Discrepancies between patient-reported and physician-reported severity and disability in functional and non-functional movement disorders

Journal of Neurology Neurosurgery & Psychiatry, vol. 97, pp. jnnp–2025

Abstract

BACKGROUND: Functional movement disorder (FMD) is a common cause of debilitating symptoms in neurology patients. Due to the stigma that is associated with FMD, it is possible that discrepancies between patient and physician judgements of severity and disability are more pronounced in FMD compared with non-FMD. A patient-physician discrepancy in judgement may be explained by associated comorbid non-motor symptoms. METHODS: In the prospective TASMAN study, 171 FMD and 294 non-FMD patients were recruited from the Netherlands and Australia. Patient characteristics included non-motor symptoms: depression, anxiety, dissociation, pain and fatigue. Patient-reported and physician-reported severity and disability were collected using seven-point Likert scales. A quantitative measure of discrepancies was calculated by subtracting the physician's score from the patient's score. Associations between non-motor symptoms and disability were analysed using linear regression. RESULTS: Patients reported significantly higher severity and disability compared with physicians in both groups. Patient-physician discrepancies in both severity and disability outcomes were not statistically different between FMD and non-FMD. FMD patients scored significantly higher on all non-motor symptoms compared with non-FMD. Patient-reported, but not physician-reported, disability was associated with increased pain and fatigue in both the FMD and non-FMD groups. In FMD, dissociation was associated with disability in both patient-reported and physician-reported outcomes. In non-FMD, depression was associated with disability in both patient-reported and physician-reported outcomes. CONCLUSIONS: Our results do not support notions of ongoing FMD-specific stigmatisation in physicians. Similar patient-physician discrepancies regarding severity and disability exist in both FMD and non-FMD patients. Patient-physician discrepancies in disability in all movement disorder patients might be in part explained by different appreciation of the importance of non-motor symptoms.

Authors 6

1. O. Vermeulen

   University Medical Center Groningen

   Affiliation as printed

   Department of Neurology, University Medical Centre Groningen, Groningen, The Netherlands

2. Tjerk Joppe Lagrand Aachen Department of Neurology, Alrijne Hospital Location Leiderdorp

   University Medical Center Groningen · Alrijne Ziekenhuis

   Affiliation as printed

   Department of Neurology, Alrijne Hospital Location Leiderdorp, Leiderdorp, The Netherlands

   UMCG Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen, Groningen, The Netherlands

3. Jeannette Gelauff

   Amsterdam University Medical Centers · Amsterdam UMC Location University of Amsterdam

   Affiliation as printed

   Department of Neurology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands

4. Marjolein G J Brusse-Keizer

   University of Twente · Medisch Spectrum Twente

   Affiliation as printed

   Department of Health Technology and Services Research, University of Twente Faculty of Behavioural Sciences, Enschede, The Netherlands

   Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands

5. Alexander Lehn

   Queensland University of Technology · Princess Alexandra Hospital

   Affiliation as printed

   Department of Neurology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia

   School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia

6. Marina A.J. Tijssen

   University Medical Center Groningen

   Affiliation as printed

   Department of Neurology, University Medical Centre Groningen, Groningen, The Netherlands

   UMCG Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen, Groningen, The Netherlands