Internet-based self-help randomized trial for motor functional neurologic disorder (SHIFT). (29th September 2020)

• Record Type: Journal Article
• Authors: Gelauff, Jeannette M.; Rosmalen, Judith G.M.; Carson, Alan; Dijk, Joke M.; Ekkel, Martijn; Nielsen, Glenn; Stone, Jon; Tijssen, Marina A.J.
• Is Part Of: Neurology. Volume 95:Number 13(2020)
• Publication Date: 2020-09-29
• Subjects: Neurology -- Periodicals; Neurology -- Periodicals; Neurologie -- Périodiques; 616.8
• DOI: 10.1212/WNL.0000000000010381
• Languages: English
• ISSNs: 0028-3878

Abstract

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.