Efeitos da fisioterapia motora na funcionalidade de indivíduos com esclerose lateral amiotrófica: uma revisão sistemática

Abstract

Introduction: The benefits of physical exercise prescription for patients with Amyotrophic Lateral Sclerosis (ALS) have been increasingly reported in the literature, regarding the improvement of the various motor symptoms caused by the disease. However, there is still no systematic review that encompasses other physiotherapeutic interventions besides physical exercise on the functionality of individuals with ALS. Objectives: To evaluate the effects of motor physical therapy on the functionality of individuals with ALS. Methods: Randomized clinical trials obtained from Medline, Embase, Cochrane (CENTRAL) and Physiotherapy Evidence Database (PEDro) databases were included, without restriction on publication date, language or location, searching for English terms related to ALS, functionality and physiotherapy. Searches were conducted in January 2023. We used Review Manager Web Version for meta-analysis and studies were grouped to compare motor physical therapy techniques to no intervention. We used the 5 components of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess the quality of evidence. Results: Two randomized clinical trials with a total of 41 participants were included in this review. The ALS Functional Rating Scale (ALS-FRS) instrument was used as an outcome measure to assess functionality. Motor physical therapy techniques were compared with no intervention, with motor physical therapy being shown to be more effective than control for the outcome assessed. The quality of evidence was rated as very low in three GRADE domains (risk of bias, inconsistency, and imprecision) in both included studies. Conclusion: In the short term, motor physical therapy is able to improve the overall function of people with ALS. However, due to significant methodological flaws, small sample sizes, and wide confidence intervals, our confidence in estimating the effect is limited, and further studies are needed to assess the impact of motor physical therapy on function.