The median survival of patients with amyotrophic lateral sclerosis (ALS) is 3 to 5 years and mortality is mainly related to respiratory failure. Non-invasive ventilation (NIV) and multidisciplinary management improve the quality of life and survival of patients. However, patients have mobility difficulties related to the progressive worsening of functional disabilities. The research team hypothesize that the use of a multimodal digital platform, including in particular telemonitoring of NIV and teleconsultation, will slow down the evolution of the disabilities of patients with ALS and improve their quality of life.
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease with a median life expectancy of 3 to 5 years. Respiratory failure due to alveolar hypoventilation is the main cause of mortality and respiratory impairment leads to a significant deterioration in quality of life. Non-invasive ventilation (NIV) improves patient quality of life, improves gas exchange and improves patient survival. NIV should be initiated early, based on symptomatology and lung function, and monitored closely to adjust device parameters. NIV is a complex intervention that must be individualized for each patient. In addition, multidisciplinary management involving different healthcare professionals, keeping the patient and caregivers at the center of the network, also allows for an improvement in the quality of life and survival of these patients. However, patients with ALS have difficulty moving around and access to care becomes more complicated as the disease progresses. This phenomenon was increased during the COVID- 19 pandemic with a more rapid functional decline. The development of new technologies should make it possible to rethink patient management, in particular through remote monitoring of NIV devices, teleconsultation, administration of questionnaires and better interprofessional organization. Several studies have confirmed the feasibility and acceptance of telemedicine solutions in this population. In this project, The research team hypothesize that the use of a multimodal digital platform will slow the progression of disability in ALS patients and improve their quality of life, in particular by improving the quality of NIV and optimizing the coordination of a multidisciplinary team.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
43
Patients in the experimental group will have access to a multimodal digital platform (m-Rehab®). The solution includes a website and an application available on smart phones for the patient and caregivers. Patients and caregivers will have access to educational content about the condition and its treatments, NIV compliance data, digital group educational workshops, secure messaging and video conferencing. All the professionals forming the patient's circle of care will be able to have access to the solution, after the patient's authorization. The circle of care, in a non-exhaustive way, includes specialist doctors, the general practitioner, the staff of the reference center of the Montpellier University Hospital, the physiotherapist, the speech therapist, the dietician and the psychologist.
Usual management including NIV.
Uh Montpellier
Montpellier, Montpellier, France
Clinique du Millénaire
Montpellier, France
Difference in change in functional abilities between the experimental and control groups over 6 months of follow-up.
Difference in variation of the functional capabilities assessed by the Amyotrophic lateral sclerosis functional rating scale (ALSFRS) score at Baseline (D0) and 6 months between the experimental group and the control group. A scale to determine different aspects of functionality in patients with ALS, minimum 0 points, maximum 48 points, derived from a questionnaire with 12 questions, each of which can yield up to 4 points, higher score indicates better functionality
Time frame: Between baseline and 6 months
Difference in change in functional abilities between the experimental and control groups during 3 months of follow-up (Between 3 months and 6 months).
Difference in variation of the functional capabilities assessed by the Amyotrophic lateral sclerosis functional rating scale (ALSFRS) score at 3 month and 6 month between the experimental group and the control group. A scale to determine different aspects of functionality in patients with ALS, minimum 0 points, maximum 48 points, derived from a questionnaire with 12 questions, each of which can yield up to 4 points, higher score indicates better functionality
Time frame: Between 3 months and 6 months
Difference in change in functional abilities between the experimental and control groups during 3 months of follow-up (Between Baseline and 3 months).
Difference in variation of the functional capabilities assessed by the ALSFRS score at Baseline (D0) and 3 month between the experimental group and the control group. A scale to determine different aspects of functionality in patients with ALS, minimum 0 points, maximum 48 points, derived from a questionnaire with 12 questions, each of which can yield up to 4 points, higher score indicates better functionality
Time frame: Between Baseline and 3 months
Evolution of dyspnea between the 2 groups between baseline and 3 months
Dyspnea assessed by modified Borg scale. Minimum is 0 (best). Maximum is 10 (worse).
Time frame: Between Baseline and 3 months
Evolution of dyspnea between the 2 groups between baseline and 6 months
Dyspnea assessed by modified Borg scale. Minimum is 0 (best). Maximum is 10 (worse).
Time frame: Between Baseline and 6 months
Evolution of Quality of life between the 2 groups between baseline and 3 months
Quality of life assessed by the EuroQol-5 Dimensions (EQ5D) scale. The descriptive system has five dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression), each described by five levels of intensity ("no problems", "slight problems", "moderate problems", "severe problems" and "extreme problems or complete inability"). This decision results in a 1-digit number that expresses the level selected for that dimension. The digits for the five dimensions can be combined into a 5-digit number that describes the patient's health state.
Time frame: Between Baseline and 3 months
Evolution of Quality of life between the 2 groups between baseline and 6 months
Quality of life assessed by the EQ5D scale. The descriptive system has five dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression), each described by five levels of intensity ("no problems", "slight problems", "moderate problems", "severe problems" and "extreme problems or complete inability"). This decision results in a 1-digit number that expresses the level selected for that dimension. The digits for the five dimensions can be combined into a 5-digit number that describes the patient's health state.
Time frame: Between Baseline and 6 months
Evolution of evaluation of Anxiety and depression between the 2 groups between baseline and 3 months
Anxiety and depression assessed by the Hospital Anxiety and Depression (HAD) scale. The HAD results in a score ranging from 0 (low anxiety or depression) to 21 (strong anxiety or depression).
Time frame: Between Baseline and 3 months
Evolution of evaluation of Anxiety and depression between the 2 groups between baseline and 6 months
Anxiety and depression assessed by the HAD scale. The HAD results in a score ranging from 0 (low anxiety or depression) to 21 (strong anxiety or depression).
Time frame: Between Baseline and 6 months
Evolution of Patient satisfaction between the 2 groups between baseline and 3 months
Patient satisfaction assessed by the CSQ-8 (Consumer satisfaction questionnaire) Minimal score is 8 and maximal score is 32. The best score is 32, that mean that patient is satisfied.
Time frame: Between Baseline and 3 months
Evolution of Caregivers satisfaction between the 2 groups between baseline and 3 months
Caregivers satisfaction assessed by the CSQ-8. Minimal score is 8 and maximal score is 32. The best score is 32, that mean that patient is satisfied.
Time frame: Between Baseline and 3 months
Evolution of Patient satisfaction between the 2 groups between baseline and 6 months
Patient satisfaction assessed by the CSQ-8. Minimal score is 8 and maximal score is 32. The best score is 32, that mean that patient is satisfied.
Time frame: Between Baseline and 6 months
Evolution of Caregivers satisfaction between the 2 groups between baseline and 6 months
Caregivers satisfaction assessed by the CSQ-8. Minimal score is 8 and maximal score is 32. The best score is 32, that mean that patient is satisfied.
Time frame: Between Baseline and 6 months
Evolution of Anthropometric criteria between the 2 groups between baseline and 3 months (Weight measurements)
Weight measurements
Time frame: Between Baseline and 3 months
Evolution of Anthropometric criteria between the 2 groups between baseline and 3 months (BMI)
BMI
Time frame: Between Baseline and 3 months
Evolution of Anthropometric criteria between the 2 groups between baseline and 6 months (weight measurements)
weight measurements
Time frame: Between Baseline and 6 months
Evolution of Anthropometric criteria between the 2 groups between baseline and 6 months (BMI)
BMI
Time frame: Between Baseline and 6 months
Evaluation of the quality and tolerance of NIV between the 2 groups at 3 months
The quality and tolerance of NIV assessed by the S3-NIV score. Score 0 to 10, lower units represent worse outcome.
Time frame: At 3 months
Evaluation of the quality and tolerance of NIV between the 2 groups at 6 months
The quality and tolerance of NIV assessed by the S3-NIV score. Score 0 to 10, lower units represent worse outcome.
Time frame: At 6 months
Evaluation of the effectiveness of NIV between the 2 groups at 3 months assessed by nocturnal oximetry
The effectiveness of NIV assessed by nocturnal oximetry
Time frame: At 3 months
Evaluation of the effectiveness of NIV between the 2 groups at 6 months assessed by nocturnal oximetry
The effectiveness of NIV assessed by nocturnal oximetry
Time frame: At 6 months
Evaluation of the effectiveness of NIV between the 2 groups at 3 months assessed by nocturnal capnography
The effectiveness of NIV assessed by nocturnal capnography
Time frame: At 3 months
Evaluation of the effectiveness of NIV between the 2 groups at 6 months assessed by nocturnal capnography
The effectiveness of NIV assessed by nocturnal capnography : * average compliance * AHI apnea hypopnea index (number per hour) * leakage * respiratory frequency (number per minute) * tidal volume * percentage of triggered cycles.
Time frame: At 6 months
Evaluation of the NIV parameters between the 2 groups at 3 months
NIV parameters obtained using data from the machine report : * expiratory pressure (cmH²O) * inspiratory pressure (cmH²O) * respiratory rate (number per minute) * minimum and maximum inspiratory time (seconde) * inspiratory and expiratory trigger * inspiratory and expiratory slope
Time frame: At 3 months
Evaluation of the NIV parameters between the 2 groups at 6 months
NIV parameters obtained using data from the machine report
Time frame: At 6 months
Evaluation of survival between the 2 groups at 3 months
Evaluation of survival between the 2 groups at 3 months
Time frame: At 3 months
Evaluation of survival between the 2 groups at 6 months
Evaluation of survival between the 2 groups at 6 months
Time frame: At 6 months
Evaluation of time to first hospitalization between the 2 groups at 3 months
recovery of hospitalization data
Time frame: At 3 months
Evaluation of time to first hospitalization between the 2 groups at 6 months
recovery of hospitalization data
Time frame: At 6 months
Evaluation at 3 months in the experimental group of the Satisfaction of professionals with the digital solution
Satisfaction of professionals with the digital solution by a VAS (Visual Analog Scale) of satisfaction rated from 0 (most dissatisfied) to 100 (extremely satisfied)
Time frame: At 3 months
Evaluation at 6 months in the experimental group of the Satisfaction of professionals with the digital solution
Satisfaction of professionals with the digital solution by a VAS (Visual Analog Scale) of satisfaction
Time frame: At 6 months
Medico-economic evaluation: incremental cost-utility ratio
Utility will be derived from the EQ5D
Time frame: 6 months
Evaluation at 3 months in the experimental group of the Patient satisfaction with the digital solution
Patient satisfaction with the digital solution assessed by a VAS (Visual Analog Scale) of satisfaction
Time frame: At 3 months
Evaluation at 6 months in the experimental group of the Patient satisfaction with the digital solution
Patient satisfaction with the digital solution assessed by a VAS (Visual Analog Scale) of satisfaction
Time frame: At 6 months
Evaluation at 3 months in the experimental group of the caregiver satisfaction with the digital solution
Caregiver satisfaction with the digital solution assessed by a VAS (Visual Analog Scale) of satisfaction
Time frame: At 3 months
Evaluation at 6 months in the experimental group of the caregiver satisfaction with the digital solution
Caregiver satisfaction with the digital solution assessed by a VAS (Visual Analog Scale) of satisfaction
Time frame: At 6 months
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