Investigating the relationship of theory of mind and empathy with neuroimaging, neuropsychological, and neuropsychiatric data in persons with multiple sclerosis.

Theory of Mind (ToM) is understanding others' minds. Empathy is an insight into emotions and feelings of others. Persons with multiple sclerosis (pwMS) may experience impairment in ToM and empathy. To investigate ToM, empathy, and their relationship with neuroimaging, neuropsychological, and neuropsychiatric data. 41 pwMS and 41 HC were assessed using RMET for ToM, EQ, BICAMS, HADS. Cortical and subcortical gray matter volumes were calculated with Freesurfer from 3T MRI scans. pwMS showed lower EQ scores (44.82 ± 11.9 vs 51.29 ± 9.18, p = 0.02) and worse RMET performance (22.37 ± 4.09 vs 24,47 ± 2.93, p = 0.011). Anxiety and depression were higher in pwMS. EQ correlated with subcortical (amygdala) and cortical (anterior cingulate) volumes. RMET correlated with cortical volumes (posterior cingulate, lingual). In regression analysis, amygdala volume was the single predictor of empathy performance (p = 0.041). There were no significant correlations between social cognitive tests and general cognition. A weak negative correlation was found between EQ and the level of anxiety (r = -0.342, p = 0.038) The present study indicates that pwMS have impairment on ToM and empathy. The performance of ToM and empathy in MS is linked to the volumes of critical brain areas involved in social cognition.

COVID-19 vaccine response in Neuromyelitis Optica Spectrum Disorder.

OBJECTIVES AND AIMS: Neuromyelitis Optica Spectrum Disorder (NMOSD) is a disabling autoimmune disease of the central nervous system that requires immunosuppressants to control the relapses. The latter puts them at risk for more severe COVID-19 infection. Vaccines are an effective way to control the pandemic. However, we do not know how effective they are in immunologically compromised patients. We aimed to evaluate and compare antibody levels in NMOSD patients treated with disease-modifying therapies after two doses of inactivated and mRNA COVID-19 vaccines. METHODS: Patients with NMOSD diagnosis and age-sex matched healthy controls who received two doses of either inactivated and mRNA COVID-19 vaccine were recruited in the study. Serum samples were collected at least two weeks after the second dose. RESULTS: Serum samples from 24 NMOSD patients (Mean age-36.58, Female-70.83%) and 24 healthy controls (Mean age-36.71, Female-70.83%) were evaluated. Mean antibody titer was lower in the NMOSD group (Mean; SD (2.43 ± 1.51) than in healthy controls (Mean; SD 3.23 ± 0.80). Seronegativity was only seen in the rituximab group, there were no such cases in the azathioprine group. (9 vs 0). CONCLUSIONS: The study shows that NMOSD patients treated with rituximab may still be susceptible to severe COVID-19 infection even after both inactivated and mRNA vaccines.

Investigation of the Relationship Between Coping With the Disease and Affecting Cognitive, Physical, and Psychosocial Factors in People with Multiple Sclerosis.

OBJECTIVE: To investigate the relationship between coping mechanisms in people with multiple sclerosis (MS, pwMS) and cognitive, physical, and psychosocial factors such as socio-demographic characteristics, disability, personality, stigma, quality of life, depression, and anxiety. METHOD: One hundred and two pwMS were enrolled in this cross-sectional study. Demographics and clinical characteristics were recorded. Coping with the MS Scale (CMSS), including seven subscales, which are problem-solving, physical assistance, acceptance, avoidance, personal health control, energy conservation, and emotional release, was used to measure coping. Anxiety and depression levels, stigma, neuropsychological symptoms, and personality were measured by the Hospital Anxiety and Depression Scale (HAD), EuroQol-5D Quality of Life Scale (EQ-5D), Quality of Life in Neurological Diseases (NeuroQoL) -Stigma Scale, Multiple Sclerosis Neuropsychological Questionnaire (MSNQ), and Revised Eysenck Personality Questionnaire-Abbreviated Form (EKA-GGK), respectively. RESULTS: There was a weak statistically significant positive correlation between the physical support subscale and age and the disease duration and a strong positive correlation with EDSS (r = .214, p = .035; r = .213, p = .036; r = .582, p ≤ .0001, respectively). There was a moderate negative relationship between the physical support subscale and the EQ-5D mobility, self-care, pain, and health subscales (r = -.434, p = .000; r = -.482, p = .000; r = -.526, p ≤ .001, respectively), a weak negative correlation with anxiety, and a strong negative relationship with usual activities (r = -.379, p ≤ .001; r = -.243, p = .017; r = -.384, p ≤ .001, respectively). CONCLUSION: It has been shown that coping with MS can be affected by cognitive, physical, and psychosocial factors.

Predictors of relapse severity in multiple sclerosis.

BACKGROUND: The severity of relapses is one of the determinants of residual disability in multiple sclerosis (MS), contributing to the final progressive state. However, the factors that predict the severity of relapses are not fully understood. AIM: To predict relapse severity in MS and investigate the relationship between relapse severity and the degree of improvement in physical, cognitive, and social tests. METHODS: This observational single-center study prospectively assesses relapse severity in patients with MS. Relapses were classified as mild, moderate, and severe. Before relapse treatment and 1 month into remission four physical tests, four cognitive tests, and six surveys were performed. Multinomial regression analyses were applied to predict relapse severity. RESULTS: A total of 126 relapses were studied prospectively. Twenty-two were lost to follow-up. Multiple sclerosis International Quality of Life (MusiQol) questionnaire (r = 0.28, p = 0.006) and Symbol Digit Modalities Test (SDMT, r = 0.23, p = 0.022) improvement statuses were correlated with the severity of the relapse. Higher cases with improvement were observed in the severe relapse group on both MusiQol and SDMT, but no difference for those with a mild relapse. In the predictive model, only disease duration [Odds Ratio (OR) 0.808 95% confidence interval (CI) 0.691 to 0.945; p = 0.008] and Body Mass Index (BMI, OR 1.148 95% CI 1.018 to 1.294; p = 0.024) were associated with relapse severity. CONCLUSION: Only disease duration was found to be predictive of relapse severity among disease-related variables. On the other hand, BMI may be a modifiable patient-related factor to consider in the management of exacerbations in MS.

Feasibility of Telerehabilitation-Based Pelvic Floor Muscle Training for Urinary Incontinence in People With Multiple Sclerosis: A Randomized, Controlled, Assessor-Blinded Study.

BACKGROUND AND PURPOSE: Urinary incontinence is a common symptom in people with multiple sclerosis. The primary aim was to investigate feasibility of telerehabilitation-based pelvic floor muscle training (Tele-PFMT) and compare its effects on leakage episodes and pad usage with home exercise-based pelvic floor muscle training (Home-PFMT) and control groups. METHODS: Forty-five people with multiple sclerosis with urinary incontinence were randomized into 3 groups. Tele-PFMT and Home-PFMT groups followed the same protocol for 8 weeks, but Tele-PFMT performed exercises 2 sessions/week under a physiotherapist's supervision. The control group did not receive any specific treatment. Assessments were made at baseline, weeks 4, 8, and 12. Primary outcome measures were feasibility (compliance to exercise, patient satisfaction, and number of participants included in the study), number of leakage episodes, and pad usage. Secondary outcomes included severity of urinary incontinence and overactive bladder symptoms, sexual function, quality of life, anxiety, and depression. RESULTS: Participant eligibility rate was 19%. Patient satisfaction and compliance to exercise were significantly higher in Tele-PFMT than in Home-PFMT ( P < 0.05). No significant differences in the change of leakage episodes and pad usage were found between Tele-PFMT and Home-PFMT. No significant differences in secondary outcomes were found between PFMT groups. Participants in both the Tele-PFMT and Home-PFMT groups had significantly better scores for some measures of urinary incontinence, and overactive bladder and quality of life in compared with the control group. DISCUSSION AND CONCLUSIONS: Tele-PFMT was feasible and acceptable in people with multiple sclerosis, and this mode of delivery was associated with greater exercise compliance and satisfaction compared with Home-PFMT. However, Tele-PFMT did not exhibit superiority in terms of leakage episodes and pad usage compared with Home-PFMT. A large trial comparing Home-PFMT and Tele-PFMT is warranted.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content, available at: http://links.lww.com/JNPT/A440 ).

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.

Three doses of COVID-19 vaccines in multiple sclerosis patients treated with disease-modifying therapies.

OBJECTIVES AND AIMS: Disease modifying therapies used in multiple sclerosis can decrease humoral response after COVID-19 vaccines. This problem must be adequately addressed because new variants evolve, and COVID-19 still poses a risk to patients with comorbidities and immunosuppression. We aimed to evaluate the antibody response after the third dose of the COVID-19 vaccine in people with multiple sclerosis on disease-modifying therapies. METHODS: People with multiple sclerosis who received the third dose of either mRNA or inactivated vaccine after two doses of inactivated vaccine were recruited for the study. Blood samples were collected at least two weeks after the third dose. RESULTS: Blood samples of 339 (female 72.5%) people with multiple sclerosis and 52 (female 71.2%) healthy controls were evaluated. Healthy controls (mean: 4.07 ± 0.66) have higher antibody titers than people with multiple sclerosis (mean: 2.79 ± 2.95). Seronegative cases were observed only in the fingolimod and ocrelizumab treatment groups. Patients on fingolimod who received mRNA as a third dose had significantly higher antibody titer than those who had inactivated vaccines. Longer disease duration, having inactivated vaccine as a third dose, and DMT use was associated with lower antibody response. CONCLUSIONS: The study shows that even after inactivated vaccine schedule, mRNA still offers more protection in people with multiple sclerosis on disease-modifying therapies.

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.

Relationship between presence of spinal cord lesion and restless legs syndrome in multiple sclerosis.

BACKGROUND: Even though the prevalence of restless leg syndrome in multiple sclerosis (MS) is known to vary between 12.5% and 60%, the underlying pathophysiological mechanism remains unclear. AIM: This study aims to investigate the relationship between spinal cord lesions and restless leg syndrome in MS. MATERIALS AND METHODS: In total, 959 persons with MS were enrolled in this study. Demographic and clinical data of persons with MS were recorded by interviewing and medical records. Neurologists blind to the presence of restless leg syndrome evaluated MRI scans for the presence of demyelinating lesions in the brainstem and spinal cord. RESULTS: The restless leg syndrome was detected in 222 participants (23.15%). Restless leg syndrome was not significantly linked to mean age, body mass index, gender, and MS duration, but persons with MS with restless leg syndrome have a higher disability level (p = 0.044). In addition, no difference in the brainstem and thoracic cord was found between persons with MS with and without restless leg syndrome, while there is a significant relationship between the presence of cervical cord lesion and restless leg syndrome. CONCLUSION: Higher disability scores and characteristics of lesion patterns in the spinal cord could explain higher rates of restless leg syndrome in persons with MS. Considering the negative effects of restless leg syndrome, the increased awareness and treatment of restless leg syndrome among persons with MS is essential for better managing.

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.

Fatigue is associated with physical inactivity in people with multiple sclerosis despite different environmental backgrounds: Merging and comparing cohorts from Turkey and Israel.

BACKGROUND: Examining leisure-time physical activity in people with multiple sclerosis (PwMS) from different environmental backgrounds might increase understanding and awareness of inactivity in PwMS. Therefore, the study objective was twofold; to compare the level of physical activity in PwMS in Israel and Turkey and to examine the relationship between the level of physical activity with common disease-related symptoms and demographical characteristics of PwMS. METHODS: Cross-sectional data collected by two centers were combined. The physical activity level was determined by the Godin Leisure-Time Exercise Questionnaire, and subsequently, classified into one of three subgroups: "active", "moderately active" and "insufficiently active". Logistic regressions determined the risks of insufficiently active PwMS, according to age, gender, body mass index, disability, impact of walking impairment, disease duration, type of MS and perceived fatigue. The analysis of variance test determined the differences between countries in terms of outcome variables. RESULTS: The study comprised 458 patients from Israel and 575 from Turkey; 68.2% Turkish PwMS were classified as insufficiently active compared with 52.0% of Israeli PwMS. The percentage of insufficiently active PwMS was significantly higher in those categorized as fatigued compared to non-fatigued in the total cohort (72.4% vs. 51.9%, p<0.001) and in each country separately. Based on the regression analysis, fatigue was the main factor associated with the insufficiently physically active group; odds ratio=1.968. CONCLUSION: PwMS with increased fatigue tend to participate in less leisure-time physical activities compared with the non-fatigued. This observation is supported by the merged data collected from two countries, Turkey and Israel, representing PwMS from different environmental backgrounds.

Restless legs syndrome in people with multiple sclerosis: An updated systematic review and meta-analyses.

BACKGROUND: Restless legs syndrome (RLS) is a sensory-motor disorder characterized by an uncomfortable sensation felt in the lower extremity. The aim of this systematic review and meta-analyses was (i) to provide updated information on the prevalence and clinical characteristics of RLS amongst people with multiple sclerosis (PwMS) and (ii) clarify RLS-related factors in PwMS. METHODS: MEDLINE (PubMed), Scopus, and EMBASE were searched from their inception through April 2021 for the following keywords: 'restless legs syndrome' or 'RLS' and 'multiple sclerosis' or 'MS'. For the analysis of RLS prevalence, we calculated the percentage of RLS sufferers amongst the PwMS and people without MS. The prevalence of RLS was pooled separately for PwMS and healthy controls, regardless of the heterogeneity between studies. The odds ratios (ORs) and 95% CIs were extracted from the data in order to analyze the association between MS and RLS. RESULTS: Nineteen studies were included in the review (9 case-controlled and 10 cross-sectional).The mean prevalence of RLS in the MS population was 27.5%, ranging from 13.2% to 65.1%, higher than the healthy controls. Based on the case control studies, the pooled RLS prevalence was much higher in PwMS than in healthy controls (OR 4.535, 95% CI 3.043-6.759, p<0.001). The majority of studies found no significant relationship between the presence of RLS in PwMS with disability, disease duration, type of MS, age, or gender. CONCLUSIONS: Our updated systematic review strengthens the evidence of the increased risk of RLS amongst PwMS. Nevertheless, significant data reporting on characteristics of the MS disease, which increases the risk of suffering from RLS, is still lacking.

Validity and reliability of "Cognitive Reserve Index Questionnaire" for the Turkish Population.

BACKGROUND: Cognitive reserve (CR) is the ability to counteract brain damage through differential recruitment of brain networks. Besides, it has also been observed that lifetime intellectual enriching skills reduce the effect of disease burden on cognitive status. The Cognitive Reserve Index questionnaire (CRIq), which is a method for the quantitative measurement and comprehensive evaluation of the CR, that individuals have accumulated throughout their lifetimes. The present study aimed to adapt CRIq to the Turkish population. METHODS: CRIq is a 20-item questionnaire consisting of 3 sub-scales (CRI-Education, CRI- Working Activity, CRI-Leisure Time). 271 females and 228 males, a total of 499 healthy volunteers participated in the study (mean age: 39.54±14.05, mean education years 13.14±4.84). Participants were evaluated with the "Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS)" and CRIq was applied. BICAMS was used to determine the validity of the CRIq. To determine the reliability, the questionnaire was applied again two weeks after the first application. Internal consistency and test-retest reliability were measured for reliability analysis. Independent sample t-test was conducted to observe the difference between genders. RESULTS: The Cronbach alpha coefficient of the questionnaire was 0.78, and the reliability of the questionnaire was acceptable. The findings showed that inter-rater reliability was quite high (ICC:0.95, 95% CI=1.000, n=36). The correlation between the first and second application of the questionnaire was found to be acceptable for both the sub-scales and the whole questionnaire. The highest CRIq scores were shown for young adults in CRI-Education and CRI-LeisureTime, for the middle-aged in CRIq-WorkingActivity, no significant differences in total CRIq scores. The males scored significantly higher in CRIq total scores than females, but there was not a significant difference in CRI-LeisureTime between genders. CONCLUSION: The Turkish version of CRIq was found to be a valid and reliable method for evaluating cognitive reserve in healthy individuals.

Associations between smoking and walking, fatigue, depression, and health-related quality of life in persons with multiple sclerosis.

Smoking is associated with increased multiple sclerosis (MS) risk. In addition, some studies have reported that smoking is associated with anxiety and depression. However, the associations between smoking, walking, and fatigue are needed to be investigated. The objective was to investigate the associations between cigarette smoking and walking, fatigue, depression symptom severity, and health-related quality of life in persons with MS. Two hundred seventy-nine persons with MS were evaluated in this cross-sectional study. Study outcomes were neurological disability level, walking speed, walking endurance, perceived walking impact of MS, fatigue, depression symptom severity, and health-related quality of life. There were 95 (34.1%) current smokers who had significantly higher fatigue (p = 0.003, pη2 = 0.031) and depression (p = 0.044, pη2 = 0.015), and lower health-related quality of life (p = 0.003, pη2 = 0.031) after adjusting for age, gender, neurological disability level, and disease duration compared to non-smokers (n = 184). There was no significant difference between smokers and non-smokers in walking measures (p > 0.05). Smoking intensity was significantly correlated with age (r = 0.487), neurological disability level (r = 0.227), disease duration (r = 0.30), walking speed (r = 0.574), walking endurance (r = - 0.461), perceived walking impact of MS (r = 0.684), fatigue (r = 0.370), health-related quality of life (r = - 0.259), and depression (r = 0.269) in current smokers. Cigarette smokers with MS had significantly more fatigue and depression symptom severity and less health-related quality of life compared to non-smokers. Increased pack-years of cigarette smoking was associated with worse walking ability and health-related quality of life, and greater depression symptom severity and fatigue.

Cross-cultural adaptation, validity and reliability of the Turkish version of the patient determined disease steps scale in persons with multiple sclerosis.

Background: Patient Determined Disease Steps (PDDS) scale is a patient-reported outcome measure to assess disability in persons with multiple sclerosis (pwMS). This scale can be used as an alternative to Expanded Disability Status Scale (EDSS) as it is a costly, more time-consuming, and clinician-based method. This study aimed to conduct Turkish translation and cross-cultural adaptation of PDDS and investigate its psychometric properties.Methods: Turkish translation and cross-cultural adaptation of PDDS was conducted. Its psychometric properties including validity (i.e. content, criterion, and construct) and test-retest reliability (relative and absolute) were investigated in 100 pwMS.Results: PDDS had a significant strong correlation with EDSS (rs = 0.61, p < .001). Regression model to predict EDSS scores from PDDS scores was significant (p < .001, R2 = 0.67). Both PDDS and EDSS were significantly correlated with age, disease duration, walking speed and endurance, perceived impact of MS on walking, functional mobility, working memory and information processing speed, visual memory, manual dexterity, and health-related quality of life (p < .05). No significant difference was observed in the correlation coefficients of PDDS and EDSS (p > .05). Relative test-retest reliability was found high [ICC = 0.99 (95%CI = 0.99, 0.99)]. Absolute test-retest reliability was high as the Bland-Altman analyses showed no significant systematic bias between the repeated assessments. A narrow range of the limits of agreement indicated that PDDS had high stability and low variation between first and second assessments.Conclusion: Turkish version of PDDS presented high validity and test-retest reliability in pwMS.

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.

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.

Physical, cognitive and psychosocial effects of telerehabilitation-based motor imagery training in people with multiple sclerosis: A randomized controlled pilot trial.

INTRODUCTION: Motor imagery training delivered at home via telerehabilitation is a novel rehabilitation concept. The aim was to investigate the effects of telerehabilitation-based motor imaging training (Tele-MIT) on gait, balance and cognitive and psychosocial outcomes in people with multiple sclerosis (pwMS). METHODS: This randomized, controlled pilot trial included pwMS and healthy individuals. pwMS were randomly divided into two groups, intervention and control. The intervention group received Tele-MIT twice a week for 8 weeks. The control group was a wait-list group without any additional specific treatment. Healthy participants served as a baseline comparison. The Dynamic Gait Index, used to assess dynamic balance during walking, was the primary outcome. Secondary outcomes included assessments of walking speed, endurance and perceived ability, balance performance assessed by a computerized posturography device, balance confidence, cognitive functions, fatigue, anxiety, depression and quality of life. RESULTS: Baseline comparisons with healthy individuals revealed that motor imagery abilities were preserved in pwMS (p > 0.05). The intervention group exhibited significant improvements in dynamic balance during walking (p = 0.002), walking speed (p = 0.007), perceived walking ability (p = 0.008), balance confidence (p = 0.002), most cognitive functions (p = 0.001-0.008), fatigue (p = 0.001), anxiety (p = 0.001), depression (p = 0.005) and quality of life (p = 0.002). No significant changes were observed in the control group in any of the outcome measures (p > 0.05). DISCUSSION: Tele-MIT is a novel method that proved feasible and effective in improving dynamic balance during walking, walking speed and perceived walking ability, balance confidence, cognitive functions, fatigue, anxiety, depression and quality of life in pwMS.