Effects of Telerehabilitation-Based Motor Imagery Training on Pain in People With Multiple Sclerosis
Condition: Multiple Sclerosis; Pain
MeSH terms: Multiple Sclerosis; Sclerosis
Study type: Interventional

Summary: 
      In this studly, the effects of an 8-week telerehabilitation-based motor imagery training on
      pain and related factors in persons with multiple sclerosis will be investigated.
    

Detailed description: 
      Multiple sclerosis (MS) is a chronic, progressive, and demyelinating disease of the central
      nervous system that affects more than 2.5 million people worldwide and is more common in
      young adults. The most common clinical signs and symptoms include motor dysfunction, fatigue,
      spasticity, cognitive impairment, depression, decreased quality of life, bladder and bowel
      dysfunction and pain. People with Multiple Sclerosis (pwMS) show a wide range of pain
      symptoms, from acute pain symptoms to chronic pain symptoms. Pain is an important symptom in
      pwMS and is often associated with disability. Pain is a fairly common symptom in pwMS. The
      prevalence of pain in MS was found to be 63%. In addition, 30% of pwMS describe pain as their
      most severe symptom.

      In the studies, it was found that motor imagery training, which is defined as imagining
      movement without revealing the movement in reality, is a training at the cortical level and
      reduces pain by creating positive effects on the impaired body schema perception. However,
      the effect of motor imagery training on pain in pwMS has not been investigated before.

      For this reason, the aim of this study is to investigate the effect of
      telerehabilitation-based motor imagery training protocol, guidance of a physiotherapist, on
      pain, fatigue, anxiety, depression, quality of life and sleep quality in pwMS.

      Persons who followed by the outpatient Multiple Sclerosis Clinic of Dokuz Eylül University
      Hospital will participate in the study. A total of 32 participants will randomly be divided
      into 2 groups. (1) Telerehabilitation-based motor imagery training, (2) Control group.
      Telerehabilitation-based motor imagery training group will individually receive
      telerehabilitation-based motor imagery training under the guidance of a physiotherapist for 8
      weeks.

      The first 2 weeks of the treatment period, will reserved for implicit motor imagery /
      lateralization training. It will be performed by the "noi group application" application that
      can be downloaded to the participants' mobile devices (smartphone or tablet). Lateralization
      training will be aimed at the initially evaluated areas of the participants (neck, back,
      shoulder, knee, hand/wrist, foot/ankle) that have a pain level of at least 30 mm according to
      the Visual Pain Scale (VAS). In the application, the participants will be asked to
      discriminant right and left with simple photographs of the painful areas determined at the
      beginning, and more complex photographs will be used as the training progresses. Participants
      will be asked to use the app 3 times a day. In each application session, the right / left
      discrimination of the region in the photograph will be requested within 5 seconds and 30
      photographs will be shown for each painful region. Each session will last 2-3 minutes on
      average, depending on the number of painful areas of the participants. Controls will be made
      over the results sent to the e-mail address of the physiotherapist through the application.
      For 3rd to 8th weeks of the treatment period telehabilitation-based motor imagery training
      will be given to the participants individually, in synchronization, using the Google Meet
      videoconference platform, under the guidance of a physiotherapist. Participants will
      participate the treatment with their smart phones, tablets or computers that have an active
      internet connection and are suitable for meeting via videoconference. The duration of the
      sessions will last 20-30 minutes.

      The control group will not receive treatment other than their routine treatment, and the
      patients will be informed that the control group participants will be treated if the
      participants wish at the end of the study. The assessments will be applied at baseline, 8,
      and 12 weeks.
    

Intervention name(s): Telerehabilitation-based motor imagery training
Intervention type(s): Behavioral
Intervention description(s): Telerehabilitation has been defined as "the delivery of rehabilitation services through information and communication technologies".
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: multiple sclerosis; motor imagery; pain; telerehabilitation