Two Steps From Hell - Halloween (2012) MP3 320 28

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Two Steps From Hell - Halloween (2012) MP3 320 28 Functional improvement in amyotrophic lateral sclerosis: a systematic review of clinical trials. Evidence of clinical improvement in amyotrophic lateral sclerosis (ALS) is derived from studies of patients treated with unlicensed drug combinations. We have undertaken a systematic review of the literature to identify functional outcomes, the change in which predicts prolonged survival in ALS. A search for studies published between 1966 and 2006 was conducted using MEDLINE and Embase, and a search of the reference lists of included studies. Randomized controlled trials (RCTs), controlled clinical trials and observational studies of patients with ALS were eligible for inclusion. Functional outcome measures were classified according to whether they assess disease-specific function, the upper or lower limbs, ability to perform daily activities or motivation. Studies that measured the change in functional outcome were included in the review. Nine hundred and ninety-four articles were identified in the initial search, and 24 articles (six RCTs and 18 uncontrolled studies) met the inclusion criteria. Functional outcome measures assessed in the control arms of three RCTs (n = 193) included the ALSFRS-R (n = 165), the ALS Functional Rating Scale (n = 1), the Webster scale (n = 1), the Karnofsky scale (n = 4), the Medical Research Council scale (n = 1), the Life Situation Test (n = 4), the Tinetti scale (n = 1), the Patient Activation Measure (n = 2) and the Barthel Index (n = 2). Studies identified by the search of reference lists contained seven additional RCTs and 23 uncontrolled studies that measured change in functional outcomes, representing a total of 50 arms. Outcomes were measured at baseline and at regular intervals throughout the trial. A decline in mean ALSFRS-R scores (standardized mean difference = -0.72, 95% CI: -0.91 to -0.51; P Q:

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