A multidisciplinary approach improves quality of life perception in patients with amyotrophic lateral sclerosis

Objectives: A multidisciplinary approach, including physical therapy assisted programs, in neuromuscular disease patients has proven to improve quality of life (QoL) in Amyotrophic Lateral Sclerosis (ALS) patients. The effects of physical exercise in patients with ALS are controversial but there are indications that QoL improves. The general objective of our study is to verify whether management in a multidisciplinary center improves perception of quality of life in patients with ALS. More specifically, we wish to determine whether an individualized physical exercise program improves QoL as perceived by the patients. Methods: 15 patients (8 male, 7 females, age range 51-76, mean 61.57 ± 8.38) with diagnosis of ALS were subjected to: (1) MMT; (2) ALS-FRS-r; (3) FVC; (4) Therapeutic exercise (i.e. active assisted and passive mobilization, and stretching); (5) McGill QoL Single-Item Scale (MQoL-SIS) before access to the multidisciplinary clinical center and at discharge after the physical program. Results: When the patients were asked about their symptoms, physical symptoms subscore was better after the recovery than on admission (respectively 16.50 ± 6.69 and 21.43 ± 5.93, p = 0.017). Moreover, the subscore about existential well-being showed a significant improvement at the discharge compared to admission (respectively 45.93 ± 7.16 and 41.57 ± 9.29, p = 0.019). The other subscores (psychological symptoms and support domains) did not show any significant change. Conclusions: A multidisciplinary approach, including an individualized physical exercise program, appears to provide an improvement of the physical symptoms and existential well-being a perceived by ALS patients. These results emphasize the necessity of a coordinated multidisciplinary care between specialist and therapists for ALS patients. We wish to further explore quality of life perception in patients with neuromuscular disorders as a result of a physical exercise program in a multidisciplinary context using INQoL, an individualized QoL scale, specifically constructed for patients with neuromuscular diseases. This scale will possibly allow us to better correlate aspects of QoL related to the muscle condition, which may have been underscored by the more generic measure of QoL.