Impact of a rehabilitation program in the overall survival of amyotrophic lateral sclerosis patients

Abstract

Amyotrophic lateral sclerosis’ (ALS) survival ranges from a median of 37–49 months. There's no cure for ALS, so the goal is to provide clinical support and rehabilitate patient's needs to prolong survival and improve quality of life. Exercise prescription has been controversial but some authors consider it can help improve function, slow disease progression and lessen caregiver burden. This study's aim was to identify whether integrating a rehabilitation program (RP) has an impact on the survival of ALS patients. Retrospective cohort study from medical records of 75 patients diagnosed with ALS between 01/01/2005 and 31/12/2016 at Centro Hospitalar de Trás-os-Montes e Alto Douro, Portugal. The variables were analyzed with IBM SPSS Statistics 22.0 software. t -test for independent samples and Mann–Whitney were used. All reported P -values are two-tailed (0.05 indicating statistical significance). The median survival since ALS’ diagnosis was significantly higher for patients integrated into a RP (786 days) rather for those who did not undergo these treatments (450 days) ( P = 0.006). Patients with spinal onset ALS (sALS) took significantly longer to integrate a RP (median of 677,50 days) than patients with bulbar onset ALS (bALS) (median of 293,50 days) ( P = 0.009). Also, sALS patients who survived longer than 17 months started the RP later in the course of the disease (median of 858 days vs. 271 days) ( P = 0.007). There was a moderate positive correlation ( r = 0.53; P < 0.001) between the time to initiate the RP since the symptoms onset and the overall survival after diagnosis. Integrating a RP can improve overall survival of ALS’ patients. The sALS’ patients who took longer to seek help (therefore, joined a RP later) had probably a slower progression of the disease, with longer survival. There's a lack of quality data to draw clear evidence-based conclusions about exercise's effect. Available evidence points toward mild-to-moderate exercise as beneficial.