Multidisciplinary care for adults with amyotrophic lateral sclerosis or motor neuron disease.
Identifieur interne : 003554 ( Main/Exploration ); précédent : 003553; suivant : 003555Multidisciplinary care for adults with amyotrophic lateral sclerosis or motor neuron disease.
Auteurs : Louisa Ng ; Fary Khan ; Susan MathersSource :
- The Cochrane database of systematic reviews [ 1469-493X ] ; 2009.
Descripteurs français
- KwdFr :
- MESH :
- rééducation et réadaptation : Sclérose latérale amyotrophique.
- Adulte, Humains, Études prospectives, Études transversales.
English descriptors
- KwdEn :
- MESH :
- rehabilitation : Amyotrophic Lateral Sclerosis.
- Adult, Cross-Sectional Studies, Humans, Prospective Studies.
Abstract
BACKGROUND
Multidisciplinary care (MDC) is increasingly thought to be an important means of symptomatic and supportive management for motor neuron disease (MND) but the evidence base for its effectiveness is unclear.
OBJECTIVES
To assess the effectiveness of MDC in adults with MND, especially the types of approaches that are effective (settings, intensity) and the outcomes that are affected.
SEARCH STRATEGY
We searched The Cochrane Neuromuscular Disease Group Specialized Register (11 May 2009), and The Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2009), MEDLINE (1966 to April 2009), EMBASE (1980 to April 2009), CINAHLPlus (1937 to April 2009), AMED (1985 to April 2009) and LILACS (1982 to April 2009).
SELECTION CRITERIA
Randomised and controlled clinical trials that compared MDC in MND with either routinely available local services or lower levels of intervention; or studies that compared MDC in different settings or at different levels of intensity.Studies of 'other designs' (such as observational studies) were included only in the Discussion since such studies could only be of limited contribution to the best evidence synthesis.
DATA COLLECTION AND ANALYSIS
We performed a 'best evidence' synthesis based on methodological quality. We grouped studies in terms of setting and intensity (high or low) of therapy.
MAIN RESULTS
No randomised controlled trials or controlled clinical trials were identified. We summarised the results of five observational studies (including one with two reports) in the Discussion section of this review.
AUTHORS' CONCLUSIONS
In the absence of randomised controlled trials or controlled clinical trials, the 'best' evidence to date is based on three 'low' and two 'very low quality' observational studies. These suggest 'very low quality evidence' for an advantage for mental health domains (only) of quality of life without increasing healthcare costs, and 'low level quality' evidence for reduced hospitalisation for MDC in low-intensity outpatient settings; and 'very low quality' evidence for improved disability in high-intensity settings. The evidence for survival is conflicting. These conclusions are tentative and the gap in current research should not be interpreted as proof that MDC is ineffective. Further research is needed into appropriate study designs; outcome measurement; caregiver needs; and the evaluation of optimal settings, type, intensity or frequency and cost-effectiveness of MDC in the MND population. Future research should focus on observational designs to assess care and outcomes in 'real-life' settings. The interface between neurology, rehabilitation and palliative care should be explored to provide long-term support for MND.
DOI: 10.1002/14651858.CD007425.pub2
PubMed: 19821416
Affiliations:
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Multidisciplinary care for adults with amyotrophic lateral sclerosis or motor neuron disease.</title><author><name sortKey="Ng, Louisa" sort="Ng, Louisa" uniqKey="Ng L" first="Louisa" last="Ng">Louisa Ng</name><affiliation><nlm:affiliation>Rehabilitation, Royal Melbourne Hospital, Royal Park Campus, Poplar Road, Parkville, Victoria, Australia, 3052.</nlm:affiliation><wicri:noCountry code="subField">3052</wicri:noCountry></affiliation></author><author><name sortKey="Khan, Fary" sort="Khan, Fary" uniqKey="Khan F" first="Fary" last="Khan">Fary Khan</name></author><author><name sortKey="Mathers, Susan" sort="Mathers, Susan" uniqKey="Mathers S" first="Susan" last="Mathers">Susan Mathers</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2009">2009</date><idno type="RBID">pubmed:19821416</idno><idno type="pmid">19821416</idno><idno type="doi">10.1002/14651858.CD007425.pub2</idno><idno type="wicri:Area/Main/Corpus">003427</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">003427</idno><idno type="wicri:Area/Main/Curation">003427</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Curation">003427</idno><idno type="wicri:Area/Main/Exploration">003427</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Multidisciplinary care for adults with amyotrophic lateral sclerosis or motor neuron disease.</title><author><name sortKey="Ng, Louisa" sort="Ng, Louisa" uniqKey="Ng L" first="Louisa" last="Ng">Louisa Ng</name><affiliation><nlm:affiliation>Rehabilitation, Royal Melbourne Hospital, Royal Park Campus, Poplar Road, Parkville, Victoria, Australia, 3052.</nlm:affiliation><wicri:noCountry code="subField">3052</wicri:noCountry></affiliation></author><author><name sortKey="Khan, Fary" sort="Khan, Fary" uniqKey="Khan F" first="Fary" last="Khan">Fary Khan</name></author><author><name sortKey="Mathers, Susan" sort="Mathers, Susan" uniqKey="Mathers S" first="Susan" last="Mathers">Susan Mathers</name></author></analytic><series><title level="j">The Cochrane database of systematic reviews</title><idno type="eISSN">1469-493X</idno><imprint><date when="2009" type="published">2009</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term><term>Amyotrophic Lateral Sclerosis (rehabilitation)</term><term>Cross-Sectional Studies (MeSH)</term><term>Humans (MeSH)</term><term>Prospective Studies (MeSH)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte (MeSH)</term><term>Humains (MeSH)</term><term>Sclérose latérale amyotrophique (rééducation et réadaptation)</term><term>Études prospectives (MeSH)</term><term>Études transversales (MeSH)</term></keywords><keywords scheme="MESH" qualifier="rehabilitation" xml:lang="en"><term>Amyotrophic Lateral Sclerosis</term></keywords><keywords scheme="MESH" qualifier="rééducation et réadaptation" xml:lang="fr"><term>Sclérose latérale amyotrophique</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Cross-Sectional Studies</term><term>Humans</term><term>Prospective Studies</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Humains</term><term>Études prospectives</term><term>Études transversales</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>Multidisciplinary care (MDC) is increasingly thought to be an important means of symptomatic and supportive management for motor neuron disease (MND) but the evidence base for its effectiveness is unclear.</p></div><div type="abstract" xml:lang="en"><p><b>OBJECTIVES</b></p><p>To assess the effectiveness of MDC in adults with MND, especially the types of approaches that are effective (settings, intensity) and the outcomes that are affected.</p></div><div type="abstract" xml:lang="en"><p><b>SEARCH STRATEGY</b></p><p>We searched The Cochrane Neuromuscular Disease Group Specialized Register (11 May 2009), and The Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2009), MEDLINE (1966 to April 2009), EMBASE (1980 to April 2009), CINAHLPlus (1937 to April 2009), AMED (1985 to April 2009) and LILACS (1982 to April 2009).</p></div><div type="abstract" xml:lang="en"><p><b>SELECTION CRITERIA</b></p><p>Randomised and controlled clinical trials that compared MDC in MND with either routinely available local services or lower levels of intervention; or studies that compared MDC in different settings or at different levels of intensity.Studies of 'other designs' (such as observational studies) were included only in the Discussion since such studies could only be of limited contribution to the best evidence synthesis.</p></div><div type="abstract" xml:lang="en"><p><b>DATA COLLECTION AND ANALYSIS</b></p><p>We performed a 'best evidence' synthesis based on methodological quality. We grouped studies in terms of setting and intensity (high or low) of therapy.</p></div><div type="abstract" xml:lang="en"><p><b>MAIN RESULTS</b></p><p>No randomised controlled trials or controlled clinical trials were identified. We summarised the results of five observational studies (including one with two reports) in the Discussion section of this review.</p></div><div type="abstract" xml:lang="en"><p><b>AUTHORS' CONCLUSIONS</b></p><p>In the absence of randomised controlled trials or controlled clinical trials, the 'best' evidence to date is based on three 'low' and two 'very low quality' observational studies. These suggest 'very low quality evidence' for an advantage for mental health domains (only) of quality of life without increasing healthcare costs, and 'low level quality' evidence for reduced hospitalisation for MDC in low-intensity outpatient settings; and 'very low quality' evidence for improved disability in high-intensity settings. The evidence for survival is conflicting. These conclusions are tentative and the gap in current research should not be interpreted as proof that MDC is ineffective. Further research is needed into appropriate study designs; outcome measurement; caregiver needs; and the evaluation of optimal settings, type, intensity or frequency and cost-effectiveness of MDC in the MND population. Future research should focus on observational designs to assess care and outcomes in 'real-life' settings. The interface between neurology, rehabilitation and palliative care should be explored to provide long-term support for MND.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">19821416</PMID><DateCompleted><Year>2010</Year><Month>01</Month><Day>27</Day></DateCompleted><DateRevised><Year>2018</Year><Month>12</Month><Day>21</Day></DateRevised><Article PubModel="Electronic"><Journal><ISSN IssnType="Electronic">1469-493X</ISSN><JournalIssue CitedMedium="Internet"><Issue>4</Issue><PubDate><Year>2009</Year><Month>Oct</Month><Day>07</Day></PubDate></JournalIssue><Title>The Cochrane database of systematic reviews</Title><ISOAbbreviation>Cochrane Database Syst Rev</ISOAbbreviation></Journal><ArticleTitle>Multidisciplinary care for adults with amyotrophic lateral sclerosis or motor neuron disease.</ArticleTitle><Pagination><MedlinePgn>CD007425</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1002/14651858.CD007425.pub2</ELocationID><Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">Multidisciplinary care (MDC) is increasingly thought to be an important means of symptomatic and supportive management for motor neuron disease (MND) but the evidence base for its effectiveness is unclear.</AbstractText><AbstractText Label="OBJECTIVES" NlmCategory="OBJECTIVE">To assess the effectiveness of MDC in adults with MND, especially the types of approaches that are effective (settings, intensity) and the outcomes that are affected.</AbstractText><AbstractText Label="SEARCH STRATEGY" NlmCategory="METHODS">We searched The Cochrane Neuromuscular Disease Group Specialized Register (11 May 2009), and The Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2009), MEDLINE (1966 to April 2009), EMBASE (1980 to April 2009), CINAHLPlus (1937 to April 2009), AMED (1985 to April 2009) and LILACS (1982 to April 2009).</AbstractText><AbstractText Label="SELECTION CRITERIA" NlmCategory="METHODS">Randomised and controlled clinical trials that compared MDC in MND with either routinely available local services or lower levels of intervention; or studies that compared MDC in different settings or at different levels of intensity.Studies of 'other designs' (such as observational studies) were included only in the Discussion since such studies could only be of limited contribution to the best evidence synthesis.</AbstractText><AbstractText Label="DATA COLLECTION AND ANALYSIS" NlmCategory="METHODS">We performed a 'best evidence' synthesis based on methodological quality. We grouped studies in terms of setting and intensity (high or low) of therapy.</AbstractText><AbstractText Label="MAIN RESULTS" NlmCategory="RESULTS">No randomised controlled trials or controlled clinical trials were identified. We summarised the results of five observational studies (including one with two reports) in the Discussion section of this review.</AbstractText><AbstractText Label="AUTHORS' CONCLUSIONS" NlmCategory="CONCLUSIONS">In the absence of randomised controlled trials or controlled clinical trials, the 'best' evidence to date is based on three 'low' and two 'very low quality' observational studies. These suggest 'very low quality evidence' for an advantage for mental health domains (only) of quality of life without increasing healthcare costs, and 'low level quality' evidence for reduced hospitalisation for MDC in low-intensity outpatient settings; and 'very low quality' evidence for improved disability in high-intensity settings. The evidence for survival is conflicting. These conclusions are tentative and the gap in current research should not be interpreted as proof that MDC is ineffective. Further research is needed into appropriate study designs; outcome measurement; caregiver needs; and the evaluation of optimal settings, type, intensity or frequency and cost-effectiveness of MDC in the MND population. Future research should focus on observational designs to assess care and outcomes in 'real-life' settings. The interface between neurology, rehabilitation and palliative care should be explored to provide long-term support for MND.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Ng</LastName><ForeName>Louisa</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>Rehabilitation, Royal Melbourne Hospital, Royal Park Campus, Poplar Road, Parkville, Victoria, Australia, 3052.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Khan</LastName><ForeName>Fary</ForeName><Initials>F</Initials></Author><Author ValidYN="Y"><LastName>Mathers</LastName><ForeName>Susan</ForeName><Initials>S</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016454">Review</PublicationType><PublicationType UI="D000078182">Systematic Review</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2009</Year><Month>10</Month><Day>07</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>Cochrane Database Syst Rev</MedlineTA><NlmUniqueID>100909747</NlmUniqueID><ISSNLinking>1361-6137</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000690" MajorTopicYN="N">Amyotrophic Lateral Sclerosis</DescriptorName><QualifierName UI="Q000534" MajorTopicYN="Y">rehabilitation</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D003430" MajorTopicYN="N">Cross-Sectional Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011446" MajorTopicYN="N">Prospective Studies</DescriptorName></MeshHeading></MeshHeadingList><NumberOfReferences>58</NumberOfReferences></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2009</Year><Month>10</Month><Day>13</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2009</Year><Month>10</Month><Day>13</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2010</Year><Month>1</Month><Day>28</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>epublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">19821416</ArticleId><ArticleId IdType="doi">10.1002/14651858.CD007425.pub2</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list></list><tree><noCountry><name sortKey="Khan, Fary" sort="Khan, Fary" uniqKey="Khan F" first="Fary" last="Khan">Fary Khan</name><name sortKey="Mathers, Susan" sort="Mathers, Susan" uniqKey="Mathers S" first="Susan" last="Mathers">Susan Mathers</name><name sortKey="Ng, Louisa" sort="Ng, Louisa" uniqKey="Ng L" first="Louisa" last="Ng">Louisa Ng</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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