Occupational therapy consensus recommendations for functional neurological disorder.

BACKGROUND: People with functional neurological disorder (FND) are commonly seen by occupational therapists; however, there are limited descriptions in the literature about the type of interventions that are likely to be helpful. This document aims to address this issue by providing consensus recommendations for occupational therapy assessment and intervention. METHODS: The recommendations were developed in four stages. Stage 1: an invitation was sent to occupational therapists with expertise in FND in different countries to complete two surveys exploring their opinions regarding best practice for assessment and interventions for FND. Stage 2: a face-to-face meeting of multidisciplinary clinical experts in FND discussed and debated the data from stage 1, aiming to achieve consensus on each issue. Stage 3: recommendations based on the meeting were drafted. Stage 4: successive drafts of recommendations were circulated among the multidisciplinary group until consensus was achieved. RESULTS: We recommend that occupational therapy treatment for FND is based on a biopsychosocial aetiological framework. Education, rehabilitation within functional activity and the use of taught self-management strategies are central to occupational therapy intervention for FND. Several aspects of occupational therapy for FND are distinct from therapy for other neurological conditions. Examples to illustrate the recommendations are included within this document. CONCLUSIONS: Occupational therapists have an integral role in the multidisciplinary management of people with FND. This document forms a starting point for research aiming to develop evidence-based occupational therapy interventions for people with FND.

CBT-based group therapy intervention for nonepileptic attacks and other functional neurological symptoms: a pilot study.

Despite the high prevalence and disabling nature of nonepileptic attacks (NEAs) and other types of functional neurological symptoms (FNSs), treatment trials are few. Preliminary evidence supports the efficacy of cognitive behavioral therapy (CBT) approaches, and CBT-based group therapies have the potential to improve cost-effectiveness and deliverability of treatment. This pilot study was undertaken to evaluate whether CBT-based group therapy would offer a feasible treatment option for patients with NEAs and other FNSs. We evaluated the outcomes of an information and management intervention within a neuropsychiatry service, which included weekly CBT-based group therapy sessions for patients with NEAs and other FNSs. Outcomes pertaining to quality of life and physical and emotional well-being were measured using the 36-item Short-Form Health Survey (SF-36), the Hospital Anxiety and Depression Scale (HADS), and the Clinical Global Impression (CGI) scale. Data were collected from 16 patients, of whom 10 presented with NEAs. Significant improvements were selectively reported in the 'emotional well-being' (p=0.04) and 'role limitation due to emotional well-being' (p=0.04) subscores of the SF-36. Improvements in overall quality-of-life scores (p=0.22), as well as in HADS anxiety (p=0.34) and depression (p=0.46) scores, did not reach statistical significance. These trends were supported by a positive mean CGI improvement scale score of 2.4, indicating minimal-to-considerable improvement. Group therapy intervention with a CBT-based approach is a feasible treatment option in the management of NEAs and other FNSs, as shown by significant improvements in emotional domains of quality of life in this low power pilot study.

Remote Dwelling Location Is a Risk Factor for CKD Among Indigenous Canadians.

INTRODUCTION: Rural and remote indigenous individuals have a high burden of chronic kidney disease (CKD) when compared to the general population. However, it has not been previously explored how these rates compare to urban-dwelling indigenous populations. METHODS: In a recent cross-sectional screening study, 1346 adults 18 to 80 years of age were screened for CKD and diabetes across 11 communities in rural and remote areas in Manitoba, Canada, as part of the First Nations Community Based Screening to Improve Kidney Health and Prevent Dialysis (FINISHED) program. An additional 284 Indigenous adults who resided in low-income areas in the city of Winnipeg, Manitoba, Canada were screened as part of the NorWest Mobile Diabetes and Kidney Disease Screening and Intervention Project. RESULTS: Our findings indicate that a gradient of CKD and diabetes prevalence exists for Indigenous individuals living in different geographic areas. Compared to urban-dwelling Indigenous individuals, rural-dwelling individuals had more than a 2-fold (2.1, 95% CI = 1.4-3.1) increase in diabetes whereas remote-dwelling individuals had a 4-fold (4.1, 95% CI = 2.8-6.0) increase, and more than a 3-fold (3.1, 95% CI = 2.2-4.5) increase in CKD prevalence. CONCLUSION: Although these results highlight the relative importance of geography in determining the prevalence of diabetes and CKD in Indigenous Canadians, geography is but an important surrogate of other determinants, such as poverty and access to care.