Virtual Reality-based Motor Imagery in Patients With Fibromyalgia

Pain during rest and activity will be assessed using the VAS. The VAS is a 10-cm scale where 0 points indicate 'no pain' and 10 points indicate 'the worst pain imaginable'. Participants will be asked to mark the scale based on their assessment of pain intensity over the past 24 hours. Pain intensity will be measured using the scale and recorded in centimetres.

Pain during rest and activity will be assessed using the VAS. The VAS is a 10-cm scale where 0 points indicate 'no pain' and 10 points indicate 'the worst pain imaginable'. Participants will be asked to mark the scale based on their assessment of pain intensity over the past 24 hours. Pain intensity will be measured using the scale and recorded in centimetres.

An algometer will be used to assess the pressure pain threshold. During the assessment, tender points at the occipital base, lower cervical region, trapezius, supraspinatus, second costochondral joint, lateral epicondyle and medial knee border will be measured bilaterally. In addition, the patient will be asked to stand upright so that the tender points of the gluteus and greater trochanter can also be assessed. Each measurement will be repeated three times bilaterally, and the average of the values obtained will be recorded.

An algometer will be used to assess the pressure pain threshold. During the assessment, tender points at the occipital base, lower cervical region, trapezius, supraspinatus, second costochondral joint, lateral epicondyle and medial knee border will be measured bilaterally. In addition, the patient will be asked to stand upright so that the tender points of the gluteus and greater trochanter can also be assessed. Each measurement will be repeated three times bilaterally, and the average of the values obtained will be recorded.

Galvanic skin response is an important physiological parameter that measures changes in the electrical conductivity of the skin surface and reflects sympathetic nervous system activity. It is frequently used as a non-invasive, reliable and sensitive method for assessing autonomic nervous system responses. In this study, galvanic skin response measurements will be carried out using a galvanic skin response sensor to be acquired as part of the project, with the aim of objectively evaluating the effects of a virtual reality-based motor imagery intervention on autonomic physiological responses. The galvanic skin response will be recorded.

Galvanic skin response is an important physiological parameter that measures changes in the electrical conductivity of the skin surface and reflects sympathetic nervous system activity. It is frequently used as a non-invasive, reliable and sensitive method for assessing autonomic nervous system responses. In this study, galvanic skin response measurements will be carried out using a galvanic skin response sensor to be acquired as part of the project, with the aim of objectively evaluating the effects of a virtual reality-based motor imagery intervention on autonomic physiological responses. The galvanic skin response will be recorded .

The Central Sensitivity Inventory is a patient-completed questionnaire used to assess the severity of central sensitivity symptoms associated with chronic pain. The questionnaire consists of 9 items, each of which examines pain and associated symptoms originating from the central nervous system. High scores on the scale indicate that symptoms of central sensitisation are more pronounced and severe; low scores, on the other hand, indicate a milder level of central sensitisation.

The Central Sensitivity Inventory is a patient-completed questionnaire used to assess the severity of central sensitivity symptoms associated with chronic pain. The questionnaire consists of 9 items, each of which examines pain and associated symptoms originating from the central nervous system. High scores on the scale indicate that symptoms of central sensitisation are more pronounced and severe; low scores, on the other hand, indicate a milder level of central sensitisation.

A 13-item self-report instrument that assesses individuals' catastrophising regarding pain, i.e. their negative cognitive and emotional responses. The scale covers the dimensions of pain exaggeration, feelings of helplessness and persistent negative thoughts. A high score is associated with an intensified perception of pain in patients with chronic pain .

A 13-item self-report instrument that assesses individuals' catastrophising regarding pain, i.e. their negative cognitive and emotional responses. The scale covers the dimensions of pain exaggeration, feelings of helplessness and persistent negative thoughts. A high score is associated with an intensified perception of pain in patients with chronic pain

The Revised Fibromyalgia Impact Questionnaire is used to assess the overall impact of fibromyalgia on a patient's daily life, functional status and symptom burden. It is a reliable and valid tool for monitoring disease severity and response to treatment in both clinical practice and research. The scale consists of three sub-sections: functional status, overall impact and symptoms, and contains a total of 21 items. Items are scored on a scale of 0-10, and the sub-sections are adjusted using specific weightings to produce an overall score out of 100. A higher score is associated with a more severe clinical presentation and a lower quality of life.

The Revised Fibromyalgia Impact Questionnaire is used to assess the overall impact of fibromyalgia on a patient's daily life, functional status and symptom burden. It is a reliable and valid tool for monitoring disease severity and response to treatment in both clinical practice and research. The scale consists of three sub-sections: functional status, overall impact and symptoms, and contains a total of 21 items. Items are scored on a scale of 0-10, and the sub-sections are adjusted using specific weightings to produce an overall score out of 100. A higher score is associated with a more severe clinical presentation and a lower quality of life.

The Hospital Anxiety and Depression Scale is used to measure patients' levels of anxiety and depression. It is a self-report scale comprising a total of 14 items. Seven items assess anxiety levels, whilst the other seven assess depression levels. Each item is scored on a scale of 0 to 3 using a 4-point Likert-type scale. The cut-off value is set at 10 for anxiety and 7 for depression.

The Hospital Anxiety and Depression Scale is used to measure patients' levels of anxiety and depression. It is a self-report scale comprising a total of 14 items. Seven items assess anxiety levels, whilst the other seven assess depression levels. Each item is scored on a scale of 0 to 3 using a 4-point Likert-type scale. The cut-off value is set at 10 for anxiety and 7 for depression.

The Pittsburgh Sleep Quality Index will be used to assess sleep quality over the past month. It consists of a total of 24 questions, 18 of which are answered by the individual, and the assessment is based on seven components: subjective sleep quality, time taken to fall asleep, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime functional impairment. Each item is scored on a scale of 0-3, and the sum of the component scores forms the overall sleep quality score. The total score ranges from 0 to 21, with higher scores indicating poorer sleep quality.

The Pittsburgh Sleep Quality Index will be used to assess sleep quality over the past month. It consists of a total of 24 questions, 18 of which are answered by the individual, and the assessment is based on seven components: subjective sleep quality, time taken to fall asleep, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime functional impairment. Each item is scored on a scale of 0-3, and the sum of the component scores forms the overall sleep quality score. The total score ranges from 0 to 21, with higher scores indicating poorer sleep quality.

The Fatigue Severity Scale assesses individuals' levels of fatigue over the past month. It is a 9-item self-report instrument. Each item is scored on a scale of 1 to 7, with higher scores indicating greater fatigue severity .

The Fatigue Severity Scale assesses individuals' levels of fatigue over the past month. It is a 9-item self-report instrument. Each item is scored on a scale of 1 to 7, with higher scores indicating greater fatigue severity.

Following completion of the exercise programme, patients will be asked to assess changes in their symptoms before and after treatment. The 7-point Likert-scale PGPCS will be used to subjectively measure patients' response to treatment. The scale allows patients to rate changes in their general health status as follows: 1) improved considerably, 2) improved a lot, 3) improved slightly, 4) no change, 5) slightly worse, 6) worse, 7) much worse. It is widely used in clinical trials and routine practice to assess patients' response to treatment quickly and effectively.

Following completion of the exercise programme, patients will be asked to assess changes in their symptoms before and after treatment. The 7-point Likert-scale PGPCS will be used to subjectively measure patients' response to treatment. The scale allows patients to rate changes in their general health status as follows: 1) improved considerably, 2) improved a lot, 3) improved slightly, 4) no change, 5) slightly worse, 6) worse, 7) much worse. It is widely used in clinical trials and routine practice to assess patients' response to treatment quickly and effectively.

The Kinesthetic and Visual Imagery Questionnaire aims to determine the extent to which individuals can visualise and kinesthetically perceive the movements they imagine. All items are administered whilst the participant is seated and consist of two subscales: visual imagery and kinesthetic imagery. In the Kinesthetic and Visual Imagery Questionnaire, each item is scored on a scale of 1-5 (1 = no sensation/image, 5 = as intense as if performing the movement/as clear as the real thing), with the total score ranging from 10 to 50; higher scores indicate better imagery ability.

The Kinesthetic and Visual Imagery Questionnaire aims to determine the extent to which individuals can visualise and kinesthetically perceive the movements they imagine. All items are administered whilst the participant is seated and consist of two subscales: visual imagery and kinesthetic imagery. In the Kinesthetic and Visual Imagery Questionnaire, each item is scored on a scale of 1-5 (1 = no sensation/image, 5 = as intense as if performing the movement/as clear as the real thing), with the total score ranging from 10 to 50; higher scores indicate better imagery ability.