Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 70069

AbstractMaterial and MethodsResultsDiscussionConclusionAcknowledgementReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
ĹKnowledge is treasure of a wise man.ĺ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help oneĺs reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


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 journalsľNo manuscriptsľNo 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

Important Notice

Original article / research
Year : 2022 | Month : March | Volume : 16 | Issue : 3 | Page : KC05 - KC08 Full Version

Efficacy of Hot and Dry Bath (Hammam-i-Har-Yabis) in Activities of Daily Living for Management of Post Stroke Hemiplegia: An Exploratory Clinical Trial


Published: March 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/53459.16121
Mobassir Abbas, Abdul Nasir Ansari, Mohd Nayab, Umar Afzal, Adil Abdalrhman Abalkhai

1. Assistant Professor, Department of Ilaj bit Tadbeer, Ila State Unani Medical College, Prayagraj, Uttar Pradesh, India. 2. Professor, Department of Ilaj bit Tadbeer, National Institute of Unani Medicine, Bangalore, Karnataka, India. 3. Assistant Professor, Department of Ilaj bit Tadbeer, National Institute of Unani Medicine, Bangalore, Karnataka, India. 4. Assistant Professor, Department of Ilaj bit Tadbeer, Al-Ameen Unani Medical College, Malegaon, Maharashtra, India. 5. Head, Department of Public Health, College of Public Health and Health Informatics, Qassim, Saudi Arabia.

Correspondence Address :
Mohd Nayab,
Assistant Professor, Department of Ilaj bit Tadbeer, National Institute of Unani Medicine,
Bangalore, Karnataka, India.
E-mail: nayabdr@gmail.com

Abstract

Introduction: Hemiplegia (Fa¯ lij) is usually caused due to obstruction (sudda) in ventricles of brain (butu¯ n-i-dima¯ gh) or base of the brain (mabda-un-nukha). Viscid and tenacious phlegm (Balgham) chokes the passages present in the nerves and blocks the transmission of motor impulses (Ru¯ h-i-Muharrik) into the organs to cause paralysis of a limb. Rarely, in the absence of any obstruction, the paralysis occurs due to unresponsiveness of organs due to their changed constitution (Sue-Miza¯ j-i-A'za¯ ). Turkish bath (H ? amma¯ m) is recommended for the resolution (Tahllul) and evacuation (Tanqiya) of viscid phlegm (Ghaleez Balgham) from impacted nerves by virtue of heat therapy to rejuvenate the motor functions in hemiplegia.

Aim: To evaluate the effect of hot and dry bath (H ? amma¯ m-i-Ha¯ rYa¯ bis) in activities of daily living in management of post stroke hemiplegia.

Materials and Methods: This open, single arm, exploratory clinical trial was conducted during January 2018 to February 2019 at NIUM hospital, Bangalore, on 30 diagnosed patients of post stroke hemiplegia. Patients were subjected with hot dry bath for 15 minutes at a temperature of 60°C from day 1st till 30th day. A total of 10 sittings were given on every 3rd day. Barthel Index (BI), which consists of Activities of Daily Living (ADL), was used to assess the efficacy of hot and dry bath in the patients of hemiplegia. Friedman's test with Dunn's multiple comparison test was used to assess the efficacy of the treatment.

Results: The mean age of the participants in the study was 42.54±3.3 with male dominance. Statistically significant improvement was observed in BI scores between pretreatment to 15th day (p<0.01); 15th to 30th day (p<0.001) and pretreatment to 30th day (p<0.001).

Conclusion: Hot and dry bath significantly improved the activities of daily living in the patients of post stroke hemiplegia. Another benefit of this therapy is infrequent and mild severity of side effects as compared to the oral medications in conventional system of medicine for post stroke neurodisabilities.

Keywords

Temperament, Thermotherapy, Unani medicine

Hemiplegia (Falij), a well-known disease since Greek-o-Arabic period, means “to halve”. It is characterised by loss of movements and sensations in longitudinal half of the body as sensory impulse (Ruh-i-Hassas) and motor impulse (Muharrik) either fail to penetrate the organs or may penetrate but the organs fail to respond duestructural derangement (1),(2),(3),(4). It is caused due to obstruction (Sudda) in nerve impulse (Ruh-i-Nafsani), congestion (Imtila), and inflammation (Warm). Obstruction in the passage of nerve impulse is formed due to increased viscosity, tenacity, and enormous quantity of thick fluid. Inflammation obstructs the passages of nerve impulses by exerting pressure over them while congestion inside the vessels causes their rupture due to builtup tension (1),(5). Rhazes (Razi) quoted a statement of Galen (Jalinus) that, if trouble is at the origin of the spinal cord it leads to the paresis of whole body, except face. The study further stated that cervical vertebrae may lead to the paralysis of the whole body if, dislocated inwards impinging on spinal cord. (6). Tabri R. proposed that hemiplegia occurs due to an obstruction in any part of the brain. In hemiplegia, the nerves absorb the pathogenic fluid (Ratubat-e-Raddiya), descending from the brain and get paralysed leading to loss of voluntary movements of involved part (7).

Prodromal features of hemiplegia such as heaviness of head, sudden severe headache, blackouts, venous engorgement in the neck, coldness of extremities, twitching in whole body, heaviness in feet, difficulty in movement, giddiness, and vomiting have also been discussed by Sina I, Razi Z, Tabri R, Hubal I (1),(6),(7),(8). Clinically, stroke or cerebrovascular accident is defined as an abrupt onset of neurological deficit that is attributable to a focal vascular cause which is supported by radiological brain imaging (9). Acute focal stroke is characterised by the sudden appearance of a focal deficit of brain functions (10). Approximately, 85% of strokes are caused by sudden onset of inadequacies of blood flow to some part or whole of the brain. The remaining strokes are due to haemorrhages into the brain tissue and into the spaces surrounding the brain, most frequently the subarachnoid space (11). Location and extent of lesions affect the duration and severity of sign and symptoms in the patients of stroke due to cerebral infarction (12). Cerebrovascular diseases are one of the major causes of human mortality and morbidity. It was the second leading cause of death in 2004 amounting to 5.7 million deaths worldwide representing 9.7% of total deaths. Projection to the year 2030 shows that 8 million lives are likely to be lost due to cerebrovascular diseases globally (13). In India, age-adjusted prevalence rate of stroke was between 250-350/100,000 in the last decade (14).

Cerebrovascular accident is the most common cause of hemiplegia, which imperils millions of stroke survivors to lead their lives with altered activities of daily living (13). Management of hemiplegia in conventional medicine, secondary to ischaemic stroke consists of medical support, thrombolytics, anticoagulants, antiplatelet agents and neuroprotection (9). The figures in terms of deaths and disability caused by stroke grossly suggest the limitations in its management. Considering this unconvincing scenario, Unani medicine axiomatically comes to fore, as the, hemiplegia has successfully been treated since ancient times without any significant and obnoxious side effects on the body. The Unani treatment of hemiplegia consists of evacuation of morbid matter (TanqiaMawad-i-Raddiya), rejuvenation of weak organs (TadilMizaj), general strengthening (Taqwiat-i-am) and nervine strengthening (Taqwiat-i-Asab). Eminent Unani physicians have advocated massage (dalk), exercise (Riyadat), Turkish bath (H?ammam) etc, in the rehabilitation of hemiplegia (1),(2),(3),(4),(5),[]6],(7),(8),(15),(16),(17),(18).

?ammam is an Arabic word, derived from ?amm meaning to heat. Architectural structure of ?ammam consists of three rooms having variable temperature and humidity. First, second and third rooms have cold and wet (Barid-Ra?ab), hot and wet (?ar-Ra?ab) and hot and dry (?ar-Yabis) temperaments, respectively (7). Evacuation (Istifragh) is the most preferable principle of treatment for the diseases caused by excessive pathogenic fluid (MaddiAmra?) (19). Turkish bath is considered effective among several regimenal modalities employed for evacuation of causative morbid material from the body in the form of sweat (5). The mechanism, procedure and benefits of Turkish bathfairly resemble today’s famous procedure like sauna bath. In recent years, Turkish bath gained increasing international attention due to its preventive as well as therapeutic beneficial effects. Reported evidence reveal its benefits in rheumatic diseases, skin ailments, hormonal disturbances, and cardiovascular system, etc. (20),(21),(22). To the best of the knowledge available, this study is the first of its kind to scientifically explore the efficacy of ?ammam-i-Har-Yabisin cases of post stroke hemiplegia through rigour of a clinical trial.

Material and Methods

The present open, single arm exploratory clinical trial was conducted from January 2018 to February 2019 at National Institute of Unani Medicine (NIUM), Bangalore, Karnataka, India. Institutional Ethical Committee accorded the Ethical clearance with following number: NIUM/IEC/2016-17/027/IBT/05. The study was conducted according to the Declaration of Helsinki and the Good Clinical Practice (GCP) guidelines. The trial was registered in clinical trial registry of India (www.ctri.nic.in) bearing a number CTRI/2018/03/012677.

Inclusion criteria: Radiologically and clinically diagnosed patients of post stroke hemiplegia, patients between 30-65 years of age, patients of stroke suffering not less than 30 days, in both genders.

Exclusion criteria: Patients with minor stroke having non disabling deficit, patients with altered sensorium and aphasia, serious enough with impaired understanding of simple commands, pregnant and lactating women, orthopaedic or rheumatological diseases impairing mobility, evidence of fixed contracture, patients with liver, kidney, cardiac, and other co-morbidities, uncontrolled diabetes mellitus and severe hypertension were excluded.

Sample size calculation: The sample size was calculated using the following formula: N=(Zα)2 S2/d2) (23). Where, N=sample size required, S=standard deviation obtained from previous study (38.9) (24), d=expected clinically significant difference between pre and post means=14, and Zα=normal deviate for two tailed hypothesis=1.96. The final calculated sample size was 30.

Study Procedure

Patients fulfilling the inclusion criteria were provided with an information sheet having details regarding the nature of the study and the procedure of intervention. Patients were selected randomly using convenient sampling from the NIUM outpatient/inpatient Department and they reported at the Regimenal Therapy Centre. Patients were given sufficient time to go through the contents of informed consent sheet and ensured to feel free to ask any doubt regarding the study and procedure. After voluntarily agreeing to it, they were requested to sign the informed consent form for the enrolment in the study. Socio-economic classification of the patients was done on the basis of modified Kuppuswamy Scale (25). The enrolled cases of hemiplegia underwent the hot and dry bath every third day for 15 minutes per sitting at a temperature of 60o C till the 30th day of the study (10 sittings) (26). The timing for the treatment was from 11:00 am to 1:00 pm daily. Out of 44 screened patients, 35 fulfilled the inclusion criteria and 30 cases completed the study as five cases were lost to follow-up, as they discontinued the intervention (Table/Fig 1).

Barthel Index (27): The assessment of the efficacy of hot and dry bath in the patients of hemiplegia was done on the basis of Barthel Index (BI) which consists Activities of Daily Living (ADL) such as feeding, bathing, grooming, dressing, bowels, bladder, toilet use, transfer (from bed to chair and back), mobility (on level surfaces), and stairs. On the day of enrolment, the baseline values of the activities of daily living were assessed and compared with post treatment values. Before starting the treatment, assessment of activities of daily living (ADL) was done using Barthel index. No patient reported any adverse effect or reaction; therefore, it is assumed that the intervention is free from any kind of unexpected or unusual side effect.

Patients were followed-up fortnightly (0, 15th, and 30th day) and enquired about any improvement or worsening of their symptomsat every visit. Enrolled cases of controlled diabetes mellitus and hypertension using concomitant medications were allowed to continue in the study provided there was no change in dosage and schedule of the used drugs before 15 days of enrollment and during the entire duration of the study.

Statistical Analysis

The statistical analysis was restricted to those patients who had completed the study. Statistical Package of Social Science (SPSS) version 22.0, and R Environment version 3.2.2 software for the analysis of the data. Friedman’s test with Dunn’s multiple comparison tests were applied and p<0.05 was considered as statistically significant.

Results

The demography of the participants is depicted in (Table/Fig 2). The mean age of the participant in the study was found to be 42.54±3.3 years with male dominance among the studied participants.

As depicted in (Table/Fig 3), rank sum difference from 0 to 15th day was -25.500 and was statistically significant (p<0.01). The rank sum difference from 15th to 30th day was -30.000 and found statistically significant (p<0.001). The rank sum difference from 0 to 30th day was -55.500 and was statistically significant (p<0.001).

Discussion

Present open, single arm exploratory clinical study was conducted on 30 patients of hemiplegia with disabilities in activities of daily living. The assessment of efficacy was carried out on the basis of BI comprising activities of daily living. Pre, mid and post treatment values of BI were statistically analysed using Friedman’s test with Dunn’s multiple comparison tests. Hot and dry bath therapy showed a significant difference in the mean scores of BI indicating its effect in reducing the post stroke neurodisabilities. The results showed significant improvement in activities of daily living after 30 days of study.

Phlegmatic matter (Balghami Madda) is thought to be the pathogenic matter for hemiplegia, which accumulates first in brain (Dimagh) followed by a descent in spinal cord (Nukha) and nerves (Aas?ab), blocking the routes of sensory impulse (Ruh-i-Hassas) and motor impulse (Muharrik) (27). According to the principles of treatment, phlegmatic diseases (Balghami Amraz) require evacuation of the causative material followed by normalisation and rejuvenation of physiological functions of the diseased organ. Once the matter is evacuated, the organs start regaining vigour and vitality due to tonic and stimulant properties of the drugs (Muqawwi-e-Aasabwa Muharrik-e-Aasab). Phlegmatic matter is eliminated from the brain through concoctive and purgative (Munzijwa Mushil) therapies, while the matter diffused in the peripheral nervesis eliminated by hot and dry bath (?ammam-i-Har-Yabis). Hemiplegia is a cold and moist disease (Baridwa Ratab), hence, the employed treatment should have hot and dry (?arwaYabis) properties. ?ammam-i-Har-Yabisin has hot and dry properties and therefore, beneficial in the treatment of hemiplegia as evidenced by the account of available classic Unani literature (1),(2),(3),(4),(5).

Hot and dry bath has potential effect to dissolve and liquefy the morbid material. It generates a dry heat which is endowed with hot and dry properties. These properties confer it as the properties of resolution (Tahallul), attenuation (Tal?eef), evacuation (Tanqiya) and rejuvenation (Tadeel) (22). Razi Z mentioned in Al-Hawi that, he treated many patients of hemiplegia by employing hot and dry bath only (6). It may be put forth, that, heat of hot and dry bath may dissolve the matter diffused in nerves and eliminate it by sudation thereby, completing the process of evacuation and rejuvenation (28). As soon as the causative cold and moist matter is dissolved and eliminated by the action of heat, the passage of the nerves begin to reopen to enable pulse to travel normally to the paralysed parts, imparting them vigour and vitality, as exhibited by improved motor functions and activities of daily living, thereby, improved quality of life.

Hot and dry bath induces vasodilatation and increases the blood circulation to eventually cause detoxification. The tissues of diseased organ bathe with more than normal amount of blood and nutrients which invigorate the paralysed part and strengthen them and thus potentiate the function of the nerves enabling them to provide activity and strength in the paralysed extremities (29).

There is a general belief among rehabilitation professionals that the motor recovery occurs earlier in leg and is more complete than in the arm. After a stroke, maximum recovery was achieved in 95% of patients within nine weeks. The extent of recovery is highly dependent on the severity of initial deficit. About 79% of patients with initial mild paresis regained full recovery, compared to only 18% of patients with initial severe paresis (29),(30).

In present study, almost all patients reported improvement in motor power of paralysed limbs as well as improvement in ADL, especially in personal hygiene and dressing which are considered important milestones in management of post stroke patients. This improvement is expected to reduce dependence of care providers as well as burden for patient’s family.

Limitation(s)

Some of the potential limitations of the present study were, of a control and short duration of the study. Thus, it is recommended that future clinical trial should necessarily be done as a randomised control trial with a larger sample size and longer duration involving other comprehensive assessment scales.

Conclusion

It may be concluded that hot and dry bath is effective in the treatment of post stroke neurodisabilities. This treatment regimen may be used to reduce the dependence and improve the quality of life in patients of hemiplegia. Another benefit of this therapy is infrequent and mild severity of side effects as compared to the oral medications in conventional system of medicine for post stroke neurodisabilities.

Acknowledgement

The authors thank the hospital staff and participants of the study for their complete support.

AuthorsÔÇÖ contribution: Study concept, interpretation of result: ANA; writing the protocol, conducting the study, and drafting the manuscript: MA and UA; critical revision and editing: MN, and AAA. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

Editorial note: The Unani Medicine offers treatments for chronic ailments and diseases and lifestyle disorders which have been found to be highly effective and acceptable. However, the way Unani Medicine explains the organs and diseases is different than how modern medicine explains the modern organs and diseases. It is good to bring in tradition medicine into the main stream medicine, which this article has attempted. We must encourage such work, especially when presented as clinical trials.

References

1.
Sina I. Al Qanoon Fil Tib. (Urdu translation by Kantoori GH). New Delhi: Idara-Kitab-us-Shifa. 2007;1(3):p. 120-126,178-179, 211-212.
2.
Jurjani I. Zakheera Khawarzam Shahi (Urdu translation by Khan HH). New Delhi: Idara-Kitab-us-Shifa. 2010;3(6): p 75-85, 152-155.
3.
Ali M, Ansari AN, Nayab M, Ansari H, Ansari S. Efficacy of a poly-herbal Unani formulation and dry cupping in treatment of post-stroke hemiplegia: An exploratory, single arm clinical trial. Adv Integr Med. Available online 24 November 2020. Doi: https://doi.org/10.1016/j.aimed.2020.11.001. [crossref]
4.
Nayab M, Kouser HV, Ansari AN. Tanqiya-wa-Tadeel (Evacuation and Rejuvenation): The Unani Concept as Evolutionary Basis for Conventional Stroke Management. J Drug Deliv Ther. 2021;11:195-200. Doi: http://dx.doi.org/10.22270/jddt.v11i1.4686. [crossref]
5.
Majoosi AA. KamilulSanaah, (Urdu translation by Kantoori GH). Vol-1, 2. New Delhi: Idara-Kitab-us-Shifa; 2010.
6.
Razi Z. Al Hawi fit Tib. (Urdu translation by CCRUM). Vol-1 New Delhi: CCRUM, Ministry of Health and Family Welfare, Govt. of India; 1997.
7.
Tabri R. Firdos ul Hikmat. (Urdu translation by Shah A.M.) New Delhi: Idara-Kitab-us-Shifa; 2017.
8.
Hubal I. Kitab-ul-Mukhtarat Fit Tibb, (Urdu translation CCRUM). Vol-1, 2, 3. New Delhi: Ministry of Health and Family Welfare Govt. of India; 2005. p. 51-56, 77, 122-179,201-202, 218-293.
9.
Fauci AS, Kasper DL, Braunwald E, Hauser SL, Longu DL, Jameson JL, et al. Harrison's Principles of Internal Medicine. 18th ed. Vol. 2nd. New Delhi: McGraw-Hill; 2008.
10.
Colledge RN, Walker RB, Ralston HS. Davidson's Principle & Practice of Medicine. 22nd ed. London: Churchill Livingstone, Elsevier; 2012.
11.
Goldman L, Schafer AI. Goldman's Cecil Medicine. 25th ed. Philadelphia: Elsevier Saunders; 2012,406,2424,2434-46.
12.
Warrell DA, Benz EJ, Cox TM, Firth JD, editors. Oxford textbook of medicine. Oxford University Press, USA; 2003.
13.
World Health Organization. The global burden of disease: 2004 update. [crossref]
14.
Banerjee TK, Das SK. Epidemiology of stroke in India. Neurol Asia. 2006;11:01-04.
15.
Qamri MH, GhinaMuna (Urdu translation by CCRUM) New Delhi: Ministry of health and family welfare, Govt. of India; 2008: 35-38.
16.
Ali SJ, Ansari AN, Khan SA. Scientific interpretation of Unani Medicinal approach in Management of post stroke hemiplegia (Falij). Int. j. sci. res. methodol... 2015; 2:54-62.
17.
Sherwani AMK, Ahmed M, Naaz SA, Khan SA, Sherwani AMK, Khan MQ. Balneology: A concept of Public Health-Bath Houses in Arabian Life. JISHIM 2006; 5:15-18.
18.
Ansari AN, Anwar M, Nayab M, Yasir M, Ali SA. Efficacy of Unani treatment in acute motor axonal neuropathy variant of Guillain barre syndrome- a case report. Unani Medicus-an International Journal. 2013;2(1):12-16.
19.
Hina Kouser V, Khan F, Tehseen A, Nayab M, Ansari AN. Understanding the concept of Purgation (Ishal) in Unani Medicine: A Review. J Drug Deliv Ther. 2021;11:241-46. Doi: http://dx.doi.org/10.22270/jddt.v11i1.4584. [crossref]
20.
Hannuksela ML, Ellaham S. Benefits and Risks of Sauna Bathing. Am. J. Med. 2001; 110:118-26. [crossref]
21.
Hussain J, Cohen M. Clinical effects of regular Dry Sauna Bathing: A Systematic Review. Evid Based Complement Alternat Med. 2018;7:01-30. Doi: 10.1155/2018/1857413. [crossref] [PubMed]
22.
Ahmad MZ, Ansari AN, Nayab N. Efficacy of ?ammam-i-Har-Yabisin (dry bath) in Metabolic Syndrome: A single arm, open-labelled clinical trial. J Complement Integr. Published online on 16 July, 2021. Doi: https://doi.org/10.1515/jcim-2021-0072. [crossref] [PubMed]
23.
Suresh KP, Chandrashekara S. Sample size estimation and power analysis for clinical research studies. J Hum Reprod Sci. 2012;5:07-13. Doi: 10.4103/0974-1208.97779. [crossref] [PubMed]
24.
Musa KI, Keegan TJ. The change of Barthel Index scores from the time of discharge until 3-month post-discharge among acute stroke patients in Malaysia: A random intercept model. PloS one. 2018;13: e0208594. Doi: 10.1371/journal.pone.0208594. [crossref] [PubMed]
25.
Wani RT. Socioeconomic status scales-modified Kuppuswamy and Udai Pareekh's scale updated for 2019. J Family Med Prim Care. 2019;8(6):1846-49. Doi: 10.4103/jfmpc.jfmpc_288_19. [crossref] [PubMed]
26.
Crinnion WJ. Sauna as a valuable clinical tool for cardiovascular, autoimmune, toxicant induced and other chronic health problems: Altern Med Rev. 2011;16:215-25.
27.
Mahoney FI, Barthel D. "Functional evaluation: The Barthel Index." Maryland State Med Journal. 1965;14:56-61. [crossref]
28.
Tabri AM. MolaejatBuqratiyah. (Urdu translation by CCRUM). Vol. 1st. New Delhi: Ministry of Health and Family Welfare, Govt. of India; 1997;420-421.
29.
Alam MA, Nayab M, Azeez A, Quamri MA, Ansari AN. Muscular Dystrophy (Istirkha) and its management through Unani Medicine: A Review. International Journal of Herbal Medicine. 2014;2(4):01-04.
30.
Nakayama H, Jorgensen HS, Raaschou HO, Olsen TS. Recovery of upper extremity function in stroke patients: The Copenhagen Stroke Study. Arch Phys Med Rehabil. 1994:75:394-98. Doi: 10.1016/0003-9993(94)90161-9. [crossref]

DOI and Others

DOI: 10.7860/JCDR/2022/53459.16121

Date of Submission: Dec 03, 2021
Date of Peer Review: Jan 20, 2022
Date of Acceptance: Feb 11, 2022
Date of Publishing: Mar 01, 2022

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 04, 2021
• Manual Googling: Jan 08, 2022
• iThenticate Software: Feb 22, 2022 (21%)

Etymology: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com