{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:58:54Z","timestamp":1790791134479,"version":"4.1.0"},"reference-count":14,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Morbidity Management and Disability Prevention (MMDP) practices are essential in mitigating the progression of lymphedema and in preventing episodes of adenolymphangitis. Despite their importance, patients\u2019 adherence to these prescribed practices has frequently been found to be suboptimal. Currently, there is a lack of a standardized tool for the objective assessment of patients\u2019 adherence to MMDP practices in patients with filarial lymphedema. This study was undertaken to develop a scoring system for assessing patients\u2019 adherence to MMDP and to validate this among patients attending a filariasis management clinic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methodology<\/jats:title>\n                    <jats:p>A scoring tool (VCRC MMDP Adherence Assessment Tool and VAAT score) was developed to evaluate adherence to MMDP practices across eight defined domains. The total score ranges from 0 to 40, reflecting the degree of adherence. This tool was validated through a cross-sectional study involving 90 patients diagnosed with varying grades of filarial lymphedema.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Based on the VAAT score, patients were categorizable into three different levels of adherence: optimal adherence (\u2265 30), medium adherence (20\u201329) and poor adherence (&lt; 20). Among the 90 patients assessed, 21 (23%) demonstrated optimal adherence, 47 (52%) showed medium adherence and 22 (25%) were categorized as having poor adherence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study marks the first development and validation of a scoring system to assess adherence to MMDP practices in patients with filarial lymphedema. The tool proved useful in effectively identifying individuals with suboptimal adherence. However, further validation is required in a greater number of patients in a prospective manner and in different geographical and epidemiological settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0358191","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:38:01Z","timestamp":1790789881000},"page":"e0358191","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Developing a scoring tool for assessing adherence to morbidity management and disability prevention (MMDP) practices in patients with filarial lymphedema: A pilot study"],"prefix":"10.1371","volume":"21","author":[{"given":"Ganga","family":"Ramar","sequence":"first","affiliation":[{"name":"Unit of Clinical and Molecular Medicine, ICMR-National Institute for Vector Control Research (NIVCR)","place":["Indira Nagar, Puducherry, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anbusivam","family":"Sadhasivam","sequence":"additional","affiliation":[{"name":"Unit of Clinical and Molecular Medicine, ICMR-National Institute for Vector Control Research (NIVCR)","place":["Indira Nagar, Puducherry, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijayalakshmi","family":"Gnanasekaran","sequence":"additional","affiliation":[{"name":"Unit of Clinical and Molecular Medicine, ICMR-National Institute for Vector Control Research (NIVCR)","place":["Indira Nagar, Puducherry, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madhumidha","family":"Periyathambi","sequence":"additional","affiliation":[{"name":"Model Rural Health Research Unit (MRHRU), Karikalampakkam CHC Campus","place":["Puducherry, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijayakumar","family":"Balakrishnan","sequence":"additional","affiliation":[{"name":"Unit of Clinical and Molecular Medicine, ICMR-National Institute for Vector Control Research (NIVCR)","place":["Indira Nagar, Puducherry, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8435-218X","authenticated-orcid":true,"given":"Vijesh Sreedhar","family":"Kuttiatt","sequence":"additional","affiliation":[{"name":"Unit of Clinical and Molecular Medicine, ICMR-National Institute for Vector Control Research (NIVCR)","place":["Indira Nagar, Puducherry, India"]},{"name":"Model Rural Health Research Unit (MRHRU), Karikalampakkam CHC Campus","place":["Puducherry, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"pone.0358191.ref001","author":"World Health Organization","year":"2022"},{"key":"pone.0358191.ref002","first-page":"41","article-title":"Prospects of elimination of lymphatic filariasis in India","volume":"32","author":"S Pani","year":"2022","journal-title":"ICMR Bulletin"},{"key":"pone.0358191.ref003","author":"National Center for Vector Borne Diseases Control (NCVBDC)","year":"2022"},{"key":"pone.0358191.ref004","author":"S Akhter","year":"2018"},{"issue":"41","key":"pone.0358191.ref005","first-page":"489","article-title":"Global programme to eliminate lymphatic filariasis: progress report, 2022","volume":"98","author":"World Health Organization","year":"2023","journal-title":"Wkly Epidemiol Rec"},{"issue":"2","key":"pone.0358191.ref006","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1007\/s00436-020-06991-y","article-title":"Lymphatic filariasis in Asia: a systematic review and meta-analysis","volume":"120","author":"N Bizhani","year":"2021","journal-title":"Parasitol Res"},{"key":"pone.0358191.ref007","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/1475-2883-6-2","article-title":"Morbidity management in the Global Programme to Eliminate Lymphatic Filariasis: a review of the 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Kumari","year":"2012","journal-title":"ScientificWorldJournal"},{"issue":"2","key":"pone.0358191.ref012","first-page":"7","article-title":"A survey on foot care practices among filarial lymphoedema patients in Orissa, India","volume":"24","author":"VB Bontha","year":"2007","journal-title":"Trop Biomed"},{"key":"pone.0358191.ref013","volume-title":"Health-seeking behavior and morbidity management practices among chronic lymphatic filariasis patients in South India","author":"H DeBacker"},{"issue":"2","key":"pone.0358191.ref014","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.physio.2016.11.001","article-title":"The development and initial psychometric evaluation of a measure assessing adherence to prescribed exercise: the Exercise Adherence Rating Scale (EARS)","volume":"103","author":"NA Newman-Beinart","year":"2017","journal-title":"Physiotherapy"}],"container-title":["PLOS 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