Psychogenic gait disorder: A randomized controlled trial of physical rehabilitation with one-year follow-up
Anika Aakerøy Jordbru, Liv Marit Smedstad, Ole Klungsøyr, Egil Wilhelm Martinsen
Vestfold Hospital Trust, Clinic physical medicine and rehabilitation, NO-3101 Tønsberg, Norway. E-mail: Anika.Jordbru@siv.no
Objective: Psychogenic gait disorder, defined as loss of ability to walk without neurological aetiologies, has poor rehabilitation options that are well documented. Left untreated these patients have substantial and long-lasting dysfunction. The present study examined the effect of a 3-week inpatient rehabilitation programme compared with a waiting list control condition, and whether eventual gains were maintained at 1-month and 1-year follow-up.
Design: A cross-over design evaluated the effect of treatment, and a carry-over effect was considered as a long-lasting treatment effect. Treatment consisted of adapted physical activity within a cognitive behavioural framework, and focused on offering an alternative explanation of symptoms, positively reinforcing normal gait and not reinforcing dysfunction.
Patients: A total of 60 patients were recruited from neurological departments and were randomly assigned to immediate treatment (intervention) or treatment after 4 weeks (controls).
Results: Cross-over design revealed that the mean difference between treatment vs no treatment was 8. 4 Functional Independence Measure units (p < 0. 001, 95% confidence interval 5. 2–11. 7), and 6. 9 Functional Mobility Scale units (p < 0. 001, 95% confidence interval 5. 5–8. 3). Patients significantly improved their ability to walk and their quality of life after inpatient rehabilitation compared with the untreated control group. The improvements in gait were sustained at 1-month and 1-year follow-up.
Conclusion: Substantial and lasting improvement can be achieved by inpatient rehabilitation of patients with psychogenic gait, and the gains are maintained during follow-up.
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