Impact of Virtual Reality Physiotherapy on Multiple Sclerosis Patients

Modified Fatigue Impact Scale is a self-report questionnaire designed to assess the impact of fatigue on patients with multiple sclerosis (MS). It evaluates how fatigue affects physical, cognitive, and psychosocial functioning on daily life in MS patients. The MFIS consists of 21 items divided into three subscales: physical, cognitive, and psychosocial. Higher scores indicate a greater impact of fatigue. The total score is the sum of all item scores, with subscale scores calculated separately.

The administration time is approximately 5-10 minutes. It is typically self-administered, but can be conducted as an interview if necessary.

MSIS-29 is patient-reported outcome measure designed to assess the physical and psychological impact of multiple sclerosis on patients' lives. It consists of 29 items divided into two subscales:

• Physical Impact (20 items): Evaluates the physical limitations and challenges faced by MS patients.
• Psychological Impact (9 items): Assesses the emotional and cognitive effects of MS.

Each item is rated on a scale, with higher scores indicating a greater impact of MS. The total score is the sum of the physical and psychological subscale scores. The administration Time is approximately 10-15 minutes. It can be self-administered or conducted as an interview.

It will be measured using the Purdue Pegboard TEST (PPT). It is a performance-based assessment used to measure manual dexterity and fine motor skills. Assesses fine motor skills and coordination of the fingers, hands, and arms. The test involves a rectangular board with two sets of 25 holes and four concave cups at the top. Participants are asked to place small metal pegs into the holes as quickly as possible. The test includes five subtests: right hand, left hand, both hands, right + left + both hands (a calculated score), and an assembly task. Each subtest is timed, typically 30 seconds for the hand tasks and 60 seconds for the assembly task. The administration time is approximately 5-10 minutes. It will be conducted by a test administrator. The participant is seated during the test.

It will be evaluated through the Box and Block Test (BBT). It is designed to assess gross manual dexterity by measuring the ability to move small blocks from one compartment to another.The test involves a rectangular box divided into two equal compartments by a partition. One hundred and fifty small wooden blocks (2.5 cm each) are placed in one compartment. Participants are instructed to move as many blocks as possible, one at a time, from one compartment to the other within a 60-second period. The score is the number of blocks successfully transferred within the time limit. Higher scores indicate better manual dexterity. The administration time is approximately 2-5 minutes. The test will be administered with the participant seated at a table, and it will be conducted by a clinician or researcher.

It will be assessed using The Barthel Index (BI). It assesses the ability to perform activities of daily living (ADLs) independently. Evaluates the degree of assistance required by an individual to perform 10 basic ADLs, including feeding, bathing, grooming, dressing, bowel and bladder control, toilet use, transfers (e.g., from chair to bed), mobility, and stair climbing.

The index consists of 10 items, each scored on a scale that reflects the level of independence. The total score ranges from 0 to 100, with higher scores indicating greater independence.

Each activity is scored based on the amount of assistance required, with possible scores of 0 (dependent), 5 (needs some help), or 10 (independent) for most items. The total score is the sum of the individual item scores.The administration time is approximately 5-10 minutes.

It can be administered through direct observation, patient self-report, or interviews with caregivers.

It will be measured with the Lawton-Brody Instrumental Activities of Daily Living (IADL) Scale. It is a tool used to assess an individual's ability to perform complex daily activities necessary for independent living. Measures the ability to perform instrumental activities of daily living, which are more complex than basic self-care tasks.

The scale includes 8 items that assess activities such as using the telephone, shopping, food preparation, housekeeping, laundry, transportation, medication management, and handling finances.

Each item is scored based on the level of independence, with a total score ranging from 0 (low function, dependent) to 8 (high function, independent). For men, the score ranges from 0 to 5 to avoid gender bias.

The administration time is approximately 10-15 minutes. It can be administered through an interview or a written questionnaire, with responses provided by the patient or a caregiver familiar with the patient's abilities.

It will be assessed with the Montreal Cognitive Assessment (MoCA). It evaluates multiple cognitive domains to provide a comprehensive overview of an individual's cognitive abilities.

The MoCA includes tasks that measure attention and concentration, executive functions, memory, language, visuospatial skills, conceptual thinking, calculations, and orientation.

The test is scored out of 30 points, with higher scores indicating better cognitive function. A score of 26 or above is generally considered normal.

The administration time is approximately 10 minutes. It is administered as a paper-and-pencil test, it can be conducted by healthcare professionals.

It will be measured with the Multiple Sclerosis Quality of Life-54 (MSQOL-54). It is a comprehensive health-related quality of life measure specifically designed for individuals with multiple sclerosis (MS). Evaluates the overall quality of life in MS patients, covering physical, mental, and social health aspects.

Consists of 54 items, including 36 items from the SF-36 Health Survey and 18 additional items specific to MS. It generates 12 subscales and two summary scores.

Subscales: Physical function, role limitations (physical and emotional), pain, emotional well-being, energy, health perceptions, social function, cognitive function, health distress, overall quality of life, and sexual function.

Summary Scores: Physical health composite and mental health composite. The administration time is approximately 11-18 minutes. It can be self-administered questionnaire, but can also be conducted as an interview if necessary.