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

TY - JOUR

T1 - The benefit of evolving multidisciplinary care in ALS

T2 - a diagnostic cohort survival comparison

AU - Martin, Sarah

AU - Trevor-Jones, Emma

AU - Khan, Sabyha

AU - Shaw, Keelan

AU - Marchment, Deepti

AU - Kulka, Anna

AU - Ellis, Catherine E

AU - Burman, Rachel

AU - Turner, Martin R

AU - Carroll, Liam

AU - Mursaleen, Leah

AU - Leigh, P Nigel

AU - Shaw, Christopher E

AU - Pearce, Neil

AU - Stahl, Daniel

AU - Al-Chalabi, Ammar

PY - 2017/7/18

Y1 - 2017/7/18

N2 - 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.

AB - 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.

KW - Journal Article

U2 - 10.1080/21678421.2017.1349151

DO - 10.1080/21678421.2017.1349151

M3 - Article

C2 - 28719997

SN - 2167-8421

SP - 1

EP - 7

JO - Amyotrophic lateral sclerosis & frontotemporal degeneration

JF - Amyotrophic lateral sclerosis & frontotemporal degeneration

ER -