Does duration Matter? Evaluating the impact of short- and long-term telemedicine in functional motor disorders

Introduction: Functional motor disorders (FMDs) are chronic neurological conditions characterized by altered expectations, disrupted attention, and a sense of agency, requiring long-term management. While 12-week telemedicine programs have shown effectiveness, the optimal duration for sustaining benefits remains unclear. We therefore aim to compare the effects of an extended 24-week telemedicine program with a standard 12-week program in managing FMDs. Methods: 52 consecutive patients with FMDs completed a five-day intensive, multidisciplinary rehabilitation program followed by a standard 12-week telemedicine program. Participants were then allocated consecutively to either a self-management program without telemedicine support (control group, CG, n = 26) or an extended 24-week telemedicine program with biweekly sessions (experimental group, EG, n = 26). Motor and non-motor symptoms, Quality of Life (QoL), and self-perception of change were assessed at baseline (T0), after 12 weeks (T1), and 36 weeks (T2). Results: Significant time effects were found for all outcomes except the Mental Health QoL. Significant Time × Group interaction was observed for TAS-20 (p < 0.001), where the CG reported a reduction both at T1 (p = 0.003) and T2 (p < 0.001), not observed in the EG. The CG reported a significant worsening in their self-perception of improvement at nine months (T2) compared to the EG (p = 0.015). Conclusions: Extending the telemedicine program, even at a reduced biweekly frequency, may help sustain perceived improvements despite the absence of additional motor benefits. Such disconnection might be related to the strong role of altered expectations and attention within this disorder.