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Öğe Development, reliability, and validity of the telerehabilitation satisfaction questionnaire in neurological diseases(Elsevier Ireland Ltd, 2024) Eldemir, Sefa; Eldemir, Kader; Saygili, Fettah; Ozkul, Cagla; Kasikci, Merve; Yilmaz, Rezzak; Akbostanci, Muhittin CenkBackground: Measuring satisfaction with telerehabilitation provides a way to evaluate and improve the effectiveness of both the technology used and the rehabilitation provided. On the other hand, valid and reliable tools are needed to evaluate satisfaction of patients receiving physiotherapy via telerehabilitation. Aims: The purpose of the current study was to develop Telerehabilitation Satisfaction Questionnaire (TrSQ) and evaluate its validity and reliability. Methods: Sixty-three patients with stroke, Multiple Sclerosis, or Parkinson's disease participated in this study. Content validity was reviewed by a panel experienced in telerehabilitation. Construct validity of the model was investigated using and Confirmatory Factor Analysis (CFA) and Explanatory Factor Analysis (EFA). Test-retest reliability and Internal consistency were used to evaluate the reliability of the TrSQ. Results: A one-factor structure was determined based on EFA. The structure fitted well in terms of the fit indices according to the confirmatory factor analysis results (x2/df = 1.016, p = 0.442, IFI=0.997, CFI=0.997, and RMSEA=0.016). The questionnaire was proven to have an acceptable reliability level (Cronbach's alpha = 0.858) and it was found that all items were necessary. Finally, an 11-item version was obtained and tested twice on 30 patients. The questionnaire was shown to have acceptable test-retest reliability (ICC=0.753). Conclusions: TrSQ can be used as a valid and reliable questionnaire in evaluating patient satisfaction with telerehabilitation in neurological diseases. However, in order for it to be widely applicable, adaptation to different languages is needed.Öğe Development, Reliability, and Validity of the Telerehabilitation Usability Questionnaire in Neurological Diseases(Gumushane University, 2025) Eldemir, Kader; Eldemir, Sefa; Saygılı, Fettah; Özkul, Çağla; Kasikci, Merve; Gündüz, Arzu GüçlüThe purpose was to develop Telerehabilitation Usability Questionnaire (TrUQ) and evaluate its validity and reliability in neurological diseases. Ninety-five people with Multiple Sclerosis, stroke, and Parkinson’s disease participated in this study. Content validity was assessed by an expert panel of 5 physiotherapist experienced in telerehabilitation. Construct validity was investigated using Confirmatory Factor Analysis (CFA) and Explanatory Factor Analysis (EFA). Test-retest reliability and Internal consistency were used to evaluate the reliability of the TrUQ. A three-factor structure was determined based on EFA. Accordingly, three factors correspond to three subscales, on the TrUQ: system availability, exercise feasibility, and telerehabilitation security. Furthermore, the model fits well according to CFA results: χ²/df = 1.573, CFI = 0.925, IFI = 0.929, GFI = 0.909, and RMSEA = 0.078. The questionnaire was proven to have an acceptable reliability level (Cronbach’s alpha= 0.712) and it was found that all items were necessary. Finally, a 10-item version was obtained, and TrUQ was shown to have acceptable test–retest reliability (ICC=645) TrUQ is a valid and reliable questionnaire can be used to measure usability of the telerehabilitation systems in neurological diseases. Adaptation to different languages and diseases is recommended to be widely applicable.Öğe Effects of modified-constraint induced movement therapy based telerehabilitation on upper extremity motor functions in stroke patients(Wiley, 2024) Saygili, Fettah; Guclu-Gunduz, Arzu; Eldemir, Sefa; Eldemir, Kader; Ozkul, Cagla; Gursoy, Gorkem TutalIntroduction: The aim of this study is to investigate the effects of Modified-Constraint Induced Movement Therapy (m-CIMT) based telerehabilitation on upper extremity motor functions in stroke patients. Methods: Eighteen stroke patients were included and randomly allocated into two groups. The Tele-CIMT (modified-constraint induced movement therapy-based telerehabilitation) (n = 10) group received m-CIMT based telerehabilitation for 90 min a day, 5 weekdays for 3 weeks at home. Additionally, both the Tele-CIMT group and the control group (CG) (n = 8) underwent the home exercise program aimed at improving range of motion, active movement, balance, and walking every weekday for 3 weeks at home. The outcome measures were the Stroke Rehabilitation Assessment of Movement Scale (STREAM), Fugl-Meyer Upper Extremity Motor Evaluation Scale (FM-UE), Wolf Motor Function Test (WMFT), 9-Hole Peg Test (9-HPT), grip strengths, pinch strengths, Motor Activity Log-28 (MAL-28), and Functional Independence Measure (FIM). Results: Significant group-by-time interactions on STREAM, FM-UE, WMFT, grip strength, pinch strengths, MAL-28, and FIM were found to be in favor of the Tele-CIMT group. Additionally, post hoc analyses revealed that the Tele-CIMT group significantly improved in terms of these parameters (p > .05). Conclusion: This is the first randomized controlled trial showing that Tele-CIMT improved upper extremity motor functions and activities of daily living in stroke patients. Tele-CIMT can help improve the upper extremities in stroke survivors who have difficulties reaching rehabilitation clinics.Öğe Effects of Pilates-based telerehabilitation on physical performance and quality of life in patients with multiple sclerosis(Taylor & Francis Ltd, 2024) Eldemir, Kader; Guclu-Gunduz, Arzu; Eldemir, Sefa; Saygili, Fettah; Ozkul, Cagla; Irkec, CeylaPurposeIt is known that clinical Pilates improves strength, core stability, balance, gait, fatigue, and quality of life (QOL) in patients with multiple sclerosis (PwMS). On the other hand, there is insufficient information about whether similar benefits can be achieved with Pilates-based telerehabilitation (Pilates-TR). We aimed to investigate the effects of Pilates-TR on physical performance and QOL in PwMS.MethodsThirty PwMS were recruited and randomly allocated into two groups. The Pilates-TR group received Pilates-TR via videoconferences three days per week during six weeks at home. The control group (CG) was a waitlist with no Pilates-TR treatment. Physical performance measures included extremity muscle strength, core endurance and power, balance, gait analysis, and functional exercise capacity. In addition, fatigue and QOL were evaluated.ResultsExtremity muscle strength, core endurance and power, balance, walking speed, cadence, distance, functional exercise capacity, and QOL were improved after Pilates-TR (p < 0.05). Fatigue level and the effects of fatigue on functions decreased in Pilates-TR, while fatigue level increased in CG (p < .05). The CG showed no changes in any other measurements (p > .05).ConclusionPilates-TR was effective in improving physical performance and QOL in PwMS. Pilates-TR can be recommended as an effective option, especially for patients with barriers to reaching the clinic.Öğe Experiences of physical therapists applying telerehabilitation to neurological patients: A qualitative study(Associacao Brasileira Pesquisa Pos-Graduacao Fisioterapia-Abrapg-Ft, 2025) Onal, Birol; Eldemir, Sefa; Ceren, Ali Naim; Eldemir, KaderBackground: Telerehabilitation has been widely used in neurological diseases in recent years. The experiences of physical therapists and the difficulties they face are critical to the effectiveness of telerehabilitation. Objective: To examine in depth the technical challenges, patient interaction strategies, and session management processes faced by physical therapists who use telerehabilitation for patients with neurological conditions and to assess the opinions of physical therapists about the advantages, disadvantages, technological infrastructure needs, and support strategies of telerehabilitation. Methods: In this study, phenomenological qualitative research method was used. In-depth interviews were conducted with eight physical therapists who treated patients with neurological disorders with telerehabilitation in our country. Interview data were analyzed using content analysis. Results: The analysis revealed seven key themes and 26 sub-themes, which were categorized into two main areas: telerehabilitation session management and perceptions of telerehabilitation sessions. In the area of session management, physical therapists reported challenges related to the adaptation of traditional rehabilitation techniques to the online environment, including difficulties with assessing patients' physical conditions remotely, ensuring patient engagement, and managing technical issues such as internet connectivity and software limitations. They also highlighted the importance of clear communication, structured session planning, and the need for additional training to effectively conduct telerehabilitation sessions. Conclusions: Considering the advantages and disadvantages stated by physical therapists using telerehabilitation with patients with neurological conditions, solutions should be developed to increase the efficiency of telerehabilitation. Applications with simple interfaces, a home environment suitable for exercise sessions, and strategies to support technology adaptation can significantly improve the efficiency of telerehabilitation.Öğe Investigation of Clinical Features of Multiple Sclerosis Patients with Good and Poor Sleep Quality(Gazi University, 2024) Eldemir, Kader; Eldemir, Sefa; Özkul, Çağla; Gündüz, Arzu Güçlü; İrkeç, CeylaBackground: Despite sleep's important role in maintaining and improving physical and mental health, sleep problems are quite common in patients with Multiple Sclerosis (MS). Aim: The aim of this study is to investigate the clinical features of MS patients with good and poor sleep quality. Method: A total of 38 MS patients included in this study. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and participants were divided into two groups as MS patients with good sleep quality (n:20) and with poor sleep quality (n:18). For clinical features, fatigue, mood, the level of physical activity, and walking capacity were evaluated using the Fatigue Severity Scale (FSS), Beck Depression Inventory (BDI), International Physical Activity Questionnaire (IPAQ), and Six-Minute Walk Test (6-MWT), respectively. Results: The results of the study showed that MS patients with good sleep quality had lower levels of fatigue, better mood, higher levels of physical activity, and greater walking capacity (pÖğe Parkinson Hastalarının Üst Ekstremite Rehabilitasyonunda Telerehabilitasyonun Yeri: Literatürün Gözden Geçirilmesi(Sivas Cumhuriyet University, 2022) Eldemir, Sefa; Eldemir, Kader; Özkul, Çağla; Gündüz, Arzu Güçlü; Saygılı, FettahParkinson Hastalığı (PH), çoğunlukla motor fonksiyonu etkileyen en sık karşılaşılan nörodejeneratif hastalıklardan biridir. Üst ekstremite fonksiyon bozukluğu bu hastalarda erken evreden itibaren ortaya çıkmakta ve bireyin günlük hayatta sıklıkla kullandığı uzanma, kavrama, yazı yazma gibi aktivitelerini olumsuz yönde etkilemektedir. PH’nin kronik nörodejeneratif bir hastalık oluşu bireylerin uzun süreli rehabilitasyona olan ihtiyacını arttırır. Diğer taraftan, uzun süreli uygulanacak olan rehabilitasyon hizmeti hem sağlık kuruluşları hem de hastalar için yüksek maliyetleri beraberinde getirir. Parkinson hastalarının çoğunlukla geriartrik popülasyondan oluşması göz önünde bulundurulduğunda, günümüzde ortaya çıkan Covid-19 salgını gibi hastalıkların artması PH'li bireylerin rehabilitasyona ulaşmasını daha fazla zorlaştırmıştır. Bu durum klinikte kullanılan fizyoterapi ve rehabilitasyon hizmetlerine alternatif oluşturabilecek rehabilitasyon hizmetlerinin gündeme gelmesini hızlandırmıştır. Diğer taraftan Parkinson hastaları için hastane ya da kliniklerde uygulanan fizyoterapi ve rehabilitasyon hizmetlerinin sınırlı olması nedeniyle, terapistler denge ve yürüme gibi transfere yönelik becerileri geliştirmeye daha fazla odaklanmakta ve çoğunlukla üst ekstremite eğitimi için yeterli zamanı bulamamaktadırlar. Tüm bu nedenlerden dolayı telerehabilitasyon uygulamaları, üst ekstremite eğitimi için avantajlı bir seçenek gibi görünmektedir. Telerehabilitasyon, çeşitli iletişim teknolojileri kullanılarak uzak mesafelere rehabilitasyon hizmetinin iletilmesi olarak tanımlanmaktadır. Son zamanlarda yaygınlaşmaya başlayan telerehabilitasyon uygulamaları, fizyoterapi ve rehabilitasyon hizmetlerinin daha pratik, daha düşük maliyetli ve zamandan daha fazla tasarruf edilerek uygulanabilmesine olanak sağlamaktadır. İnme, Multipl Skleroz, PH gibi birçok nörolojik hastalık grubunda telerehabilitasyon yaklaşımları son yıllarda sıklıkla tercih edilmektedir. Bu derlemede, PH’li bireylerin üst ekstremite rehabilitasyonunda kullanılan telerehabilitasyon yaklaşımlarını ele almak amaçlanmıştır.Öğe Relationship between lower extremity sensation, physical activity, cognition, body awareness, and fatigue in people with multiple sclerosis: a cross-sectional study(Springer Heidelberg, 2025) Eldemir, Kader; Ozkul, Cagla; Yildirim, Muhammed Seref; Eldemir, Sefa; Saygili, Fettah; Irkec, Ceyla; Guclu-Gunduz, ArzuBackground Multiple sclerosis (MS) is a chronic autoimmune disease causing sensory and motor impairments due to central nervous system demyelination. Sensory feedback, essential for balance and gait, is often disrupted in people with MS (PwMS). However, its relationship with fatigue, physical activity, cognitive function, and body awareness remains unclear. Aim To investigate the relationship between plantar sensation, knee position sense, and clinical factors in PwMS compared to healthy controls (HC). MethodsThirty-three PwMS and 11 HC participated in this study. Foot sensations including light touch threshold, two-point discrimination, vibration duration, and knee position sense were assessed. In addition, physical activity level, cognitive function, body awareness, and fatigue were assessed as clinical factors. Results No significant differences were found between PwMS and HC in most sensory measures, except for body awareness, which was higher in HC (p:0.029). In PwMS, light touch thresholds correlated with age (r = 0.454, p = 0.008), vibration duration with walking and physical activity levels (r = 0.392-0.396, p < 0.05), two-point discrimination with EDSS score (r = 0.474, p = 0.005), knee position sense with EDSS (r = 0.385, p = 0.027) and cognitive function (r = 0.382, p = 0.028). In HC, vibration duration correlated negatively with age (r=-0.834, p:0.001), and knee position sense correlated with body mass index (r = 0.764, p:0.006) and cognitive function (r = 0.609-0.736, p < 0.05). Conclusion These findings highlight the relationship between sensory function and clinical factors in PwMS, emphasizing the importance of age, disability level, physical activity, and cognitive function in preserving the sensory functions of the lower extremity.Öğe Relationship between sensation and balance and gait in multiple sclerosis patients with mild disability(Elsevier Sci Ltd, 2024) Ozkul, Cagla; Eldemir, Kader; Yildirim, Muhammed Seref; Cobanoglu, Gamze; Eldemir, Sefa; Guzel, Nevin Atalay; Irkec, CeylaBackground: Patients with Multiple Sclerosis (PwMS) often experience sensory, balance, and gait problems. Impairment in any sensation may increase imbalance and gait disorder in PwMS. This study aimed to (1) compare foot plantar sensations, knee position sense, balance, and gait in PwMS compared to Healthy Individuals (HI) and (2) examine the relationship between plantar sensations, knee position sense, balance, and gait in PwMS. Methods: Thirty PwMS with mild disability and 10 HI participated in this study. Light touch threshold, two -point discrimination, vibration duration, and knee position sense were examined on the Dominant Side (DS) and NonDominant Side (NDS). Balance and spatio-temporal gait analysis were evaluated in all participants. Results: PwMS had higher postural sway with eyes closed on the foam surface, longer swing phase of DS, longer single support phase of NDS, and shorter double support phase of DS compared to HI (p < 0.05). The results of regression analysis showed that the light touch thresholds of the 1st and 5th toes of the DS were associated with postural sway in different sensory conditions (p < 0.05). In contrast, the light touch thresholds of the 1st and 5th toes, two-point discrimination of the heel, vibration duration of the 1st metatarsal head and knee position sense of the NDS, and light touch threshold in the medial arch of both sides were associated with the gait parameters (p < 0.05). Conclusion: PwMS, even with mild disabilities needs neurorehabilitation to improve plantar sensation and knee position sense.Öğe Reliability and validity of the L test in people with multiple sclerosis(Elsevier Sci Ltd, 2025) Eldemir, Kader; Eldemir, Sefa; Ozkul, Cagla; Irkec, Ceyla; Guclu-Gunduz, ArzuObjectives: Functional mobility is an essential factor affecting the activities of daily living in people with multiple sclerosis (PwMS). The L test is a comprehensive assessment tool for functional mobility that incorporates sit-to-stand, transfers and bidirectional turning. The purpose of this study was to determine the psychometric properties of the L test in PwMS. Design: Cross-sectional study. Participants: Thirty-four PwMS [Expanded Disability Status Scale (EDSS) score 0 to 5] and 34 healthy controls were included in this study. Main outcome measures: The L test was administered along with the timed up and go (TUG) test, 10-m walk test (10-MWT), 6-minute walk test (6-MWT), timed 360 degree turn test, and EDSS by the same rater. Fall history was recorded to categorize PwMS with and without a history of falls. The L test was repeated after 1 week to determine test-retest reliability. Results: The L test showed excellent test-retest reliability (intraclass correlation coefficient 0.995). The minimum detectable change for the L test time was 1.4 seconds. The L test demonstrated significant positive correlations with the TUG test, timed 360 degree turn test and EDSS score, and significant negative correlations with the 10-MWT and 6-MWT (P < 0.001). Significant differences in the L test times were found between PwMS and healthy controls, and between PwMS with a history of falls and those without a history of falls (P < 0.05). The cut-off time of 14.7 seconds on the L test was found to best discriminate between PwMS and healthy people, while 16.4 seconds was found to best discriminate between PwMS with a history of falls and those without a history of falls. Conclusion: The L test is a reliable and valid tool for the assessment of functional mobility in PwMS.Öğe The effects of online pilates training on cognitive functions and dual task performance in people with multiple sclerosis: A randomized controlled study(Elsevier Sci Ltd, 2025) Eldemir, Kader; Eldemir, Sefa; Ozkul, Cagla; Irkec, Ceyla; Guclu-Gunduz, ArzuBackground: Cognitive impairments in people with multiple sclerosis (PwMS) are common and aggravate dualtask (DT) performance. This study aimed to investigate the effectiveness of online Pilates training on cognitive functions and the DT performance of balance, walking, and functional mobility in PwMS. Method: In this randomized controlled trial, forty-six PwMS were recruited and randomly allocated into two groups. The Online Pilates group (OPG) received Pilates training via videoconferences three days per week during six weeks at home. The control group (CG) was a waitlist with no Pilates treatment. Cognitive Functions were assessed with Montreal Cognitive Asssessment (MoCA), The Trail Making Test (TMT), and The Stroop Test (ST). DT performance was assessed with mental tracking and verbal fluency during postural stability (PS), walking, and functional mobility. Results: At the end of six weeks, the interaction effects (time x group) revealed significant differences for MoCA (p = 0.024), TMT-B (p = 0.012), ST (p <= 0.012), PS-with mental tracking (p = 0.004), PS-with verbal fluency (p = 0.003), cadence-with mental tracking (p = 0.048), and functional mobility-with mental tracking (p = 0.043) in favor of the OPG. Additionally, MoCA, TMT, ST, and DT performance during balance and functional mobility significantly improved in after six-week online Pilates training, but did not in CG. Conclusion: Pilates training via videoconference was effective in the improvement of cognitive functions and DT performance in PwMS. Online Pilates may be considered for improving cognitive impairments and DT performances in PwMS with barriers to accessing clinics. Trial registration: ClinicalTrials.gov: NCT06462339Öğe The effects of standard and modified LSVT BIG therapy protocols on balance and gait in Parkinson's disease: A randomized controlled trial(Wiley, 2024) Eldemir, Sefa; Eldemir, Kader; Saygili, Fettah; Ozkul, Cagla; Yilmaz, Rezzak; Akbostanci, Muhittin Cenk; Guclu-Gunduz, ArzuBackground: Lee Silverman voice treatment (LSVT) BIG is an exercise program developed for patients with Parkinson's disease (PwPD), consisting of sets of exercises performed for 4 consecutive days a week for 4 weeks. However, the standard protocol suggests a treatment frequency difficult to follow for most patients who have difficulties reaching rehabilitation clinics. Our aim was to compare the standard LSVT BIG protocol with a modified LSVT (m-LSVT) BIG protocol (twice a week in the clinic for 4 weeks and twice a week at home for 4 weeks). Methods: In this randomized controlled trial, 16 PwPD (aged 18-80 years, Hoehn and Yahr stages I-III) were recruited into two groups. The LSVT group received standard LSVT BIG training (four times per week for 4 weeks at the clinic). The other group was given m-LSVT BIG exercises, but unlike the LSVT group, the m-LSVT group exercised twice a week at the clinic and twice a week at home for 4 weeks. The Berg Balance Scale was used to assess functional balance. Biodex Balance System was used to assess laboratory balance measures. Timed Up and Go test and G-Walk sensor system were used to assess functional mobility and spatiotemporal gait analysis. Results: Significant group-by-time interactions on the eyes open-firm surface score of the modified clinical test of sensory integration of balance (F = 10.138, p = .007) and gait cycle symmetry index (F = 10.470, p = .010) were found to be in favor of the LSVT group. Additionally, post hoc analyses revealed that both groups significantly improved postural stability, gait speed, motor symptoms, and functional mobility (p < .05). Conclusion: The results revealed the beneficial effects of the modified protocol on balance and gait in PwPD, as well as the superiority of the standard LSVT BIG protocol. The m-LSVT BIG protocol may be an effective intervention method, especially for PwPD who have difficulty adapting to the treatment frequency of the standard protocol.Öğe The immediate efficacy of the spinomed orthosis and biofeedback posture orthosis on balance and gait in older people with thoracic hyperkyphosis(Elsevier Ireland Ltd, 2024) Eldemir, Kader; Eldemir, Sefa; Ozkul, Cagla; Guclu-Gunduz, ArzuBackground: Increased kyphosis is a common condition among older people that may, directly or indirectly, be a risk factor for poor balance and gait. Spinomed and Biofeedback Posture Trainer (BPT) orthoses is an effective treatment approach for hyperkyphosis. This study aimed to compare the immediate effects of the Spinomed and BPT orthoses on balance and gait in the older population. Methods: A total of 52 volunteer older people with hyperkyphosis (kyphosis angle>40 degrees) participated in this study and were randomly allocated into two groups, to either the Spinomed orthosis (n = 26, mean age = 65.50 +/- 5.50) or the BPT (n = 26, mean age = 65.38 +/- 5.69) orthosis. All participants were asked to wear the orthoses for 1.5 h to get used to them. Balance parameters, which are Postural Stability Test (PST), Limits of Stability (LOS), and Clinical Test of Sensory Integration for Balance (m-CTSIB) were assessed using the Biodex Balance System, while walking parameters were assessed using the G-Walk with and without orthosis. Results: The Spinomed had a positive effect on balance parameters (p < 0.05) except for the closed eyes firm surface and the opened eyes foam surface conditions of the m-CTSIB (p > 0.05). BPT had a significant impact on the PST score, LOS, and the closed eyes firm surface condition of the m-CTSIB (p < 0.001). Spinomed had a significant effect on cadence, speed, gait cycle duration, elaborated steps, and symmetry index of pelvic angles (p < 0.05), while the BPT had a significant effect only on step length and rotation symmetry index. No significant difference was detected between the two types of orthoses in the balance and gait parameters (p > 0.05). Conclusions: Spinomed and BPT were both effective in improving balance performance, with similar improvements demonstrated by both orthoses. Additionally, Spinomed may provide significant improvements in cadence, speed, gait cycle duration, elaborated steps, and all symmetry indexes of pelvic angles in the short term.
