We have demonstrated that it is possible to train physiotherapists to deliver specialist interventions, that are highly regarded by both the patient and clinician.
We found that specialist physiotherapy for FMD, compared to standard physiotherapy, has a high probability of being cost-effective at the £20,000 cost per QALY threshold. Specialist physiotherapy has additional benefits, including a higher OR of patient-reported improvement, better scores of mental health and other benefits related to self-efficacy. Additionally, physiotherapy was found to be safe, with no SAEs related to treatment. Our findings suggest that specialist physiotherapy has value for some people with FMD and that usual-care physiotherapy may be augmented with strategies described in the specialist physiotherapy approach.
There are currently regions in the UK where there is no provision for NHS-funded physiotherapy or other rehabilitation for FMD.49 Despite the lack of allocated resources, we found a high cost of illness, mostly accounted for by hospital outpatient appointments and admissions. There is a strong argument that the costs could be reduced if healthcare resources were directed towards early diagnosis and treatment. Different treatment pathways are needed to meet the needs of this large heterogenous population, including psychology and specialist multidisciplinary interventions involving occupational therapy and speech and language therapy.54