Effects of Telerehabilitation-Based Motor Imagery Training on Pain in People With Multiple Sclerosis

Expanded Disability Status Scale is the most frequently used scale in evaluating the disability of pwMS. Scoring based on neurological examination findings takes a value between 0-10. While 0 shows normal neurological findings, 10 means death due to MS. In this scale in which pyramidal, cerebral, cerebellar, visual, sensory, brainstem, bladder and bowel functions are scored, the best performance of the patient without any special effort is evaluated.

Patient-Determined Disease Steps Scale was designed in 1995 as a self-reported outcome measure to enable neurologists without EDSS evaluator certification to measure the level of disability of pwMS. It consists of one question. In PDDS, the patient is asked to choose one of the 9 items that best describes his current walking ability.

Numeric Rating Scale will be used to determine pain levels in functional activities of participants. Participants are asked to name the number representing the amount of pain, where 0 is "no pain" and 10 is "most unbearable pain". Participants will be asked to identify the 5 activities they find most difficult to do because of their pain and to evaluate their pain for activities.

PainDETECT Questionnaire is used to determine neuropathic pain of participants. The questionnaire assesses the typical symptoms, signs, and extent of pain of neuropathic pain. A questionnaire score of ≥19 indicates probable neuropathic pain, a score of 13 to 18 indicates that the result is uncertain, and neuropathic pain of ≤12 is unlikely.

Nordic Musculoskeletal Questionnaire is used to determine the musculoskeletal system pain of participants. Questionnaire; whether there is pain on a figure showing the nine regions anatomically: neck, shoulder, back, elbow, hand/wrist, waist, hip/thigh, knee, foot/ankle, whether you have experienced pain in the last week or one year. questions whether the pain affects work/home life. The form consists of three parts and provides descriptive information about whether the participants have experienced various musculoskeletal pain in the last year and in the last seven days, and whether these pains affect their work/home life. The classical evaluation method is in the form of calculating the response distribution ratios and obtaining descriptive data.

Kinesthetic and Visual Imagery Questionnaire- 20 is used to determine the motor imagery skills of participants. The questionnaire consists of a total of 10 movements measuring 5 visual and 5 kinesthetic visualization skills developed to determine the extent to which individuals visualize and feel the imagined movements. The participant give a score between 1 and 5, as "1 point: no image, 5 points: as clear as the original" for the image in the imagery. At the end of the questionnaire, visual imagery score, kinesthetic imagery score and total score are calculated.

Modified Fatigue Impact Scale is used to determine the fatigue level of participants. The questionnaire consists of a total of 21 questions evaluating the physical, cognitive and psychosocial effects of fatigue. Each item is given a score of 0-4. Low score indicates a low degree of fatigue

Multiple Sclerosis İnternational Quality of Life Questionnaire is used to determine the quality of life of participants. The questionnaire is a self-filled 31-item scale measuring health-related quality of life. The questionnaire questions quality of life in various areas, including activities of daily living, psychological well-being, symptoms, relationships with friends, relationships with family, health care team satisfaction, emotional life and sex life, coping and rejection. The total score is between 0 and 100, and high scores indicate high quality of life perception

Pittsburgh Sleep Quality Index is used to determine the sleep quality of participants. The questionnaire includes 24 questions evaluating the sleep quality of the participants for the last month. 19 of these are self-report questions and are answered by the participants themself. Five questions are answered by the participant's spouse or roommate and are used for clinical information only, not included in scoring. The total score takes a value between 0 and 21. Sleep quality of those with a total score of 5 or less was "good"; Those with a score above 5 are considered to have "poor" sleep quality.

Epworth Sleepiness Scale is used to determine the daytime sleepiness of participants. The scale consists of 8 items. The score of each item varies between 0-3 and the total score varies between 0-24. High scores indicate high daytime sleepiness

HADS is used to determine the risk of anxiety and depression in the participants and to measure its level and severity. It is a self-report scale consisting of 7 anxiety and 7 depression related questions in total and two subscales. Items are scored with a 3-level Likert-type scale. High scores indicates high anxiety and depression level.

Mental Chronometer Time measurement will be performed with the Timed Up and Go Test. During the Timed Up and Go Test, the participants will be asked to get up from a chair, walk three meters, turn around the board at the end of 3 meters, walk back to the chair and sit. After imagining the movement during the test, participants will actually apply the test. The temporal coherence between real and imagined motion will be calculated in terms of delta time with the formula "(real motion-imagined motion)/[(actual motion + imagined motion)/2] x 100". The duration of actual and imagined movements will be recorded with an electronic stopwatch. The time during the actual movement will be recorded by the physiotherapist. The imaginary time will be recorded by the participants. The participants will start the stopwatch when they started to move the imagined movement and will stop it when the participants completed the imagined movement. Closer scores to 100 mean better temporal coherence.

The California Verbal Learning Test-II is used to assess verbal memory. Higher scores indicate better verbal memory.

The Revised Brief Visuospatial Memory Test is used to assess visuospatial memory. Higher scores indicate better visuospatial memory.

The Symbol Digit Modalities Test is used to assess information processing speed. Using a reference key, the test taker has 90 seconds to pair specific numbers with given geometric figures in the Symbol Digit Modalities Test. The correct matches are calculated as the test score. Higher scores indicate better information processing speed.