Characteristics and factors associated with independence in the activities of daily living of patients with amyotrophic lateral sclerosis at diagnosis.
Naoki Kato, Goichi Hashida, Mizuki Kobayashi and 1 others
PMID 39493687WHAT IT FOUND
At ALS diagnosis, lower limb-onset patients had the most impaired independence in daily living, especially transferring, bathing, walking and stairs.
Knee extension strength was linked to independence.
Key findings
01Patients with lower limb-onset had significantly lower total Barthel Index scores than patients with bulbar-onset or upper limb-onset.
02Knee extension muscle strength was related to ADL independence, with a cutoff value of 32.0%.
03Bathing and stair climbing required monitoring or assistance in bulbar-onset and upper limb-onset groups, and lower limb-onset patients had assistance needs across transferring, toileting, bathing, dressing, walking, and stair climbing.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study measured patients only at diagnosis, so it shows what was true then but not how independence changed over time. It cannot prove that knee extension strength caused ADL dependence or that exercise would improve independence. The sample was small and single-centre, with 57 analysed patients and only 15 in the lower limb-onset group. Some patients were excluded for missing data or psychiatric disorders affecting ADL. Upper limb spasticity was not assessed, and the study did not report speech or swallowing outcomes.
Declared interests
The authors reported no funding, grants, equipment, financial benefits, or conflicts of interest.
The easy way to misread this
Do not treat the knee extension cutoff as proof that exercise will improve daily-living independence. The study measured strength and Barthel Index at diagnosis, so it shows an association, not a treatment effect.