Effects of Face-to-Face Versus Telerehabilitation-Based Circuit Training in People With Multiple Sclerosis

Walking endurance will be assessed using the 6-Minute Walk Test. During the test, participants will be instructed to walk as far as possible for 6 minutes along a predefined, level course. At the end of the test, the total distance covered will be recorded in meters, and this value will reflect the individual's functional walking capacity and endurance. Any assistive device used by the participant, the need for rest, and the development of symptoms during the test will also be recorded.

Walking speed will be assessed using the Timed 25-Foot Walk Test. Participants will be instructed to walk a distance of 25 feet, approximately 7 meters, safely but as quickly as possible. The time required to complete the test will be recorded in seconds; a shorter completion time indicates better short-distance walking performance. This test will be used to objectively assess ambulation and lower-extremity function in individuals with MS.

Functional mobility will be assessed using the Timed Up and Go Test. The participant will begin in a seated position on a chair; upon command, the participant will stand up, walk a distance of 3 meters, turn around, return to the chair, and sit down. The time required to complete the test will be recorded in seconds. This test provides an integrated assessment of functional movements frequently used in daily life, including sit-to-stand, walking, turning, and sitting down.

Dynamic balance will be assessed using the Mini-BESTest. The Mini-BESTest consists of tasks involving anticipatory postural control, reactive postural responses, sensory orientation, and dynamic gait. The participant's ability to use different balance strategies, generate postural responses, and maintain stability during movement will be assessed. Each item will be scored according to performance, and the total score will provide information about the level of dynamic balance.

Lower-extremity functional muscle strength will be assessed using the Five Times Sit-to-Stand Test. Participants will be instructed to stand up from and sit down on a standard chair five consecutive times, preferably without using their arms. The time required to complete the test will be recorded in seconds. A shorter completion time will indicate better lower-extremity functional muscle strength and functional transfer performance. Participants will be observed for safety during the test, and the use of an assistive device will be recorded if necessary.

The patient-perceived impact on walking ability will be assessed using the MSWS-12. The scale consists of 12 items that assess the impact of MS on walking function based on patient-reported outcomes. Participants will rate the difficulties they have experienced while walking and the impact of these difficulties on their daily lives. Higher scores indicate a greater perceived limitation in walking due to MS.

Fatigue will be assessed using the Modified Fatigue Impact Scale. The MFIS is a patient-reported measure that assesses the physical, cognitive, and psychosocial impact of fatigue on daily life. Participants will indicate the extent to which fatigue has affected their activities, cognitive functioning, social life, and overall functioning. Higher total scores indicate a greater impact of fatigue on daily life.

Quality of life will be assessed using the MusiQoL. The MusiQoL is a patient-reported measure developed to assess MS-specific health-related quality of life. The questionnaire evaluates different dimensions of quality of life, including activities of daily living, psychological well-being, symptoms, relationships with friends, family relationships, coping, relationship with the health care system, and the overall impact of the disease on the individual. Higher scores indicate better perceived quality of life.

The physical and psychological impact of MS will be assessed using the MSIS-29. The scale consists of 29 items that assess the patient-reported impact of MS on daily life, physical functioning, mobility, emotional status, and overall well-being. The physical and psychological subscales can be evaluated separately. Higher total and subscale scores indicate a greater perceived impact of the disease on the individual.