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Amyotroph Lateral Scler Frontotemporal Degener. 2017 Nov;18(7-8):569-575. doi: 10.1080/21678421.2017.1349151. Epub 2017 Jul 18.

The benefit of evolving multidisciplinary care in ALS: a diagnostic cohort survival comparison.

Author information

1
a Department of Basic and Clinical Neuroscience , Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London , London , UK.
2
b Nuffield Department of Clinical Neurosciences , John Radcliffe Hospital , Oxford , UK.
3
c Trafford Centre for Biomedical Research , Brighton and Sussex Medical School , Falmer , UK , and.
4
d Department of Medical Statistics, London School of Hygiene and Tropical Medicine , London , UK.

Abstract

BACKGROUND:

Care for people with amyotrophic lateral sclerosis (ALS) has altered at King's College Hospital over the last 20 years. The clinic has been a multidisciplinary, specialist, tertiary referral centre since 1995 with a large team with integrated palliative and respiratory care since 2006. We hypothesised that these changes would improve survival.

METHODS:

In this retrospective observational study, patients diagnosed with El Escorial definite, probable and possible ALS between 1995-1998 and 2008-2011 were followed up. The primary outcome measure was a chi-square test for the proportion of each cohort surviving. Kaplan-Meier survival analysis and Cox multivariate regression were secondary analyses.

RESULTS:

There was low reporting of some interventions. Five hundred and forty-seven people were included. Survival between the cohorts was significantly different (p = 0.022) with a higher proportion surviving during 2008-2011. Survival time was 21.6 (95% CI 19.2-24.0) months in the 2008-2011 cohort compared to 19.2 years (15.6-21.6) in the 1995-1998 cohort (log rank p = 0.018). Four hundred and ninety-three cases were included in the Cox regression. Diagnostic cohort was a significant predictor variable (HR 0.79 (0.64-0.97) p = 0.023).

CONCLUSIONS:

These results support the hypothesis that integrated specialist clinics with multidisciplinary input improve survival in ALS.

KEYWORDS:

Motor neuron disease; amyotrophic lateral sclerosis; care quality; multidisciplinary care; multidisciplinary team; survival

PMID:
28719997
DOI:
10.1080/21678421.2017.1349151
[Indexed for MEDLINE]

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