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

Martin, Sarah, Trevor-Jones, Emma, Khan, Sabyha, Shaw, Keelan, Marchment, Deepti, Kulka, Anna, Ellis, Catherine E, Burman, Rachel, Turner, Martin R, Carroll, Liam, Mursaleen, Leah, Leigh, P Nigel, Shaw, Christopher E, Pearce, Neil, Stahl, Daniel and Al-Chalabi, Ammar (2017) The benefit of evolving multidisciplinary care in ALS: a diagnostic cohort survival comparison. Amyotrophic Lateral Sclerosis & Frontotemporal Degeneration. pp. 1-7. ISSN 2167-9223

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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.

Item Type: Article
Keywords: Motor neuron disease, amyotrophic lateral sclerosis, multidisciplinary team, multidisciplinary care, survival, care quality
Schools and Departments: Brighton and Sussex Medical School > Neuroscience
Subjects: R Medicine > RC Internal medicine > RC0321 Neurosciences. Biological psychiatry. Neuropsychiatry > RC0346 Neurology. Diseases of the nervous system Including speech disorders
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Depositing User: Patricia Butler
Date Deposited: 17 Aug 2017 06:41
Last Modified: 17 Aug 2017 06:41
URI: http://sro.sussex.ac.uk/id/eprint/69758
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