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Multiple Sclerosis: Walking performance, Statistical analysis

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Each motor and cognitive performance of the patients were evaluated by functional tests in a clinical environment. Patients were also asked to evaluate their performance during daily activities using self-reported questionnaires.

Postural stability: The posturography was used to assess postural sway and sensory interaction. The patients were asked to stand on both feet for 30 seconds under altered sensory conditions, which are: 1. Eyes open-firm surface, 2. Eyes closed-firm surface; 3. Eyes open-foam surface, 4. Eyes closed-foam surface.

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Berg Balance Scale: The BBS assesses clinically static and dynamic balance ability via 14 different functional activities. Each item is scored from 0 (the lowest level) to 4 (highest level) and the total maximum score is 56.

Activities-specific Balance Confidence: In ABC scale, the patients rate their perceived level of balance confidence during 16 different ambulatory activities between 0 (no confidence) and 100. The Turkish version of the scale was used in this study.

Timed Up and Go test: Functional mobility was evaluated using TUG. The patients were asked to stand up from a chair, walk 3 m, turn around and sit on the chair. The test duration was recorded in seconds using the stopwatch.

The Functional Gait Assessment: FGA is a clinical gait test including 10 items: walk at normal speeds, at fast and slow speeds, with vertical and horizontal head turns, with eyes closed, over obstacles, in tandem, backward, and while ascending and descending stairs. Each item is scored from 0 (severe impairment) to 3.

The 12-item Multiple Sclerosis Walking Scale: MSWS-12 is a self-assessment scale and assesses the impacts of MS on walking ability during the last 2 weeks. Each item is scored from 1 to 5.

International Physical Activity Questionnaire (IPAQ): The long version of IPAQ was used to assess total physical activity in different domains (job-related, transport-related, domestic and leisure-time physical activity) and intensities (moderate, vigorous, walking) during the last week. The Turkish version of the scale was used in this study. The Nine Hole Peg Test: NHPT assesses manual dexterity of both the dominant and non-dominant hands. The patient picks up the nine pegs one at a time as quickly as possible, puts them in the nine holes, and then removes them again as quickly as possible one at a time. The test duration was recorded in seconds using the stopwatch.

Brief Repeatable Battery of Neuropsychological Tests: Cognitive performance was assessed by BRB-N. The battery assesses the cognitive domains and includes the following tests: 10/36 Spatial Recall Test, for visual memory acquisition and delayed recall; Selective Reminding Test (SRT), for verbal memory acquisition and delayed recall; Word List Generation, for semantic verbal fluency; The Symbol Digit Modalities Test and Paced Auditory Serial Addition Test (PASAT-3) for attention, concentration, and speed of information processing.

Neuropsychological Questionnaire: Multiple Sclerosis Neuropsychological Questionnaire (MSNQ) is a 15-item self-report measure of perceived neuropsychological impairment. The items include attention and processing speed, memory, and other cognitive functions in everyday life. The Turkish version of the scale was used in this study.

Statistical analysis was performed using the SPSS software version 15. The variables were determined by the measurement (histograms, probability plots, Shapiro-Wilk test) and was expressed as the median and Interquartile Range because of non-normal distribution . Chi-square test was used to compare categorical variables between the groups. The Mann-Whitney U Test was used to compare baseline values between the groups. The pre-training and post-training measurements were compared with the Wilcoxon Test.

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