Kronik İnme Hastalarında Telerehabilitasyon Temelli Spinal Stabilizasyon Egzersizlerinin Fiziksel Aktivite Düzeyi ve Yorgunluk Üzerine Etkisi

Abstract

The aim of this study was to investigate the effects of telerehabilitation-based spinal stabilization exercises on physical activity level, fatigue, functional capacity, trunk impairment, endurance of trunk stabilizer muscles, and quality of life in chronic stroke patients. This randomized-controlled, single-blind, mixed-method study included anterior circulation ischemic stroke patients between the ages of 50 and 75. The study was completed with a total of 30 patients, 7 females and 8 males in both groups. Spinal stabilization exercises were performed for 1 hour, 3 days a week for 6 weeks, in both groups, with the telerehabilitation method in the study group and the face-to-face exercise method in the control group. Evaluations were made before and after both exercise programs. In the evaluations; physical activity level was assessed with daily step counts and walking distances obtained from the smart bracelet, fatigue with the Fatigue Severity Scale (FSS) and Fatigue Impact Scale (FIS), functional capacity with the 6-Minute Walk Test (6MWT), trunk impairment with the Trunk Impairment Scale (TIS), endurance of the trunk stabilizer muscles according to the McGill protocol, and quality of life with the Stroke Impact Scale (SIS). Additionally, qualitative interviews were conducted with the patients before and after the study. Data were collected about patients' experiences with physical activity and fatigue through qualitative interviews conducted before the exercise programs. After the treatment programs, positive effects were observed in both telerehabilitation and face-to-face exercise groups on physical activity level (daily step count: p<0.001, p<0.001; walking distances: p<0.001, p<0.001), fatigue (FSS: p<0.001, p<0.001; FIS: p=0.001, p=0.026), functional capacity (6MWT: p<0.001, p=0.007), trunk impairment (TIS: p=0.001, p=0.001) and quality of life ( SIS: p=0,001, p<0.001). In addition, positive effects were observed in all parameters on the endurance of trunk stabilizer muscles in both groups (p<0.05), except trunk extensors in the face-to-face group (p=0.069). However, it was found that both exercise methods had no superiority over each other in terms of treatment effectiveness on physical activity (daily step count, p=0.150; walking distance, p=0.086), fatigue (FSS, p=0.084; FIS, p=0.835), functional capacity (6MWT, p=0.600), trunk impairment (TIS, p=0.861), the endurance of trunk stabilizer muscles (p=0.05) and quality of life (SIS, p=0.263). Additionally, the findings obtained from the quantitative data were supported by qualitative interviews conducted with the patients after the exercise programs. In addition, patients' experiences with telerehabilitation and face-to-face exercise programs were explored through qualitative interviews and the advantages and disadvantages of both methods were determined. In line with all these findings, it was concluded that telerehabilitation-based spinal stabilization exercises would have positive effects on physical activity level, fatigue, functional capacity, trunk impairment, endurance of trunk stabilizer muscles and quality of life in chronic stroke patients. In addition, it was concluded that telerehabilitation-based spinal stabilization exercises could be preferred as an alternative to face-to-face spinal stabilization exercises.