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Introduction Amyotrophic Lateral Sclerosis (ALS) is a heterogeneous neurodegenerative disease that primarily affects both upper and lower motor neurons, leading to their progressive degeneration and subsequent, often rapid loss of motor function and death (Brotman et al., 2022)

For randomised clinical trials, the Jadad scale ( To complement the Jadad score, the Cochrane Risk of Bias Tool (RoB 2) (Sterne et al., 2019) was also used for RCTs to provide a domain-based qualitative evaluation, assessing risks related to selection, performance, detection, attrition, and reporting

In research, it increases the production of collagen, elastin, and glycosaminoglycans and supports blood vessel growth