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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Effectiveness of Nurse-Directed Exercises on Pelvic Girdle Pain and Functional Status among Antenatal Mothers in Tertiary Care Hospital- A Quantitative Research
Correspondence Address :
Dr. V Poongodi,
Professor, Department of Obstetric and Gynaecological Nursing, Kasturba Gandhi Nursing College, Sri Balaji Vidyapeeth University, Pillayarkupam-607402, Puducherry, India.
E-mail: sudharsaivenkat77@gmail.com
Introduction: Pelvic Girdle Pain (PGP) is a common musculoskeletal disorder that leads to significant disabilities in day-to-day activities during pregnancy. PGP increases with advancing pregnancy.
Aim: To evaluate the effectiveness of nurse directed exercises on PGP and functional status among antenatal mothers.
Materials and Methods: A quantitative research approach (two group pre-test post-test) was adopted for the present study. By simple random sampling technique, with permuted block method, 108 antenatal mothers who attended the antenatal Out Patient Department (OPD) in Mahatma Gandhi Medical College and Research Institute, Pillaiyarkuppam, Puducherry, India, at 27 weeks of gestation were selected. The study has been carried out from 30th March 2022 to 14th May 2022. The numerical pain rating scale and pelvic girdle questionnaire was used. Group-I received nurse directed exercises such as diaphragmatic breathing, Kegel’s exercise, squatting exercise, child pose exercise etc., Group-II received routine care such as diet counselling, personal cleanliness, care of breast, immunisation, rest and sleep, dental care, and avoidance of travelling. Post-test was done at 31 weeks of gestation. Descriptive statistics such as frequency, percentage, mean, and standard deviation and inferential statistics like Independent t-test, Spearman correlation coefficient, Kruskal-Wallis test was used.
Results: Nurse directed exercises were more effective method in reducing the PGP level (4.26 vs 3.02) and improving the functional status (61.059 Vs 55.680) among antenatal mothers with PGP. There was a significant association between the PGP with nature of work (p-value-0.001) and previous history of abdominal or pelvic surgery (p-value 0.0102).
Conclusion: Nurse directed exercises were more effective in alleviating the PGP level and helps in improving the normal daily activities of antenatal mothers with PGP.
Pain level, Pregnancy, Routine care, Stabilising exercises
Massive physical changes that occur during pregnancy cause a variety of illnesses, including nausea, vomiting, varicose veins, leg cramps and PGP (1),(2). PGP happens when the woman relaxes too much, enabling the pelvic bones to glide up and down when walking, causing pain in the pubic area as well as backache (3),(4),(5).
PGP is not just experienced during a specific pregnancy trimester but is also felt throughout pregnancy and postpartum; however, the onset is usually at 14-30 weeks of gestation (6),(7). About 42% of the women had reported problems with low back pain earlier, and 34% of women had reported that the family history of PGP in pregnancy (8). PGP results in greater disability than lumbar pain and is more prevalent in pregnant women (9),(10). PGP causes significant physical disability and has important psychosocial implications, including extended leave from work during pregnancy, poorer quality of life (as a result of being unable to carry out normal roles, affecting their ability to care for their children) and predisposition to chronic pain syndrome (11),(12),(13). Therefore, PGP can be treated with various modalities like precise stabilising exercises to ease pain and build up supporting muscles, acupuncture, hydrotherapy, Transcutaneous Electrical Nerve Stimulation (TENS), and life style changes (14). Nurses are regularly doing antenatal visits and they are able to teach the exercises and do the follow-up activities. Very few interventional studies have been reported so far in India. Evidence-based practice is essential in promoting quality of care (2). Hence, the aim of the present study was to evaluate the effectiveness of nurse directed exercises on PGP and functional status among antenatal mothers.
The present true experimental research (two group pre-test post-test) design study was conducted at Antenatal OPD in Mahatma Gandhi Medical College and Research Institute, Pillaiyarkuppam, Puducherry, India, for the duration of seven weeks from 30th March 2022 to 14th May 2022. The approval was obtained from the Institutional Human Ethics Committee (KGNC/IHEC/2021/037).
Inclusion criteria: Antenatal mothers both primigravida and multigravida with the gestational age of 27 weeks with PGP (minimum pain score-3) and gave informed consent were included in the study.
Exclusion criteria: Antenatal mothers with 27 weeks of gestation with high-risk pregnancy, having mental impairment, conceived by assisted reproductive technique and those who received any pharmacological treatment for PGP were excluded from the study.
Sample size: According to the reference of previous study conducted by Gupta SS with the confidence of 95% and the available preliminary data, the sample size was considered as 108 antenatal mothers (15). Pilot study was conducted with 10% of the sample size. After conducting the pilot study, the data were analysed. No further changes were made in the tool after pilot study. Antenatal mothers meeting the selection criteria who reported to the Antenatal Outpatient Department (OPD) within the study duration were included in the study by simple random sampling technique with permuted block method in which 54 antenatal mothers were assigned in experimental group and 54 antenatal mothers were assigned in control group. Pre-interventions scores were collected for both the groups. PGP level was assessed by using numerical pain rating scale (16). Functional status was assessed by pelvic girdle questionnaire. It helps to assess the activity limitations and symptoms in mothers with PGP. Items should be scored on a 4 point response scale which ranges from ‘Not at all’ to ‘To a large extent’ (17),(18).
Maximum score 75
% Disability=(total score/75)×100
Score interpretation
<40%: Mild limited functional status
40-75%: Moderate limited functional status
≥75%: Severe limited functional status
Group-I (Experimental group) nurse directed exercises such as diaphragmatic breathing, kegel’s exercise, squatting exercise, seated piriformis stretch, bound angle pose, forward pose exercise, child pose exercise was demonstrated and had to be practiced from 27 to 30 weeks of gestation. Antenatal women had practiced these exercises for 5-10 minutes (morning and evening) every day in their home. Daily exercise monitoring chart had given the antenatal mothers to mark daily performed exercise and video call observation was made.
Group-II (Control group) routine care advice was given like avoid standing/sitting for long time, try to avoid carrying heavy objects, avoid legs crossed position, intake of calcium rich foods, using pillow between knees and ankles and so on.
Post-intervention score was conducted by using numerical pain rating scale and pelvic girdle questionnaire during 31 weeks of gestation.
Statistical Analysis
Descriptive statistics such as frequency, percentage, mean, standard deviation and inferential statistics like independent t-test, Spearman correlation coefficient, Kruskal-Wallis test was used. All statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 16.0.
Majority i.e., 18 (33.3%) belongs to 26-28 years, and two (3.7%) belonged to 20-22 years in experimental group and 18 (33.3%) belonged to 23-25 years, and one (1.9%) belongs to 20-22 years in control group (Table/Fig 1).
(Table/Fig 2) shows that in Group-I out of 54, the highest number of mothers 34 (63%) had moderate pain in pre-test and 34 (63%) had mild pain in post-test. In Group-II, 34 (63%) had moderate pain in pre-test and 24 (44.4%) had moderate pain in post-test.
(Table/Fig 3) shows that in Group-I highest number of mothers 47 (87%) had moderate limited function in pre-test and 45 (83.3%) had moderate limited function in post-test. In Group-II, 47 (87%) had moderate limited function in pre-test and 47 (87%) had moderate limited function in post-test.
(Table/Fig 4) shows that comparison of pre-test and post-test level of PGP among antenatal mothers with PGP. The obtained paired t-test value was 17.823 in Group-I and 0.314 in Group-II and independent t-test value was 0.455 in Group-I and 9.682 in Group-II. It was highly significant with p<0.05 level.
(Table/Fig 5) shows the comparison of pre-test and post-test functional status score among antenatal mothers with PGP. The obtained paired t-test value was 6.24 in Group-I and 0.028 in
Group-II and Independent t-test value was 0.074 in Group-I and 0.235 in Group-II. It was highly statistically significant with p<0.05 level.
(Table/Fig 6) shows that there was no correlation between PGP and functional status among antenatal mothers with PGP. There was a significant association found between PGP with the selected demographic variables like nature of work and previous history of abdominal/pelvic surgery among antenatal mothers with p-value <0.05 level. There was no significant association found between pre-test level of functional status with the selected demographic variables (Table/Fig 7).
The PGP during pregnancy is a common complaint for women all over the world irrespective of the socio-economic conditions of the countries. PGP has been frequently dismissed as trivial and inevitable, although it significantly affects quality of life and causes considerable disabilities in daily activities such as walking, lifting, climbing stairs, lying flat on the back, turning in bed, housekeeping and working (1). In a study from North West Ethiopia, shows that the prevalence of PGP was more among the antenatal women and it was majorly associated with previous history of PGP, previous history of back pain (19). Robinson PS et al., had assessed the impact of pregnancy and PGP on health related quality of life. It shows that women with PGP had lower health-related quality of life (HRQOL) than women without, and the most affected women scored lowest (20).
Nurse directed exercises was more effective method in reducing the PGP (4.26 Vs 3.02) and improving the functional status (61.059 Vs 55.680) among antenatal mother with PGP compared with control group PGP (4.31 Vs 4.28) and improving the functional status (60.739 Vs 60.722), respectively. The above findings were consistent with the study findings by Sathya J and Santhi M modified pelvic girdle questionnaire and patient specific functional scale scores of the experimental groups were statistically lower than the mean score of the control group (2). The difference between the score averages of the group was found to be significant. PGP and specific activities mean scores of the experimental groups were found to be higher than the control group. Similarly the research findings of Wacharapreechanont TE had revealed that the mean Visual Analog Scale (VAS) of back pain in the experimental group 12was significantly lower at day 56 than at day 0 and lower than the control group at day 56 at p-value <0.05 and shown that sitting pelvic tilt exercise during the third trimester in primigravida could decrease back pain intensity (21). Similarly the study findings of Sukamti S et al., had shown that yoga was effective in reducing PGP during the pregnancy (22).
The study had the following implications in the field of nursing practice, nursing education, nursing administration and nursing research. Nurse directed exercises should be adopted in hospitals and maternity centre. It is also safe. Continuing nursing education programs can be organised for the community health nurse, which helps them to practice nurse directed exercises for antenatal mothers with PGP. Administrators can formulate policies and procedures regarding the implementation of nurse directed exercises for antenatal mothers with PGP and thereby improving the activities of daily living of women.
Limitation(s)
Mothers felt little discomfort during the procedure and convincing the mothers for the procedure was difficult. These apprehensions could have introduced some bias in the study.
In the current study, nurse directed exercises was found to be significant in reducing the PGP level and improving the functional status among antenatal mothers with PGP. Thus, the study results can be used as an informative illustration for nursing students who can effectively practice it and reduce the disabilities of PGP in the post-natal period among antenatal mother with PGP.
DOI: 10.7860/JCDR/2023/62043.18137
Date of Submission: Dec 06, 2022
Date of Peer Review: Mar 20, 2023
Date of Acceptance: May 11, 2023
Date of Publishing: Jul 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Dec 07, 2022
• Manual Googling: Apr 12, 2023
• iThenticate Software: May 10, 2023 (20%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6
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