Canadian ALS Best Practice Recommendations (2749)

Objective: Canadian ALS clinicians feel that it is important to develop best practice recommendations that could be used to set a national standard for management of Canadian patients living with ALS. The guidelines would be an update to previously published guidelines and address several issues unique to Canada. The recommendations would be supported by evidence or by Canadian expert consensus where evidence was unavailable. Background: Several ALS clinical practice guidelines have been published including the AAN ALS Practice Parameters, EFNS ALS guidelines, and NICE Motor Neurone Disease guidelines. There are no published Canadian ALS clinical guidelines. Design/Methods: The guideline working group consisted of eleven Canadian ALS clinicians with geographic representation from across the country. Clinical questions of interest were obtained by surveying clinicians and staff at all the Canadian ALS clinics, and then further refined by the working group. Literature searches on the questions were conducted by a consulting firm (Centre for Effective Practice) with guideline development experience. Medline, EMBASE, and CINHAL databases were searched. Retrieved abstracts were screened for inclusion criteria, and selected publications were reviewed for relevance and data quality. Guideline statements for each clinical question were developed on an iterative basis until consensus was obtained. Finally, each guideline statement was assigned an evidence rating, which included the option of expert consensus. Public feedback on the draft recommendations was elicited. Results: Canadian ALS Best practice recommendations have been developed covering the topics of: 1) delivery of an ALS diagnosis, 2) disease related treatment, 3) multidisciplinary care, 4) respiratory management, 5) nutrition management, 6) DVT risk, 7) medication alignment, 8) symptom management, 9) dysarthria management, 10) exercise in ALS, 11) cognition, 12) caregiver burden and support, 13) palliative care, and 14) medical assistance in dying. Conclusions: These recommendations will serve to better support the clinical care and management of Canadian patients living with ALS. Disclosure: Dr. Shoesmith has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Mitsubishi Tanabe Pharma Canada. Dr. Abrahao has nothing to disclose. Dr. Benstead has nothing to disclose. Dr. Chum has nothing to disclose. Dr. Dupre has nothing to disclose. Dr. Izenberg has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Mitsubishi Tanabe Pharma Canada. Dr. Johnston has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Mitsubishi Tanabe Pharma Canada. Dr. Kalra has nothing to disclose. Dr. Leddin has nothing to disclose. Dr. O’Connell has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Mitsubishi Tanabe Pharma Canada. Dr. Schellenberg has nothing to disclose. Dr. Tandon has nothing to disclose. Dr. Zinman has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Mitsubishi Tanabe Pharma Canada.