What are the benefits of the ALS Functional Scale from a physician’s perspective?

The result of the ALS Functional Rating Scale (ALSFRS-R) is of particular interest to doctors in specialized outpatient clinics. The ALSFRS-R can be used to determine the ALS progression rate (ALSPR), which is an established measure of the speed of disease progression. The change in the ALSFRS-R per month is a key prognostic factor for ALS, which is of major importance in the medical assessment of the individual prognosis.

Certain questions in the ALSFRS-R are used as decision criteria for medication (e.g. question 1 on speech impairment or question 2 on excess salivation) and to check the effectiveness of the symptomatic medication used (e.g. DMC for speech impairment or ipratropium bromide for excess salivation). The ALSFRS-R can also be used to arrange for assistive devices (e.g. a wheelchair for severely restricted walking). Question 3 of the ALSFRS-R is used to record the presence of a swallowing disorder in a standardized manner. This data – in addition to the weight measurement – can be helpful in deciding on a feeding tube (PEG tube). From a medical perspective, questions 10 and 11 are particularly important for recording respiratory dysfunction (dyspnoea). These questions relate to respiratory effort during exertion and at rest (question 10) and when lying in a sleeping position (question 11). The systematic recording of dyspnoea has the advantage that possible respiratory effort can be recognized and documented at an early stage. This information can be helpful for treating physicians in making a decision on respiratory support with mask ventilation.