The symposium aims to support cross pollination of ideas & concepts between different medical specialties and professional backgrounds.

Topics covered include visual loss, urological symptoms, dissociation, dizziness, interception, clinical signs, mental health and neurocognitive perspectives.

The St George's FND service is hosting its annual multidisciplinary symposium on functional disorders Friday 5 September 2025

Program:
www.citystgeorges.ac.uk/__data/asset...

Register through link below:
shop.sgul.ac.uk/short-course...

Face to face and virtual attendance both possible.

Congratulations Gita! Well deserved

Specialist physiotherapy for functional motor disorder in England and Scotland (Physio4FMD): a pragmatic, multicentre, phase 3 randomised controlled trial Although more participants who were assigned specialist physiotherapy self-rated their motor symptoms as improved and had better scores on subjective measures of mental health, the intervention did no...

The clinical outcomes can be found here
www.thelancet.com/journals/lan...

Despite costing slightly more, SP is most likely more cost effective than TAU, especially once societal costs are considered, eg loss of work productivity and the time spent by carers

TAU/community physio may be more cost effective if components of SP are incorporated into treatment.

It is possible to have a treatment that may not be significantly more clinically effective, but has a high probability of being more cost effective.

The clinical trial found no difference between SP and TAU for the primary outcome, however SP were twice as likely to report improved movement on the CGI at 1 year
...

Health economic evaluations do not use p-values to determine outcomes because they are not the main outcome, cost data is skewed, and it is hard to calculate the p-value of the incremental cost per QALY gained. Instead, probability of cost effectiveness is determined with bootstrapping.

This is a cost effectiveness acceptability curve
The probability of cost effectiveness at the £20,000 cost per QALY threshold was 86%
When we included societal costs, the probability was 89%
This is the probability that SP is more cost effective than TAU

Dots in the south east quadrant represent more effective and less costly treatment (compared to TAU).
63% of simulations fell in the south east quadrant.

This is a Cost Effectiveness Plane

Each of the 5000 blue dots represent a different simulation that tested different probabilities of cost effectiveness to account for the variability in the data.

The red dot is the mean of all the blue dots

Cost effectiveness is calculated as cost per QALY gained with treatment
SP cost an additional £143, for 0.03 extra QALYS
To determine the cost for 1.0 QALY, we divide the cost by the QALYs gained
£143.23 ÷ 0.034648 = £4133

values less than £20,000 are usually considered cost effective

QALYs are measured on a scale of 0 - 1
1 QALY = I year of life lived in full health

We used the EQ-5D-5L to calculate the number of QALYS gained with treatment and found SP was associated with a gain of 0.03 QALYs at 12 months compared to TAUP
(95% CI -0.007, 0.067)

When cost of treatment is added to health and social care costs (not including societal costs) the SP group cost an extra £143

So what do we get for this additional cost?
In health economics this value is measured in QALYS = quality adjusted life years

When we included societal costs, such as carer time, the difference was greater:
Cost of SP £24,565 (32,686)
Cost of TAUP £28,751 (44,311)
Adjusted difference, SP cost less than TAUP by -£5519 (-15,460, 4423)

We calculated health and social care costs over 12 months post randomisation
Costs for SP £3214 (SD 3581)
Costs for TAUP £3314 (SD 4279)
After adjusting for baseline and other factors SP cost less than TAU: difference -£208 (95% CI -1410, 994)

We calculated the cost of the treatment
Cost of SP £646 (SD 72) for a mean of 9 sessions
Cost of TAUP £272 (SD 374) for a mean of 5 sessions

The cost of SP included an additional £189 per participant to account for the cost of training received by the physio delivering SP

The Physio4FMD RCT clinical outcomes were published last year. Here we report the health economic analysis, comparing
Specialist Physiotherapy (SP) vs
Treatment as usual physiotherapy (TAUP)

Cost Utility of Specialist Physiotherapy for Functional Motor Disorder (Physio4FMD) | Neurology Clinical Practice Background and ObjectivesFunctional motor disorder (FMD), a motor-dominant variant of functional neurologic disorder, is a disabling condition associated with high health and social care resource use ...

The economic evaluation of the Physio4FMD trial was finally published today!
www.neurology.org/doi/10.1212/...
@jonstoneneuro.bsky.social

A timely review led by the brilliant @sadnicka.bsky.social