The Role of Specialist Home Physiotherapy in Functional Neurological Disorder (FND) for People Living in Lanarkshire
Functional Neurological Disorder (FND) is a common and disabling condition presenting with symptoms such as weakness, abnormal movement, and gait disturbances, often without a clear structural neurological cause. For people in Lanarkshire, access to effective, patient-centred care is crucial. Specialist home physiotherapy has emerged as a promising approach, combining the benefits of evidence-based rehabilitation with the comfort and practicality of the patient’s own environment.
Evidence Base for Specialist Home Physiotherapy in FND
Clinical Effectiveness
- Symptom Improvement Rates:
Multiple studies and recent systematic reviews confirm that physiotherapy tailored to FND leads to significant symptom improvement in 60–70% of patients. These improvements include gains in mobility, balance, and daily functioning, with both short- and long-term benefits documented.
- Symptom Improvement Rates:
- Specialist vs. Standard Physiotherapy:
The landmark Physio4FMD multicentre randomised controlled trial (RCT), which included Scottish sites, compared specialist protocolised physiotherapy (nine sessions plus follow-up) to usual community physiotherapy. While the primary outcome (physical functioning at 12 months) did not differ significantly between groups, 72% of those receiving specialist physiotherapy rated their symptoms as improved at six months, compared to 18% in standard care.
- Specialist vs. Standard Physiotherapy:
- Home-Based Rehabilitation:
Outpatient and home-based physiotherapy programs are particularly valuable for FND, as they allow therapy to be delivered in a familiar environment, which may reduce anxiety and promote the transfer of skills to daily life. Home-based approaches can be individualized, flexible, and better integrated into the patient’s routine, addressing barriers such as travel and accessibility.
Key Components of Specialist Home Physiotherapy
Biopsychosocial Framework
- Holistic Assessment:
Specialist physiotherapy is delivered within a biopsychosocial model, addressing not only physical symptoms but also illness beliefs, self-directed attention, and abnormal habitual movement patterns. Treatment is individualized and goal-oriented.
- Holistic Assessment:
Movement Retraining and Self-Management
- Active, Task-Oriented Exercises:
Focus is on retraining automatic movement patterns using functional tasks and distraction techniques (e.g., walking while focusing on an external cue) to reduce abnormal self-monitoring.
- Active, Task-Oriented Exercises:
- Self-Management Strategies:
Patients are taught to recognize and manage symptom flares, maintain exercise routines, and build resilience for long-term recovery.
- Self-Management Strategies:
Education and Support
- Patient Education:
Clear explanations about FND and the rationale for physiotherapy are central, empowering patients and reducing stigma.
- Patient Education:
- Multidisciplinary Collaboration:
Home physiotherapy can be coordinated with occupational therapy, psychological support, and regular medical review, ensuring comprehensive care.
- Multidisciplinary Collaboration:
Clinical Implications for Lanarkshire
Accessibility and Engagement
- Overcoming Barriers:
Specialist home physiotherapy addresses key barriers to care in Lanarkshire, such as transportation difficulties, rurality, and limited access to specialist clinics.
- Overcoming Barriers:
- Patient Satisfaction:
Both specialist and community physiotherapy are valued by patients, with home-based care often leading to higher engagement and satisfaction.
- Patient Satisfaction:
Safety and Cost-Effectiveness
- Safety:
Recent RCTs confirm that specialist physiotherapy, including home-based delivery, is safe with no significant adverse events.
- Safety:
- Cost-Effectiveness:
Specialist physiotherapy is likely cost-effective, especially when considering reduced hospital visits and improved patient independence.
- Cost-Effectiveness:
Conclusion
Specialist home physiotherapy is a robust, evidence-based intervention for FND, offering substantial and lasting improvements in motor symptoms, functional ability, and quality of life. For people living in Lanarkshire, home-based specialist physiotherapy overcomes key barriers to access and engagement, providing individualized, holistic, and cost-effective care. Continued investment in specialist training, multidisciplinary collaboration, and service development will ensure that more patients benefit from these advances.
Key Journal References and Clinical Evidence
- Nielsen G, et al. “Physiotherapy for functional motor disorders: a consensus recommendation.” J Neurol Neurosurg Psychiatry. 2015
- Nielsen G, et al. “Specialist physiotherapy for functional motor disorder in England and Scotland (Physio4FMD): a multicentre, phase 3, randomised controlled trial.” Lancet Neurology. 2024
- FND Hope International. “Physio/Physical Therapy.” 2020
- Gelauff J, et al. “Management of functional neurological disorder.” PubMed Central. 2020[6].
- NR Times. “Functional Neurological Disorder and physiotherapy.” 2024
References