Measuring the validation of assessing the non-dominant-hand function by ALSFRS-r in Chinese ALS patients

ALSFRS-r is a widely accepted rating scale for measuring the global function of Amyotrophic Lateral Sclerosis (ALS) patients, but we found some limitations of ALSFRS-r in assessing the function of non-dominant hand in Chinese ALS patients. We reviewed 95 ALS patients who expressed upper-limb symptoms at first visit and analyzed the ALSFRS-r score and subscale. In both upper limb involved patients, the ALSFRS-r had no difference between dominant-hand and non-dominant-hand onset groups (39.15 ± 5.55 vs 38.0 ± 5.91, p = 0.477). But in only one upper limb involved patients, the ALSFRS-r score in non-dominant-hand onset patients was higher than dominant-hand onset patients (43.94 ± 3.44 vs 40.87 ± 4.42, p < 0.05), especially in item of handwriting, cutting food and handing utensils (3.56 ± 0.89 vs 2.2 ± 1.27 p = 0.001, 3.44 ± 1.03 vs 1.8 ± 1.21 p = 0.000). When the item of cutting food and handing utensils was replaced by using food bowl and chopsticks to assess the function of non-dominant-hand, the modified ALSFRS-r score was significantly lower than original ALSFRS-r (43.94 ± 3.44 vs 42.88 ± 3.07 p = 0.001), the progression rate was slower (0.81 ± 0.63 vs 0.64 ± 0.63, p = 0.001). So, for Chinese ALS patients, using food bowl and chopsticks should replace the item of cutting food and handling utensils to assess the non-dominant-hand function, especially in non-dominant-hand onset patients.