Multiple Sclerosis (MS) is a chronic progressive disease that often leads to
deterioration of health-related quality of life, including symptoms such as muscle
weakness, extreme fatigue, gait disturbances, sensory problems, balance problems, and
chronic pain, cognitive and motor impairments. Physiotherapy and rehabilitation programs
that include aerobic and progressive resistance exercises in the treatment of functional
disorders by controlling the symptoms of the disease increase the quality of life by
improving aerobic capacity, but sustainability can be difficult due to difficulties in
accessing the clinic. Following exercise programs with telerehabilitation (TR) methods
improves cognitive function, mobility, balance, participation, and quality of life by
increasing physical activity and reducing fatigue. However, the details of the frequency,
duration, and the way the program is delivered are not known, and although the exercise
methods applied with TR methods are found to be as effective as the practices performed
in the clinic, the remote limited patient-therapist relationship creates potential
problems for patients to follow up on the digital platform. The hybrid TR model, in which
a certain part of the exercise program is carried out face-to-face, can provide a
solution to these problems by increasing patient-therapist communication. To the best of
our knowledge, there is no study examining the effectiveness of a rehabilitation program
applied with the hybrid TR model for individuals with MS. The aim of our study is to
compare the effects of hybrid telerehabilitation (TR)-based exercise program applied in
patients with MS, only TR-based exercise program and only clinical-based exercise program
on walking speed, functional capacity, peripheral muscle saturation and fatigue.
Forty-five individuals with MS with EDSS scores between 0-4 will be included in the
study. The patients will be randomized into three groups: Group A, Group B, and Group C.
Group A- Telerehabilitation group will be included in an aerobic and strengthening
exercise program over the synchronized videoconference system with the physiotherapist 2
days a week for 8 weeks. Group B- Hybrid Telerehabilitation group will be included in the
same exercise program 2 days a week for 2 weeks in the clinic, and will continue remotely
over the synchronized videoconference system with the physiotherapist 2 days a week for 6
weeks. In Group C-Clinical Based Rehabilitation group, the same exercise program will be
applied in the clinic 2 days a week for 8 weeks. In addition to aerobic and strengthening
exercises, traditional breathing exercises and energy conservation techniques will be
taught to all three groups within the scope of patient education Demographic and clinical
information of all patients to be included in the study will be recorded with a "Case
Evaluation Form". The gait speed of the patients will be evaluated with the Timed 25-step
walking test, their functional capacity with the 6-minute walking test, their Quadriceps
muscle activation will be tested with the EMG muscle activation, the fatigue will be
evaluated with the "Modified Fatigue Impact Scale", and the Patient Satisfaction with the
"Global Rating Scale". In addition, feasibility evaluation will be made by calculating
the attendance rate of the patients to the programs. All data will be evaluated by
statistical analysis methods. The aim of this study is to investigate the effect of
hybrid telerehabilitation program on walking speed, functional capacity, peripheral
muscle activation and fatigue in patients with MS.
For these purposes:
To increase compliance and participation of MS patients in exercises,
To prevent fatigue by increasing the functional capacity of MS patients who
regularly participate in exercise programs,
To provide a sustainable program for exercise continuity for MS patients who have
difficulty reaching the clinic and to examine its effects on fatigue,
To compare the effects of Telerehabilitation, Hybrid Telerehabilitation and the same
exercise programs performed in the clinic on gait speed, functional capacity,
peripheral muscle activation and fatigue,
To examine the statistical differences and relationships between the expected
improvements in functional capacity, peripheral muscle activation and fatigue
parameters,
To offer an innovative and effective treatment option to clinicians and experts
working in the relevant field with the hybrid telerehabilitation model, which can be
an alternative to traditional methods,
It is aimed to contribute to the literature in this field by transforming the
results obtained because of the study into qualified scientific publications.
