Restoring Independence With Stimulation-Enhanced Treatment for People With Functional Neurological Disorder

The Tinetti POMA is a reliable and valid assessment for use with a broad range of neurological conditions, with excellent interrater reliability. It evaluates key symptom domains of gait, trunk stability, and postural balance. The minimum and worst score is zero. The maximum and best score is 28. The odds ratio for achieving effective treatment will be calculated for the treatment group relative to the control group.

The FMDQ is a summed severity and impact questionnaire in which participants rate the presence and severity of functional movement symptoms across multiple domains. Each item is scored on a Likert type scale, and a total score (range 31-181) is calculated, with higher scores indicating greater functional symptom burden.

The EQ-5D-5L is a self-reported questionnaire of quality of life that is validated for general and neurological populations. The EQ-5D-5L assesses five key dimensions of health and using a 5-point Likert scale. An index score is derived from the combination of individual domain ratings using a country-specific value set which reflects societal preferences for different health states.

The Tinetti POMA score will be obtained via video call during the follow-up period. It evaluates key symptom domains of gait, trunk stability, and postural balance. The minimum and worst score is zero. The maximum and best score is 28.

Walking independence will be evaluated with the Functional Ambulation Category (FAC), which is a valid and reliable measure of a person's level of independence in mobility and walking. The lowest and worst score is zero, meaning fully dependent. The highest and best score is 5, meaning fully independent walking. Participants will be classified as independent if they have a FAC score of 4 or 5 out of 5. Participants will be classified as dependent if they have a FAC score of 0, 1, 2 or 3.

The S-FMDRS is a clinician-rated score of overall functional movement symptom severity. The assessor will video the assessment to support their review and scoring accuracy. A total score out of 54 is recorded with higher scores indicating greater symptom severity.

Total lower limb strength score will be calculated by summing the Medical Research Council grades for knee flexion, knee extension, ankle dorsiflexion, and ankle plantarflexion for each limb. The summed bilateral score will be used for analysis of between-group effects. The minimum and worst score is zero, the maximum and best score is 40.

Lower limb sensation will be assessed using Semmes-Weinstein monofilaments. With vision occluded, participants will be asked to indicate detection of progressively smaller filament sizes applied perpendicularly to the plantar surface of the great toe until the smallest reliably perceived filament is identified. Lower filament scores indicate better light touch sensation.

The Patient Global Impression of Improvement (PGI-I) scale is a patient-reported measure used to evaluate participants' overall impression of change following treatment. The lowest score is zero, meaning "very much worse", and the highest score is 7, meaning "very much improved".

The Box and Blocks Test is a timed test of upper limb motor performance. It will be used to evaluate the more-affected upper limb of participants who report upper limb functional symptoms. More blocks moved in 60 seconds indicates better upper limb motor performance.

The Brief Illness Perception Questionnaire (B-IPQ) is a patient-reported measure of illness perception. Each of eight items is scored individually on a 0 to 10 scale. Higher scores indicate a more threatening or negative perception.

The PROMIS Pain Interference Short Form is a patient-reported measure of how much pain has interfered with daily activities over the past 7 days. The scale has 8 items, each rated on a 5-point scale with the lowest score of zero meaning "not at all", and the highest score of 5 meaning "very much".

The PROMIS Fatigue Interference Short Form is a patient-reported measure of how much pain has interfered with daily activities over the past 7 days. The scale has 8 items, each rated on a 5-point scale with the lowest score of zero meaning "not at all", and the highest score of 5 meaning "very much".

The Patient-Specific Functional Scale is an evaluation of participant-identified functional limitations. Participants nominate up to 3 activities they are currently unable to perform, or have difficulty performing, due to their symptoms. Each activity is rated on an 11-point scale from zero meaning 'unable to perform' to 10 meaning 'able to perform at prior level'.

Treating clinicians will independently rate participant readiness to progress using a simple 4-point Likert scale, where zero means "definitely not ready" and 4 means "definitely ready".

Participation in paid work or employment will be evaluated by asking participants to provide the average number of hours worked per week over the past 6 months. They will be asked to rate their perceived ability to work on a Likert scale, with a minimum score of zero meaning no ability to work, and a maximum score of 10 meaning able to fully participate in work.