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Background: Functional movement disorders (FMD, aka psychogenic movement disorders) are very common and frequently chronic and disabling. Despite this, there is a paucity of evidence-based treatment to manage and alleviate these conditions. Specialized physical therapy (PT), involving sequential motor relearning and redirecting attention, has shown promise as a therapeutic intervention for motor symptoms. Methods: The objective of this study was to critically assess current evidence regarding specialized PT compared with usual care in improving motor symptoms among patients with FMD. This was addressed through the development of a structured critically appraised topic. This included a clinical scenario with a clinical question, literature search strategy, critical appraisal, results, evidence summary, commentary, and bottom-line conclusions. Participants included consultant and resident neurologists, a medical librarian, and content experts in the fields of physical medicine and rehabilitation, physical and occupational therapy, psychiatry, and psychology. Results: A randomized controlled feasibility trial was identified and selected for critical appraisal. This study randomized 60 patients with FMD to a 5-day specialized outpatient PT program or to general outpatient PT referral, and measured patient-reported and clinician-measured outcomes. At 6 months, 72% of patients in the intervention group had a good outcome compared with 18% of control group patients. Patients in the specialized outpatient PT program had significantly better outcomes in 3 Short-Form 36 (SF36) domains (d=0.46 to 0.79) and multiple other scales of physical and social function as well as clinician-measured outcomes. The intervention resulted in 0.08 additional quality-adjusted life years in a cost-effective manner. Conclusions: Current evidence suggests that in patients with FMD, specialized PT improves motor symptoms in a clinically significant, sustained, and cost-effective manner. This promising intervention warrants further investigation and replication.

AbstractBackgroundOne nonpharmacological intervention for persons with amnestic Mild Cognitive Impairment (MCI) is development of a compensatory memory notebook/planner system. De Wit et al. (2019) showed that global cognitive status is the primary predictor of learning success with training on a memory notebook system and that learning success predicts ongoing adherence to the tool. The purpose of our work is to validate their analysis in a new sample and evaluate whether or not patient or partner personality traits predict learning success over and above that explained by cognitive status.MethodTraining in the Memory Support System (MSS) is one component of the multi‐disciplinary behavioral intervention program called Healthy Action to Benefit Independence and Thinking (HABIT) offered at Mayo Clinic. 183 patient and partner dyads completed the HABIT program and enrolled in our IRB approved ongoing research registry to allow use of their clinical data for research purposes. Personality traits were measured with the self‐report Ten Item Personality Inventory (TIPI) based on the five‐factor model of personality (Agreeableness, Conscientiousness, Emotional Stability, Openness, and Extraversion) completed by both the patient and the partner. For our analyses, we fit logistic regression models to predict full MSS mastery at the end of the two‐week program and dichotomized TIPI into “high” or “low” for each trait based on its median (low was the reference group).ResultConsistent with De Wit et al. (2019), global cognitive status again was the only significant predictor of MSS learning mastery when considering age, education, baseline depression score and baseline global cognitive status (Table 2). When adding patient personality traits, only openness significantly added to the model with higher openness predicting learning success (Table 3). Adding both patient and partner personality traits resulted in a significant interaction between patient and partner openness (Table 4). The direction of this interaction indicates that learning success is highest when either the partner or patient is high in openness (but not both).ConclusionHigh openness to experience in the patient with MCI or their partner (but not both) significantly improves learning success for a cognitive rehabilitation memory support tool in patients with MCI.

This pilot study examined the functional impact of computerized versus compensatory calendar training in cognitive rehabilitation participants with mild cognitive impairment (MCI). Fifty-seven participants with amnestic MCI completed randomly assigned calendar or computer training. A standard care control group was used for comparison. Measures of adherence, memory-based activities of daily living (mADLs), and self-efficacy were completed. The calendar training group demonstrated significant improvement in mADLs compared to controls, while the computer training group did not. Calendar training may be more effective in improving mADLs than computerized intervention. However, this study highlights how behavioral trials with fewer than 30–50 participants per arm are likely underpowered, resulting in seemingly null findings.

ObjectiveThis study aims to provide effect size estimates of the impact of two cognitive rehabilitation interventions provided to patients with mild cognitive impairment: computerized brain fitness exercise and memory support system on support partners' outcomes of depression, anxiety, quality of life, and partner burden.MethodsA randomized controlled pilot trial was performed.ResultsAt 6 months, the partners from both treatment groups showed stable to improved depression and anxiety scores, while partners in an untreated control group showed worsening depression and anxiety over 6 months. There were no statistically significant differences on quality of life or burden outcomes in this small pilot trial; however, effect sizes were moderate, suggesting that the sample sizes in this pilot study were not adequate to detect statistical significance.ConclusionEither form of cognitive rehabilitation may help partners' mood or anxiety, compared with providing no treatment. However, effect size estimates related to other partner outcomes (i.e., burden, quality of life) suggest that follow‐up efficacy trials will need sample sizes of at least 30–100 people per group to accurately determine significance. Copyright © 2017 John Wiley & Sons, Ltd.

Abstract Solid organ and stem cell transplant patients and their caregivers report a substantial level of distress. Mindfulness‐based stress reduction has been shown to alleviate distress associated with transplant, but there is limited experience in this population with other mindfulness‐based interventions, or with combined transplant patient and caregiver interventions. We evaluated a novel, 6‐week mindfulness‐based resilience training ( MBRT ) class for transplant patients and their caregivers that incorporates mindfulness practice, yoga, and neuroscience of stress and resilience. Thirty‐one heart, liver, kidney/pancreas, and stem cell transplant patients and 18 caregivers at Mayo Clinic in Arizona participated. Measures of stress, resilience, depression, anxiety, health‐related quality of life, positive and negative affect, and sleep were completed at baseline, 6 weeks, and 3 months postintervention. At 6 weeks and 3 months, patients demonstrated significant ( P <.005) improvements from baseline in measures of perceived stress, depression, anxiety, and negative affect. Quality‐of‐life mental component ( P =.006) and positive affect ( P =.02) also improved at follow‐up. Most participants adhered to the program, were satisfied with class length and frequency, and reported improved well‐being as a result of the class. MBRT holds promise as an intervention to enhance resilience and manage stress for transplant patients and their caregivers.