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Functional movement disorders: Successful treatment with a physical therapy rehabilitation protocol

机译：功能性运动障碍：物理疗法康复方案成功治疗

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Background: Functional (" psychogenic" ) gait and other movement disorders have proven very difficult to treat. Objectives: Describe the Mayo Clinic functional movement disorder motor-reprogramming protocol conducted in the Department of Physical Medicine and Rehabilitation (PMR), and assess short-term and long-term outcomes. Design: Historical-cohort-study assessing non-randomized PMR intervention. Setting: Tertiary care center. Patients: Interventional group: 60 consecutive patients with a chronic functional movement disorder that underwent the PMR protocol between January 2005 and December 2008. Control group: age- and sex-matched patients with treatment-as-usual (n = 60). Interventions: An outpatient, one-week intensive rehabilitation program based on the concept of motor-reprogramming following a comprehensive diagnostic neurological evaluation, including psychiatric/psychological assessment. Main outcome measures: Improvement of the movement disorder by the end of the week-long program (patient- and physician-rated), plus the long-term outcome (patient-rated). Results: Patient demographics: median symptom duration, 17 months (range, 1-276); female predominance (76.7%); mean age 45 years (range, 17-79). Physician-rated outcomes after the one-week treatment program documented 73.5% were markedly improved, nearly normal or in remission, similar to the patient-ratings (68.8%). Long-term treatment outcomes (patient-rated; median follow-up, 25 months) revealed 60.4% were markedly improved or almost completely normal/in remission, compared to 21.9% of controls (p < 0.001). Conclusions: Short-term and long-term successful outcomes were documented in the treatment of patients with functional movement disorders by a rehabilitative, goal-oriented program with intense physical and occupational therapy. The rapid benefit, which was sustained in most patients, suggests substantial efficacy that should be further assessed in a prospective, controlled, clinical trial.
机译：背景：功能性（“心理性”）步态和其他运动障碍已被证明很难治疗。目标：描述在物理医学和康复部（PMR）进行的Mayo临床功能性运动障碍运动重编程方案，并评估短期和长期结果。设计：历史队列研究评估非随机PMR干预。地点：三级护理中心。患者：干预组：2005年1月至2008年12月间接受了PMR方案治疗的连续60例患有慢性功能性运动障碍的患者。对照组：按常规治疗的年龄和性别匹配的患者（n = 60）。干预措施：一项基于运动重编程概念的门诊，为期一周的强化康复计划，经过全面的诊断性神经学评估（包括精神病学/心理评估）后进行。主要结局指标：在为期一周的计划（患者和医生评价）结束后，以及长期结局（患者评价）改善运动障碍。结果：患者人口统计学：中位症状持续时间17个月（范围1-276）;女性占多数（76.7％）;平均年龄45岁（范围17-79）。在记录了为期一周的治疗计划后，医师对患者的评估结果有73.5％的显着改善，接近正常或缓解，与患者的评估（68.8％）相似。长期治疗结果（患者评分;中位随访时间为25个月）显示60.4％的患者明显改善或几乎完全正常/缓解，而对照组为21.9％（p <0.001）。结论：通过康复的，以目标为导向的，有力的物理和职业疗法，在功能性运动障碍患者的治疗中记录了短期和长期成功的结果。在大多数患者中持续的快速获益表明，其实质性疗效应在一项前瞻性，对照的临床试验中进一步评估。

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