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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
Effect of Water-based Inspiratory Muscle Training on Lung Functions and Respiratory Muscle Strength in Parkinson’s Disease: A Longitudinal Study
Correspondence Address :
Priya Chauhan,
H-168, Block B, Gulmohar Complex, Sector-125, Mohali, Punjab, India.
E-mail: isicpriyachauhan1@gmail.com
Introduction: Water-based exercises are widely accepted exercises due to its acceptance and additional benefits from them. Exclusively, aquatic exercises are more advantageous than Land Exercises (LE), particularly in the early phase after rehabilitation for respiratory benefits.
Aim: To evaluate the efficacy of water-based inspiratory muscle training in respiratory muscle strength, lung functions and functional capacity in patients with Parkinson’s Disease (PD).
Materials and Methods: A longitudinal study was conducted on 30 participants with idiopathic PD, at Chandigarh University, Mohali, Punjab, India, between 50-65 years and in stages I-III (Modified Hoehn and Yahr Scale). Respiratory muscle strength was evaluated through inspiratory muscle training and functional capacity was evaluated with a 6-minute walk test. After the assessment, the participants were randomly assigned into two groups. Group A: Along with conventional exercise, water-based inspiratory muscle training was given to the population of this group. Group B: Along with conventional exercise, land-based respiratory muscle training was given to the population of this group.
Results: Mean age of group A was 69±6 years and group B was 69±4 years (p-value=0.90). As per statistical analysis using paired t-test, both the groups showed improvement from baseline in all the parameters {Forced Vital Capacity (FVC)%, Forced Expiratory Volume in one second (FEV1)%, Maximal Expiratory Pressure (MEP) (cmH2O)} after the intervention. When compared within the groups using independent sample t-test, there was statistically significant change seen in mean value of the parameters and group A was found to be better as compared to Group B.
Conclusion: The study revealed that water-based respiratory muscle training is safe and more effective intervention as compared to land-based exercise. Further, water-based intervention safely helps in improvement of inspiratory and expiratory muscle strength, pulmonary functions as well as for general body activity in patients with mild-to-moderate PD.
Forced vital capacity, Hydrotherapy, Maximum inspiratory pressure
Parkinson’s Disease (PD) is a progressive disorder of neurodegenerative changes having multifactorial aetiology, resulting from the degeneration of various dopaminergic neurons in the substantia nigra (1),(2). The various characteristics include the presence of multiple dysfunctions including Noradrenergic serotonergic and cholinergic system deficits. Medications used for the treatment of PD, found to alter the functions of cardiovascular, musculoskeletal, and respiratory systems due to decline in functional activity (3).
Reduced lung function, muscle strength, joint mobility, bone quality, and respiratory volumes are few secondary symptoms notes in PD. Respiratory system deteriorations are associated with osteoarticular degeneration postural remodelling and alteration in intercostal muscle tone which results in decreased chest mobility and range of motion (4). Changes due to restriction in respiratory function, lead to deterioration in the pulmonary ventilation. This further increases the risk of respiratory complications. The correlation of PD and respiratory dysfunctions is poorly understood; however, it has been proven that medulla oblongata, which is known to control respiratory depth and rate, may be affected during the initial neurodegeneration (5). All this results in a reduction in the levels of lung volume and ventilator function along with variability in inspiratory and expiratory muscle strength (5),(6). There may be obstructive, restrictive, or mixed alteration in pulmonary functions in PD. Respiratory muscle dysfunction is crucial in the depletion of lung functions, making individuals symptomatic with decline in tolerance for functional mobility or exercise (7).
In PD due to decline in physical activity/sedentary lifestyle, there occurs deterioration in physical function and functional capacity of lungs. Many studies have proved the effectiveness of water-based exercises in improving the balance, functional abilities, and gait pattern in various neurological disorders like cerebral palsy, PD and stroke however no study was conducted on patients suffering from PD (8),(9),(11),(12). So, this study aimed to find out whether water-based respiratory muscle training is better as compared to ground training in improving the respiratory function lung function for thoracic mobility and functional capacity in patients with mild to moderate PD.
Stage II indicates bilateral involvement without impairment of balance and
Stage III indicates mild to moderate bilateral disease some postural instability, physical independence.
The UPDRS (Unified Parkinson’s Disease Rating Scale) assesses parkinsonism disease related disability and impairment. The UPDRS composed of 42 items grouped under 4 subscales (16).
Respiratory muscle strength was evaluated through inspiratory muscle training and functional capacity was evaluated with a 6-minute walk test. Along with conventional exercise as prescribed by patient’s neurologist and the water-based inspiratory muscle training in group A and land-based respiratory muscle training in group B was done. In experimental group (group A), patients were encouraged to walk in the hydrotherapy pool, with water level till 4th intercostal space or above (17). The exercise intensity was adjusted to maintain the walking speed at 60% of the heart rate and the walking was continued for 40 minutes a day four times a week for four weeks. Heart rate was measured continuously using wrist-type pulsometer. The subjects were provided with proper outfit to carry out the hydrotherapy protocol.
In control group (group B), similar protocols were adopted and subjects were asked to perform this over a levelled ground for 40 minutes a day four times a week for six weeks.
Statistical Analysis
Data was analysed by using the Statistical Package for the Social Sciences (SPSS) version 20.0 for statistical analysis. Shapiro-Wilk test was used to assess the normality of the data distribution. As variables where shown to be parametric, student t-test was used to compare variables within each group and for comparisons between the groups paired t-test was used to analyse within group differences. A level of significance was set at p-value ≤0.05.
Mean age of group A was 69±6 years and group B was 69±4 years (p-value=0.90) (Table/Fig 1). There was significant change in FVC pretest and post-test (p-value=0.03) in group A and group B (p-value=0.01) (Table/Fig 2),(Table/Fig 3).
Group A showed significant improvement of FVC (%) (p-value=0.013), FEV1 (%) (p-value=0.04), MEP (cmH2O) (p-value=0.05) when compared with Group B (Table/Fig 4).
The present study noted the changes in the functional capacity of lungs with remarkable improvement in forced vital capacity in both groups. However, improvement was more with water-based training protocol as compared to the land-based Inspiratory Muscle Training (IMT) training patients. The present study results are in accordance to the result published by McNamara RJ et al., who concluded that water-based exercise training was significantly more effective than land-based exercise training in increasing peak and endurance exercise capacity in people with Chronic Obstructive Pulmonary Disease (COPD) (18),(19). In a systematic review conducted by De Brandt J et al., also concluded the importance of water-based exercises in comparison to land based to improve various parameters (20). Further, a systematic review with a meta-analysis of Randomised Control Trial (RCT) proved that respiratory muscle training to enhance ventilator function, FEV1, MIP, MEP, and respiratory muscle strength in subjects with Amyotrophic Lateral Sclerosis (ALS) and Multiple Sclerosis (MS), however there was no remarkable benefits in clinical condition, forced vital capacity and six minutes walk test noted with this intervention (19). A study by McNamara RJ et al., documented the remarkably high benefits of water based exercises in comparison to the land based exercise in enhancing the peak and endurance exercise capacity among subjects with COPD (19).
The physiological basis for the improvement in respiratory parameters in aquatic medium is explained by the mechanism by of hydrostatic pressure on the abdominal cavity, leads to elevate the diaphragm and to squeeze the lungs. Moreover, hydraulic pressure led to reduction in the thoracic compliance (21),(22). It is found that the chest wall circumference declines approximately by 0.8 cm with the aquatic pressure, due to water at clavicle level as compared to land (23). Further, expiratory muscle fatigue is instigated more by aquatic movement in comparison to land mobility. Moreover, it is found that the respiratory muscle strength and vital capacity decline with the water level rising above the umbilical level (14). Consequently, it is viewed that the strength of inspiratory muscles improves in the water since augmented pressure of water expands the thorax during inspiration. This can be the possible mechanism for the improvement of the parameters in water-based group (24),(25).
Limitation(s)
The present study was a preliminary investigation which involved small sample size. Further studies which involve higher sample size are needed to confirm these results. Furthermore, the duration of treatment was six weeks, might have been insufficient to promote an optimal response for various parameters for the participants. It remains unknown whether additional benefits can be obtained when this study is carried out with a longer treatment period. Future studies can be done to investigate the possible carry over effects of the therapy.
The result of the study concluded that water-based respiratory muscle training is safe and more effective intervention as compared to land-based exercise in improving inspiratory and expiratory muscle strength and pulmonary functions in patients with parkinsons disease.
DOI: 10.7860/JCDR/2022/49954.15880
Date of Submission: Apr 16, 2021
Date of Peer Review: Jun 09, 2021
Date of Acceptance: Sep 22, 2021
Date of Publishing: Jan 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. No
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Apr 17, 2021
• Manual Googling: Sep 07, 2021
• iThenticate Software: Dec 29, 2021 (22%)
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