The Effect of the Physiotherapy Program for Diabetic Individuals on Dexterity, Proprioception, and Functionality

35 degrees wrist flexion and 45 degrees wrist extension will be taught to the patient, and the patient will be asked to bring the wrist to the same position with eyes closed, and the angle of deviation will be measured with a goniometer and recorded.

The 9-Hole Peg Test, which is a valid and reliable assessment method, will be used to evaluate the hand and finger dexterity of the patients. Randomly placing 9 wooden pins on the 9-hole wooden block as quickly as possible and then removing the pins one by one from the wooden block and placing them in the storage section will be recorded by measuring with a stopwatch. By calculating the total time, 20 seconds or more will be considered as a loss of skill.

The Quick Diasbilities of Arm, Shoulder and Hand (DASH) questionnaire will be used to determine the level and symptoms of physical disability in the upper extremity. Higher scores indicate higher disability in the upper extremity. The Michigan Hand Outcome Questionnaire is used to evaluate complaints in the hands of patients. It can evaluate each hand separately and was developed to evaluate the symptoms of all hand disorders. The parameters it evaluates respectively; function, daily activities, work performance, pain, aesthetics, satisfaction. A high score in the pain domain indicates worsening, and a high score in all other domains indicates a better condition. The total score is obtained by summing the results of the affected extremity or, if bilateral extremities are affected, by adding the mean scores of the areas and dividing by six. This questionnaire is valid and reliable for Turkish society.

Grip strength will be evaluated using the Jamar Dynamometer. The average of three attempts for each hand will be recorded in kilograms. This test is a reliable and valid test to evaluate manual grip strength.

Grip strength will be evaluated using the Jamar Pinchmeter. The average of three attempts for each hand will be recorded in kilograms. This test is a reliable and valid test to evaluate manual grip strength.

Mc Gill Pain Scale Short Form will be used in pain assessment. The scale consists of 3 sub-sections that evaluate the sensory and perceptual aspects of pain, the severity of pain, and whether there is currently pain. In the first part, there are 15 expressions describing pain and it is graded between 0 (absent) and 3 (severe). In the second part, the patient is expected to mark the severity of pain on a linear scale. In the third part, it evaluates whether the patient currently has pain, and if there is pain, its severity is evaluated with a visual comparison scale. The nature of neuropathic pain will be evaluated with the Neuropathic Pain Questionnaire Short Form (NPQ-SF). The NPQ-SF is a tool used to determine whether there is a complaint of neuropathic pain. It has 3 sub-parameters; tingling pain, increased pain and numbness from constant touch.

Two-point discrimination and light touch will be evaluated.

• Two-point separation; will be done using the discriminator. Two-point discrimination is made to determine the shortest distance that can be felt between two separate points on the skin. It is used to measure the fine work ability and sensitivity of the hand.
• Light touch; It will be evaluated with the Semmes-Weinstein Monofilament Test. The Semmes-Weinstein Monofilament kit consists of 20 nylon monofilament probes. It is a diagnostic test that objectively measures the touch threshold and is used to reveal the sensory level.

Myoton PRO device will be used to evaluate the viscoelastic properties of the muscle. Three measurements will be made by marking the muscles determined from the thenar (Abductor pollicis brevis) and hypothenar region (Abductor digiti minimi). Myoton PRO (Myoton AS, Tallinn, Estonia) is a handheld device that generates a mechanical impulse on the skin above the target structure. The measurement method implemented by Myoton PRO involves a mechanical pulse oscillating under a constant pressure. The oscillation of the tissue under the probe allows the viscoelastic properties of the tissue to be calculated.

Beck Depression Scale will be used to determine the level of depression. It was developed by Beck et al., and its validity and reliability study in our country was performed by Hisli. It contains a total of 21 self-evaluation sentences and is measured with a four-point Likert scale. Each item gets progressively increasing points between 0-3 and the total score varies between 0-63. The high total score indicates the high level of depression or its severity. In the Turkish validity and reliability study of the scale, the cut-off point was determined as 17. A study of the cut-off and psychometric properties of the Beck Depression Scale in the adult Turkish population Kapçı et al. made by. A total score of 0-10 = no depression, 11-17 = mild depression, 18-23 = moderate depression, 24 and above = severe depression.

Beck Anxiety Scale will be used to determine the level of anxiety. This scale is a Likert-type self-assessment scale consisting of 21 items and scored between 0-3. The high total score indicates the high level of anxiety experienced by the person. It was developed by Beck et al., and its validity and reliability study in our country was performed by Ulusoy et al.