International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - Vol 03 Issue 01, January, 2011

Pages: 18-27

Date of Publication: 30-Nov--0001


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EFFECT OF SUPERVISED EXERCISE PROGRAM AND HOME BASED EXERCISE PROGRAM IN
OSTEOARTHRITIS OF KNEE JOINT

Author: Vandana J. Rathod Jagatheesan Alagesan, Parthipan Ramasamy

Category: Healthcare

Abstract:Introduction: Osteoarthritis of knee is a most common degenerative joint disease. Exercise programmes have been shown to be effective when patients are closely supervised by physiotherapists; however, data are lacking on the efficacy of an unsupervised home based exercise regimen in subjects with osteoarthritis of knee. Materials and Method: An experimental study was carried out to compare supervised exercise program and home based exercise program in osteoarthritis of knee joint. A convenient sample of 60 subjects with unilateral osteoarthritis of knee joint, age between 45 and 55 years of both sexes were divided in to supervised exercise group (Group-A) and home based exercise group (Group-B). Group-A was receiving exercises under the supervision of physiotherapist at outpatient department of Physiotherapy College and Group-B was doing exercises at home following a specially designed exercise pamphlet. Numeric Pain Rating Scale and Western Ontario and McMaster universities Index were used as outcome measure before and after two months of intervention. Results: There was a significant decrease in pain and also significant improvement in physical function (p< 0.001) in subjects with knee osteoarthritis who received supervised exercises and home based exercises. Both are effective in treatment of osteoarthritis of knee joint. Conclusion: The results of this study indicate that both supervised exercise programme and home based exercises are effective in alleviation of pain and improving physical function in osteoarthritis of knee joint.

Keywords: Knee osteoarthritis, supervised exercises, home based exercises, exercise pamphlet

Full Text:

INTRODUCTION

Osteoarthritis is a chronic joint disorder in which there is a progressive softening and disintegration of articular cartilage accompanied by new growth of cartilage and bone at the joint margins and capsular fibrosis.1 Disease resulting from uncoupling of the balance between the cartilage degeneration and regeneration. Osteoarthritis contributes greatly to disability in the general population, particularly in the elderly.2,3 World Health Organization estimated that it accounts for 14.8 million disability adjusted life years (DALYs) lost, with 80% percent of those afflicted having some degree of limitation of movement and 25% being unable to perform the major activities of daily living. As the incidence and prevalence of osteoarthritis increase with age, the DALYs lost due to this disease are expected to increase by 40% by 2030.4,5,6 Generally the process of clinically detectable osteoarthritis is irreversible and typical treatment consists of medication and other interventions includes physiotherapy in majority.7,8 Management of osteoarthritis is directed towards decreasing the symptoms. Physiotherapeutic treatment, particularly exercise, has been part of the management of knee osteoarthritis for nearly a century and is the second most frequently prescribed treatment after oral medication.9,10 There are many barriers to the uptake of exercises in population and two are of particular importance: (1) Failure in the part of medical practitioners to properly recommend exercises to patients and make appropriate referrals to exercise professionals and (2) failure of patients to comply with prescribed exercises programs. Exercises are underused by medical practitioners as a treatment strategy for osteoarthritis.11 Given the large number of patients who choose to exercise independently where many failed to consult a professional regarding the most appropriate exercise. Thus, it is important to understand prescribing exercises to patients and potential benefits such exercises. Recent researchs12,13,14,15,16 has provided a rationale for the use of muscle rehabilitation as part of overall treatment regimen for knee osteoarthritis. Regular knee strengthening and aerobic exercises shows improvement in functional ability, aerobic capacity and endurance and reduce knee pain. However, the most effective types and combinations of exercise and dosage are unclear. Various studies have examined the effect of different home based exercises in knee osteoarthritis.17,18,19,20 Exercises reduce pain and improve physical function in patient with osteoarthritis knee.17,21 The need for cost effectiveness throughout the health care system emphasizes the importance of knowing whether patients require numerous visits to a physical therapist or whether they might receive a similar benefit from a well-designed home program. The purpose of this study is to determine the effectiveness of a treatment that included exercise under supervision compared with an exercise program performed at home for osteoarthritis of the knee. Home based exercises training require participants to perform different exercises in home in guidance with exercises booklet. The effects of unsupervised exercises are still controversy and need to be proved.

MATERIALS AND METHODS

An experimental study was carried out to compare supervised exercise program and home based exercise program in osteoarthritis of knee joint at outpatient department of a physiotherapy college. Ethical clearance was obtained from institutional review board. A convenient sample of 60 subjects with unilateral osteoarthritis of knee joint, age ranging between 45 and 55 years of both sexes were included in the study after obtaining informed consent. Subjects with lower extremity joint replacement, post fracture stiffness, ligament injury of knee joint and secondary osteoarthritis were excluded. Subjects were consecutively assigned in to Group-A or Group-B i.e. first one to Group-A and second to Group-B and so on. The subjects of both groups were explained about the importance of exercise. Subjects of Group-A were put under supervision of therapist during exercises in physiotherapy outpatient department and also taught five joint protection techniques. Subjects of Group-B were advised to do the same exercises at home with the help of exercise pamphlet (Exercise Pamphlet is printed in two pages of standard A4 size paper in both Vernacular [Kannada] and English with diagrams prepared for this study vide Annexure). Exercises consist of Quadriceps strengthening exercise in lying and sitting, Hamstring and VMO Strengthening exercises and proprioceptive training exercises with five joint protection techniques as follows,

1. Quadriceps strengthening exercise in lying- Lie on your back with leg straight at knees and arms at sides. With a thick fold of 5-10? cotton towel roll, subject was advised to place under knee and to press it till 10 seconds. Relax. Repeat.

2. VMO strengthening exercise- Lie on your back with leg straight at knees and arms at sides. Rotate your one leg outside, maintain this position and receive your leg up without bending your knee up to 600 . Hold it for 10 seconds. Lower the leg as slowly as possible. Relax. Repeat.

3. Hamstring strengthening exerciseLie on your abdomen and place hands on your sides with knee straight. Try to bend your knee at a time as much as possible. Hold for 10 seconds. Straight the leg. Relax. Repeat.

4. Quadriceps strengthening exercise in sitting- Sit on chair or high stool. Sit straight and try to straighten your knee as high as possible. Hold for 10 seconds. Lower the leg to floor as slowly as possible. Relax. Repeat.

5. Proprioceptive training exercise- Sit on chair or high stool with leg above the ground. Place a soft ball under your feet and try to move the ball in all direction in circular and linear direction. Do it for 10 seconds. Relax. Repeat.

Joint protection techniques

1. Avoid crossed leg sitting.

2. Avoid squatting.

3. Avoid prolonged standing.

4. Avoid prolonged walking.

5. Avoid stair climbing.

Subjects of both the groups were advised to do each exercise 10 times with 10 seconds hold and 10 seconds relaxation, once a day for six days in a week for two months. The outcome measures used were Numeric Pain Rating Scale (NPRS) and Western Ontario and McMaster universities (WOMAC) Index; all subjects of both groups were assessed before and after two months of intervention.

RESULTS

The data collected were analyzed for demographic variables and significance by using SPSS-17 for windows. Significance was tested by independent t-test and paired t-test for NPRS and Mann Whitney U-test and  Wilcoxon Signed Rank test for WOMAC index with p < 0.05. Table-1 shows age and sex distribution of both groups, the Mean SD for age in Group-A is 49.73 3.27 and group-B is 49.23 3.13. Inter group comparison at baseline was done by independent t-test for NPRS shown in table-2. The Mean SD for Group-A is 6.60 1.16 and Group-B is 6.28 1.07 with p=0.26 proves homogeneity of both groups before intervention. Intra group comparison was done by using Paired t-test shown in table-3, the Mean SD of post treatment for Group-A is 5.38 1.11 and Group-B is 5.01 1.06 with p value < 0.001 for both groups confirms that there is significant reduction of pain in both groups after intervention. Table-4 shows post treatment comparison between groups by independent t-test with t=1.31 and p=0.19 proves no significant difference between groups after intervention. WOMAC Index scores at baseline were compared by Mann Whitney U test for homogeneity shown in table-5. The median for Group-A is 50 and group-B is 52.5 before intervention in WOMAC Index with p=0.569 and z=0.570 proves the same. Intra group comparison was done by Wilcoxon Signed Rank test for both groups shown in table-6 with p value is <0.001 indicating a statistically significant improvement in physical function in subjects with osteoarthritis of knee after intervention. Table-7 shows post treatment comparison between groups by Mann Whitney Utest with z= 0.185 and p=0.853 proves no significant difference between groups after intervention.

DISCUSSION

Osteoarthritis is a degenerative progressive disorder. To answer the question of optimal type, frequency, and also dose of exercises, head to head comparisons in which participants are randomly assigned to receive different exercises are highly needed. There was numerous theories proposed effectiveness of various exercises in treatment osteoarthritis of knee.9,10 Physical therapy interventions might be useful for the people with osteoarthritis of knee, but for some of interventions the effect is unclear. Exercises are considered as the mainstay in the treatment of osteoarthritis of knee. Many treatment modes have been developed in the form of exercises, orthosis, mobilization and modalities.19,22,23 Some studies proved the effectiveness of unsupervised exercises showing small but significant reduction in knee pain.9,14 In this study supervised exercises and home based exercises were given with joint protection techniques. The result of this led to inference that both supervised exercises and home based exercises are effective in reducing pain and improving physical function in subjects with osteoarthritis of knee, when given with proper dosage. Numerous studies have come up with effective home based exercises in treatment of osteoarthritis of knee.17,18,19,20 Although the dosage of exercises with proper guidance provided additional benefits to the subjects in the present investigation. It would be useful to determine the long term effectiveness of such interventions in future studies. The result of this study may be applied to a population with secondary osteoarthritis of knee. This study did not include long-term follow up period, though exercises are effective with long term benefits.12,23 Other limitations of this study are convenient sampling and inclusion of both dominant and non dominant side.

CONCLUSION

This study concludes that home based exercises with proper guidance, exercise pamphlet and dosage are as effective as supervised exercise program in Physiotherapy outpatient department in reducing pain and improving physical function in treatment of unilateral osteoarthritis of knee joint.

 

References:

1. Apley's system of orthopaedics and fractures, 7th edition, Butterworth - Heineman, Page 80-81.

2. Felson DT, Naimark A, Anderson JJ, Kazis L, Castelli W, Meenan RF. The prevalence of knee osteoarthritis in the elderly: the Framingham osteoarthritis study. Arthritis Rheum 1987; 30:914-918.

3. Badley EM, Tennant A. Disablement associated with rheumatic disorders in a British population: problems with activities of daily living and level of support. Br J Rheumatol 1993; 32: 601-608.

4. Clinical practice guidelines. Osteoarthritis of knee, MOH clinical practice guidelines. Singapore Society of Rheumatology, College of Family Physicians, Singapore, Ministry of Health, Singapore, Chapter of Rheumatologists, College of Physicians, Singapore. 4/May,2007

5. American College of Rheumatology. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines: recommendations for the medical management of osteoarthritis of the hip and knee. Arthritis Rheum. 2000; 43:1905-1915

. 6. Thumboo J, Chew LH, Lewin-Koh SC. Socioeconomic and psychosocial factors influence pain and physical function in Asian patients with knee or hip osteoarthritis. Ann Rheum Dis 2002, 61:1017-20.

7. Felson D T, Lawrence R C, Hochberg M C, et al. Osteoarthritis: New insights. Part 2: Treatment approaches. Annals of Internal Medicine 2000;133:726-737.

8. Jordan K M, Arden N K, Doherty M, et al. EULAR Recommendations: an evidence based approach to the management of knee osteoarthritis: Report of a task force of the standing committee for international clinical studies including therapeutic trials (ESCISIT). Annals of the Rheumatic Diseases 2003;62:1145- 1155.

9. C. J. McCarthy, P. M. Mills1, R. Pullen, C. Roberts, A. Silman and. A. Oldham Supplementing a home exercise programme with a classbased exercise programme is more effective than home exercise alone in the treatment of knee osteoarthritis. Rheumatology 2004; 43:880-886.

10. Tallon D, Chard JA, Dieppe PA. Exploring the priorities of patients with osteoarthritis of the knee. Arthritis Care Res 2000;13:312-19.

11. DeHaan MN, Guzman J, Bayley MT, et al.Knee osteoarthritis clinical practice guidelines-how are we doing? J Rheumatol 2007;34(10):2099-105.

12. Roddy E, Zhang W and Doherty M. Aerobic walking or Strengthening Exercise for Osteoarthritis of the Knee? A Systematic Review. Annals of Rheumatic Disease 2005;64:544- 548.

13. Fransen M, McConnell S and Bell M. Exercise for osteoarthritis of the hip or knee. The Cochrane Database of Systematic Reviews 2005;4.

14. Thomas et al., Home based exercises programme for knee pain and knee osteoarthritis; Randomized controlled trial.BMJ oct.5,2002 ;325: 752-5.

15. Evick, D. Sonel B., Effectiveness of a home based exercises therapy and walking programme on osteoarthritis of knee.Rhematol.Int.2002, July:22(3) ; 103-06.

16. La Mantia K, Marks R. The efficacy of aerobic exercises for treating osteoarthritis of the knee. New Zealand Journal of Physiotherapy. 1995;23:23-30.

17. Christensen R, Astrup A and Bliddal H. Weight loss: the treatment of choice for knee osteoarthritis? A randomized trial. Osteoarthritis Cartilage 2005;13:20- 27.

18. Adedoyin R, Olaogun M O B and Fagbeja O O. Effect of Interferential Current Stimulation in Management of Osteo-arthritis Knee Pain. Physiotherapy 2002;88:493-499.

19. Deyle G D, Henderson N E, Matekel R L, et al. Effectiveness on manual physical therapy and exercise in osteoarthritis of the knee - A randomized controlled trial.Annals of Internal Medicine 2000;132:173-181

20. Maillefert J F, Hudry C, Baron G, et al. Laterally elevated wedge insole in the treatment of medial knee osteoarthritis: a prospective randomised controlled trial. Osteoarthritis and Cartilage 2001;9:738- 745.

21. P Ravaud, B Giraudeau, I Logeart, J Larguier, D Rolland, R Treves, L Euller-Ziegler, B Bannwarth, and M Dougados. Management of osteoarthritis (OA) with an unsupervised home based exercise programme and/or patient administered assessment tools. A cluster randomised controlled trial with a 2x2 factorial design. Ann Rheum Dis. 2004 June; 63(6): 703- 708.

22. Lin S Y, Davey R C and Cochrane T. Community rehabilitation for older adults with osteoarthritis of the lower limb: a controlled clinical trial. Clinical Rehabilitation 2004;18:92-101.

23. Brosseau L, Judd MG, Marchand S, et al. Thermotherapy for treatment of osteoarthritis. The Cochrane Database of Systematic Reviews 2005; 2.

Announcements

Dr. Pramod Kumar Manjhi joined Editor-in-Chief since July 2021 onwards

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Awards, Research and Publication incentive Schemes by IJCRR

Best Article Award: 

One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

Women Researcher Award:

This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

Emerging Researcher Award:

‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.


Best Article Award

A Study by Amr Y. Zakaria et al. entitled "Single Nucleotide Polymorphisms of ATP-Binding Cassette Gene(ABCC3 rs4793665) affect High Dose Methotrexate-Induced Nephrotoxicity in Children with Osteosarcoma" is awarded Best Article for Vol 13 issue 19
A Study by Kholis Ernawati et al. entitled "The Utilization of Mobile-Based Information Technology in the Management of Dengue Fever in the Community Year 2019-2020: Systematic Review" is awarded Best Article for Vol 13 issue 18
A Study by Bhat Asifa et al. entitled "Efficacy of Modified Carbapenem Inactivation Method for Carbapenemase Detection and Comparative Evaluation with Polymerase Chain Reaction for the Identification of Carbapenemase Producing Klebsiella pneumonia Isolates" is awarded Best Article for Vol 13 issue 17
A Study by Gupta R. et al. entitled "A Clinical Study of Paediatric Tracheostomy: Our Experience in a Tertiary Care Hospital in North India" is awarded Best Article for Vol 13 issue 16
A Study by Chandran Anand et al. entitled "A Prospective Study on Assessment of Quality of Life of Patients Receiving Sorafenib for Hepatocellular Carcinoma" is awarded Best article for Vol 13 issue 15
A Study by Rosa PS et al. entitled "Emotional State Due to the Covid – 19 Pandemic in People Residing in a Vulnerable Area in North Lima" is awarded Best Article for Vol 13 issue 14
A Study by Suvarna Sunder J et al. entitled "Endodontic Revascularization of Necrotic Permanent Anterior Tooth with Platelet Rich Fibrin, Platelet Rich Plasma, and Blood Clot - A Comparative Study" is awarded Best Article for Vol 13 issue 13
A Study by Mona Isam Eldin Osman et al. entitled "Psychological Impact and Risk Factors of Sexual Abuse on Sudanese Children in Khartoum State" is awarded Best Article for Vol 13 issue 12
A Study by Khaw Ming Sheng & Sathiapriya Ramiah entitled "Web Based Suicide Prevention Application for Patients Suffering from Depression" is awarded Best Article for Vol 13 issue 11
A Study by Purushottam S. G. et al. entitled "Development of Fenofibrate Solid Dispersions for the Plausible Aqueous Solubility Augmentation of this BCS Class-II Drug" is awarded Best article for Vol 13 issue 10
A Study by Kumar S. et al. entitled "A Study on Clinical Spectrum, Laboratory Profile, Complications and Outcome of Pediatric Scrub Typhus Patients Admitted to an Intensive Care Unit from a Tertiary Care Hospital from Eastern India" is awarded Best Article for Vol 13 issue 09
A Study by Mardhiah Kamaruddin et al. entitled "The Pattern of Creatinine Clearance in Gestational and Chronic Hypertension Women from the Third Trimester to 12 Weeks Postpartum" is awarded Best Article for Vol 13 issue 08
A Study by Sarmila G. B. et al. entitled "Study to Compare the Efficacy of Orally Administered Melatonin and Clonidine for Attenuation of Hemodynamic Response During Laryngoscopy and Endotracheal Intubation in Gastrointestinal Surgeries" is awarded Best Article for Vol 13 issue 07
A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by situs slot and Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh et al. situs slot "Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma situs slot entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by situs slot et al entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09
Late to bed everyday? You may die early, get depression situs slot
Egg a day tied to lower risk of heart disease situs slot
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List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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