Romatizmal hastalığı olan bireylerde telerehabilitasyon yoluyla biyopsikososyal egzersiz modeli
Year 2026,
Volume: 13 Issue: 1
,
1
-
10
,
16.04.2026
Zeynep İrem Bulut
,
Nur Banu Karaca
,
Yavuz Yakut
,
Sevim Öksüz
,
Sedat Kiraz
,
Edibe Ünal
Abstract
Amaç: Bu çalışmanın amacı, COVID-19 salgını sırasında romatizmalı bireylerde telerehabilitasyon yoluyla uygulanan biyopsikososyal egzersiz modelinin etkilerini araştırmaktı.
Yöntem: Romatizmal hastalığı olan bireylere sosyal mesajlaşma programı aracılığıyla 24 hafta boyunca haftada 3 seans telerehabilitasyon uygulandı. Müdahale seansları 10 dakikalık dans terapisi-otantik hareket, 40 dakikalık egzersiz ve 10 dakikalık dans terapisinden oluşuyordu. Bu egzersiz içeriği, çalışmada kullanılan Bilişsel Egzersiz Terapi Yaklaşımı (BETY) olarak adlandırılan ve hastaların pandemiden önce de uyguladığı bir yöntem olan biyopsikososyal modele dayanıyordu. Yetiyitimi düzeyini değerlendirmek için Sağlık Değerlendirme Anketi (HAQ), duygudurum etkilenimini değerlendirmek için Hastane Anksiyete ve Depresyon Ölçeği (HADS) ve biyopsikososyal düzey etkilenimini değerlendirmek için BETY Biyopsikososyal Anketi (BETY-BQ) kullanıldı. Değerlendirmeler çalışmanın başında yapıldı ve 12. ve 24. haftalarda tekrarlandı.
Bulgular: Çalışmaya toplamda 28 romatizmal hastalığı olan birey dahil edildi ve yaş ortalamaları 56,50 ± 5,51 yıldı. HAQ'nun birinci ve ikinci değerlendirmesi arasında artan (p= 0,031), BETY-BQ'nun birinci ve ikinci değerlendirmesi arasında azalan (p= 0,004) ve üçüncü ve birinci değerlendirmesi arasında artan (p= 0,015) anlamlı fark bulundu.
Sonuç: BETY'nin telerehabilitasyon ile uygulanması yetiyitimi, duygudurum düzeyi ve biyopsikososyal açıdan bireylerin daha önce kazanmış oldukları iyileşme düzeyinin korunmasına yardımcı oldu. Bu sonuçlar, biyopsikososyal egzersiz yaklaşımları yüzyüze deneyimlendikten sonra romatizmal hastalığı olan bireyler sağlıklarını desteklemek için telerehabilitasyon yoluyla uzaktan uygulamayı sürdürebileceklerini göstermektedir.
Ethical Statement
Bu çalışma Helsinki Bildirgesi ilkeleri doğrultusunda gerçekleştirildi. Hacettepe Üniversitesi Etik Kurulu'ndan onay alındı (GO-18/1182).
References
-
Guaracha-Basáñez GA, Contreras-Yáñez I, Hernández-Molina G, et al. Quality of life of patients with rheumatic diseases during the COVID-19 pandemic: The biopsychosocial path. PLoS One. 2022;17:e0262756.
-
Hider S, Muller S, Gray L, et al. Exploring the longer-term impact of the COVID-19 pandemic on physical and mental health of people with inflammatory rheumatic diseases: a cross-sectional survey. Clin Rheumatol. 2023;42:1903-1909.
-
Pinto AJ, Dunstan DW, Owen N, et al. Combating physical inactivity during the COVID-19 pandemic. Nat Rev Rheumatol. 2020;16:347-348.
-
Reinoso-Cobo A, Ortega-Avila AB, Pineda-Galan C, et al. Follow-up of health-related quality of life and pain in a cohort of patients with rheumatoid arthritis before and after COVID-19. Foot Ankle Surg. 2023;29:616-620.
-
Eriksen TE, Dinesen WKH, Uhrenholt L, et al. Isolation in patients with inflammatory rheumatic diseases during COVID-19 pandemic compared to healthy individuals: a questionnaire survey. Rheumatol Int. 2022;42:783-790.
-
Ceravolo MG, de Sire A, Andrenelli E, et al. Systematic rapid "living" review on rehabilitation needs due to COVID-19: update to March 31st, 2020. Eur J Phys Rehabil Med. 2020;56:347-353.
-
Niknejad N, Ismail W, Bahari M, et al. Understanding Telerehabilitation Technology to Evaluate Stakeholders' Adoption of Telerehabilitation Services: A Systematic Literature Review and Directions for Further Research. Arch Phys Med Rehabil. 2021;102:1390-1403.
-
Nikiphorou E, Santos EJF, Marques A, et al. 2021 EULAR recommendations for the implementation of self-management strategies in patients with inflammatory arthritis. Ann Rheum Dis. 2021;80:1278-1285.
-
Cottrell MA, Galea OA, O'Leary SP, et al. Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: a systematic review and meta-analysis. Clin Rehabil. 2017;31:625-638.
-
Latif-Zade T, Tucci B, Verbovetskaya D, et al. Systematic Review Shows Tele-Rehabilitation Might Achieve Comparable Results to Office-Based Rehabilitation for Decreasing Pain in Patients with Knee Osteoarthritis. Medicina (Kaunas). 2021;57:764.
-
Wu YQ, Long Y, Peng WJ, et al. The Efficacy and Safety of Telerehabilitation for Fibromyalgia: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Internet Res. 2023;25:e42090
-
de Thurah A, Bosch P, Marques A, et al. 2022 EULAR points to consider for remote care in rheumatic and musculoskeletal diseases. Ann Rheum Dis. 2022;81:1065-1071.
-
Fragoulis GE, Edelaar L, Vliet Vlieland TPM, et al. Development of generic core competences of health professionals in rheumatology: a systematic literature review informing the 2019 EULAR recommendations. RMD Open. 2019;5:e001028.
-
Karaca NB, Ünal E, Karakaya J, et al. Effectiveness of a supervised group exercise therapy based on the biopsychosocial model introduced simultaneously with anti-TNF therapy in anti-TNF-naive patients with active ankylosing spondylitis. Turk J Med Sci. 2022;52:667-676.
-
Kisacik P, Unal E, Akman U, et al. Investigating the effects of a multidimensional exercise program on symptoms and antiinflammatory status in female patients with ankylosing spondylitis. Complement Ther Clin Pract. 2016;22:38-43.
-
Unal E, Karaca NB, Saldirdak GA, et al. Investigation of the Effectiveness of a Biopsychosocial-Based Exercise Approach in Rheumatic Diseases: A Mixed Methods Research With Patients' Perspectives. J Eval Clin Pract. 2025;31:e70033.
-
Tüfekçi O, Ünal E, Aktaş BE, et al. Do functionality, strength, vascularization, inflammatory and biopsychosocial status improve by biopsychosocial model-based exercise in SSc?. Rheumatology. 2025;64:1940-1948.
-
Ünal E, Arın G, Karaca NB, et al. Development of a quality of life measurement for rheumatic patients: item pool construction. J Exerc Ther Rehabil. 2017;4:67-75.
-
Zahid M, Unal E, Özdemir Işık Ö, et al. The reliability, validity, and responsiveness of Cognitive Exercise Therapy Approach-Biopsychosocial Questionnaire for patients with fibromyalgia. Int J Rheum Dis. 2022;25:685-691.
-
Bulut S, Karakaya J, Oksuz S, et al. The reliability, validity, and responsiveness of Cognitive Exercise Therapy Approach: Biopsychosocial Questionnaire for patients with psoriatic arthritis. Rheumatol Int. 2022;42:1973-1981.
-
Verep U, Unal E, Oksüz S, et al. A new biopsychosocial questionnaire (BETY-BQ) for patients with ankylosing spondylitis. Eur J Integr Med. 2023;61:102267.
-
Ahıskalı GN, Tüfekçi O, Karaca NB, et al. A biopsychosocial questionnaire for patients with primary Sjögren's syndrome: The BETY-Biopsychosocial Questionnaire. Mod Rheumatol. 2025;35:326-331.
-
Demirtekin M, Yardımcı GK, Avcı H, et al. The validity, reliability, and responsiveness of a new biopscyhosocial questionnaire for patients with systemic lupus erythematosus. Curr Med Res Opin. 2024;40:1245-1252.
-
Bulut, ZI, Unal E, Oksuz, S. et al. Validity, Reliability and Responsiveness of the Cognitive Exercise Therapy Approach-Biopsychosocial Questionnaire (BETY-BQ) in Knee Osteoarthritis. Indian J Orthop. 2025;59:521-529.
-
Fries JF, Spitz PW, Young DY. The dimensions of health outcomes: the health assessment questionnaire, disability and pain scales. J Rheumatol. 1982;9:789-793.
-
Janssens X, Decuman S, De Keyser F, et al. Assessment of activity limitations with the health assessment questionnaire predicts the need for support measures in patients with rheumatoid arthritis: a multicenter observational study. PLoS One. 2014;9:e106749.
-
Snaith RP. The Hospital Anxiety And Depression Scale. Health Qual Life Outcomes. 2003;1:29.
-
Aydemir O, Güvenir T, Küey L, et al. Reliability and Validity of the Turkish version of Hospital Anxiety and Depression Scale. Turk J Psychiatry 1997;8:280-287.
-
Seron P, Oliveros MJ, Gutierrez-Arias R, et al. Effectiveness of Telerehabilitation in Physical Therapy: A Rapid Overview. Phys Ther. 2021;101:pzab053.
-
Nanda U, Luo J, Wonders Q, et al. Telerehabilitation for Pain Management. Phys Med Rehabil Clin N Am. 2021;32:355-372.
-
Çağlayan BÇ, Keskin A, Gür Kabul E, et al. Effects of clinical Pilates exercises in individuals with fibromyalgia: A randomized controlled trial. Eur J Rheumatol. 2021;8:150-155.
-
Xie SH, Wang Q, Wang LQ, et al. Effect of Internet-Based Rehabilitation Programs on Improvement of Pain and Physical Function in Patients with Knee Osteoarthritis: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Internet Res. 2021;23:e21542.
-
Nelligan RK, Hinman RS, Kasza J, et al. Effects of a Self-directed Web-Based Strengthening Exercise and Physical Activity Program Supported by Automated Text Messages for People With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA Intern Med. 2021;181:776-785.
-
van den Berg MH, Ronday HK, Peeters AJ, et al. Using internet technology to deliver a home-based physical activity intervention for patients with rheumatoid arthritis: A randomized controlled trial. Arthritis Rheum. 2006;55:935-45.
-
Hernando-Garijo I, Ceballos-Laita L, Mingo-Gómez MT, et al. Immediate Effects of a Telerehabilitation Program Based on Aerobic Exercise in Women with Fibromyalgia. Int J Environ Res Public Health. 2021;18:2075.
Biopsychosocial exercise model via telerehabilitation in individuals with rheumatic disease
Year 2026,
Volume: 13 Issue: 1
,
1
-
10
,
16.04.2026
Zeynep İrem Bulut
,
Nur Banu Karaca
,
Yavuz Yakut
,
Sevim Öksüz
,
Sedat Kiraz
,
Edibe Ünal
Abstract
Purpose: The aim of this study was to investigate the effects of the biopsychosocial exercise model applied via telerehabilitation on individuals with rheumatism during the COVID-19 epidemic.
Methods: Individuals with rheumatic diseases received telerehabilitation 3 times a week for 24 weeks via a social messaging program intervention sessions formed from 10 minutes of dance therapy-authentic movement, 40 minutes of exercises, and 10 minutes of dance therapy. This exercise content was based on the biopsychosocial model, named as Cognitive Exercise Therapy Approach (BETY) which was a method that individuals had already practiced before the pandemic. The Health Assessment Questionnaire (HAQ) was used to assess the level of disability, the Hospital Anxiety and Depression Scale (HADS) was used to assess mood involvement, and the BETY Biopsychosocial Questionnaire (BETY-BQ) was used to assess biopsychosocial involvement level. Evaluations were made at the beginning of the study and repeated at the 12th and 24th weeks.
Results: A total of 28 individuals with rheumatic diseases were included in the study and their mean age was 56.50 ± 5.51 years.
There was a significant difference between the first and second assessment of HAQ (p= 0.031), between the first and second assessment of BETY-BQ (p= 0.004) and between the third and first assessment (p= 0.015).
Conclusion: The application of BETY with telerehabilitation helped individuals maintain the level of recovery they had previously achieved in terms of disability, mood level and biopsychosocial. These results indicate that individuals with rheumatic diseases can continue the remote application via telerehabilitation to support their health after experiencing biopsychosocial exercise approaches face-to-face.
Ethical Statement
This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Hacettepe University (GO-18/1182).
Supporting Institution
none
References
-
Guaracha-Basáñez GA, Contreras-Yáñez I, Hernández-Molina G, et al. Quality of life of patients with rheumatic diseases during the COVID-19 pandemic: The biopsychosocial path. PLoS One. 2022;17:e0262756.
-
Hider S, Muller S, Gray L, et al. Exploring the longer-term impact of the COVID-19 pandemic on physical and mental health of people with inflammatory rheumatic diseases: a cross-sectional survey. Clin Rheumatol. 2023;42:1903-1909.
-
Pinto AJ, Dunstan DW, Owen N, et al. Combating physical inactivity during the COVID-19 pandemic. Nat Rev Rheumatol. 2020;16:347-348.
-
Reinoso-Cobo A, Ortega-Avila AB, Pineda-Galan C, et al. Follow-up of health-related quality of life and pain in a cohort of patients with rheumatoid arthritis before and after COVID-19. Foot Ankle Surg. 2023;29:616-620.
-
Eriksen TE, Dinesen WKH, Uhrenholt L, et al. Isolation in patients with inflammatory rheumatic diseases during COVID-19 pandemic compared to healthy individuals: a questionnaire survey. Rheumatol Int. 2022;42:783-790.
-
Ceravolo MG, de Sire A, Andrenelli E, et al. Systematic rapid "living" review on rehabilitation needs due to COVID-19: update to March 31st, 2020. Eur J Phys Rehabil Med. 2020;56:347-353.
-
Niknejad N, Ismail W, Bahari M, et al. Understanding Telerehabilitation Technology to Evaluate Stakeholders' Adoption of Telerehabilitation Services: A Systematic Literature Review and Directions for Further Research. Arch Phys Med Rehabil. 2021;102:1390-1403.
-
Nikiphorou E, Santos EJF, Marques A, et al. 2021 EULAR recommendations for the implementation of self-management strategies in patients with inflammatory arthritis. Ann Rheum Dis. 2021;80:1278-1285.
-
Cottrell MA, Galea OA, O'Leary SP, et al. Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: a systematic review and meta-analysis. Clin Rehabil. 2017;31:625-638.
-
Latif-Zade T, Tucci B, Verbovetskaya D, et al. Systematic Review Shows Tele-Rehabilitation Might Achieve Comparable Results to Office-Based Rehabilitation for Decreasing Pain in Patients with Knee Osteoarthritis. Medicina (Kaunas). 2021;57:764.
-
Wu YQ, Long Y, Peng WJ, et al. The Efficacy and Safety of Telerehabilitation for Fibromyalgia: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Internet Res. 2023;25:e42090
-
de Thurah A, Bosch P, Marques A, et al. 2022 EULAR points to consider for remote care in rheumatic and musculoskeletal diseases. Ann Rheum Dis. 2022;81:1065-1071.
-
Fragoulis GE, Edelaar L, Vliet Vlieland TPM, et al. Development of generic core competences of health professionals in rheumatology: a systematic literature review informing the 2019 EULAR recommendations. RMD Open. 2019;5:e001028.
-
Karaca NB, Ünal E, Karakaya J, et al. Effectiveness of a supervised group exercise therapy based on the biopsychosocial model introduced simultaneously with anti-TNF therapy in anti-TNF-naive patients with active ankylosing spondylitis. Turk J Med Sci. 2022;52:667-676.
-
Kisacik P, Unal E, Akman U, et al. Investigating the effects of a multidimensional exercise program on symptoms and antiinflammatory status in female patients with ankylosing spondylitis. Complement Ther Clin Pract. 2016;22:38-43.
-
Unal E, Karaca NB, Saldirdak GA, et al. Investigation of the Effectiveness of a Biopsychosocial-Based Exercise Approach in Rheumatic Diseases: A Mixed Methods Research With Patients' Perspectives. J Eval Clin Pract. 2025;31:e70033.
-
Tüfekçi O, Ünal E, Aktaş BE, et al. Do functionality, strength, vascularization, inflammatory and biopsychosocial status improve by biopsychosocial model-based exercise in SSc?. Rheumatology. 2025;64:1940-1948.
-
Ünal E, Arın G, Karaca NB, et al. Development of a quality of life measurement for rheumatic patients: item pool construction. J Exerc Ther Rehabil. 2017;4:67-75.
-
Zahid M, Unal E, Özdemir Işık Ö, et al. The reliability, validity, and responsiveness of Cognitive Exercise Therapy Approach-Biopsychosocial Questionnaire for patients with fibromyalgia. Int J Rheum Dis. 2022;25:685-691.
-
Bulut S, Karakaya J, Oksuz S, et al. The reliability, validity, and responsiveness of Cognitive Exercise Therapy Approach: Biopsychosocial Questionnaire for patients with psoriatic arthritis. Rheumatol Int. 2022;42:1973-1981.
-
Verep U, Unal E, Oksüz S, et al. A new biopsychosocial questionnaire (BETY-BQ) for patients with ankylosing spondylitis. Eur J Integr Med. 2023;61:102267.
-
Ahıskalı GN, Tüfekçi O, Karaca NB, et al. A biopsychosocial questionnaire for patients with primary Sjögren's syndrome: The BETY-Biopsychosocial Questionnaire. Mod Rheumatol. 2025;35:326-331.
-
Demirtekin M, Yardımcı GK, Avcı H, et al. The validity, reliability, and responsiveness of a new biopscyhosocial questionnaire for patients with systemic lupus erythematosus. Curr Med Res Opin. 2024;40:1245-1252.
-
Bulut, ZI, Unal E, Oksuz, S. et al. Validity, Reliability and Responsiveness of the Cognitive Exercise Therapy Approach-Biopsychosocial Questionnaire (BETY-BQ) in Knee Osteoarthritis. Indian J Orthop. 2025;59:521-529.
-
Fries JF, Spitz PW, Young DY. The dimensions of health outcomes: the health assessment questionnaire, disability and pain scales. J Rheumatol. 1982;9:789-793.
-
Janssens X, Decuman S, De Keyser F, et al. Assessment of activity limitations with the health assessment questionnaire predicts the need for support measures in patients with rheumatoid arthritis: a multicenter observational study. PLoS One. 2014;9:e106749.
-
Snaith RP. The Hospital Anxiety And Depression Scale. Health Qual Life Outcomes. 2003;1:29.
-
Aydemir O, Güvenir T, Küey L, et al. Reliability and Validity of the Turkish version of Hospital Anxiety and Depression Scale. Turk J Psychiatry 1997;8:280-287.
-
Seron P, Oliveros MJ, Gutierrez-Arias R, et al. Effectiveness of Telerehabilitation in Physical Therapy: A Rapid Overview. Phys Ther. 2021;101:pzab053.
-
Nanda U, Luo J, Wonders Q, et al. Telerehabilitation for Pain Management. Phys Med Rehabil Clin N Am. 2021;32:355-372.
-
Çağlayan BÇ, Keskin A, Gür Kabul E, et al. Effects of clinical Pilates exercises in individuals with fibromyalgia: A randomized controlled trial. Eur J Rheumatol. 2021;8:150-155.
-
Xie SH, Wang Q, Wang LQ, et al. Effect of Internet-Based Rehabilitation Programs on Improvement of Pain and Physical Function in Patients with Knee Osteoarthritis: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Internet Res. 2021;23:e21542.
-
Nelligan RK, Hinman RS, Kasza J, et al. Effects of a Self-directed Web-Based Strengthening Exercise and Physical Activity Program Supported by Automated Text Messages for People With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA Intern Med. 2021;181:776-785.
-
van den Berg MH, Ronday HK, Peeters AJ, et al. Using internet technology to deliver a home-based physical activity intervention for patients with rheumatoid arthritis: A randomized controlled trial. Arthritis Rheum. 2006;55:935-45.
-
Hernando-Garijo I, Ceballos-Laita L, Mingo-Gómez MT, et al. Immediate Effects of a Telerehabilitation Program Based on Aerobic Exercise in Women with Fibromyalgia. Int J Environ Res Public Health. 2021;18:2075.