Developing interventions to improve engagement in community-based Occupational Therapy and self-management for people with Functional Neurological Disorder.

Background Functional Neurological Disorder (FND) is a common and disabling condition which affects approximately 100,000 adults in the UK. Despite its prevalence, understanding of the condition is poor and treatment pathways are under-developed.

For those people with FND who can access treatment, it usually involves consultation with an occupational therapist (OT). International OT consensus recommendations for FND were published in 2020 (2).

However, OTs continue to report reduced knowledge, skills, and confidence in working with people with FND, particularly in community settings where multi-disciplinary support is often limited.

Little is also known about the patient experience of OT for FND and what supports rehabilitation engagement, and self-management. Delivering OT, patient engagement in OT and self-management are all forms of human behaviour.

Applying behavioural science theory and frameworks could therefore aid identification and understanding of factors that influence these behaviours, allowing the development of targeted supportive interventions.

This research will specifically use the Behaviour Change Technique Taxonomy (BCTTv1), the Behaviour Change Wheel (BCW), the COM-B and the Theoretical Domains Framework (TDF).

Aim This research aims to co-develop theoretically informed behaviour change interventions to support people with FND to rehabilitate within the community with the help of OTs, enhancing their abilities to self-manage their symptoms within daily routines.

Methods This will be a multi-phased mixed methods study with three planned phases: Phase 1: A systematic review of existing studies pertaining to community rehabilitation interventions for people with long-term neurological conditions; specifically applying the BCTTv1 and BCW to identify which behaviour change techniques (BCTs) are commonly used to support patient engagement in community rehabilitation and self-management, and which are effective.

The relevance of the evidence for people with FND will be explored.

Phase 2: Qualitative semi-structured interviews with adults with FND and carers and a survey with community OTs working with people with FND.

The TDF will be used to structure the topic guide for the interviews and survey and subsequent data analysis, to explore the broad range of potential barriers and enablers.

Data will aid identification of what needs to be targeted for change to increase patient engagement in community OT and self-management.

Phase 3: Findings from phases 1 and 2 will be brought together using the behaviour change frameworks to identify potential intervention strategies to address barriers and enablers identified in phase 2.

Iterative co-design workshops will be conducted with the research team, people with FND, carers and OTs to prioritise and develop the content of interventions.

Consensus on the interventions to take forward to intervention design and future piloting will be reached using Nominal Group Technique.

Impact The key deliverables from this research will be to co-develop the content of a set of interventions which can be taken forward for piloting in a separate research project. This will include but not limited to a draft patient therapy workbook and an OT assessment and treatment manual.

By improving symptom management, occupational participation and performance, these interventions will enhance the health, social and quality of life outcomes for people with FND.