Telerehabilitation Based Motor Imagery and Action Observation Training in Multiple Sclerosis

Effect of Telerehabilitation-Based Motor Imagery and Action Observation Training on Balance and Functional Mobility in Multiple Sclerosis: Randomized Controlled Study

This study aims to investigate the effects of the treatment combination consisting of motor imagery and action observation therapy on balance, functional mobility, lower extremity muscle strength, fatigue and quality of life.

Study Overview

• Status: Completed
• Conditions: Multiple Sclerosis
• Intervention / Treatment: Other: Traditional rehabilitation; Other: Action observation therapy and motor imagery

Detailed Description

The study population was participants with relapsing remitting multiple sclerosis. The traditional rehabilitation program consists of a joint treatment in which lower extremity strengthening and balance exercises are carried out synchronously for the experimental and control groups. Motor imagery and action observation therapy based on telerehabilitation of certain movements will be applied to the experimental group. All treatments will be carried out online via the Whatsapp program. The treatment program will be applied 3 times a week for 6 weeks. Evaluations will be made before and after the treatment program. Assessments include balance, lower extremity muscle strength and functional mobility, fatigue, and quality of life.

• Study Type: Interventional
• Enrollment (Actual): 29
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Battalgazi
    • Malatya, Battalgazi, Turkey (Türkiye), 44280
      • Inonu University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Being diagnosed with mulltiple sclerosis according to the McDonald criteria
• Expanded Disability Status Scale<5.5,
• Being between the ages of 18-65,
• Mini mental test score>24,
• Have a phone that can adapt to participating in a video call

Exclusion Criteria:

• Having another additional neurological disease that may cause balance and coordination disorders,
• having received physical therapy and regularly engaged in sports in the last 6 months
• Having an attack in the last 3 months
• Refusal to participate in the study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Experimental group; Individuals will receive standard rehabilitation and telerehabilitation-based motor imagery and action observation therapy.	Other: Traditional rehabilitation; The program consists of a joint treatment in which lower extremity strengthening and balance exercises are carried out synchronously. The program will include a total of 5 minutes of warm-up, 5 minutes of cool-down and 30 minutes of exercises related to the program. The difficulty of the program will increase by changing the number of exercises and increasing the weight in strengthening exercises. Progress in balance and coordination exercises will vary by changing the ground, increasing the standing time, and keeping the eyes open and closed.; Other: Action observation therapy and motor imagery; In the experimental group, in addition to traditional telerehabilitation, action observation and motor imagery of 4 exercises will be performed in each session. A video will be prepared for 4 exercises. Then, the participant will perform 2 minutes of action observation of each movement, followed by 1 minute of motor imagery. In addition to the traditional telerehabilitation program, a 12-minute combination of action observation and motor imagery will be performed in each session. Exercises will be changed every two weeks, gradually increasing the difficulty.
Experimental: Control group; Individuals will receive standard rehabilitation.	Other: Traditional rehabilitation; The program consists of a joint treatment in which lower extremity strengthening and balance exercises are carried out synchronously. The program will include a total of 5 minutes of warm-up, 5 minutes of cool-down and 30 minutes of exercises related to the program. The difficulty of the program will increase by changing the number of exercises and increasing the weight in strengthening exercises. Progress in balance and coordination exercises will vary by changing the ground, increasing the standing time, and keeping the eyes open and closed.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Berg Balance Scale	Berg Balance Scale consists of a total of 14 items. Evaluation for each stage is made between 0-4. Higher score indicates better functional balance performance	Baseline
Berg Balance Scale	Berg Balance Scale consists of a total of 14 items. Evaluation for each stage is made between 0-4. Higher score indicates better functional balance performance	6 weeks after baseline
Muscle strength and functional mobility	The participant will be asked to sit and stand up from a standard chair between 42-45 cm, with hands crossed on the chest, without support, 5 times. The time will be stopped when the participant completes the last sitting. It will be recorded in seconds.	Baseline
Muscle strength and functional mobility	The participant will be asked to sit and stand up from a standard chair between 42-45 cm, with hands crossed on the chest, without support, 5 times. The time will be stopped when the participant completes the last sitting. It will be recorded in seconds.	6 weeks after baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Fatigue Severity Scale	This scale consists of a total of 9 items and is scored between 0-7. >4 points indicate fatigue	Baseline
Fatigue Severity Scale	This scale consists of a total of 9 items and is scored between 0-7. >4 points indicate fatigue	6 weeks after baseline
Multiple Sclerosis International Quality of Life (MusiQoL) questionnaire	The scale consists of 31 questions in 9 dimensions (subscales). The index score is calculated as the average of these subscale scores. All 9 dimensions and the index score are linearly transformed and standardized on a scale from 0 to 100; where 0 indicates the worst possible level of quality of life and 100 indicates the best level.	Baseline
Multiple Sclerosis International Quality of Life (MusiQoL) questionnaire	The scale consists of 31 questions in 9 dimensions (subscales). The index score is calculated as the average of these subscale scores. All 9 dimensions and the index score are linearly transformed and standardized on a scale from 0 to 100; where 0 indicates the worst possible level of quality of life and 100 indicates the best level.	6 weeks after baseline

Collaborators and Investigators

• Sponsor: Inonu University
• Investigators: Study Director: Burcu talu, Inonu University

Study record dates

Study Major Dates

• Study Start (Actual): April 20, 2025
• Primary Completion (Actual): November 15, 2025
• Study Completion (Actual): November 25, 2025

Study Registration Dates

• First Submitted: February 21, 2024
• First Submitted That Met QC Criteria: March 4, 2024
• First Posted (Actual): March 6, 2024

Study Record Updates

• Last Update Posted (Actual): June 2, 2026
• Last Update Submitted That Met QC Criteria: May 30, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: motor imagery; telerehabilitation; action observation therapy
• Additional Relevant MeSH Terms: Nervous System Diseases; Autoimmune Diseases; Immune System Diseases; Demyelinating Autoimmune Diseases, CNS; Autoimmune Diseases of the Nervous System; Demyelinating Diseases; Multiple Sclerosis
• Other Study ID Numbers: 2025/7369

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Study data can be shared with other researchers if desired.
• IPD Sharing Time Frame: After the study was published
• IPD Sharing Access Criteria: If requested from the authors, it can be shared with researchers at the authors' discretion.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No