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

Martin, SarahORCID logo; Trevor-Jones, Emma; Khan, Sabyha; Shaw, Keelan; Marchment, Deepti; Kulka, Anna; Ellis, Catherine E; Burman, Rachel; Turner, Martin RORCID logo; Carroll, Liam; +6 more...Mursaleen, Leah; Leigh, P Nigel; Shaw, Christopher E; Pearce, NeilORCID logo; Stahl, Daniel; and Al-Chalabi, AmmarORCID logo (2017) The benefit of evolving multidisciplinary care in ALS: a diagnostic cohort survival comparison. Amyotrophic lateral sclerosis & frontotemporal degeneration, 18 (7-8). pp. 569-575. ISSN 2167-8421 DOI: 10.1080/21678421.2017.1349151
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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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