Effect of the Synchronized Telerehabilitation-Based Upper Extremity Training Program on Hand-Arm Functions in People With Multiple Sclerosis

Abstract

Background: Between 60 % and 75 % of people with MS (PwMS) report having upper extremity dysfunction. Synchronized telerehabilitation offers immediate feedback and personalized treatment beyond standard clinical services. Objectives: To evaluate the effects of an 8-week synchronized telerehabilitation-based upper extremity training program on hand-arm function in PwMS and compare these effects with an asynchronous treatment group. Method: The Synchronized group (n=12) received online upper extremity exercises twice a week from a physiotherapist. The Asynchronous group (n=13) performed the same exercises via instructional videos. All participants were assessed at baseline and after 8 weeks using the Nine-Hole Peg Test (N-HPT), JAMAR Hand Dynamometer, and the Arm Function Questionnaire for Multiple Sclerosis (AMSQ). Additionally, quality of life, fatigue, physical activity, participation, and pain were evaluated using various validated scales and questionnaires. Results: The Synchronized group showed significant improvements in the N-HPT, JAMAR Hand Dynamometer scores, and the AMSQ after 8 weeks (p<0.05). Specifically, the synchronized group demonstrated a marked reduction in the time to complete the N-HPT, indicating enhanced dexterity and coordination. The JAMAR Hand Dynamometer scores revealed substantial gains in grip strength, suggesting improved muscle function. Patient-reported outcomes from the AMSQ indicated better perceived upper extremity functionality. Furthermore, the synchronized group experienced a significant reduction in fatigue levels (p<0.05) and an increase in quality of life and participation in daily activities (p<0.05). However, both the synchronized and asynchronous groups did not show significant changes in pain levels (p>0.05). The Asynchronous group also displayed improvements in upper extremity function, but these were less pronounced compared to the synchronized group. Conclusion: The results show that synchronized-based telerehabilitation training performed with a physiotherapist is an effective method on hand-arm function. In addition, synchronized training seems to be effective on fatigue, quality of life and participation in PwMS,