Adaptation to Turkish and Reliability Study of the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R)

Care burden and related factors among informal caregivers of patients with amyotrophic lateral sclerosis

Objective: Amyotrophic lateral sclerosis (ALS) affects the life of the family caregiver as well as the patient. This study aimed to determine the care burden and related factors among family caregivers of Turkish ALS patients. Methods: This descriptive study was conducted with 108 ALS patients and their informal caregivers through face-to-face interviews at home. The data were collected using the ALS Functional Rating Scale, Zarit Burden Interview, European Quality of Life-Five Dimensions Questionnaire, Multidimensional Scale of Perceived Social Support, and the Hospital Anxiety and Depression Scale. Results: The mean age of the caregivers was 48.1 ± 13.4 years; the vast majority were female, and they were either spouses or children of the patients. While 49.1% reported moderate or severe burden, the quality of life was moderate (mean 70.4 ± 22.8). The caregiver burden was related to sex and the functional state of the patient, as well as caregiver factors such as the relation to the patient, sex, health status, time spent for care, and living in the same house with a limited environment. Walking ability, percutaneous endoscopic gastrostomy, tracheostomy, and communication problems were not associated with the burden. Furthermore, burden was associated with the caregiver's quality of life, social support, anxiety, and depression. Conclusions: The present study draws attention to the fact that the care burden in family caregivers of ALS patients is high and their quality of life is impaired. Our findings reveal that not only ALS patients but also caregivers need to be supported with an organized and planned system.

ALSFRS-R-SE: an adapted, annotated, and self-explanatory version of the revised amyotrophic lateral sclerosis functional rating scale

BACKGROUND

The ALS Functional Rating Scale in its revised version (ALSFRS-R) is a disease-specific severity score that reflects motor impairment and functional deterioration in people with amyotrophic lateral sclerosis (ALS). It has been widely applied in both clinical practice and ALS research. However, in Germany, several variants of the scale, each differing slightly from the others, have developed over time and are currently in circulation. This lack of uniformity potentially hampers data interpretation and may decrease item validity. Furthermore, shortcomings within the standard ALSFRS-R questions and answer options can limit the quality and conclusiveness of collected data.

METHODS

In a multistage consensus-building process, 18 clinical ALS experts from the German ALS/MND network analyzed the ALSFRS-R in its current form and created an adapted, annotated, and revised scale that closely adheres to the well-established standardized English version.

RESULTS

Ten German-language variants of the ALSFRS-R were collected, three of which contained instructions for self-assessment. All of these variants were compiled and a comprehensive linguistic revision was undertaken. A short introduction was added to the resulting scale, comprising general instructions for use and explanations for each of the five reply options per item. This adapted version of the scale, named ALSFRS-R-SE (with the "SE" referring to "self-explanatory"), was carefully reviewed for language and comprehensibility, in both German and English.

CONCLUSION

An adapted and annotated version of the ALSFRS-R scale was developed through a multistage consensus process. The decision to include brief explanations of specific scale items and reply options was intended to facilitate ALSFRS-R-SE assessments by both healthcare professionals and patients. Further studies are required to investigate the accuracy and utility of the ALSFRS-R-SE in controlled trials and clinical real-world settings.

Evaluation of ALSFRS-R Scale with Fuzzy Method in Amyotrophic Lateral Sclerosis

INTRODUCTION

Amyotrophic lateral sclerosis (ALS) is a disease with high morbidity and mortality that adversely affects the activities of daily living. Disease progression in ALS is characterized by loss of function in bulbar, motor, and respiratory parameters. The revised amyotrophic lateral sclerosis functional rating scale (ALSFRS-R), which consists of 12 criteria, is used to determine disease effects on each of these functions. While each criterion is equally important when calculating the total ALSFRS-R score, the importance levels of the 12 criteria may vary in clinical practice. In this classical approach, the relationships among the parameters are not considered and the effects of bulbar, spinal, and respiratory dysfunctions on a patient's activities of daily living may be different.

METHODS

In this study, we aimed to evaluate ALS cases with the ALSFRS-R fuzzy method. Although each subheading in the ALSFRS-R had the same score, the disease score was determined by the fuzzy ALSFRS-R method, based on whether a subheading had priority in management of the disease. While creating the functional rating scale ALSFRS-R approach, fuzzy ALSFRS-R score values were obtained by creating fuzzy models for each main group and integrating the fuzzy model results of each main group into a separate model.

RESULTS

In total, 50 patients with definite ALS according to the El Escorial criteria (33 men [66%] and 17 women [34%]; mean age, 58.49±10.01 years) were included in the study. When ALSFRS-R results and fuzzy ALSFRS-R results were compared, the prioritization order of 45 patients increased using the fuzzy ALSFRS-R score, while the prioritization order of five patients remained the same in both evaluations.

CONCLUSION

The approach obtained by using fuzzy membership functions and decision rules, formed in accordance with expert opinion, was applied to the data of 50 patients from a large-scale hospital. In total, 90% of the patients had increased prioritization when using the fuzzy ALSFRS-R scoring method. Our results showed that the fuzzy approach provided more accurate information regarding a patient's condition.

Validity and reliability of the Turkish version of "the Dyspnea-ALS-Scale (DALS-15)"

AIM

The aim of this study was to investigate the validity and reliability of the Turkish version of The Dyspnea-ALS-Scale (DALS-15).

METHODS

Forward translation, back translation, and cross-cultural adaptation were used to ensure the equivalency of translated version of the scale. Then, patients with amyotrophic lateral sclerosis (ALS) who have dyspnea or orthopnea that develops with effort or at rest were evaluated using DALS-15 via online surveys. The respiratory subscale of ALS Functional Rating Scale-Revised (ALSFRS-R) and Modified Borg Dyspnea Scale (MBDS) was used to investigate the construct validity of the Turkish DALS-15. Reliability was assessed with Cronbach's α and inter-item correlation matrix (internal consistency).

RESULTS

We have included 52 ALS patients in the study. Findings showed that Turkish version of DALS-15 was highly correlated with respiratory subscale of ALSFRS-R (r =  - 0.668; p =  < 0.0001) and MBDS (for upright position: r = 0.728; p =  < 0.0001 and for supine: r = 0.78; p =  < 0.0001). The scale did not show any ceiling or floor effect. Also, DALS-15 had a high level of Cronbach's α (0.95) and internal consistency (ICC: 0.949; 95%CI: 0.92-0.96). Test-re-test reliability of the questionnaire was (ICC: 0.909; 95% CI: 0.81-0.95). The standard error of measurement value was 2.76, whereas the minimal detectable change score was 7.66 points for the translated version of the scale.

CONCLUSIONS

The Turkish version of DALS-15 possesses strong psychometric properties with excellent validity and reliability. It is shown to be useful for online self-assessment, outside of the clinical settings, especially in hard times such as a pandemic.

Amyotrophic lateral sclerosis in Antalya, Turkey. A prospective study, 2016-2018

OBJECTIVE

The aim of the study is to find the prevalence and incidence of amyotrophic lateral sclerosis in Antalya and to define patient characteristics.

METHODS

The study represents five major districts in the Antalya metropolitan region, with a population of 1,286,943, which is defined as the provincial center. In cooperation with the neurology departments of all hospitals and private practices, existing cases were identified and new cases were recorded with continuous monitoring. Detailed demographic and clinical features of each patient were recorded, Revised El-Escorial Criteria were used for diagnosis. Incidence and prevalence rates are standardized by age based on USA 2016 population.

RESULTS

Point prevalence rates of 2016, 2017 and 2018 are 3.7, 4.7 and 5.4 per hundred thousand, respectively. Standardized prevalence rates for the US population are 5.5, 7.1 and 8.6 per hundred thousand in the same order. The incidence rate in 2017 is 1.4 per hundred thousand, and 2018 is 1.2. Standardized incidence rates for the US population are 2.1 and 1.8 per hundred thousand, respectively. About 75.6% of the cases were classified as definite, 11.0% probable, 11.0% possible, 2.4% probable laboratory-supported. The male/female ratio is 2.0 for total cases and 2.8 for new cases. The site of onset is spinal in 81.7% of patients and bulbar in 18.3%.

CONCLUSIONS

ALS rates detected in Antalya and the general features of the disease show similarities with European countries rather than Asian countries and comply with the literature.

Validity and Reliability of the Turkish Version of the Amyotrophic Lateral Sclerosis Assessment Questionnaire

OBJECTIVE

The aim of this study was to adapt the Amyotrophic Lateral Sclerosis Assessment Questionnaire (ALSAQ), developed for the evaluation of quality of life in amyotrophic lateral sclerosis (ALS) patients, into the Turkish society.

METHODS

This methodological study was conducted in 92 ALS patients registered in 2 chapters (Istanbul and Izmir) of Turkish ALS-Motor Neuron Diseases Association. The expert opinion and forward-backward translation methods were applied for the linguistic validity of the ALSAQ (long and short versions: ALSAQ-40 and ALSAQ-5, respectively).

RESULTS

In the analysis of internal consistency, the Cronbach's α reliability coefficient was .96 for the total scale, whereas it was between .88 and .98 for the 5 dimensions. The dimensions of the long form were correlated with the items of the short form.

CONCLUSION

The Turkish versions of the ALSAQ short and long forms are valid and reliable tools to be used in the assessment of the quality of life in ALS patients.

Assessment of the factorial validity and reliability of the ALSFRS-R: a revision of its measurement model

The amyotrophic lateral sclerosis functional rating scale-revised (ALSFRS-R) is a widely used primary outcome measure in amyotrophic lateral sclerosis (ALS) clinical practice and clinical trials. ALSFRS-R items cannot, however, validly be summed to obtain a total score, but constitute domain scores reflecting a profile of disease severity. Currently, there are different measurement models for estimating domain scores. The objective of the present study is, therefore, to derive the measurement model that best fits the data for a valid and uniform estimation of ALSFRS-R domain scores. Data from 1556 patients with ALS were obtained from a population-based register in The Netherlands. A random split of the sample provided a calibration and validation set. Measurement models of the ALSFRS-R were investigated using both exploratory factor analyses and confirmatory factor analyses. The measurement model with a four-factor structure (i.e., bulbar, fine motor, gross motor, and respiratory function), with correlated factors and cross-loading items on dressing and hygiene and turning in bed and adjusting bed clothes on both motor function scales, provided the best fit to the data in both sets. Correlation between factors ranged from weak to modest, confirming that the ALSFRS-R constitutes a profile of four clinically relevant domain scores rather than a total score that expresses disease severity. The internal consistency of the four domain scores was satisfactory. Our revision of the measurement model may allow for a more adequate estimation of disease severity and disease progression in epidemiological studies and clinical trials.