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Effectiveness of Home-Based Exercises Without Supervision by Physical Therapists for Patients With Early-Stage Amyotrophic Lateral Sclerosis: A Pilot Study

Published:March 30, 2018DOI:https://doi.org/10.1016/j.apmr.2018.02.015

      Abstract

      Objective

      To verify the effects of structured home-based exercises without supervision by a physical therapist in patients with early-stage amyotrophic lateral sclerosis (ALS).

      Design

      A historical controlled study that is part of a multicenter collaborative study.

      Setting

      Rehabilitation departments at general hospitals and outpatient clinics with a neurology department.

      Participants

      Patients (N=21) with ALS were enrolled and designated as the home-based exercise (Home-EX) group, and they performed unsupervised home-based exercises. As a control group, 84 patients with ALS who underwent supervised exercise with a physical therapist for 6 months were extracted from a database of patients with ALS and matched with the Home-EX group in terms of their basic attributes and clinical features.

      Intervention

      The Home-EX group was instructed to perform structured home-based exercises without supervision by a physical therapist that consisted of muscle stretching, muscle training, and functional training for 6 months.

      Main Outcome Measures

      The primary outcome was the score on the ALS Functional Rating Scale–Revised (ALSFRS-R), which is composed of 3 domains: bulbar function, limb function, and respiratory function. The score ranges from 0 to 48 points, with a higher score indicating better function.

      Results

      In the Home-EX group, 15 patients completed the home-based exercises for 6 months, and 6 patients dropped out because of medical reasons or disease progression. No adverse events were reported. The Home-EX group was found to have a significantly higher respiratory function subscore and total score on the ALSFRS-R than the control group at follow-up (P<.001 and P<.05, respectively).

      Conclusions

      Structured home-based exercises without supervision by a physical therapist could be used to alleviate functional deterioration in patients with early-stage ALS.

      Keywords

      List of abbreviations:

      ALS (amyotrophic lateral sclerosis), ALSFRS-R (ALS Functional Rating Scale–Revised), CPF (cough peak flow), Home-EX (home-based exercise), MMT (manual muscle testing)
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      References

        • Dal Bello-Hass V.
        • Florence J.M.
        Therapeutic exercise for people with amyotrophic lateral sclerosis or motor neuron disease.
        Cochrane Database Syst Rev. 2013; ([review])CD005229
        • Kamide N.
        • Asakawa T.
        • Shibasaki N.
        • et al.
        Identification of the type of exercise therapy that affects functioning in patients with early-stage amyotrophic lateral sclerosis: a multicenter, collaborative study.
        Neurol Clin Neurosci. 2014; 2: 135-139
        • Ohashi Y.
        • Tashiro K.
        • Itoyama Y.
        • et al.
        Study of functional rating scale for amyotrophic lateral sclerosis: revised ALSFRS (ALSFRS-R) Japanese version.
        No To Shinkei. 2001; 53: 346-355
        • Kugo A.
        • Terada S.
        • Ata T.
        • et al.
        Japanese version of the Frontal Assessment Battery for dementia.
        Psychiatry Res. 2007; 153: 69-75
        • Dal Bello-Hass V.
        • Florence J.M.
        • Kloos A.D.
        • et al.
        A randomized controlled trial of resistance exercise in individuals with ALS.
        Neurology. 2007; 68: 2003-2007
        • Rosenbaum P.R.
        • Rubin D.B.
        The central role of the propensity score in observational studies for causal effect.
        Biometrika. 1983; 70: 41-55
        • Kanada Y.
        Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics.
        Bone Marrow Transplant. 2013; 48: 452-458
        • Pinto A.C.
        • Alves M.
        • Nogueira A.
        • et al.
        Can amyotrophic lateral sclerosis patients with respiratory insufficiency exercise?.
        J Neurol Sci. 1999; 169: 69-75
        • Eidenberger M.
        • Nowotny S.
        Inspiratory muscle training in patients with amyotrophic lateral sclerosis: a systematic review.
        NeuroRehabilitation. 2014; 35: 349-361