de Almeida Filipe Emanuel Oliveira, do Carmo Santana Anne Kelly, de Carvalho Fernanda Oliveira
Sergipe University Hospital of Universidade Federal de Sergipe-UFS, Aracaju, SE, Brazil.
Health Sciences Graduate Center of Universidade Federal de Sergipe-UFS, São Cristóvão, SE, 49100-000, Brazil.
Neurol Sci. 2021 Mar;42(3):911-923. doi: 10.1007/s10072-020-05011-2. Epub 2021 Jan 14.
Multidisciplinary care (MDC) has been the most recommended approach for symptom management in amyotrophic lateral sclerosis (ALS) but there is conflicting evidence about its effectiveness on survival and quality of life (QoL) of ALS patients. We conducted a systematic review to determine the effects of multidisciplinary care compared to general neurological care in survival and quality of life of ALS patients. A comprehensive literature search using Scopus, MEDLINE-PubMed, Cochrane, Web of Science, PEDro, and Science Direct was undertaken. Studies related to multidisciplinary care or general neurological care in ALS patients that assessed survival and quality of life and were published in the period up to and including January 2020 were included. A total of 1192 studies were initially identified, but only 6 were included. All studies that investigated survival showed and advantage of MDC over NC, and this benefit was even greater for bulbar onset patients. A meta-analysis was performed and showed a mean difference of 141.67 (CI 95%, 61.48 to 221.86), indicating that patients who received MDC had longer survival than those who underwent NC (p = 0.0005). Concerning QoL, only one study found better mental health scores related to QoL for patients under MDC. Multidisciplinary care is more effective than general neurology care at improving survival of patients with ALS, but only improves mental health outcomes related to quality of life of these patients.
多学科护理（MDC）一直是肌萎缩侧索硬化症（ALS）症状管理中最推荐的方法，但关于其对ALS患者生存率和生活质量（QoL）的有效性存在相互矛盾的证据。我们进行了一项系统综述，以确定多学科护理与一般神经科护理相比对ALS患者生存率和生活质量的影响。使用Scopus、MEDLINE-PubMed、Cochrane、Web of Science、PEDro和Science Direct进行了全面的文献检索。纳入了截至2020年1月（含1月）发表的、评估ALS患者生存率和生活质量且与多学科护理或一般神经科护理相关的研究。最初共识别出1192项研究，但仅纳入了6项。所有调查生存率的研究均显示MDC优于NC，对于延髓起病的患者，这种益处更大。进行了一项荟萃分析，结果显示平均差异为141.67（95%置信区间，61.48至221.86），表明接受MDC的患者比接受NC的患者生存期更长（p = 0.0005）。关于生活质量，只有一项研究发现接受MDC的患者与生活质量相关的心理健康得分更高。多学科护理在提高ALS患者生存率方面比一般神经科护理更有效，但仅改善了这些患者与生活质量相关的心理健康结果。
