Journal
AMYOTROPHIC LATERAL SCLEROSIS AND FRONTOTEMPORAL DEGENERATION
Volume 18, Issue 7-8, Pages 569-575Publisher
TAYLOR & FRANCIS LTD
DOI: 10.1080/21678421.2017.1349151
Keywords
Motor neuron disease; amyotrophic lateral sclerosis; multidisciplinary team; multidisciplinary care; survival; care quality
Categories
Funding
- Motor Neuron Disease Association
- [MNDA Al-Chalabi/Mar15/931-794 Al-Chalab]
- Medical Research Council [G0900688, MC_G1000733, G1100695, MR/L021803/1, G0600974, G0900635, G0500289, G0300329, MR/L501529/1, G0500289B] Funding Source: researchfish
- Motor Neurone Disease Association [Shaw/Nov14/985-797, Shaw/Apr15/970-797] Funding Source: researchfish
- National Institute for Health Research [ACF-2016-14-008] Funding Source: researchfish
- MRC [G0900635, G1100695, G0300329, MR/L021803/1, G0600974, G0500289, MC_G1000733, G0900688, MR/K01014X/1] Funding Source: UKRI
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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.
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