Psychogenic gait disorder: a randomized controlled trial of physical rehabilitation with one-year follow-up.

Abstract

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.