A brief neuromotor-therapy-augmented pathway for pediatric functional movement disorders: a sequential historical cohort study

Background Pediatric functional movement disorders (FMD) often improve, but access to specialized motor rehabilitation is heterogeneous. We compared two sequential, non-overlapping care periods within one clinical unit: usual care (UC) and a neuromotor-therapy-augmented pathway (NMT-A), which added brief hospital-based neuromotor therapy before community referral. Methods This retrospective, non-randomized historical cohort included 17 UC patients (June 2021–January 2023) and 29 NMT-A patients (February 2023–June 2025). The primary outcome was continuous S-FMDRS at 6 months; S-FMDRS-defined motor symptom-free status (score = 0) was secondary. Both were reassessed at 12 months, together with community-treatment engagement. Results At 6 months, the adjusted NMT-A-minus-UC S-FMDRS difference was −1.66 points (95% CI, −4.04 to 0.72). Motor symptom-free status occurred in 55.2% versus 5.9% (risk difference, 49.3 percentage points; 95% CI, 21.8 to 66.4), and in 86.2% versus 52.9% at 12 months (risk difference, 33.3 percentage points; 95% CI, 6.5 to 56.8). The pathway-by-time interaction was not significant. Sustained community physical and/or occupational therapy was documented in 75.0% versus 17.6% (RR, 4.25; 95% CI, 1.74–12.46). Conclusion The NMT-A pathway-period was associated with more frequent motor symptom-free status and greater continuity of community motor rehabilitation, although the adjusted mean S-FMDRS difference was not statistically significant. Because pathway and calendar period were inseparable, these findings should be interpreted as associations with the overall later care pathway rather than as an isolated effect of NMT.