Summary of findings for the main comparison. Exercise for people with amyotrophic lateral sclerosis or motor neuron disease.
| Exercise for people with amyotrophic lateral sclerosis or motor neuron disease | ||||||
| Patient or population: people with amyotrophic lateral sclerosis or motor neuron disease Settings: Intervention: exercise | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Exercise | |||||
| ALS Functional Rating Scale (ALSFRS) score at 3 months Scale from: 0 to 40 (higher is better). | The mean ALSFRS score at 3 months ranged across control groups from 14 to 35 | The mean ALSFRS score at 3 months in the intervention groups was 3.21 higher (0.46 to 5.96 higher) | ‐ | 43 (2 studies) | ⊕⊕⊝⊝ low1,2 | |
| Short‐Form‐36 Health Survey (SF‐36) score at 3 months Scale from: 0 to 100 (higher is better). | The mean SF‐36 score at 3 months in the control groups was 80 | The mean SF‐36 score at 3 months in the intervention groups was 2.70 higher (3.1 lower to 8.5 higher) | ‐ | 18 (1 study) | ⊕⊕⊕⊝ moderate3 | |
| Fatigue Severity Scale score at 3 months Scale from: 0 to 63 (lower is better). | The mean Fatigue Severity Scale score at 3 months in the control groups was 35 to 59 | The mean Fatigue Severity Scale score at 3 months in the intervention groups was 6.25 lower (13.82 lower to 1.31 higher) | ‐ | 43 (2 studies) | ⊕⊕⊝⊝ low1,2 | |
| Manual Muscle Testing score at 3 months Right and left shoulder abduction, elbow flexion and extension, finger abduction and extension, hip flexion, knee flexion and extension, foot dorsiflexion and plantarflexion assessed and graded 0 to 5 Medical Research Council scale. Twenty individual muscle grades summed. Scale from: 0 to 100 (higher is better). | The mean Manual Muscle Testing score at 3 months in the control groups was 87.3 | The mean Manual Muscle Testing score at 3 months in the intervention groups was 10.9 lower (23.56 lower to 1.76 higher) | ‐ | 18 (1 study) | ⊕⊕⊕⊝ moderate3 | |
| Upper extremity maximum voluntary isometric contraction score at 3 months Quantitative Muscle Assessment (QMA) system. Data were normalized, summed and averaged to yield an U/E megascore (higher is better). | The mean upper extremity maximum voluntary isometric contraction score at 3 months in the control groups was ‐9.47 | The mean upper extremity maximum voluntary isometric contraction score at 3 months in the intervention groups was 1.48 lower (4.78 lower to 1.82 higher) | ‐ | 22 (1 study) | ⊕⊕⊕⊝ moderate4 | |
| Lower extremity maximum voluntary isometric contraction score at 3 months Quantitative Muscle Assessment (QMA) system. Data were normalized, summed and averaged to yield a L/E megascore (higher is better). | The mean lower extremity maximum voluntary isometric contraction score at 3 months in the control groups was ‐23.5 | The mean lower extremity maximum voluntary isometric contraction score at 3 months in the intervention groups was 2.51 higher (2.05 lower to 7.07 higher) | ‐ | 20 (1 study) | ⊕⊕⊕⊝ moderate4 | |
| Adverse effects related to the intervention | See comment | See comment | Not estimable | 43 (2 studies) | See comment | No adverse effects reported |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio; ALS: amyotrophic lateral sclerosis | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 Two small studies. No allocation concealment in either study. No blinding of assessors and no intention‐to‐treat analysis in one of the studies. Intevention group loss to follow‐up = 22.2%, control group loss to follow‐up = 12%. 2 Different exercise interventions used. 3 Small study. No allocation concealment. No blinding of assessors. Intervention group loss to follow‐up = 28.6%, control group loss to follow‐up = 27.3%. 4 Small study. Loss to follow‐up in intervention group = 15.4% (0% control group).