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Abstract
Objective To determine whether self-rated health of patients with motor functional neurologic disorder (FND) can be improved by unguided Internet-based self-help and education.
Methods In this nonblinded randomized controlled trial, patients were allocated 1:1 unbiased to an unguided education and self-help website in addition to usual care or usual care only. Patients over 17 years of age with a functional motor symptom that caused distress or disability were included. The primary outcome was self-rated health on the Clinical Global Improvement scale at 3 and 6 months. Secondary outcomes were severity of motor symptoms, other physical and psychiatric symptoms, physical functioning, quality of life, work and social adjustment, illness beliefs, and satisfaction with care.
Results A total of 186 patients were randomized, with a follow-up rate of 87% at 6 months. There was no difference in improvement of self-rated health at 3 months (44% vs 40%, p = 0.899) or 6 months (42% vs 43%, p = 0.435). Secondary outcomes did not differ between groups, with a threshold of p < 0.01. Satisfaction was high, with 86% of patients recommending the website to other patients.
Conclusion We found no significant effect of the intervention added to usual care on self-rated health or secondary outcome measures, despite high patient satisfaction with the intervention. These results suggest that online education and nonguided self-help could be valuable additions to stepped care for motor FND, but are not effective treatments as interventions in their own right.
Clinicaltrials.gov identifier NCT02589886.
Classification of evidence This study provides Class III evidence that for patients with motor FND, online education and self-help intervention does not significantly improve self-rated health.
Glossary
- CGI=
- Clinical Global Improvement;
- DSM-5=
- Diagnostic and Statistical Manual of Mental Disorders, 5th edition;
- FND=
- functional neurologic disorder;
- IQR=
- interquartile range;
- OR=
- odds ratio;
- RAND36=
- Dutch equivalent of Short Form–36 health-related quality of life;
- RCT=
- randomized controlled trial;
- WHO-QoL=
- a single question from the 1998 WHO Quality of Life scale;
- WI=
- Whitely Index;
- WSAS=
- Work and Social Adjustment Scale
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
↵* These authors contributed equally to this work.
This Null Hypothesis article is published as part of a collaborative effort between Neurology and CBMRT.
Class of Evidence: NPub.org/coe
- Received September 23, 2019.
- Accepted in final form April 7, 2020.
- © 2020 American Academy of Neurology
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