DNS: Face-to-face and Telerehabilitation

Spirometric Pulmonary Function FEV1

Pulmonary function will be assessed in the sitting position using a portable spirometer (Cosmed Pony FX, Italy) in accordance with the American Thoracic Society (ATS) guidelines. Before the test, participants will be instructed to wear loose and comfortable clothing and to avoid heavy meals immediately before the assessment. Participants will also be advised to temporarily discontinue specific inhaled medications if instructed by their physician. For the test, participants will sit in an upright position and will be fitted with a nose clip. They will place their lips tightly around a disposable mouthpiece connected to the spirometer. After taking a maximal deep inspiration, participants will be instructed to exhale into the mouthpiece as forcefully and rapidly as possible until complete expiration.

Spirometric Pulmonary Function FVC

Pulmonary function will be assessed in the sitting position using a portable spirometer (Cosmed Pony FX, Italy) in accordance with the American Thoracic Society (ATS) guidelines. Before the test, participants will be instructed to wear loose and comfortable clothing and to avoid heavy meals immediately before the assessment. Participants will also be advised to temporarily discontinue specific inhaled medications if instructed by their physician. For the test, participants will sit in an upright position and will be fitted with a nose clip. They will place their lips tightly around a disposable mouthpiece connected to the spirometer. After taking a maximal deep inspiration, participants will be instructed to exhale into the mouthpiece as forcefully and rapidly as possible until complete expiration.

Spirometric Pulmonary Function FEV1/FVC ratio

Pulmonary function will be assessed in the sitting position using a portable spirometer (Cosmed Pony FX, Italy) in accordance with the American Thoracic Society (ATS) guidelines. Before the test, participants will be instructed to wear loose and comfortable clothing and to avoid heavy meals immediately before the assessment. Participants will also be advised to temporarily discontinue specific inhaled medications if instructed by their physician. For the test, participants will sit in an upright position and will be fitted with a nose clip. They will place their lips tightly around a disposable mouthpiece connected to the spirometer. After taking a maximal deep inspiration, participants will be instructed to exhale into the mouthpiece as forcefully and rapidly as possible until complete expiration.

Y-Balance Test

Dynamic balance will be assessed using the Y-Balance Test. Four measuring tapes will be positioned on the floor to form intersecting lines, creating a star-shaped grid with 45° angles. Only three directions will be tested: anterior (A), posteromedial (PM), and posterolateral (PL). Participants will place their dominant foot at the center of the grid while reaching as far as possible with the opposite foot in the specified directions. The plantar surface of the first metatarsophalangeal joint of the stance foot will be required to remain at the grid center to ensure consistency. Testing will begin in the anterior direction and proceed clockwise. During posterolateral reaching tasks, participants will be instructed to reach behind the stance leg. Each participant will perform three practice trials followed by three test trials in each direction. The average of the three test trials will be recorded as the test score. To account for limb length differences, normalized reach distance will

Posture

Postural alignment will be assessed using the PostureScreen Mobile® application (PostureCo; http://postureanalysis.com/mobile/). Participants will stand in a neutral position while photographs are captured from anterior, posterior (coronal plane) and lateral (sagittal plane) views. The application provides an on-screen target to ensure consistent image capture. Digitization will be performed by overlaying a grid on each image, allowing calculation of postural angles and assessment of body segment alignment relative to neutral posture. Output will include quantified postural variables and annotated images.

Deep Stabilization System (DSS) Function Assessment

Deep Stabilization System (DSS) function will be assessed by a certified physiotherapist through palpation and visual observation. Six DSS tests will be administered in a fixed order: diaphragm, trunk flexion, back extension, hip flexion, intra-abdominal pressure, and side plank. Each test will be scored on a 5-point scale (1 = adequate activation; 5 = inadequate function). Tests will be repeated twice, and the consistent score will be used for analysis. Diaphragm Test: Participant seated upright with arms and legs relaxed; instructed to perform deep inhalation while the physiotherapist palpates laterodorsal regions of the abdominal wall and observes lateral rib movement. Trunk Flexion Test: Participant supine with arms relaxed alongside the body; instructed to flex the neck and trunk until the inferior angles of the scapulae lift off the table. Trunk and chest muscle activation will be visually assessed. Back Extension Test: Participant prone with

Treatment Satisfection

Participant satisfaction with the intervention will be assessed at the end of the study using the Treatment Satisfection scale. The Treatment Satisfection is a patient-reported outcome measure that captures perceived changes in health status over time. In this study, a 7-point scale ranging from -3 to +3 will be used, where -3 indicates "much worse," 0 indicates "no change," and +3 indicates "completely recovered."