disorder, is a disabling condition associated with high health and social care resource use and poor employment outcomes. Specialist physiotherapy presents a possible treatment option, but there is limited evidence for clinical effectiveness and cost-effectiveness. Physio4FMD is a multicenter randomized controlled trial of specialist physiotherapy for FMD compared with treatment as usual (TAU). The aim of the analysis was to conduct a randomized trial based on economic evaluation of specialist physiotherapy compared with TAU.MethodsEleven centers in England and Scotland randomized participants 1:1 to specialist physiotherapy or TAU (referral to community neurologic physiotherapy). Participants completed the EuroQoL EQ-5D-5L, Client Service Receipt Inventory, and Work Productivity and Activity Impairment Questionnaire at baseline, 6 months, and 12 months. The mean incremental cost per quality-adjusted life year (QALY) for specialist physiotherapy compared with TAU over 12 months was calculated from a health and social care and wider societal perspective. The probability of cost-effectiveness and 95% CIs were calculated using bootstrapping.ResultsThe analysis included 247 participants (n = 141 for specialist physiotherapy, n = 106 for TAU). The mean cost per participant for specialist physiotherapy was £646 (SD 72) compared with £272 (SD 374) for TAU. Including the costs of treatment, the adjusted mean health and social care cost per participant at 12 months for specialist physiotherapy was £3,814 (95% CI £3,194–£4,433) compared with £3,670 (95% CI £2,931–£4,410) for TAU, with a mean incremental cost of £143 (95% CI £–825 to £1,112). There was no significant difference in QALYs over the 12-month duration of the trial (0.030, 95% CI –0.007 to 0.067). The mean incremental cost per QALY was £4,133 with an 86% probability of being cost-effective at a £20,000 threshold. When broader societal costs such as loss of productivity were taken into consideration, specialist physiotherapy was dominant (incremental cost: £−5,169, 95% CI £–15,394 to £5,056).DiscussionFMD was associated with high health and social care costs. There is a high probability that specialist physiotherapy is cost-effective compared with TAU particularly when wider societal costs are taken into account.Trial Registration InformationInternational Standard Randomised Controlled Trial registry, ISRCTN56136713

Publication Date

2025-04-01

Publication Title

Neurology: Clinical Practice

Volume

15

Issue

3

ISSN

2163-0402

Acceptance Date

2025-01-25

Deposit Date

2025-01-28

Funding

This study is funded by the National Institute for Health and Care Research (NIHR), Health Technology Assessment (HTA) Programme (project reference 16/31/63\u2014A randomised controlled trial of specialist physiotherapy for FMD [Physio4FMD]). Funding has been further granted by the NIHR HTA for a 22-month costed extension. This study also represents independent research (by L.H.G.) partly funded by the NIHR Maudsley Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust and King's College London. The study benefited from the support of the Clinical Research Network South London Study Support Service for recruitment and set-up advice. The authors thank the FND charities FND Hope International, FND Hope UK, FND Action and FND Dimensions for their support. The views expressed are those of the authors and not necessarily those of the NIHR, NHS, or the Department of Health and Social Care. G. Nielsen receives research funding from the NIHR, is a founding member of the Functional Neurological Disorder Society (FNDS), and is on the advisory board for FND patient charities FND Hope UK and FND Action. R.M. Hunter receives research funding from the NIHR, and was co-Chair of the European Union funding board for Transforming Health and Care Systems. L. Marston receives research funding from the NIHR. M.J. Edwards does medical expert reporting in personal injury and clinical negligence cases, including in cases of FND; has shares in Brain & Mind, which provides neuropsychiatric and neurologic rehabilitation in the independent medical sector, including in people with FND, has received financial support for lectures from the International Parkinson's and Movement Disorders Society and the FNDS, receives royalties from Oxford University Press for his book The Oxford Specialist Handbook of Parkinson's Disease and Other Movement Disorder, has received honoraria for medical advice to Teva Pharmaceuticals, receives grant funding, including for studies related to FND, from the NIHR and the Medical Research Council, is an associate editor of the European Journal of Neurology, is a member of the international executive committee of the International Parkinson's and Movement Disorders Society and a board member of the FNDS, and is on the medical advisory boards of the charities FND Hope UK and Dystonia UK. J. Stone reports honoraria from UptoDate, personal fees from Expert Witness Work and grants from National Research Scotland; runs a free self-help website, neurosymptoms.org , for patients with FND, and is secretary of FNDS and on the medical advisory boards of the charities FND Hope UK and FND Action. I. Nazareth has received research funding from NIHR, UK Research and Innovation, and the Wellcome Trust, and was a member of a data safety and monitoring board for a RCT of herbal medication for long COVID. M. Reuber has received research funding from Epilepsy Research UK, the NIHR, receives a salary from Elsevier as editor-in-chief of Seizure-European Journal of Epilepsy, has received honoraria for talks on unrelated subjects from Angelini Pharma and UCB Pharma, sits on a Lennox Gastaut Syndrome advisory board for UCB Pharma, and received payment from Precisis for chairing a data safety monitoring board of an unrelated commercial study. A. Carson receives research funding from the NIHR, the Medical Research Council, Chief Scientist Office Scotland, and European Union (Etude Program), has received an honorarium from Forum for Indian Neurologic Education, has received personal fees from expert testimony in medicolegal cases relating to FND, is the president of the FNDS, and is a paid associate editor of the Journal of Neurology, Neurosurgery and Psychiatry. All other authors report no disclosures relevant to the manuscript. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp . TAKE-HOME POINTS This study is funded by the National Institute for Health and Care Research (NIHR), Health Technology Assessment (HTA) Programme (project reference 16/31/63-A randomized controlled trial of specialist physiotherapy for FMD [Physio4FMD]). Funding has been further granted by the NIHRHTA for a 22-month costed extension. This study also represents independent research (by L.H.G.) partly funded by the NIHR Maudsley Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust and King s College London. The study benefited from the support of the Clinical Research Network South London Study Support Service for recruitment and set-up advice. The authors thank the FND charities FND Hope International, FND Hope UK, FND Action and FND Dimensions for their support. The views expressed are those of the authors and not necessarily those of the NIHR, NHS, or the Department of Health and Social Care.

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