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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
Case report
Full Version
Conservative Physiotherapy for Grade 4 Osteoarthritis Secondary to Genu Varum Deformity: A Case Report
Correspondence Address :
Purva Gulrandhe,
Intern, Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Sawangi, Wardha-442004, Maharashtra, India.
E-mail: purvagulrandhe456@gmail.com
Osteoarthritis (OA) is a prevalent form of degenerative joint disease that primarily affects the knees, leading to a gradual loss of function, severe pain, joint stiffness, and reduced quality of life. Despite its severity, exercise treatment offers promising results and proves beneficial for a wide range of patients. Preoperative rehabilitation for OA patients often involves therapeutic approaches such as exercise treatment, electrotherapy, and manual therapy. The present case revolves around a 58-year-old male diagnosed with OA in both knees, with the presence of genu varum deformity. A personalised preoperative rehabilitation protocol was designed based on his specific symptoms of pain, stiffness, and difficulties in daily activities. The case study highlights the effectiveness of the preoperative physical therapy approach for managing bilateral osteoarthritic knees with genu varum deformity.
Degenerative joint disease, Exercise therapy, Joint stiffness, Manual therapy, Pain
A 58-year-old male farmer visited the Physiotherapy Department, presenting complaints of pain and stiffness in both knees for the past three months, along with difficulty performing daily activities. The pain started gradually and has been progressively worsening. Three months ago, the patient experienced a dull aching pain near the knee joint that was limited to activities. The patient’s medical records indicate a history of hypertension, managed with thiazide diuretics, and he was asymptomatic until around 5-6 years ago. The patient sought medical attention at a local hospital in the past and received conservative management. Investigation with an X-ray of the knee joint (Table/Fig 1) in an anteroposterior view revealed grade 4 OA according to the Kellgren and Lawrence system (1), attributed to genu varum (bowleggedness). Following the diagnosis, total knee replacement surgery was recommended. Consequently, the patient was referred to the Physiotherapy Department for prehabilitation. In the present case, informed consent was obtained from the patient before conducting any examinations or treatments.
Clinical findings: The patient’s physical examination was performed in an upright standing position. Upon observation, the patient displayed an ectomorphic body type. Genu varum deformity was evident and confirmed by X-ray findings (Table/Fig 1), along with lateral knee thrust. Palpation indicated Grade 2 tenderness (2) and minimal swelling in both knees. During knee extension, crepitus was noticed. The patient was asked to rate the severity of pain using the Numerical Pain Rating Scale (NPRS) (3), resulting in a score of 6/10 during activity and 3/10 at rest. Pain was exacerbated during activities like walking and squatting. Manual muscle testing was performed for the lower limb as given in (Table/Fig 2) to assess muscle strength (4). Range Of Motion (ROM) for the knee joint was measured using a goniometer. (Table/Fig 3) shows the ranges. Gait analysis revealed a waddling gait pattern characterised by reduced arm swing, swing phase, and incomplete heel strike.
Medical management: Along with implementing various safety precautions, the patient was recommended to take Tab Ultracet twice daily for a couple of weeks, followed by Tab Paracetamol 650 mg thrice daily for another couple of weeks.
Physiotherapy Management
Patient education: The patient received education regarding the significance of exercise and rehabilitation. The therapist provided demonstrations of exercise techniques and offered ergonomic advice. The patient received instruction in a self-stretching technique for the lower limbs, which consisted of stretches for the calf, hamstring, quadriceps femoris, tendoachilles, and piriformis muscles (5). Details of the management plan are given in (Table/Fig 4) (6),(7),(8),(9),(10),(11),(12),(13).
Afterward, the patient participated in the Otago exercise program, which comprises 17 strength and balance exercises and a walking program for maintaining and improving the effects of the treatment (14). The patient performed these exercises three times a week, gradually increasing sets and repetitions. The treatment sessions were scheduled for 12 weeks, five days a week. Pre- and post-treatment assessments were conducted to monitor the patient’s progress. (Table/Fig 5) shows the patient performing ROM exercises.
Outcome Measures
Outcome measures were recorded both before and after rehabilitation. The NPRS score during activity was initially 6/10 and reduced to 2/10 after rehabilitation. Additionally, the pre- and post rehabilitation scores for the Western Ontario and McMaster Universities Arthritis Index (WOMAC) (15) and the Lower Extremity Functional Scale were calculated (14),(16). Objective assessment was performed using the Time Up and Go test. All the outcome measures displayed moderate improvements, as shown in (Table/Fig 6). These findings highlight the positive impact of the rehabilitation program on the patient’s ROM, muscle strength, and overall functional ability. Furthermore, the improvements observed in post rehabilitation regarding ROM and muscle strength are discussed, as presented in (Table/Fig 7),(Table/Fig 8), respectively.
Osteoarthritis (OA) is a prevalent form of degenerative joint disease that primarily affects the knee, leading to a gradual loss of function, severe pain, joint stiffness, and reduced quality of life. It is anticipated that approximately 10% of individuals over the age of 50 years would be affected by this condition (17). Despite the severity of OA, exercise treatment can have favourable results, making it useful for a broad range of patients (18).
The case presented here involves OA secondary to genu varum. The patient received a combination of manual therapy and electrotherapy as part of the treatment. A customised rehabilitation protocol was designed in phases specifically for the preoperative stage. According to Mahmoudian A et al., there may be a “window of opportunity” in patients with early-stage knee OA to halt disease progression and restore joint homeostasis (19). Early diagnosis plays a crucial role in the effective management of the condition and reducing the disease burden in clinical practice (19). However, a limitation of the present study was that the patient lacked access to an effective healthcare facility nearby, which impacted their management.
In their systematic review, Tsokanos A et al., examined the effectiveness of manual therapy for knee OA patients. The results of their study demonstrated that the application of manual treatment techniques can offer advantages to knee OA patients, leading to pain reduction and improved functioning. Moreover, the positive effects were observed in the short-term on the functionality of patients with knee OA (20). According to Benner RW et al., achieving optimal knee performance depends on the joint’s capability to move through the full Range Of Motion (ROM). The Shelbourne Knee Centre’s ROM-based rehabilitation program places a strong emphasis on initially restoring normal knee extension, including hyperextension, before progressing to enhance flexion and strength. This approach has proven to be effective in improving ROM, reducing pain, alleviating symptoms, and enhancing overall function in OA patients. Remarkably, 76% of the patients were able to avoid undergoing Total Knee Arthroplasty (TKA) surgery as a result of this ROM-based rehabilitation program (18). The present study also encompassed a focus on ROM exercises. Dantas LO et al., emphasised in their review article that effective treatment for OA patients involves patient education, exercise training, and weight management (21). These aspects were duly considered while designing the management protocol for the present case.
The patient’s rural residence and the considerable distance from the rehabilitation centre resulted in insufficient healthcare amenities, leading to a delay in the diagnosis. Additionally, a lack of patient education contributed to the development of joint stiffness, eventually leading to deformity. Another limitation of the study was the loss of follow-up due to personal reasons on the part of the patient.
The case study provides valuable insights into the positive outcomes of prehabilitation for individuals with bilateral osteoarthritic knees and genu varum deformity. The success of the customised rehabilitation program in alleviating symptoms and enhancing the quality of life highlights the potential benefits of early intervention in managing OA. However, despite the promising results, there is still much to explore and understand in this area. Encouraging more research in prehabilitation for osteoarthritic patients with genu varum deformity can lead to further advancements and refinements in treatment protocols. By conducting rigorous studies, researchers can delve into the optimal timing, duration, and specific components of prehabilitation to maximise its benefits. Collaborative studies involving physiotherapists, orthopaedic surgeons, and other healthcare specialists can contribute to a more holistic understanding of how prehabilitation can fit into the overall treatment plan for patients.
DOI: 10.7860/JCDR/2024/65461.18983
Date of Submission: May 28, 2023
Date of Peer Review: Jul 21, 2023
Date of Acceptance: Nov 13, 2023
Date of Publishing: Feb 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: May 29, 2023
• Manual Googling: Sep 22, 2023
• iThenticate Software: Nov 11, 2023 (6%)
ETYMOLOGY: Author Origin
EMENDATIONS: 5
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