Kinesiophobia Associated With Fatigue in Patients With Multiple Sclerosis.

This study is planned as a descriptive cross-sectional investigation. In this cross-sectional study, the study population will consist of 352 patients diagnosed with multiple sclerosis (MS) who present to the Physical Medicine and Rehabilitation and Neurology outpatient clinics of Dokuz Eylul University Faculty of Medicine and meet the inclusion criteria. Patients who are evaluated according to the inclusion and exclusion criteria and enrolled in the study will be asked to complete the planned questionnaires after providing written informed consent.

Demographic characteristics including age, height, weight, occupation, and educational status will be recorded. In addition, clinical data such as year of MS diagnosis, disease type and site of involvement, family history of MS, use of assistive devices, presence of comorbidities, current medications and duration of medication use, history of medication use for spasticity, smoking and alcohol consumption, and participation in physical therapy and rehabilitation programs will be documented. A musculoskeletal system examination will be performed for all patients, and spasticity levels, if present, will be recorded according to the Modified Ashworth Scale (MAS). Expanded Disability Status Scale (EDSS) scores will also be recorded.

The Timed 25-Foot Walk Test will be performed for each patient. Additionally, the Functional Ambulation Scale (FAS), Visual Analog Scale (VAS) for pain, VAS for sleep, Tampa Scale for Kinesiophobia-Fatigue, International Physical Activity Questionnaire, and Hospital Anxiety and Depression Scale will be completed for all patients. Levels of fatigue-related kinesiophobia will be assessed using the Tampa Scale for Kinesiophobia-Fatigue. This scale consists of 17 items, each rated on a 4-point Likert scale ranging from "strongly disagree" to "strongly agree." Total scores range from 17 to 68, with higher scores indicating greater levels of kinesiophobia.

The Modified Ashworth Scale is a 6-point scale used to determine the severity of spasticity. Pain intensity and sleep quality will be evaluated using the Visual Analog Scale (VAS), which consists of a 100-mm horizontal line. Patients will be asked to mark the point on the scale that best represents their pain intensity and sleep quality. The Functional Ambulation Scale (FAS) is a classification system used to assess functional ambulation capacity and is scored from 0 to 5.

Physical activity levels will be assessed using the International Physical Activity Questionnaire-Short Form (IPAQ-SF), which consists of seven questions addressing physical activities performed for at least 10 minutes during the previous week. The Hospital Anxiety and Depression Scale will be used to assess anxiety and depression levels in patients. The Timed 25-Foot Walk Test will be used to evaluate mobility, balance, and lower extremity function.

Inclusion criteria

Age between 18 and 65 years, EDSS (Expanded Disability Status Scale) score ≤ 6, Mini-Mental State Examination score ≥ 24, Diagnosis of multiple sclerosis according to the 2017 revised McDonald criteria, Willingness to participate in the study.

Exclusion criteria

Experiencing an MS relapse within the past 3 months, Having undergone a change in MS treatment within the past 3 months, EDSS (Expanded Disability Status Scale) score > 6, Presence of another neurodegenerative disease in addition to MS, Presence of psychiatric, neurological, or other chronic diseases (other than MS) that may affect cognitive functions, Presence of orthopedic or rheumatologic diseases (other than MS) that may affect functional ambulation, Refusal to participate in the study.