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    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 Cenk
    Background: 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.
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    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 Tutal
    Introduction: 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.
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    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, Ceyla
    PurposeIt 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.
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    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, Arzu
    Background 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.
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    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, Arzu
    Background: 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.