What Does the Research Say?
Physical Therapy for Functional Movement Disorders: What the Largest Trial Found
The Physio4FMD trial was the first large-scale randomized controlled trial to test specialist physiotherapy for functional motor disorder. Here is what it showed.
355
adults with functional motor disorder randomized across sites in England and Scotland, making Physio4FMD the largest trial of its kind.
What the Trial Showed
9+1
Treatment sessions in the specialist arm
Nine sessions plus one follow-up, delivered by physiotherapists trained specifically in FND management using distraction and automatic movement strategies.
3.5
Point difference on the SF-36 physical functioning scale
The primary outcome did not reach statistical significance, but both groups improved. This matters: it means physiotherapy in general helps FND patients.
✓
Significantly more self-rated improvement
Patients receiving specialist physiotherapy were significantly more likely to report that their motor symptoms had improved compared to the control group.
0
Serious adverse events from physiotherapy
Both specialist and community-based physiotherapy were safe. No serious adverse events were related to the treatment intervention.
The modest between-group difference reflects that both groups received active physiotherapy, not that specialist therapy lacks benefit. Secondary outcomes (mental health, well-being, self-rated improvement) clearly favored the specialist approach.
3 Takeaways for Your Practice
1
Treatment Planning
Physiotherapy Helps. Specialist Physiotherapy Helps More.
Both groups improved, but specialist training in FND-specific techniques produced better subjective outcomes and mental health scores. Seek out FND-specific continuing education.
2
Outcome Selection
Patient-Reported Outcomes Capture What Matters
The primary measure (SF-36 physical functioning) missed the signal that patient self-rating and mental health outcomes detected. In FND research and practice, ask patients how they feel.
3
Safety Confidence
Physiotherapy for Functional Neurological Disorders Is Safe
Zero serious adverse events related to treatment. Physiotherapy is well-accepted by patients with FND and can be recommended with confidence across the disability spectrum.
