The Effect of Cognitive Exercise Therapy Approach in Individuals With Systemic Sclerosis

It is a 5-point Likert-type scale consisting of 30 questions developed with individuals with rheumatism. It is a practical scale that evaluates individuals in terms of fatigue and functionality, sleep, mood, sexuality, pain and sociability. Each question is scored as "0= never, 1=yes rarely, 2=yes sometimes, 3=yes often 4=yes always" and gives a total score over 30 items. A high score means a low biopsychosocial level. The total score is scored between 0-120

A method in which the skin firmness of the person is evaluated by holding the skin between two fingers and looking at the degree of stretching. It is a standard disease activity scoring applied in doctor's examinations for Systemic Sclerosis patients. It evaluates the skin hardness of 17 different parts of the body. 0= normal skin , 1= mild skin thickness, 2= moderate skin thickness, 3= severe skin thickness. A high score indicates increased skin thickness. The total score is scored between 0-51

SF-36 Quality of Life Scale; It is a 36-item, 11-question scale that allows general health screening with 8 sub-parameters consisting of general health, physical function, social function, pain, emotional well-being, role limitations due to physical health, role limitations due to emotional problems and vitality. It is a generic scale, Items are scored as '0 = worst health condition 100 = best health state'. Each subcategory is scored between 0 and 100 points, with a high score indicating good health.

Dressing and grooming, arising, eating, walking, hygiene, reach, grip and activities are evaluated with 20 items divided into eight areas. The answers given to each question range from "without any difficulty (0)", "with some difficulty (1)", "with much difficulty (2)" and "unable to do (3)". Afterwards, it is requested to show how Raynaud's phenomenon, digital ulcers, intestinal involvement, respiratory and overall disease severity affect the daily activity level on a 15 cm long section. The SHAQ-global score is formed by dividing the sum of the scores of these 8 parameters and 5 items by 13. High score indicates low functionality.

It is a method in which the hand functions of individuals are evaluated by a physiotherapist. It evaluates 4 different hand functions based on observation.

Questionnaire form-18 is a likert-type scale that evaluates different hand functions. It can score between 0-90. A high score means a low hand functions.

In order to evaluate the aerobic capacity of individuals, they will be toured for 6 minutes at a distance of 30 meters. The average 6MWT is between 400 and 700 meters.

Muscle strength assessment of knee joint flexor and extensor muscle group will be made with Biodex System Pro3® (Biodex Corp, Shirley, NY, USA) device. Before each measurement, patients will be tested 3 times, and knee flexor and extensor maximal concentric isokinetic muscle strength will be measured at 180°/sec 10 repetitions and 60°/sec 5 repetitions angular speeds, with a 30 sec rest interval after each angular velocity.

Doppler ultrasonography technique is an ultrasonography method that evaluates the blood flow passing through the lumens of the vascular structures in the body. In this method, flow velocity and resistance measurements can be made in vascular structures by measuring the changing return frequencies of sound waves sent from ultrasound probes to the tissues due to the movement of blood cells flowing in the vessel. In the study, the vascular status of the arteries on the forearm and palmar face will be examined by Doppler ultrasonography.

Examination of the cytokine profiles of the patients will be done before and after the treatment for Group 1, and for Group 2 at the initial and final evaluation. IL-6, IL-10, TNF-a and Irisin values, which are the cytokines that the literature focuses on in the pathophysiology of systemic sclerosis, will be checked by blood analysis with the same measurement units at Hacettepe University Central Laboratory.

It is a scale that evaluates anxiety and depression, which are psychological symptoms that can occur with diseases, with 14 items. Each question is scored between 0-3 points and a total score between 0 and 21 points can be obtained. A total score of 0-7 is considered normal, a score of 8-10 is considered borderline abnormal (borderline case), and a score of 11-21 is considered abnormal (case).

0-7 points are normal, 8-10 points are borderline abnormal (borderline case) and 11-21 points are abnormal (case) It is considered.