Related Experiment Video
Updated: Jun 4, 2026
Setup for the Quantitative Assessment of Motion and Muscle Activity During a Virtual Modified Box and Block Test
Published on: January 12, 2024
Discrepancies between patient-reported and physician-reported severity and disability in functional and
Olof Cb Vermeulen1, Tjerk J Lagrand2,3, Jeannette Gelauff4
1Department of Neurology, University Medical Centre Groningen, Groningen, The Netherlands.
Background:
Functional movement disorder (FMD) is a common cause of debilitating symptoms in neurology patients. Due to the stigma that is associated with FMD, it is possible that discrepancies between patient and physician judgements of severity and disability are more pronounced in FMD compared with non-FMD. A patient-physician discrepancy in judgement may be explained by associated comorbid non-motor symptoms.
Methods:
In the prospective TASMAN study, 171 FMD and 294 non-FMD patients were recruited from the Netherlands and Australia. Patient characteristics included non-motor symptoms: depression, anxiety, dissociation, pain and fatigue. Patient-reported and physician-reported severity and disability were collected using seven-point Likert scales. A quantitative measure of discrepancies was calculated by subtracting the physician's score from the patient's score. Associations between non-motor symptoms and disability were analysed using linear regression.
Results:
Patients reported significantly higher severity and disability compared with physicians in both groups. Patient-physician discrepancies in both severity and disability outcomes were not statistically different between FMD and non-FMD. FMD patients scored significantly higher on all non-motor symptoms compared with non-FMD. Patient-reported, but not physician-reported, disability was associated with increased pain and fatigue in both the FMD and non-FMD groups. In FMD, dissociation was associated with disability in both patient-reported and physician-reported outcomes. In non-FMD, depression was associated with disability in both patient-reported and physician-reported outcomes.
Conclusions:
Our results do not support notions of ongoing FMD-specific stigmatisation in physicians. Similar patient-physician discrepancies regarding severity and disability exist in both FMD and non-FMD patients. Patient-physician discrepancies in disability in all movement disorder patients might be in part explained by different appreciation of the importance of non-motor symptoms.
Insights
Patient and physician perceptions of severity and disability in functional movement disorder (FMD) show similar discrepancies to other neurological conditions. Non-motor symptoms like pain and fatigue significantly impact patient-reported disability in FMD and non-FMD groups.
Area of Science:
- Neurology
- Psychiatry
Background:
- Functional movement disorder (FMD) is a common neurological condition.
- Stigma associated with FMD may lead to greater patient-physician discrepancies in perceived severity and disability compared to non-FMD.
- Comorbid non-motor symptoms might explain these discrepancies.
Purpose of the Study:
- To investigate patient-physician discrepancies in severity and disability judgments in FMD versus non-FMD patients.
- To explore the association between non-motor symptoms and disability in FMD and non-FMD patients.
Main Methods:
- Prospective TASMAN study included 171 FMD and 294 non-FMD patients.
- Assessed non-motor symptoms (depression, anxiety, dissociation, pain, fatigue).
- Collected patient- and physician-reported severity and disability using Likert scales; analyzed discrepancies and associations with non-motor symptoms via linear regression.
Main Results:
- Patients reported higher severity and disability than physicians in both groups.
- No significant difference in patient-physician discrepancies between FMD and non-FMD groups.
- FMD patients reported higher levels of all non-motor symptoms. Pain and fatigue correlated with patient-reported disability in both groups; dissociation in FMD and depression in non-FMD correlated with disability in both patient and physician reports.
Conclusions:
- Findings do not support FMD-specific physician stigmatization.
- Patient-physician discrepancies in severity and disability are similar in FMD and non-FMD.
- Discrepancies in disability may stem from differing appreciation of non-motor symptoms' impact.
