CRediT contribution statement
Glenn Nielsen (https://orcid.org/0000-0001-6053-5670): Conceptualisation, Funding acquisition, Methodology, Project administration, Resources, Supervision, Writing – original draft, Writing – reviewing and editing.
Louise Marston (https://orcid.org/0000-0002-9973-1131): Conceptualisation, Formal analysis, Funding acquisition, Methodology, Supervision, Writing – reviewing and editing.
Rachael Maree Hunter (https://orcid.org/0000-0002-7447-8934): Conceptualisation, Formal analysis, Funding acquisition, Methodology, Supervision, Writing – reviewing and editing.
Alan Carson (https://orcid.org/0000-0002-7425-0964): Conceptualisation, Funding acquisition, Methodology, Supervision, Writing – reviewing and editing.
Laura H Goldstein (https://orcid.org/0000-0001-9387-3035): Conceptualisation, Funding acquisition, Methodology, Supervision, Writing – reviewing and editing.
Kate Holt (https://orcid.org/0009-0003-9529-2420): Conceptualisation, Data curation, Investigation, Resources, Writing – reviewing and editing.
Teresa C Lee (https://orcid.org/0009-0009-0917-860X): Formal analysis, Visualisation, Writing – reviewing and editing.
Marie Le Novere (https://orcid.org/0000-0002-9479-8599): Formal analysis, Visualisation, Writing – reviewing and editing.
Jonathan Marsden (https://orcid.org/0000-0002-2037-4902): Conceptualisation, Funding acquisition, Methodology, Supervision, Writing – reviewing and editing.
Irwin Nazareth (https://orcid.org/0000-0003-2146-9628): Conceptualisation, Funding acquisition, Methodology, Supervision, Writing – reviewing and editing.
Hayley Noble (https://orcid.org/0000-0002-4267-1609): Data curation, Project administration, Validation, Writing – reviewing and editing.
Markus Reuber (https://orcid.org/0000-0002-4104-6705): Conceptualisation, Funding acquisition, Methodology, Supervision, Writing – reviewing and editing.
Jon Stone (https://orcid.org/0000-0001-9829-8092): Conceptualisation, Funding acquisition, Methodology, Supervision, Writing – reviewing and editing.
Ann-Marie Strudwick (https://orcid.org/0000-0003-2817-5219): Data curation, Project administration, Validation, Writing – reviewing and editing.
Beatriz Santana Suarez (https://orcid.org/0000-0002-1902-8332): Data curation, Project administration, Validation, Writing – reviewing and editing.
Mark J Edwards (https://orcid.org/0000-0002-8283-9015): Conceptualisation, Funding acquisition, Methodology, Supervision, Writing – reviewing and editing.
The Physio4MD Study Group
Emily Beaves, David Breen, Christine Burness, Simone Caddy, Hannah Callaghan, Andrew Carberry, Luke Chetham, Andrea Clyne, Susie Cobb, Jan Coebergh, Lewis Cook, Patrick Cookson, Paul Cooper, Clare Diamond, Lee Drake, Victoria Dunn, Paula Gardiner, Thomas Gilbertson, Dawn Golder, Rebecca Gregory, Helen Harbinson, Rory Higgins, Ingrid Hoeritzauer, Laura Irvine, Jeremy Isaacs, Emily Jay, Danielle Kearney, Uzma Khan, James Magro, Elizabeth Mallam, Eleanor Harle, Luke Massey, Sarah McRae, Shagun Misra, Steph Mitchell, Cameron Moss, Esther Mountain, Shona Murray, Rachel Newby, Marianne Novak, Annie Ross, Anna Rutherford, Gillian Sare, Rhiannon Sears, Will Sedley, Sumeet Singhal, Biba Stanton, Charlotte Stone, Gillian Szeto, Lauren Tarr, Tiago Teodoro, Volker Teweleit, Michael Walsh, Rhian Warman, Mahinda Yogarajah.
Patient data statement
This work uses data provided by patients and collected by the NHS as part of their care and support. Using patient data is vital to improve health and care for everyone. There is huge potential to make better use of information from people’s patient records, to understand more about disease, develop new treatments, monitor safety, and plan NHS services. Patient data should be kept safe and secure, to protect everyone’s privacy, and it’s important that there are safeguards to make sure that it is stored and used responsibly. Everyone should be able to find out about how patient data is used. #datasaveslives You can find out more about the background to this citation here: https://understandingpatientdata.org.uk/data-citation
Data-sharing statement
Deidentified participant data can be made available by request to the corresponding author. Requests will be considered after planned analyses and reporting have been completed by the investigators. Access will require submission of a protocol that is approved by a review committee and a signed data access agreement. Due to our data-sharing agreement and for patient confidentiality reasons, we are not able to provide access to hospital episode statistics data from NHS England and NHS Scotland.
Ethics statement
Ethics approval was granted by the London-Surrey Borders Research Ethics Committee, reference number 18/LO/0486, 28 March 2018. All participants gave written informed consent to participate.
Information governance statement
St George’s, University of London is committed to handling all personal information in line with the UK Data Protection Act (2018) and the General Data Protection Regulation (EU GDPR) 2016/679. Under the Data Protection legislation, St George’s, University of London is the Data Controller, and you can find out more about how we handle personal data, including how to exercise your individual rights and the contact details for our Data Protection Officer here: www.sgul.ac.uk/about/our-professional-services/information-services/information-governance/data-protection
Disclosure of interests
Full disclosure of interests: Completed ICMJE forms for all authors, including all related interests, are available in the toolkit on the NIHR Journals Library report publication page at https://doi.org/10.3310/MKAC9495.
Primary conflicts of interest: Glenn Nielsen receives research funding from the NIHR. Louise Marston research funding from NIHR. Alan Carson gives expert testimony in court on a range of neuropsychiatric topics, including pain disorders. He is President of the FND Society and Associate Editor of JNNP. Jonathan Marsden has undertaken commercial research for Roche-Hoffmann Pharmaceuticals. Jonathan Marsden has received research grant funding from the NIHR. Jonathan Marsden has received honorary from Bern University and MS Trust. Jonathan Marsden is the chair for NIHR PCAF panel up until 2023. Irwin Nazareth participated in a monitoring board for the APRIL Trial and for the QMUL Clinical Trials Unit. Markus Reuber has received research funding from the NIHR and Epilepsy Research UL. Markus Reuber receives a salary as Editor in Chief for Seizure-European Journal of Epilepsy. Markus Reuber has received honoraria from Angelini Pharam, UCB Pharma and Precisis. Markus Reuber has received royalties from Oxford University Press and Jessica Kingsley Publishers. IN has received research funding from the NIHR, MRC and Wellcome Trust. Jon Stone reports honoraria from UptoDate, personal fees from Expert Witness Work and grants from National Research Scotland. He runs a free self-help website, www.neurosymptoms.org, for patients with FND. He is secretary of the FND Society and on the medical advisory boards of the charities FND Hope UK and FND Action. Mark J Edwards does medical expert reporting in personal injury and clinical negligence cases, including in cases of FND. Mark J Edwards has shares in Brain & Mind, which provides neuropsychiatric and neurological rehabilitation in the independent medical sector, including in people with FND. Mark J Edwards has received financial support for lectures from the International Parkinson’s and Movement Disorders Society, European Academy of Neurology, and the FND Society (FNDS). Mark J Edwards receives royalties from Oxford University Press for his book The Oxford Specialist Handbook of Parkinson’s Disease and Other Movement Disorder. Mark J Edwards has received honoraria for medical advice to Teva Pharmaceuticals. Mark J Edwards receives grant funding, including for studies related to FND, from the National Institute for Health and Care Research (NIHR) and the Medical Research Council (MRC). Mark J Edwards is an associate editor of the European Journal of Neurology. Mark J Edwards is a member of the international executive committee of the International Parkinson’s and Movement Disorders Society and a board member of the FNDS. Mark J Edwards is on the medical advisory boards of the charities FND Hope UK and Dystonia UK. All other authors declare no competing interests.
Department of Health and Social Care disclaimer
This publication presents independent research commissioned by the National Institute for Health and Care Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, MRC, NIHR Coordinating Centre, the Health Technology Assessment programme or the Department of Health and Social Care.
This synopsis was published based on current knowledge at the time and date of publication. NIHR is committed to being inclusive and will continually monitor best practice and guidance in relation to terminology and language to ensure that we remain relevant to our stakeholders.
Trial Registration
This trial is registered as ISRCTN56136713.
Funding
This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 16/31/63.
About this synopsis
The contractual start date for this research was in May 2018. This synopsis began editorial review in April 2024 and was accepted for publication in February 2025. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The Health Technology Assessment editors and publisher have tried to ensure the accuracy of the authors’ article and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this synopsis.
Copyright
Copyright © 2025 Nielsen et al. This work was produced by Nielsen et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence, which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. See: https://creativecommons.org/licenses/by/4.0/. For attribution the title, original author(s), the publication source – NIHR Journals Library, and the DOI of the publication must be cited.
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