Individual treatment goals for patients with conversion disorder (functional neurologic symptom disorder) from the perspective of clinicians: A concept mapping study

Abstract

The complexity of conversion disorder (functional neurologic symptom disorder) requires personalized, tailored, and goal-driven therapy. The literature, however, lacks knowledge while conversion disorder remains to be a mystery, effective treatment methods are still unknown, and the treatment goals set with a patient with conversion disorder are unidentified. The aim of this preliminary study is to identify and structure encompassing sets of individual goals in patients with conversion disorder (functional neurologic symptom disorder), established through shared decision making within therapy. Using concept mapping, first a diverse group of clinicians were either (online) interviewed or they completed an online questionnaire. Second, a one-round Delphi procedure was fulfilled by the national working group of conversion disorder. Third, a card-sorting task was completed by researchers and clinicians. Fourth, a hierarchical cluster analysis was conducted with the final set of 43 treatment goals. This resulted in a seven-cluster solution combined in three overarching categories: therapeutic context (including the clusters psychiatric comorbidity and psychoeducation), empowerment (involving resilience, stress regulation, and retrieval of body control), and function improvement (consisting of symptom and function improvement and ADL). The diverse set of clusters resembles the diversity of clinicians used in this study; ranging from psychiatrists and psychologists to various physical therapists and a nurse and neurologist. Limiting the results of the study is the relatively small sample size and only one round of the Delphi procedure. The follow-up study, as this is a preliminary study, is advised to extend the sample size and conduct at least three rounds. Nevertheless, the results of this study add to our knowledge of conversion disorder. In clinicals practice, the results can be used during an intake, while setting individualized treatment goals through shared decision making, or an evaluation session.