#7214 What do patients referred for specialist physiotherapy for FND come with? A preliminary report from routinely collected questionnaire data from a specialist FND service

<h3>Introduction</h3> Functional neurological disorder (FND) is a common and disabling disorder characterised by diverse symptoms, primarily involving motor function, sensory disruptions and episodes of altered awareness.^1–5 Physiotherapy is widely used in a multidisciplinary approach, supported by Consensus Recommendations⁶ and an ongoing randomized controlled trial.⁷ The Neuropsychiatry Service at the Maudsley Hospital provides outpatient physiotherapy, along with inpatient and day hospital settings. We set out preliminary analysis of routine data collected, through patient-report questionnaire, as part of initial assessment for outpatient physiotherapy. <h3>Methods</h3> Patients referred for specialist FND outpatient physiotherapy at Maudsley Neuropsychiatry Service completed a brief 12-item questionnaire addressing themes relevant for the initial assessment. We present a summary analysis of the responses and link these findings to a literature review (2012–2023). <h3>Results</h3> Between November 2, 2021 and January 25, 2024, 48 patients returned the questionnaire. Within the sample, 77% were women, 19% men, and 4% identified as non-binary, with ages ranging from 18 to 68 years (median 40). Regarding their understanding of the diagnosis, 46% were confident, while 25% believed it was probably correct, whereas 23% were not sure, and 4% did not agree with the diagnosis. Mobility issues were prevalent, affecting 80% to a moderate to severe extent, significantly affecting their overall well-being. Specifically, 40% experienced moderate to severe challenges in self-care, while 65% reported moderate to severe impact on their usual activities. Other symptoms included severe to extreme pain (44%) and severe to extreme anxiety/depression (32%). <h3>Discussion</h3> This data comes from a particular population – patients referred for outpatient physiotherapy to a tertiary specialist neuropsychiatry service, which also provides inpatient and day hospital therapeutic options. A quarter either were not sure or did not agree with the diagnosis, and almost half had significant comorbid pain, and almost a third significant mood and anxiety difficulties. The delivery of a diagnosis of FND is well known to be an important in initial therapeutic step.^{3 6 8} Pain is prevalent in FND and is an established potential barrier to effective physiotherapy.⁹ We discuss how this data might be further analysed and correlated with the outcomes of assessment and treatment, and inform the configuration and delivery of physiotherapy in various settings. <h3>References</h3> Edwards MJ, Bhatia KP. Functional (psychogenic) movement disorders: merging mind and brain. <i>Lancet Neurol</i>. 2012;<b>11</b>:250–260. 10.1016/s1474-4422(11)70310-6 Kelmanson AN, Kalichman L, Treger I. Physical rehabilitation of motor functional neurological disorders: a narrative review. <i>Int J Environ Res Public Health</i>. 2023. 20. 10.3390/ijerph20105793 Gilmour GS, Nielsen G, Teodoro T, <i>et al</i>. Management of functional neurological disorder. <i>J Neurol</i>. 2020;<b>267</b>:2164–2172. 10.1007/s00415-020-09772-w Guy L, Caceres GA, Jackson T, <i>et al</i>. Routine outcomes and evaluation of an 8-week outpatient multidisciplinary rehabilitative therapy program for functional neurological disorder. <i>J Neurol</i>. 2023. 10.1007/s00415-023-12111-4 Carson A, Lehn A: Epidemiology. <i>Handb Clin Neurol</i>. 2016;<b>139</b>:47–60. 10.1016/b978-0-12-801772-2.00005-9 Nielsen G, Stone J, Matthews A, <i>et al</i>. Physiotherapy for functional motor disorders: a consensus recommendation. <i>J Neurol Neurosurg Psychiatry</i> 2015;<b>86</b>:1113–1119. 10.1136/jnnp-2014-309255 Nielsen G, Stone J, Buszewicz M, <i>et al</i>.: Physio4FMD: protocol for a multicentre randomised controlled trial of specialist physiotherapy for functional motor disorder. <i>BMC Neurology</i> 2019;<b>19</b>:242. 10.1186/s12883-019-1461-9 Espay AJ, Aybek S, Carson A, <i>et al</i>. Current concepts in diagnosis and treatment of functional neurological disorders. <i>JAMA Neurol</i>. 2018;<b>75</b>:1132–1141. 10.1001/jamaneurol.2018.1264 Glass SP, Matin N, Williams B, <i>et al</i>. Neuropsychiatric factors linked to adherence and short-term outcome in a U.S. functional neurological disorders clinic: a retrospective cohort study. <i>J Neuropsychiatry Clin Neurosci</i>. 2018;<b>30</b>:152–159. 10.1176/appi.neuropsych.17060117