ABSTRACT
Abstract Objective: The objective of this randomized controlled trial (RCT) was to investigate the effectiveness of the lower limb rehabilitation protocol (LLRP) combined with mobile health (mHealth) applications on knee pain, mobility, functional activity and activities of daily living (ADL) among knee osteoarthritis (OA) patients who were overweight and obese. Methods: This study was a single-blind, RCT conducted at Teaching Bay of Rehmatul-Lil-Alameen Post Graduate Institute of Cardiology between February and November 2020. 114 knee OA patients who were overweight and obese were randomly divided by a computer-generated number into the rehabilitation group with mHealth (RGw-mHealth) to receive LLRP + instructions of daily care (IDC) combined with mHealth intervention, rehabilitation group without mHealth (RGwo-mHealth) to receive LLRP + IDC intervention and control group (CG) to receive IDC intervention. All three groups were also provided leaflets explaining about their intervention. The primary outcome measure was knee pain measured by the Western Ontario and McMaster Universities Osteoarthritis Index score. The secondary outcome measures were mobility measured by the Timed up and go (TUG) test, functional activity measured by the patient-specific functional scale (PSFS), and ADL measured by the Katz Index of independence in ADL scores. Results: Among the 114 patients who were randomized (mean age, 53 years), 96 (84%) completed the trial. After 3-months of intervention, patients in all three groups had statistically significant knee pain reduction (RGw-mHealth: 2.54; RGwo-mHealth: 1.47; and CG: 0.37) within groups ( P < 0.05). Furthermore, patients in the RGw-mHealth and RGwo-mHealth had statistically significant improvement in mobility, functional activity, and ADL within groups ( P < 0.05), but no improvement was noted in the CG ( p > 0.05). As indicated in the overall analysis of covariance, there were statistically significant differences in the mean knee pain, mobility, functional activity, and ADL changes between groups after 3-months ( p < 0.001). The pairwise between-group comparisons (Bonferroni post hoc analysis) of the knee pain, mobility, functional activity, and ADL scores at 3-months revealed that patients in the RGw-mHealth had significantly higher mean change in the knee pain, TUG test, functional activity, and ADL scores compared to patients in the RGwo-mHealth or CG. Conclusion: Reduction in knee pain, improvement in mobility, functional activity, and ADL were more among patients in the RGw-mHealth compared with the RGwo-mHealth or CG. Trial registration National Medical Research Registry: NMRR-20-1094-52911. Date of registration: 05-05-2020. URL: https://www.nmrr.gov.my.
ABSTRACT
Present research was aimed towards designing and construction of efficient plastic media-trickling filter (TF) for the treatment of domestic wastewater. The hydraulic flow rate through the TF was maintained at 80±2 ml/min at a temperature range of 5-15ºC by selecting treatment time of 12, 24, 36 and 48 hrs. Parameters like COD, BOD5, TSS, turbidity, NO3, NO2, SO4, PO4 and pathogenic indicator microbes were monitored after treatment of 12, 24, 36 and 48 hrs. The efficiency of the TF was improved with increase of time from 12 to 48 hrs. Maximum efficiency of TF was observed after 48 hrs treatment viz. 93.45, 93, 86.25, 57.8, 63.15, 25, 32.43, 99.95 and 86.3% reduction from the zero time value for BOD5, COD, TSS, PO4, SO4, NO3, NO2, turbidity and fecal coliforms respectively. Finally 48 hrs treated sample was passed through sand filter (SF) for further final polishing and approximately, 95.72, 95, 100, 73.5, 65.8, 58.3, 37.83, 100 and 91.5% reduction in BOD5, COD, TSS, PO4, SO4, NO3, NO2, turbidity and fecal coliforms was observed. This study showed that plastic media-trickling filter along with sand filter is a promising technology for wastewater treatment and can be scaled up for small communities in the developing countries.