Discriminative ability of the original and short form of the Activities-specific Balance Confidence scale and its individual items for falls in people with multiple sclerosis.

BACKGROUND: Balance confidence is an essential component of fall risk assessment in persons with multiple sclerosis (pwMS). AIMS: The aims of this cross-sectional study were to 1) investigate the ability of the 16-item Activities-specific Balance Confidence scale (ABC-16), 6-item Activities-specific Balance Confidence scale (ABC-6), and each item of the ABC-16 for distinguishing fallers and 2) determine cutoff scores for these scales to discriminate fallers and non-fallers in pwMS. METHODS: One hundred and fifty-six participants [fallers/non-fallers: 60 (38.5%)/96 (61.5%), median EDSS: 1.5] were enrolled. Balance confidence was assessed using the ABC-16 and ABC-6. The self-reported number of falls in the past three months was recorded. Descriptive assessments, including walking, balance, and cognition were performed. Logistic regression and receiver operating characteristic analyses were conducted to estimate the sensitivities and specificities of the ABC-16 and ABC-6. RESULTS: Both the ABC-16 (AUC: 0.85) and ABC-6 (AUC: 0.84) had the discriminative ability for falls. Each item of the ABC-16 scale was a significantly related to falls [odds ratio (OR) range: 1.38 to 1.89]. Items 8 and 10 had the highest odds ratio (OR: 1.85; 95%CI: 1.47-2.33, OR: 1.89; 95%CI: 1.49-2.40; respectively). We found cutoff scores of ≤ 70 of 100 (sensitivity: 71.67, specificity: 86.46) and ≤ 65/100 (sensitivity: 76.67, specificity: 79.17) in discrimination between fallers and non-fallers for the ABC-16 and ABC-6, respectively. CONCLUSION: Both original and short forms of the ABC scale are an efficient tool for discriminating fallers and non-fallers in pwMS. Although all items are related to falls, outdoor walking activities have the strongest associations with falls than other items.

Sedentary behaviour and related factors in people with multiple sclerosis.

BACKGROUND: Sedentary behaviour is a major problem in persons with multiple sclerosis (pwMS). However, little is known about the related factors of sedentary behaviour in MS. Our study aimed to examine the association between sedentary behaviour and physical activity level, fear of falling, and fatigue. METHOD: Demographic and clinical data have been recorded. Sedentary behaviour was assessed with the Marshall Sitting Questionnaire, physical activity level was evaluated with the Godin Leisure Time Exercise Questionnaire, fear of falling was evaluated with the Fall Efficacy Scale International, and fatigue was evaluated with the modified fatigue impact scale (MFIS). The Timed 25-Foot Walk, 6-Minute Walk Test, Timed Up and Go Test, and 12-Item Multiple Sclerosis Walking Scale were also used to assess walking and perceived walking disability. RESULTS: We recruited 71 pwMS [49 were female (69 %), mean age:38.08 years, median EDSS:1.5]. The mean daily sitting time was 593.54 min (∼10 h). No significant correlation was found between sitting times and demographics, leisure time physical activity, fear of falling, walking, perceived walking disability, and neurological disability level (p > 0.05). Logistic regression analysis indicated that being male increased the risk of sedentary behaviour by 3.08 times, being employed increased the risk of sitting by 4.65 times, and each point increase in MFIS scores resulted in a 1.03-fold elevation in the odds of prolonged sitting. CONCLUSION: The fact that pwMS, even with a mild disability spend almost 10 h sitting highlights the significance of sedentary behaviour in this population. Developing strategies to address modifiable factors, such as fatigue, may be effective in reducing sedentary behaviour.

Effect of exergaming in people with restless legs syndrome with multiple sclerosis: A single-blind randomized controlled trial.

BACKGROUND: Restless legs syndrome (RLS) is a sensory-motor disorder characterized by an uncomfortable sensation in the lower extremity, triggered by sitting and lying positions and release with motion. There is strong evidence that RLS prevalence is higher in persons with multiple sclerosis (MS, pwMS) than in the general population. Current literature has shown that exergaming as non-pharmacological therapy may be an effective method for symptoms such as balance, walking, fatigue, cognitive functions in pwMS, but the effects on RLS are not known. Therefore, the study's main aim is to investigate the effects of exergaming in pwMS with RLS. METHODS: Thirty-one pwMS with RLS and 34 pwMS without RLS were randomly divided as exergaming group and control group. The outcome measures were International RLS Study Group Rating Scale, Modified Fatigue Impact Scale, MS Walking Scale, Timed 25-Foot Walk Test, Hospital Anxiety and Depression Scale, Godin-Shephard Leisure-Time Physical Activity Questionnaire, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, 6 min Walk Test, Timed and Up Go, MS International Quality of Life questionnaire, MS-Related Symptom Checklist. RESULTS: 26 pwMS with RLS (11 exergaming group, 15 control group) and 27 pwMS without RLS (12 exergaming group, 15 control group) were included in 8-week post-treatment analyses. After an 8-week long-term follow-up, 16 pwMS with and without RLS completed the protocol. The RLS severity (p = 0.004), anxiety level (p = 0.024), sleep quality (0.005), walking (0.004), and balance functions (0.041) were improved in pwMS with RLS exergaming group, while RLS severity increased in control group (p = 0.004). At 8-week follow-up, the effect of exergaming on RLS severity, quality of life, sleep quality, and walking capacity was preserved. There was significant improvement in gait and balance functions in pwMS without RLS exergaming group, there was no significant differences control group. In 8-week follow-up, improvement obtained in pwMS without RLS exergaming group was not preserved. CONCLUSIONS: This study suggests that exergaming training could be an effective method for managing RLS severity, anxiety, sleep quality, gait, balance, and quality of life in pwMS with RLS.

The Preference-Based Multiple Sclerosis Index: an assessment of its psychometric properties and translation into Turkish.

PURPOSE: To translate Preference-Based Multiple Sclerosis Index (PBMSI) into Turkish, investigate its psychometric properties and differences between its two scoring algorithms: PBMSI-Rating Scale (PBMSI-RS) and PBMSI-Standard Gamble (PBMSI-SG). METHODS: An expert committee supervised the translation process. Psychometric properties were evaluated in 104 people with multiple sclerosis. Exploratory common factor analysis was used to investigate structural validity. Convergent validity was assessed by formulating hypotheses about correlations between PBMSI and other HRQL measures, disability level, walking-related measures, and MS symptoms. Known-groups validity was assessed against different measures of disability and walking capacity. Test-retest reliability was assessed by calculating the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC95%). RESULTS: Factor analysis revealed one factor (Eigenvalue = 2.46). PBMSI-RS and PBMSI-SG correlated significantly with other measures (p < .001). Both could differentiate between individuals with different levels of disability and walking capacity (p < .05, d ≥ 0.50). Relative test-retest reliability was moderate for PBMSI-RS (ICC = 0.75) and good for PBMSI-SG (ICC = 0.83). SEM and MDC95% values were 0.16 and 0.44 for PBMSI-RS and 0.10 and 0.28 for PBMSI-SG, respectively. CONCLUSION: Turkish version of PBMSI has good psychometric properties to assess health-related quality of life in people with multiple sclerosis. PBMSI-SG should be preferred over PBMSI-RS.IMPLICATIONS FOR REHABILITATIONHealth-related quality of life is often used as a primary or secondary endpoint in multiple sclerosis research.The Preference-Based Multiple Sclerosis Index is the first preference-based health-related quality of life measure developed in multiple sclerosis using patient preferences.Preference-Based Multiple Sclerosis Index was translated to Turkish and demonstrated good psychometric properties, including structural, convergent, known-groups validity, internal consistency, and test-retest reliability.Professionals working in the field of multiple sclerosis research and rehabilitation may benefit from using the Preference-Based Multiple Sclerosis Index as it is a short and psychometrically robust instrument.

Effects and safety of exergaming in persons with multiple sclerosis during corticosteroid treatment: a pilot study.

BACKGROUND: There is no information about the effects and usability of rehabilitation during corticosteroid treatment. This randomized clinical trial was conducted to evaluate and compare the effects and safety of exergaming and conventional rehabilitation (CR) on persons with multiple sclerosis (MS, pwMS) during corticosteroid treatment. METHODS: The participants were randomly divided into two groups: Exergaming (n=15) and CR (n=15). Rehabilitation was applied by a physiotherapist who has expertise in MS. Measurements were done at baseline (T1), immediately after discharge (T2), and 1 month after discharge (T3). The outcome measures included upper extremity functions, walking, balance, cognitive functions, quality of life, depression, and fatigue. RESULTS: The Nine Hole Peg Test, California Verbal Learning Test, Symbol Digit Modalities Test, MS Walking Scale-12, Six Spot Step Test showed a significant difference between T1 to T2 and T1 to T3 in the exergaming and CR groups (p < 0.05). The Timed 25 Foot Walk and Multiple Sclerosis International Quality of Life Questionnaire were significantly different between T1 to T3 in the exergaming and CR groups (p < 0.05). Brief Visuospatial Memory Test-Revised was significantly different between T1 to T3 and T2 to T3 in the exergaming and CR groups (p < 0.05). The MFIS showed a significant difference between T1 to T2 and T1 to T3 in the exergaming group (p < 0.05). CONCLUSIONS: This study suggests that exergaming and CR are effective and safe methods for improving upper extremity, cognitive functions, fatigue, quality of life, balance, and walking ability in pwMS during the hospitalization period.

Changes in Gait Characteristics During and Immediately After the 6-Minute Walk Test in Persons With Multiple Sclerosis: A Systematic Review.

OBJECTIVE: There is limited information about gait patterns during prolonged walking in people with multiple sclerosis (PwMS). The aim of this review was to report on gait metrics during and immediately after the 6-Minute Walk Test (6MWT) in PwMS with different levels of disability. METHODS: The systematic search was performed in 3 databases (PubMed, Web of Science, and SCOPUS) using keywords related to multiple sclerosis and 6MWT. Studies that reported on quantitative gait outcomes before and after the 6MWT or multiple time points during the 6MWT were included. The Hedges g effect size (ES) was calculated to determine the magnitude of change in each gait parameter. RESULTS: Fourteen studies (n = 534 PwMS; n = 166 healthy controls) were eligible. Five studies investigated gait parameters prior to and immediately after the 6MWT. Nine studies collected gait measures during the 6MWT. Speed (ES = -0.43 to 0.19), cadence (ES = -0.46 to 0.16), step length (ES = -0.46 to 0.14), stability (ES = -0.35 to 0.33), and regularity (ES = -0.25 to -0.15) decreased in most studies. In the majority of included studies, step time (ES = 0 to 0.35), stance period (ES = 0.12 to 0.58), double support phase (ES = 0.03 to 0.62), variability (ES = -0.19 to 1.13), and asymmetry (ES = -0.79 to 0.62) increased following the 6MWT. The kinetic and kinematic (mainly in dorsiflexion angle [ES = -0.08 to -0.36]) features of gait were also negatively changed after 6 minutes of walking. Walking speed, cadence, step length, stride length, and stride time after 6MWT at a comfortable speed all increased. Changes in the majority of spatiotemporal parameters were more pronounced in PwMS with moderate-to-severe disability compared with PwMS with mild disability. CONCLUSION: Most quantitative gait parameters deteriorated during the 6MWT, especially in PwMS with moderate-to-severe disability. IMPACT: The deterioration of gait patterns should be considered when designing therapeutic interventions to increase sustained walking capacity.

Restless legs syndrome and related factors in people with multiple sclerosis in Turkey.

OBJECTIVE: Restless legs syndrome is one of the most reported sleep disorders in multiple sclerosis (MS). The study aims to investigate the possible factors related to the occurrence and severity of restless legs syndrome in persons with MS (pwMS) comparing with healthy controls. METHODS: This is a case-control study that included 447 pwMS and 57 healthy controls. Demographic and clinical data such as gender, age, duration of education, body mass index, marital status, disease duration, and MS type were recorded. Neurological disability was assessed by the Expanded Disability Status Scale. The Restless Legs Syndrome Rating Scale was used to assess the severity of restless legs syndrome. RESULTS: The prevalence of restless legs syndrome in pwMS was 133 (29.8%) and 3 (4.9%) in healthy controls (p < 0.001). There was no significant difference between the groups in terms of gender, body mass index, and MS type (p > 0.05). Patients with restless legs syndrome have more advanced age, longer disease duration, and higher Expanded Disability Status Scale scores than patients without restless legs syndrome (p < 0.05). The correlation between restless legs syndrome severity and age, Expanded Disability Status Scale score, disease duration was not statistically significant (p > 0.05). CONCLUSIONS: This study has shown that the presence of restless legs syndrome is high in persons with MS compared to healthy controls. Advanced age, disease duration, and higher disability level could be related to the increased rate of restless legs syndrome in persons with MS, especially those with high-frequency symptoms.

Prevalence and determinants of falls in persons with multiple sclerosis without a clinical disability.

BACKGROUND: Falls are common in persons with Multiple Sclerosis (pwMS) and lead to destructive results, specifically with increasing disability. However, there is only scarce data investigating prevalence and determinants of falls in pwMS without a clinical disability. Therefore, this study aimed to investigate proportion of fallers and related factors in pwMS without a clinical disability. METHODS: One hundred and four pwMS with no clinical disability (EDSS≤1.5) were recruited in this cross-sectional study. The outcome measures comprised of the Timed 25-Foot Walk (T25FW), Six Minute Walk Test (6MWT), Timed Up and Go Test (TUG), Multiple Sclerosis Walking Scale (MSWS-12), Single Leg Stance Test (SLS), Activities-Specific Balance Confidence Scale (ABC), Symbol Digit Modalities Test (SDMT), Modified Fatigue Impact Scale (MFIS), and Beck Depression Inventory-II (BDI-II). The number of falls during the last three months was recorded. RESULTS: Twenty-five percent of the pwMS reported at least one fall in the last three months. The TUG and MSWS-12 scores were significantly greater in the fallers compared to non-fallers (p<0.05). Whereas the fallers had significantly less ABC scores (p<0.05). Increasing TUG and MSWS-12 score and decreasing ABC score was related with increased risk of being classified as a faller adjusting for EDSS score. CONCLUSION: The present findings highlight that falls are frequent problem for pwMS, even if they do not have a clinical disability. Therefore, falls prevention strategies are also required in the early stages of the disease in clinical practice. The ABC scale, MSWS-12, and TUG test can be used by the clinicians and researchers to predict potential fallers of the pwMS without a clinical disability.

A comparative study of the effects of yoga and clinical Pilates training on walking, cognition, respiratory functions, and quality of life in persons with multiple sclerosis: A quasi-experimental study.

OBJECTIVE: The purpose was to investigate the effects of yoga and clinical Pilates training on walking, respiratory muscle strength, cognition, and quality of life and compare the effects of two popular exercise methods in persons with multiple sclerosis (pwMS). METHODS: Twenty-eight pwMS (Pilates group = 16, yoga group = 12) received the program once a week for eight weeks in addition to home exercises. At baseline and the end of the training, participants underwent assessments. The outcome measures were walking speed, mobility, balance confidence, respiratory muscle strength, cognition, and quality of life. RESULTS: Following the program, there was no significant difference in mobility (p = 0.482), perceived walking quality (p = 0.325), respiratory muscle strength (maximum inspiratory pressure: p = 0.263, maximum expiratory pressure: p = 0.866), and cognition (Symbol Digit Modalities Test: p = 0.324, California Verbal Learning Test-II: p = 0.514, Brief Visuospatial Memory Test-Revised: p = 0.279) between the two groups. Improvements were higher in balance confidence (p = 0.006), walking speed (p = 0.004), and quality of life (p = 0.019) in the clinical Pilates group compared to the yoga group. CONCLUSION: This study showed positive effects in walking and respiratory aspects in pwMS who received yoga and clinical Pilates training. Pilates training was superior in improving walking speed, quality of life, and balance confidence compared to yoga training.

Cross-cultural adaptation and psychometric properties of the Turkish version of the Manual Ability Measure-36 (MAM-36) in people with multiple sclerosis.

OBJECTIVE: The Manual Ability Measure-36 (MAM-36) has been used to assess subjective upper limb function in people with several neurological and non-neurological diseases. Besides, the MAM-36 is one of the most commonly used patient-reported outcome measures (PROMs) in people with multiple sclerosis (pwMS). The aim was to translate and conduct cross-cultural adaptation of the MAM-36 into Turkish and investigate its psychometric properties in pwMS. METHODS: The MAM-36 was translated and culturally adapted into Turkish. Two hundred pwMS were recruited for the psychometric study. Hand skills, handgrip strength, upper limb spasticity, disability level, and quality of life were evaluated by the validated performance-based tests and questionnaires including the Arm Function in Multiple Sclerosis Questionnaire (AMSQ) which is a validated MS-specific PROM to assess upper limb function. RESULTS: MAM-36 was significantly correlated with the performance-based tests and questionnaires, EDSS, age, and disease duration (p < 0.05). MAM-36 and AMSQ were strongly correlated (rs = - 0.90, p < 0.01). PwMS with spasticity had significantly lower MAM-36 scores compared to those without spasticity (p < 0.01). Internal consistency (Cronbach's alpha = 0.97) and test-retest reliability (ICC = 0.97) was high. CONCLUSION: The Turkish version of MAM-36 has been found as a valid and reliable method for measuring upper limb function in pwMS.

Explanatory factors of balance confidence in persons with multiple sclerosis: Beyond the physical functions.

BACKGROUND: Balance confidence is considered a psychological element of falls and balance-demanding activities. The relationship of balance confidence with physical factors has been investigated; however, psychosocial correlates are not well known. The aim was to investigate the relationship between balance confidence and physical and psychosocial factors and to reveal the determinants of balance confidence in persons with MS (pwMS). METHODS: A total of 445 pwMS were enrolled in the study. Balance confidence was assessed with the Activities-Specific Balance Confidence (ABC) Scale. Psychosocial-based measures included the Modified Fatigue Impact Scale (MFIS), Epworth Sleepiness Scale (ESS), Beck Depression Scale (BDI), and Symbol Digit Modalities Test (SDMT). The Godin Leisure-Time Exercise Questionnaire (GLTEQ), Timed 25-Foot Walk (T25FW), Six-Minute Walk Test (6MWT), and Single Leg Stance Test (SLS) were used to assess physical functions. RESULTS: There was a significant correlation between the ABC score and all physical and psychosocial measures (p<0.05). Hierarchical linear regression analyses indicated that psychosocial factors were significantly associated with ABC accounting for 41% of the variance. The addition of physical variables explained an additional 35% of variance over psychosocial variables. The MFIS, SDMT, BDI, T25FW, 6MWT, and SLS were significantly predictive of the ABC. CONCLUSION: This study emphasizes the importance of considering both physical and psychosocial factors for understanding balance confidence in pwMS. Besides, intervention strategies for enhancing balance confidence should aim to improve fatigue, depression, and cognition in addition to physical components.

Effect of video-based exergaming on arm and cognitive function in persons with multiple sclerosis: A randomized controlled trial.

BACKGROUND: Developments in rehabilitation technology such as video-based exergaming contributes to the treatment process as well as to increase the active participation of persons with multiple sclerosis (pwMS). The aim was to investigate the effect of video-based exergaming training on upper extremity and cognitive function as well as core stability, walking, depression, fatigue, and quality of life in pwMS. METHODS: This randomized controlled trial included 60 pwMS who were randomly divided into three groups; video-based exergaming (n = 21), conventional rehabilitation (n = 19), and control groups (n = 20). The experimental groups received therapy sessions once a week for 8 weeks. All the participants were assessed at baseline and after 8 weeks. The outcome measures included upper extremity and cognitive functions as well as core stability, walking, depression, fatigue, and quality of life measures. RESULTS: Significant improvements were observed in the primary outcome, measured by Nine-Hole Peg Test in the video-based exergaming [before= 25.8 (11.1) s; after= 22.3 (11.0) s] and conventional rehabilitation [before= 23.3 (8.1) s; after= 19.9 (3.8) s] groups (p < 0.05). Cognitive functions (with the exception of processing speed in the conventional rehabilitation group), most of the lower extremity functions, balance-related measures, fatigue and quality of life levels were significantly improved in the video-based exergaming and conventional rehabilitation groups, however, only the depression level was significantly decreased in the video-based exergaming (p < 0.05). Several significant differences were observed in the changes of the control group compared to the video-based exergaming and conventional rehabilitation groups (p < 0.05). CONCLUSION: This study suggests that video-based exergaming is almost as effective as conventional rehabilitation regarding improving walking, upper and lower extremity functions, cognitive functions, fatigue, depression, and health-related quality of life in pwMS.

The effects of Clinical Pilates training on walking, balance, fall risk, respiratory, and cognitive functions in persons with multiple sclerosis: A randomized controlled trial.

CONTEXT: Multiple sclerosis (MS) is a chronic progressive and neurodegenerative disease. Exercise programs are needed to maintain and increase functional status in persons with MS (pwMS). Pilates exercises designed by a physiotherapist can enhance participation and functionality in pwMS. OBJECTIVE: The aim of this study was to investigate the effects of Clinical Pilates training on balance, walking, fall risk, respiratory, and cognitive functions in pwMS compared with an active comparator (home exercise training). DESIGN: This study was a randomized controlled study. SETTINGS: This study was designed by researchers at Dokuz Eylül University, Izmir, Turkey. PARTICIPANTS: Forty-two pwMS were included in this randomized controlled trial. MAIN OUTCOME MEASURES: Walking, core stability, balance confidence, respiratory muscle strength, and cognitive functions were assessed before and after the program. INTERVENTIONS: The participants were randomly divided into two groups. The Pilates exercises group (n = 21) received therapy weekly for 8 weeks along with a home exercise program. The home exercise group (n = 21) was given standardized exercises reflecting routine clinical practice. The program compliance was monitored by telephone calls once a week. RESULTS: There were no significant differences in walking speed (p = 0.096), perceived walking ability (p = 0.165), and fear of falling (p = 0.385) between the Pilates and home exercise groups. Clinical Pilates training was superior to the home exercise program in walking endurance (p = 0.001), postural stability (p = 0.028), core stability (p = 0.016), respiratory (maximum inspiratory pressure: p = 0.037, maximum expiratory pressure: p = 0.008), and cognitive functions (p = 0.001-0.007). Clinical Pilates training may be preferred as an alternative method to improve balance, walking, respiratory, and cognitive functions in pwMS.

Frequency, type, distribution of pain and related factors in persons with multiple sclerosis.

BACKGROUND: Although there is accumulating evidence on neuropathic pain in persons with multiple sclerosis (pwMS), little is known about musculoskeletal pain. The aim was to examine the frequency, type, distribution of pain and related factors in pwMS. METHODS: This cross-sectional study included 223 pwMS. The Nordic Musculoskeletal Questionnaire and painDETECT Questionnaire were used to assess pain. Depression, fatigue, sleepiness, and health-related quality of life were assessed. RESULTS: 23.3% of participants did not have pain, 55.6% had musculoskeletal pain and 21.1% had neuropathic pain. There was no significant difference between the groups in age, gender, disease duration, employment status, marital status and education level (p > .05). The participants without pain had lower Expanded Disability Status Scale (EDSS) scores compared to those with neuropathic pain (p = .024). In addition, the participants with musculoskeletal pain had lower EDSS scores compared to those with neuropathic pain (p = .027). Depression, fatigue, sleepiness and quality of life scores were significantly different between the groups (p < .05). Participants with neuropathic pain had significantly lower quality of life, and higher fatigue, depression and sleepiness compared to participants with musculoskeletal pain and without pain (p < .05). Musculoskeletal pain was most common in low back (52.4%), neck (51.6%), and upper back (45.2%). CONCLUSIONS: This study suggests that pain is a very common symptom among pwMS. Pain frequency is high as 76.7%. In particular, the presence of neuropathic pain is associated with lower health-related quality of life and higher levels of depression, fatigue and sleepiness. Musculoskeletal pain was most common in the spine area including neck, upper back, and low back.

The multiple sclerosis work difficulties questionnaire: translation and cross-cultural adaptation to Turkish and assessment of validity and reliability.

Purpose: To linguistically and culturally adapt the Multiple Sclerosis Work Difficulties Questionnaire-23 (MSWDQ-23) for use in Turkey, and to examine its reliability and validity. Methods: Following standard forward-back translation of the MSWDQ-23, it was administered to 124 people with multiple sclerosis (MS). Validity was evaluated using related outcome measures including those related to employment status and expectations, disability level, fatigue, walking, and quality of life. Randomly selected participants were asked to complete the MSWDQ-23 again to assess test-retest reliability. Results: Confirmatory factor analysis on the MSWDQ-23 demonstrated a good fit for the data, and the internal consistency of each subscale was excellent. The test-retest reliability for the total score, psychological/cognitive barriers, physical barriers, and external barriers subscales were high. The MSWDQ-23 and its subscales were positively correlated with the employment, disability level, walking, and fatigue outcome measures. Conclusions: This study suggests that the Turkish version of MSWDQ-23 has high reliability and adequate validity, and it can be used to determine the difficulties faced by people with multiple sclerosis in workplace. Moreover, the study provides evidence about the test-retest reliability of the questionnaire. Implications for rehabilitation Multiple sclerosis affects young people of working age. Understanding work-related problems is crucial to enhance people with multiple sclerosis likelihood of maintaining their job. The Multiple Sclerosis Work Difficulties Questionnaire-23 (MSWDQ-23) is a valid and reliable measure of perceived workplace difficulties in people with multiple sclerosis: we presented its validation to Turkish. Professionals working in the field of vocational rehabilitation may benefit from using the MSWDQ-23 to predict the current work outcomes and future employment expectations.

Feasibility of a 6-Month Yoga Program to Improve the Physical and Psychosocial Status of Persons with Multiple Sclerosis and their Family Members.

CONTEXT: To the best of our knowledge, there has been no study on yoga that includes both persons with multiple sclerosis (MS) and their family members. Because yoga has therapeutic effects in both persons with MS and healthy persons, we hypothesized that it would be an effective method to improve not only the physical and psychosocial status but also the time persons with MS and their family members spend together. OBJECTIVE: To examine the feasibility of a 6-month (long-term) yoga program to improve the physical and psychosocial status of persons with MS and their family members. DESIGN: Uncontrolled clinical trial. SETTING: The protocol was developed at the Department of Neurology, Faculty of Medicine, and School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey. PARTICIPANTS: Persons with MS and healthy family members. MAIN OUTCOME MEASURES: Walking, balance, fatigue, health-related quality of life, depression, pain, and kinesiophobia. INTERVENTIONS: Yoga training was given once a week (at least 1h) for 6 months. The same assessors who assessed at baseline also performed the same assessments immediately after the end of the training (i.e., after 6 months). RESULTS: In total, 44 participants (27 persons with MS and 17 healthy family members) participated in the study. Twelve persons with MS and three healthy family members completed the 6-month yoga intervention. The completion rate for persons with MS and healthy subjects was 44.4% and 17.6%, respectively. In persons with MS, the mental dimension of health-related quality of life, walking speed, fatigue, and depression levels significantly improved after the yoga program (p < .05). However, there was no significant change in the self-reported walking impact, balance, pain, physical dimension of health-related quality of life, and kinesiophobia levels in the persons with MS (p > .05). This study suggests that a 6-month yoga program can improve the mental dimension of health-related quality of life, walking speed, fatigue, and depression in the persons with MS. However, the 6-month yoga program does not appear to be a feasible method to increase the time that persons with MS spend together with their family members.

Comparison of the effects of virtual reality-based balance exercises and conventional exercises on balance and fall risk in older adults living in nursing homes in Turkey.

OBJECTIVES: There is limited information on effective balance training techniques including virtual reality (VR)-based balance exercises in residential settings and no studies have been designed to compare the effects of VR-based balance exercises with conventional balance exercises in older adults living in nursing homes in Turkey. The objective of our study was to investigate the effects of VR-based balance exercises on balance and fall risk in comparison to conventional balance exercises in older adults living in nursing homes. METHODS: A total sample of 18 subjects (65-82 years of age) with fall history who were randomly assigned to either the VR group (Group 1, n = 7) or the conventional exercise group (Group 2, n = 11) completed the exercise training. RESULTS: In both groups, Berg balance score (BBS), timed up & go duration, and left leg stance and tandem stance duration with eyes closed significantly improved with time (p < 0.05), but changes were similar in both groups (p > 0.05) after training, indicating that neither the exercise method was superior. CONCLUSION: Similar improvements were found in balance and fall risk with VR-based balance training and conventional balance training in older adults living in the nursing home. Both exercise trainings can be preferable by health care professionals considering fall prevention. Appropriate patient selection is essential.

Caregiver burden, quality of life and walking ability in different disability levels of multiple sclerosis.

BACKGROUND: The caregivers of Multiple Sclerosis (MS) individuals are usually burdened with a wide range of MS-related caregiving tasks which may result in damages of their daily life and quality of life (QOL). OBJECTIVES: This study was designed to compare according to the disability level (1) the walking ability, quality of life (QOL), and disease impact of the MS patients (2) and the burden, QOL, self-efficacy and life satisfaction of their caregivers; (3) to determine the relationship between these outcome results, disease duration and caregivers' age. METHODS: 772 MS patients were recruited, 47 MS patients and their 47 caregivers finished the study. Disability, walking ability, QOL, disease impact of the MS participants; the burden, QOL, self-efficacy, life satisfaction of the caregivers were evaluated. RESULTS: MS Patients with higher disability had significantly worse scores on the MSWS-12, MUSIQOL, MSIS-29, and PDSS (p < 0.01). The caregivers facing with higher disability had significantly worse scores on CBI and CAREQOL (p < 0.01). CONCLUSIONS: The impairments on disability level, walking and QOL of MS patients were related to OQL declines and increased burden of their caregivers. Therefore, it may be important to provide acceptable education and support strategies with individual intervention while defining the needs and goals of the MS patients and their caregivers to improve the rehabilitation success.

Pain, fear of falling and stair climbing ability in patients with knee osteoarthritis before and after knee replacement: 6 month follow-up study.

OBJECTIVES: (1) to evaluate the change in time of pain, stair climbing ability and fear of falling (FOF), (2) to determine the association between pain, stair climbing ability and FOF for patients with knee osteoarthritis (OA) following the knee replacement over the course of six months, (3) and to compare the results with healthy controls in terms of stair climbing ability and FOF. METHODS: Fifteen female healthy controls and 21 female consecutive subjects who were scheduled to undergo primary bilateral knee replacement for the treatment of knee OA were involved. Pain, stair climbing ability and FOF were assessed with a numerical pain rating scale, Going up and Down Scale (GUDS) and Tampa Scale for Kinesiophobia (TSK) at pre-surgery and discharge. After discharge, patients were asked to answer the outcome measures at 2, 4, 8, 12 and 26 week by phone. RESULTS: Patients had significantly improvement in the postoperative 26-week scores of pain (p< 0.001), stair ability (p< 0.001), and FOF (p=0.006) compared with the preoperative scores. There was also decreased pain at 4.week, improved stair ability at 8.week, and delayed improvement at FOF in patients. While patients had significantly worse stair ability than controls preoperatively (p< 0.001), the difference was not significant at postoperative 26-week (p=0.561). A positive significant correlation was found between the stair ability, FOF and pain scores (p< 0.001). CONCLUSION: It would be reasonable to consider that FOF control is potentially useful for preventing severe functional limitation in stair climbing for subsequent knee OA before and early after the surgery.