Functional ambulation decline and factors associated in amyotrophic lateral sclerosis

Abstract Introduction: Amyotrophic lateral sclerosis (ALS) is a disabling neurodegenerative disease, which compromises locomotion and functional independence. As the goal of physical therapy is to maintain the individual's locomotion capacity and independence as long as possible, it is necessary to gain a better understanding of the possible factors associated with the loss of this capacity. Objective: To evaluate functional ambulation in patients with ALS and possible factors associated with its decline. Methods: A cross-sectional study was conducted with sporadic ALS patients. Demographic and clinical/functional aspects were evaluated. ALS Functional Rating Scale-Revised (ALSFRS-R), Functional Ambulation Category, Medical Research Council scale and Fatigue Severity Scale were used. Descriptive and comparative analyses were conducted of the groups capable and incapable of functional ambulation. Binary logistic regression (stepwise forward method) was performed to determine potential factors associated with the loss of functional ambulation. Results: Among the 55 patients (mean age: 56.9 ± 11.2 years), 74.5% were able to walk functionally. Differences were found between groups regarding time of diagnosis, number of falls, pain, use of noninvasive ventilation, gastrostomy, ability to turn in bed, mobility aids, home adaptations, functional performance, muscle strength and fatigue. The possible predictors of walking disability were overall muscle strength (OR = 0.837; p = 0.003) and fatigue (OR =1.653; p = 0.034). Conclusion: Muscle strength and fatigue are associated with the decline in ambulation capacity in patients with ALS. In view of the complexity of elements involved in walking, further studies are needed to investigate the influence of these aspects in this population.

摘要：肌萎缩侧索硬化症（Amyotrophic Lateral Sclerosis, ALS）是一种致残性神经退行性疾病，可损害运动功能与个体独立生活能力。由于物理治疗的目标是尽可能长久地维持患者的运动能力与独立生活能力，因此亟需深入了解与该能力丧失相关的潜在影响因素。研究目的：评估肌萎缩侧索硬化症（ALS）患者的功能性步行能力，以及与其能力下降相关的潜在影响因素。研究方法：本研究为横断面研究，纳入散发性ALS患者，对其人口统计学特征、临床及功能状态进行评估。采用的评估工具包括：肌萎缩侧索硬化功能评定量表修订版（ALS Functional Rating Scale-Revised, ALSFRS-R）、功能性步行分类量表（Functional Ambulation Category）、医学研究理事会肌力评定量表（Medical Research Council scale）以及疲劳严重度量表（Fatigue Severity Scale）。对具备功能性步行能力与不具备该能力的两组患者分别开展描述性与比较性分析，并采用二项逻辑回归（逐步向前法）筛选与功能性步行能力丧失相关的潜在影响因素。研究结果：本研究共纳入55例患者，平均年龄为56.9±11.2岁，其中74.5%的患者具备功能性步行能力。两组患者在确诊时长、跌倒次数、疼痛情况、无创通气使用情况、胃造瘘术实施情况、床上翻身能力、辅助移动器具使用情况、居家环境改造情况、功能表现、肌肉力量及疲劳程度等方面存在显著差异。步行功能障碍的潜在预测因素为整体肌肉力量（优势比=0.837；p=0.003）与疲劳程度（优势比=1.653；p=0.034）。研究结论：肌肉力量与疲劳程度与ALS患者的步行能力下降显著相关。鉴于步行能力受多种复杂因素影响，未来仍需开展进一步研究以探究上述因素在该人群中的具体作用。