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Rehabilitation Therapies for Functional Neurological Disorder: A Systematic Review and Meta-Analysis of Clinical
Eva S Keatley1, Molly Cairncross2, Shreya Raman3
1Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore.
Objective:
The authors conducted a systematic review and meta-analysis of clinical trials testing rehabilitation therapies for treating functional neurological disorder (FND).
Methods:
The authors searched databases for clinical trials of patients with FND who received rehabilitation therapies. Some trials included a mental health intervention, but psychotherapy-only trials were excluded. Study quality was assessed by using a modified version of the NIH quality assessment tool for a before-after (pre-post) study with no control group.
Results:
In total, 8,162 studies were screened for eligibility. Among these, 30 articles (N=1,581 participants) were included. Results of a meta-analysis of proportions revealed that 74% of the participants in FND rehabilitation trials had clinical improvement, but effect sizes varied significantly across studies. Twenty-three studies provided sufficient data to calculate pre-post rehabilitation effect sizes, which were uniformly positive for FND symptoms and physical function. Meta-analysis of seven available randomized controlled trials (RCTs) indicated a significant treatment effect on FND symptoms and that effects on physical function, fatigue, and mental health were not statistically significant. The generalizability of these findings was limited by heterogeneity across studies, attributed to differences in populations, treatment protocols, study designs, and outcome measures.
Conclusions:
Rehabilitation therapies are a promising approach for improving FND symptoms, and calculated estimates indicate that >70% of patients experience clinical improvement after rehabilitative treatment. However, additional high-quality RCTs are needed to clarify the overall efficacy of rehabilitation for FND and to identify which aspects of clinical improvement are most responsive to rehabilitation interventions.
