The Effect of Telerehabilitation Based Pilates Training in Multiple Sclerosis Patients
Condition: Multiple Sclerosis
MeSH terms: Multiple Sclerosis; Sclerosis
Study type: Interventional

Summary: 
      Multiple Sclerosis (MS) is a chronic inflammatory disease of the central nervous system
      characterized by myelin, oligodendrocyte, and axon damage. MS usually begins with attacks due
      to demyelination of axons in the brain, optic nerve, and spinal cord; over time it develops
      into a neurodegenerative disease associated with neurotrophic support deficiency and neuronal
      loss. In MS, various loss of strength, balance, fatigue, cognitive and gait disturbances
      arise in the central nervous system due to sensory and/or motor neuron degeneration. These
      disorders affect the quality of life by limiting the individual's activities and
      participation in their daily lives. Therefore, it is important to treat these disorders in
      the treatment of MS.

      There are various pharmacological treatments and invasive procedures for the management of MS
      symptoms and one of the most commonly used treatment options is rehabilitation.
      Clinically-based exercise and rehabilitation are some of the most beneficial rehabilitation
      strategies in people with MS (PwMS). Clinically-based exercise and rehabilitation have been
      shown to stabilize or improve many physical symptoms of MS including loss of strength,
      balance dysfunction, impaired mobility, and fatigue. These benefits have led many
      practitioners to consider physical exercise as a nonpharmaceutical disease-modifying
      treatment. However, due to various factors such as mobility disorders, fatigue, and related
      problems, geographic location, time constraints, transportation difficulties, health
      insurance coverage, and financial burden, clinical-based exercise may be problematic in some
      pwMS. To overcome these challenges, approaches to rehabilitation have been developed such as
      telerehabilitation. The telerehabilitation system provides benefits such as continuity in
      patient education and rehabilitation, showing progress in rehabilitation, making changes in
      the treatment program, and saving individuals time and financial expenses. It is also an
      innovative and potential alternative to face-to-face interventions for treating
      disease-related disorders in pwMS. In literature, there are many studies examining the
      effectiveness of telerehabilitation in pwMS. According to these studies, ıt has been shown
      that telerehabilitation, with its technical facilities, had the potential to make clinical
      interventions widely accessible and effective for MS, however, telerehabilitation-based
      interventions could not replace traditional interventions but could perfectly complement. It
      has been found that telerehabilitation improved balance and postural control in MS patients
      and had no side effects. However, it was emphasized that the evidence levels of the studies
      were insufficient for methodological reasons. It has been determined additional studies are
      needed to investigate examining the effect on walking.

      Another clinical-based exercise method is Pilates. Pilates is a "core" stability-based
      exercise method that includes endurance, flexibility, movement, posture, and respiratory
      control. Studies have shown that Pilates training can improve balance, mobility, and muscle
      strength, fatigue in pwMS due to its structure consisting of balance and strengthening
      exercises. When the literature is reviewed in terms of Telerehabilitation based on Pilates in
      pwMS, it is seen that there are only two studies. In both studies, pwMS were given 20 minutes
      of yoga, 20 minutes of Pilates, and 20 minutes of dual-task exercise. However, these studies
      were in the project phase and the results are still not reported. On the other hand, in both
      studies, Pilates is given as combined training.

      As a result, telerehabilitation is an alternative method to MS treatment. In addition, while
      there are many clinical-based Pilates studies in the literature, telerehabilitation-based
      Pilates studies are insufficient. Telerehabilitation-based Pilates training studies are
      needed. Therefore, the investigators planned this study to investigate the effect of
      telerehabilitation-based pilates training on physical performance and quality of life in
      pwMS.
    

Detailed description: 
      This study is planned as a randomized control trial. Patients will be randomly divided into
      two groups as intervention and control. The intervention group will be received
      telerehabilitation-based pilates training three times a week for six weeks.
      Telerehabilitation-based pilates will be provided via videoconferencing.

      The first session will be the introduction session, patients will be informed about basic
      principles of Pilates and it will be included teaching inward movement of the lower abdominal
      wall and supine exercises of segmental movements involving trunk muscle recruitment to
      maintain a neutral posture. Afterward the session, a typical session will be included supine,
      side-lying, quadruped exercise, sitting on the exercise ball, and standing exercises.
      Exercises will be included thoracic extension, general abdominal strengthening, core
      stabilization exercises for the deep abdominal muscles. The difficulty of these exercises
      will be gradually increased and focused on keeping neutral positions of the spine in
      different gravity orientations. The control group will be a wait-list group without any
      additional specific treatment. All assessments will be done before and after the 6-week
      intervention program or waiting period. The demographic characteristics of the participants
      initially will be taken and the Expanded Disability Status Scale score of those of MS will be
      recorded. Primary outcomes are balance, gait, core endurance and power, and muscle strength;
      secondary outcomes are physical activity, fatigue, and quality of life
    

Intervention name(s): Telerehabilitation-based Pilates Exercise
Intervention type(s): Other
Intervention description(s): The group that will receive telerehabilitation-based pilates training via telerehabilitation
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Intervention and control groups
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Multiple Sclerosis; Pilates; Exercise; Telerehabilitation; Physical performance; Balance; Gait; Fatigue