Effects of Graded Motor Imagery in Individuals With Foot/Ankle Osteoarthritis

Socio-demographic assessment form

The names, ages, genders, heights, body weights, dominant side of the lower extremity, occupations, education levels, and medication use of individuals who wish to participate in the study on a voluntary basis will be recorded, along with their phone numbers so that they can be contacted again if necessary. Radiological findings, age, and disease duration will also be included in the clinical evaluation form for individuals with foot/ankle osteoarthritis.

Pain Intensity Assessment

Patients' rest, activity, and night pain will be assessed using the Numerical Rating Pain Scale (NPRS). The NPRS is an 11-point scale scored from 0 to 10. A score of zero (0) indicates "no pain," while a score of 10 indicates "the most severe pain imaginable." Participants will be asked to mark the appropriate score on this scale for their foot/ankle pain.

Pain Threshold Measurement

In this study, the pressure pain threshold (PPT) is defined as the amount of pressure (kg/cm²) at which pressure sensation is converted into pain. PPT measurements will be performed using a mechanical pressure algometer (Commander™ Algometer, JTECH Medical, Inc.). During the measurements, participants will be asked to verbally inform the tester when the applied pressure first causes pain. The device used has a force gauge that measures force in kilograms (kg) and a round rubber tip with a diameter of 1 cm². Pressure application will be performed at a rate of approximately 0.1 kg/cm²/s. Three repetitions will be performed for each anatomical region, and the average of the measurements will be used in the analyses. A 30-second rest period will be provided between each measurement. During foot measurements, participants will be placed in a long sitting position, and the foot being evaluated will be stabilized by the examiner. Referencing Cavanagh (1987), pressure will be applied to the m

Gait Analysis

The BTS G-Walk® Spatio-Temporal Gait Analysis System will be used for gait analysis in the study. Measurements will be performed on a predetermined 10-meter flat walking track . The BTS G-Walk® system works with a wireless sensor (analysis port) placed at the patient's L4-L5 or L5-S1 vertebra level via an elastic belt, and measurement data is transferred to the computer via a Bluetooth connection. This system allows clinicians to analyze spatio-temporal walking parameters obtained during walking, general walking kinematics, and pelvic and spinal movements in three planes. The BTS G-Walk® system provides a detailed analysis by comparing data from the right and left lower extremities with normative values during gait analysis and ensures reliable measurements

Joint position sense assessment

In this study, a universal goniometer, a method recognized in the literature as valid and reliable for Ankle Joint Position Sense (AJPS) assessment, will be used. During the assessment, individuals will be placed in a supine position and their eyes will be closed to eliminate visual cues. The pivot of the goniometer will be placed 1.5 cm below the lateral malleolus, the fixed arm will be parallel to the long axis of the fibula, and the movable arm will be parallel to the long axis of the 5th metatarsal. During this measurement, the goniometer will not come into contact with the individual. During the test, three target angles will be selected from the 10° dorsiflexion, 10° plantar flexion, and 20° plantar flexion angles, which are frequently used in the literature and are important for walking function. The subjects' feet in the neutral position will be brought to the specified target angles, and they will be asked to focus on their ankle positions for 5 seconds. This process will be

Foot Pressure Assessment

Measurements will be taken using a pedobarography device to assess foot pressure in a static position. Participants will be given detailed information about the procedure and the measurement process will be explained prior to the measurement. To help participants maintain their balance and focus their attention during the measurement, a point will be marked on the wall three meters ahead, and participants will be asked to focus on this point throughout the measurement. The data displayed on the device screen when participants achieve their balance position will be recorded. As part of the evaluation, the following data will be recorded for analysis: total foot pressure, forefoot pressure, rearfoot pressure , and surface area for the dominant and non-dominant sides.

Kinesiophobia Assessment

The Tampa Kinesiophobia Scale (TKS) will be used in the kinesiophobia assessment. The TKS is a 17-item measure consisting of questions related to fear of re-injury, pain anxiety, and fear-avoidance behaviors. Each item is scored using a 4-point Likert scale ranging from 1 to 4, but items 4, 8, 12, and 16 are reverse-scored. The total score ranges from 17 to 68 points; higher scores indicate a higher level of kinesiophobia.

Quality of Life Assessment

The Nottingham Health Profile (NHP) will be used to assess participants' health-related quality of life. It is a measure developed to assess an individual's health status in terms of physical, emotional, and social aspects. The questionnaire assesses six dimensions related to health status: pain (8 items), emotional reactions (9 items), energy (3 items), social isolation (5 items), sleep (5 items), and physical activity (8 items). It consists of a total of 38 questions answered as yes (1 point)/no (0 points) (Appendix-6). A score between 0 and 100 can be obtained from each subcategory. '0' indicates no limitation, while '100' indicates the presence of all listed limitations.