Objective: To assess the maintenance of improvement in Functional Movement Disorders (FMDs) following inpatient rehabilitation one year after discharge.

Background: FMDs are chronic and challenging to treat.  Our cohort had significant improvement following rehabilitative, goal-oriented multidisciplinary inpatient rehabilitation.

Method: Methods: Patients seen in Movement Disorders (MD) clinic and diagnosed with FMD by a MD specialist panel consensus were referred for inpatient rehabilitation admission. Baseline, discharge and one year follow-up measures included: Clinical Global Impression severity and change (CGIs and c); Depression and Somatic Symptom Scale (DSSS); Generalized Anxiety Disorder (GAD-7); Patient Health Questionnaire-9 (PHQ-9); PTSD check list for DSM-5 (PCL-5). Demographic values are reported as median (min/max).

Results: Of 72 patients seen since March 2015, 20 were admitted, 17 completed the program, and 13 had an one year follow up. The cohort consisted of 14 women, disease duration 24 months (0.1/264), and moderate disease severity, CGI-s = 5 (4/6) by neurologist rating, and  CGI-s = 5 (4/7) by patient rating. For the 17 patients completing the inpatient rehabilitation program, the median duration of stay was 7.5 days (3/14). Immediately after rehabilitation, movement disorder improved in 88% (median CGI-c 2.0; 1/4) by both neurologist and patient ratings. Depression, anxiety and other somatic symptoms also improved: DSSS (Wilcoxon Z = -2.91, p < 0.004); GAD-7 (Wilcoxon Z = -3.01, p < 0.002); PHQ-9 (Wilcoxon Z = -3.42, p < 0.00). However, there was no significant improvement in PCL-5 (Wilcoxon Z =-1.51, p > 0.05). Among the 13 patients seen at 1 year, 54% maintained at least minimal improvement in their movement disorder by neurologist rating (CGI-c = 3.0; 1/7), compared to 77% by patient rating (CGI-c = 3.0; 1/7). Significant improvement was not maintained for DSSS (Wilcoxon Z = -0.39. p > 0.05), GAD (Wilcoxon Z = -0.94, p > 0.05) or PHQ-9 (Wilcoxon Z = -0.55, p > 0.05).

Conclusion: Multidisciplinary inpatient rehab resulted in improvement in the movement disorder, depression, anxiety and other somatic symptoms in this cohort of patients immediately following treatment. However, one year follow up demonstrated maintenance of at least minimal improvement in movement disorder severity, but not in depression, anxiety, other somatic symptoms or PTSD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/long-term-follow-up-following-multidisciplinary-inpatient-rehabilitation-for-functional-movement-disorders/