Physical Therapist Interventions for People With Amyotrophic Lateral Sclerosis Across Disease Stages: A Systematic Review of Efficacy.

Amyotrophic lateral sclerosis, a progressive disease that weakens muscles and eventually affects breathing and daily function, has long raised questions about what physical therapy can realistically offer, and at which stage of the disease it might help most. This systematic review pulled together thirty-nine studies covering a range of physical therapist interventions, including therapeutic exercise, pulmonary training, manual therapy, and multimodal approaches, and looked at their effects on two outcomes: a functional rating scale (the ALSFRS or its revised version) and a measure of breathing capacity called forced vital capacity. The broad picture was mixed and cautious. Multimodal training showed a moderate effect on functional scores but a negligible one on breathing capacity, while pulmonary interventions showed a small effect on breathing capacity but a negligible one on functional scores, and the quality of evidence behind these findings ranged from low to moderate.

Most studies focused on early-stage disease, and outcome measures varied widely across studies, which limits how confidently these results can be generalized or compared across stages of ALS.

If you or someone you know is living with ALS, a condition that progressively weakens muscles and eventually affects breathing and independence, you may wonder what physical therapy can actually do and when it helps most. This review looked across thirty-nine studies of different physical therapist approaches, including exercise programs, breathing training, hands-on therapy, and combined approaches, to see how they affected two things: a scale measuring daily function and a test measuring lung capacity. The results were modest and uneven.

Programs combining multiple approaches showed some improvement in functional scores but not in breathing capacity, while breathing-focused programs showed a small improvement in breathing capacity but not in functional scores. Importantly, most of the research so far has focused on people in the earlier stages of ALS, so it's unclear how these findings apply to people further along in the disease.

The studies also used many different ways of measuring outcomes, which makes it hard to compare results directly or draw firm conclusions about what works best and when.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This systematic review, using Joanna Briggs Institute methodology, synthesized thirty-nine studies (twenty-five experimental, fourteen observational) evaluating physical therapist interventions in ALS, including therapeutic exercise, pulmonary training, manual therapy, and multimodal programs. Across ninety-four outcome measures, twenty-three studies reported ALSFRS or ALSFRS-R and sixteen reported forced vital capacity, reflecting substantial heterogeneity in outcome selection. Multimodal training demonstrated moderate-quality evidence for a moderate effect on ALSFRS-R (effect size 0.56, 95% CI 0.09 to 1.03) but low-quality evidence for a negligible effect on forced vital capacity (effect size -0.03, 95% CI -1.47 to 1.41).

Pulmonary interventions showed moderate-quality evidence for a small effect on forced vital capacity (effect size 0.40, 95% CI -0.18 to 0.98) but low-quality evidence for a negligible effect on ALSFRS-R (effect size 0.04, 95% CI -0.25 to 0.33). Confidence intervals crossing zero for several estimates indicate uncertainty around whether true effects exist. Most included studies (twenty-seven) targeted early-stage disease, constraining any conclusions about efficacy in moderate to advanced ALS.

The variability in outcome measures across studies further limits pooled comparisons and underscores the need for stage-specific trials using consistent, standardized functional and respiratory outcomes.