Development, Reliability, and Validity of the Telerehabilitation Usability Questionnaire in Neurological Diseases

Yıl 2025, Cilt: 14 Sayı: 1, 124 - 132, 23.03.2025

Kader Eldemir , Sefa Eldemir , Fettah Saygılı , Çağla Özkul , Merve Kasikci , Arzu Güçlü Gündüz

Öz

The purpose was to develop Telerehabilitation Usability Questionnaire (TrUQ) and evaluate its validity and reliability in neurological diseases.
Ninety-five people with Multiple Sclerosis, stroke, and Parkinson’s disease participated in this study. Content validity was assessed by an expert panel of 5 physiotherapist experienced in telerehabilitation. Construct validity was investigated using Confirmatory Factor Analysis (CFA) and Explanatory Factor Analysis (EFA). Test-retest reliability and Internal consistency were used to evaluate the reliability of the TrUQ.
A three-factor structure was determined based on EFA. Accordingly, three factors correspond to three subscales, on the TrUQ: system availability, exercise feasibility, and telerehabilitation security. Furthermore, the model fits well according to CFA results: χ²/df = 1.573, CFI = 0.925, IFI = 0.929, GFI = 0.909, and RMSEA = 0.078. The questionnaire was proven to have an acceptable reliability level (Cronbach’s alpha= 0.712) and it was found that all items were necessary. Finally, a 10-item version was obtained, and TrUQ was shown to have acceptable test–retest reliability (ICC=645)
TrUQ is a valid and reliable questionnaire can be used to measure usability of the telerehabilitation systems in neurological diseases. Adaptation to different languages and diseases is recommended to be widely applicable.

Anahtar Kelimeler

Stroke, Multiple sclerosis, Parkinson’s disease, Telerehabilitation, Usability

Etik Beyan

Gazi University Ethics Commission approved the study (date.: 20/06/2023, numbered: 2023-815)

Destekleyen Kurum

No

Proje Numarası

None

Teşekkür

The authors are grateful to all the participants.

Nörolojik Hastalıklarda Telerehabilitasyon Kullanılabilirlik Anketinin Geliştirilmesi, Güvenilirliği ve Geçerliliği

Öz

Bu çalışmanın amacı, Telerehabilitasyon Kullanılabilirlik Anketini (TrKA) geliştirmek ve nörolojik hastalıklarda geçerliliğini ve güvenilirliğini değerlendirmektir.
Çalışmaya Multipl Skleroz, inme ve Parkinson hastalığı olan toplam 95 katılımcı dahil edilmiştir. İçerik geçerliliği, telerehabilitasyon konusunda deneyimli 5 fizyoterapistten oluşan bir uzman paneli tarafından değerlendirilmiştir. Yapı geçerliliği, Açıklayıcı Faktör Analizi (EFA) ve Doğrulayıcı Faktör Analizi (CFA) kullanılarak incelenmiştir. Güvenilirlik ise iç tutarlılık ve test-tekrar test güvenilirliği ile değerlendirilmiştir.
EFA, TrKA'nın üç alt ölçekle ilişkili üç faktör yapısına sahip olduğunu ortaya koymuştur: sistem kullanılabilirliği, egzersiz uygulanabilirliği ve telerehabilitasyon güvenliği. CFA sonuçları, modelin iyi bir uyum sergilediğini göstermiştir (χ²/df = 1,573, CFI = 0,925, IFI = 0,929, GFI = 0,909, RMSEA = 0,078). TrKA, iç tutarlılık için 0.712 olan Cronbach alfa değeriyle kabul edilebilir bir güvenilirlik sergilemiş ve tüm maddelerin gerekli olduğu bulunmuştur. Sonuç olarak, 10 maddelik bir versiyon oluşturulmuş ve TrUQ'nun test-tekrar test güvenilirliğinin iyi olduğu tespit edilmiştir (ICC = 0,645).
TrKA, nörolojik hastalıklarda telerehabilitasyon sistemlerinin kullanılabilirliğini değerlendirmek için geçerli ve güvenilir bir araçtır. Daha geniş bir kullanım alanı için farklı dillere ve hastalıklara uyarlanması önerilmektedir.

Anahtar Kelimeler

İnme, Multipl skleroz, Parkinson hastalığı, Telerehabilitasyon, Kullanılabilirlik

Proje Numarası

None

Kaynakça

• 1. Feigin VL, Vos T, Nichols E, Owolabi MO, Carroll WM, Dichgans M, et al. "The global burden of neurological disorders: translating evidence into policy." The Lancet neurology. 2020;19(3):255-65. https://doi.org/10.1016/S1474-4422(19)30411-9
• 2. Kim Y, Lai B, Mehta T, Thirumalai M, Padalabalanarayanan S, Rimmer JH, et al. "Exercise training guidelines for multiple sclerosis, stroke, and Parkinson disease: rapid review and synthesis." American journal of physical medicine & rehabilitation. 2019;98(7):613-21. https://doi.org/10.1097/PHM.0000000000001174
• 3. Bloem BR, Okun MS, Klein C. "Parkinson's disease." The Lancet. 2021;397(10291):2284-303. https://doi.org/10.1016/S0140-6736(21)00218-X
• 4. Lai B, Young H-J, Bickel CS, Motl RW, Rimmer JH. "Current trends in exercise intervention research, technology, and behavioral change strategies for people with disabilities: a scoping review." American journal of physical medicine & rehabilitation. 2017;96(10):748-61. https://doi.org/10.1097/PHM.0000000000000743
• 5. Feys P, Giovannoni G, Dijsselbloem N, Centonze D, Eelen P, Lykke Andersen S. "The importance of a multi-disciplinary perspective and patient activation programmes in MS management." Multiple sclerosis journal. 2016;22(2_suppl):34-46. https://doi.org/10.1177/1352458516650741
• 6. Kalbe E, Bloem B, Kalia L, Nieuwboer A. "Non-pharmacological interventions for people with Parkinson’s disease: are we entering a new era?" Journal of parkinson’s disease. 2024;14(s1):S1-S4. https://doi.org/10.3233/JPD-249009
• 7. Stewart C, Subbarayan S, Paton P, Gemmell E, Abraha I, Myint PK, et al. "Non-pharmacological interventions for the improvement of post-stroke quality of life amongst older stroke survivors: a systematic review of systematic reviews (The SENATOR ONTOP series)." European geriatric medicine. 2019;10:359-86. https://doi.org/10.1007/s41999-019-00180-6.
• 8. Salari N, Hayati A, Kazeminia M, Rahmani A, Mohammadi M, Fatahian R, et al. "The effect of exercise on balance in patients with stroke, Parkinson, and multiple sclerosis: A systematic review and meta-analysis of clinical trials." Neurological sciences. 2022:1-19. https://doi.org/10.1007/s10072-021-05689-y
• 9. Gürpınar B, Tomruk MS, Kara B, İdiman E. "Effects of combined Pilates and aquaplyometric exercises on postural control and physical functions in patients with multiple sclerosis." Cukurova medical journal. 2020;45(1):148-56. https://doi.org/10.17826/cumj.631595
• 10. Asadi S, Eslami R. "Effects of Different Exercise Trainings on Patients with Multiple Sclerosis: A Review Study." New approaches in exercise physiology. 2022;4(8):38-70. https://doi.org/10.3390/ijerph19127175 11. Di Tella S, Pagliari C, Blasi V, Mendozzi L, Rovaris M, Baglio F. "Integrated telerehabilitation approach in multiple sclerosis: a systematic review and meta-analysis." Journal of telemedicine and telecare. 2020;26(7-8):385-99. https://doi.org/10.1177/1357633X19850381
• 12. Pramuka M, Van Roosmalen L. "Telerehabilitation technologies: accessibility and usability." International journal of telerehabilitation. 2009;1(1):85. https://doi.org/10.5195/ijt.2009.6016 13. Özden F, Özkeskin M, Ak SM. "Physical exercise intervention via telerehabilitation in patients with neurological disorders: a narrative literature review." The Egyptian journal of neurology, psychiatry and neurosurgery. 2022;58(1):26. https://doi.org/10.1186/s41983-022-00461-1
• 14. Eldemir S, Eldemir K, Özkul Ç, Gündüz AG, Saygılı F. Role of "Telerehabilitation in Upper Extremity Rehabilitation of Parkinson's Patients: Review of the Literature." Cumhuriyet Medical Journal. 2022;44(1):9-16. https://doi.org/10.7197/cmj.1014084 15. Eldemir K, Guclu-Gunduz A, Eldemir S, Saygili F, Ozkul C, Irkec C. "Effects of Pilates-based telerehabilitation on physical performance and quality of life in patients with multiple sclerosis. Disability and rehabilitation." 2024;46(9):1807-14. https://doi.org/10.1080/09638288.2023.2205174
• 16. Saygili F, Guclu‐Gunduz A, Eldemir S, Eldemir K, Ozkul C, Gursoy GT. "Effects of modified‐constraint induced movement therapy based telerehabilitation on upper extremity motor functions in stroke patients." Brain and behavior. 2024;14(6):e3569. https://doi.org/10.1002/brb3.3569 17. Eldemir S, Guclu-Gunduz A, Eldemir K, Saygili F, Yilmaz R, Akbostancı MC. "The effect of task-oriented circuit training-based telerehabilitation on upper extremity motor functions in patients with Parkinson's disease: A randomized controlled trial." Parkinsonism & related disorders. 2023;109:105334. https://doi.org/10.1016/j.parkreldis.2023.105334
• 18. Torsney K. "Advantages and disadvantages of telerehabilitation for persons with neurological disabilities." NeuroRehabilitation. 2003;18(2):183-5. https://doi.org/10.3233/NRE-2003-18211 19. Özkeskin M, Özden F, Ekmekçi Ö, Yüceyar N. "The reliability and validity of the Turkish version of the Telemedicine Satisfaction and Usefulness Questionnaire (TSUQ) and Telemedicine Patient Questionnaire (TPQ) in individuals with multiple sclerosis." Neurological sciences. 2022;43(3):1921-7. https://doi.org/10.1007/s10072-021-05519-1. 20. Klaassen B, Van Beijnum B, Hermens HJ. "Usability in telemedicine systems—A literature survey." International journal of medical informatics. 2016;93:57-69. https://doi.org/10.1016/j.ijmedinf.2016.06.004
• 21. Parmanto B, Lewis Jr AN, Graham KM, Bertolet MH. "Development of the telehealth usability questionnaire (TUQ)." International journal of telerehabilitation. 2016;8(1):3-10 https://doi.org/10.5195/ijt.2016.6196 22. Bakken S, Grullon-Figueroa L, Izquierdo R, Lee N-J, Morin P, Palmas W, et al. "Development, validation, and use of English and Spanish versions of the telemedicine satisfaction and usefulness questionnaire." Journal of the american medical informatics association. 2006;13(6):660-7. https://doi.org/10.1197/jamia.M2146 23. Hvidt JCS, Christensen LF, Sibbersen C, Helweg-Jørgensen S, Hansen JP, Lichtenstein MB. "Translation and validation of the system usability scale in a Danish mental health setting using digital technologies in treatment interventions." International journal of human–computer interaction. 2020;36(8):709-16. https://doi.org/10.1080/10447318.2019.1680922 24. Brooke J. "SUS: a retrospective." Journal of usability studies. 2013;8(2):29-40.
• 25. Hajesmaeel-Gohari S, Bahaadinbeigy K. "The most used questionnaires for evaluating telemedicine services." BMC medical informatics and decision making. 2021;21(1):1-11. https://doi.org/10.1186/s12911-021-01407-y 26. Eldemir S, Eldemir K, Saygili F, Ozkul C, Kasikci M, Yilmaz R, et al. "Development, reliability, and validity of the telerehabilitation satisfaction questionnaire in neurological diseases." International journal of medical informatics. 2024;191:105578. https://doi.org/10.1016/j.ijmedinf.2024.105578 27. Kline TJ. "Psychological testing: A practical approach to design and evaluation." Thousand Oaks: Sage publications: 2005. https://doi.org/10.4135/9781483385693 28. Tavakol M, Dennick R. "Making sense of Cronbach's alpha." International journal of medical education, 2011;2:53–55. https://doi.org/10.5116/ijme.4dfb.8dfd
• 29. Taber KS. "The use of Cronbach’s alpha when developing and reporting research instruments in science education." Research in science education. 2018;48:1273-96. https://doi.org/10.1007/s11165-016-9602-2
• 30. Perinetti G. "StaTips Part IV: Selection, interpretation and reporting of the intraclass correlation coefficient." South European journal of orthodontics and dentofacial research. 2018;5(1):3-5. https://doi.org/10.5937/sejodr5-17434
• 31. Knapp TR, Brown JK. "Ten measurement commandments that often should be broken." Research in nursing & health. 1995;18(5):465-9. https://doi.org/10.1002/nur.4770180511
• 32. Lewis JR. "The system usability scale: past, present, and future." International Journal of Human–Computer Interaction. 2018;34(7):577-90. https://doi.org/10.1080/10447318.2018.1455307