RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA A STUDY TO ASSESS THE EFFECTIVENESS OF HOT AND COLD APPLICATION ON ARTHRITIC PAIN AND MOBILITY STATUS AMONG CLIENTS WITH OSTEOARTHRITIS IN SELECTED HOSPITALS AT KOLAR DISTRICT. SYNOPSIS PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION MS. J. ROSE JENILA A.E & C.S PAVAN College of Nursing Kolar, Karnataka-563101
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A Study to Assess the Effectiveness of Hot and Cold Application on Arthritic Pain and Mobility Status Among Clients With Osteoarthritis in Selected Hospitals at Kolar District.
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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA
A STUDY TO ASSESS THE EFFECTIVENESS OF HOT AND COLD APPLICATION ON ARTHRITIC PAIN AND MOBILITY
STATUS AMONG CLIENTS WITH OSTEOARTHRITIS IN SELECTED HOSPITALS AT KOLAR DISTRICT.
SYNOPSIS PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
MS. J. ROSE JENILAA.E & C.S PAVAN College of Nursing
Kolar, Karnataka-563101
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE,
KARNATAKA
SYNOPSIS PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 NAME OF THE CANDIDATE AND ADDRESS
MS.J.ROSE JENILAI year M.Sc (N)PAVAN College of NursingBangalore – Chennai Bypass RoadKolar, Karnataka-563101
2 NAME OF THE INSTITUTION A.E & C.S. PAVAN College of Nursing Kolar.
3 COURSE OF THE STUDYAND SUBJECT
I year M.Sc (N)Medical and Surgical Nursing
4 DATE OF ADMISSION 31-05-2007
5 TITLE OF THE TOPIC“A STUDY TO ASSESS THE EFFECTIVENESS OF HOT AND COLD APPLICATION ON ARTHRITIC PAIN AND MOBILITY STATUS AMONG CLIENTS WITH OSTEOARTHRITIS IN SELECTED HOSPITALS AT KOLAR DISTRICT.”
6.BRIEF RESUME OF THE INDENDED WORK
INTRODUCTION
“For all the happiness mankind can gain
Is not in pleasure but relief from pain.”
Osteoarthritis is primarily a degenerative, non-inflammatory
disorder of movable joints characterized by an imbalance between the
synthesis and degradation of particular cartilage leading to the classic
pathologic changes of wearing away and destruction of cartilages.1
Joint diseases affect millions of people throughout the world,
causing pain and disability with great impact on individuals and on
society as a whole. Osteoarthritis is the most common joint disease in
the near future and is projected to rank second for women and fourth
for men in the developed countries in terms of years lived with
disability. Men are more often affected than women before the age of
50. Women are affected twice as often as men after the age of 50.
Elderly patients are most often affected (joint diseases account for half
of all chronic conditions in persons aged 65 years and above) and
because the number of individuals over the age of 50 years is expected
to double world wide between 1990 and 2020, the global burden of
osteoarthritis will increase drastically. Osteoarthritis in the ageing
population will generate a global avalanche of costs and disability.2
The prevalence of osteoarthritis varies according to the method used
to detect it. Radiographic prevalence showed that 75% of women in
the age group of 50 – 70 years had evidence of osteoarthritis of distal
inter phalangeal joints of hand prevalence rate of all joint sites study
increased markedly with age in both men and women where as
osteoarthritis knee is more common in women where as osteoarthritis
of hip is more common in men Although osteoarthritis is worldwide
problem, geographic and ethnic differences have been reported. The
prevalence of hand and knee osteoarthritis is similar among Europeans
and Americans. There is a lower rate of hip osteoarthritis in African
blacks. Asians, Indians and Hon Kong Chines.3
Most of the population in India is above the age group of 60
years. 95% of them are less than 85 years. In this 87% are having acute
illness and 96% are having chronic illness. Hypertension, cataract and
osteoarthritis were the 3 most common illnesses among older
population in India.4
The pain from osteoarthritis is the first presenting complaint of
clients and is localized, deep dull ache. The pain is due to subchondral
bone changes, stretching of ligaments or nerve endings in periosteum
and inflamed or distended joint capsule. Client also experience pain
with activity due to bone on bone contact at the time of weight bearing.
80% of the clients with knee osteoarthritis reported problems related to
muscle function i.e., muscle strength, endurance and balance co-
ordination. 5
Disability due to hip and knee osteoarthritis is as great as that
attributes heart disease. While osteoarthritis affects many joints of the
body, the knee is the most commonly involved joint associated with
disability. Knee arthritis causes many limitations, which include
difficulty in floor level activities, ascending and descending stairs,
squatting, etc. High impact activities, that include running or jumping
can be detrimental and painful. These difficulties or limitations can
significantly reduce the quality of life in an active individual.6
No curative treatment has yet been found for knee
osteoarthritis and treatment is directed towards symptom relief and
preventing of further functional deterioration. Current modes of
treatment helps to decrease pain and improve functioning range from
information, education, physical therapy and aids, analgesics, non-
steroidal anti-inflammatory drugs, joint injections and knee
replacement procedures in which all or part of the joint is replaced with
plastic, metal or ceramic implants.7
Thermo therapies have been used in the conservative
management of osteoarthritis, the local stimulations of temperature
sensitive receptors in the skin, impulses travel from the periphery to
the hypothalamus and the cerebral cortex. The hypothalamus then
initiates heat producing or heat reducing location of the body. The
conscious sensations of temperature are aroused in the cerebral cortex.
These interventions are effective by decreasing pain through hot
applications and increasing large diameter nerve fibre input to block
small diameter pain fibre input to block small diameter pain fibre
messages by cold and hot application.8
6.1 NEED FOR THE STUDY
“A physically active individual lives much healthier and active
life than people who are physically inactive”. This is true for every one
but especially for people with osteoarthritis.
In America 32.9 million Americans (about 23 % of adult
populations) had some type of arthritis. In this 15% of the population
experience long term complications due to osteoarthritis related
conditions. Pain and stiffness are the main features of osteoarthritis and
it may result in deformity and disability. 9
The Health statistics report stated that, osteoarthritis of knee based
on racial categories – 27 % of Caucasian population, 2.1% of
American population and 1% of people classified in ‘other’ racial
categories. It was reported that more than 20 million Americans have
symptomatic osteoarthritis. Women had higher rates of incidence than
men especially after age of 40 years. In the US, osteo arthritis numbers
second to Ischemic heart disease as a cause of work disability in men
over the age of 50 years. In UK it affects Approximately 2.5% of the
populations. In India primary osteoarthritis was more common than
secondary osteoarthritis. 10
Osteoarthritis can have serious effects on a person’s life and well
being. Current treatment strategies include pain Relieving drugs, a
balanced rest and exercise, cost effective symptomatic management
interventions, client educations and support programs allow more
people with this disorder to lead an active and productive life.11
Pain and stiffness are the main features of Osteoarthritis and it may
results in deformity and disability if proper care is not taken. Because
of the chronic and progressive nature of the disease, hot and cold
application may be required periodically for weeks or even years
depending upon the course of the disease and the individual patient.
Therapy has a great influence on the knowledge of rehabilitation,
which helps in reducing disability or deformity thus improving the
quality of life.
Pain particularly experienced by orthopaedic patient is one of the
most common clinical stimulation encountered by health professionals
especially by nurses. The nurse is most effective in providing comfort
by understanding the nature of pain and client’s perception and
working closely with the clients to find out the best relief measures.
Hot or cold applications may relieve pain through a counter-
irritant effect as well as by direct effect on peripherals and free
encoding. Hot applications promote muscle relaxation and decrease
pain from spasm or stiffness where as cold application decreases nerve
conduction velocity, induce numbness or paresthesia. Before applying
hot and cold therapies, the nurse has to asses the physical condition for
signs of potential intolerance to heat and cold. The nurse is legally
responsible for safe administration of hot and cold application. 12
During the investigator’s clinical practice in the field of nursing,
the investigator found that many clients attending orthopedic out
patient department and inpatient department clients undergoing total
knee replacement had various degrees of osteoarthritis with severe
pain and limitations in mobility. The clients expressed that they need
an intervention to relieve pain and improve their mobility status.
Based on the review of literature various therapies like hot and cold
applications have beneficial effect in reducing joint pain and
improving the mobility status. Pain is subjective feeling and so it is
extremely important for the nurse to assess, intervene and evaluate
each clients discomfort on an individual basis. So the investigator
would like to conduct such a study on osteoarthritis.
6.2 REVIEW OF LITERATURE
Review of literature is a systematic search of literature to gain
information about a research topic .It helps to gain an insight in to the
research. Problem and provides information of what has been done
previously. It helps the researcher to be familiar with the existing
studies and also provides base for methodology tool for data collection
and research design. The literature review is based on an extensive
survey of books, journals and articles.
The relevant studies are organized in to the following
categories based on objectives. It is divided into 5 sections as follows:
Section A: Studies related to over view and risk factors of
osteoarthritis
Section B: Studies related to Pain and mobility status in osteoarthritis
of knee
Section C: Studies related to conservative therapy for osteoarthritis
Section D: Studies related to effectiveness of hot applications for
osteoarthritis
Section F: Studies related to effectiveness of cold applications for
osteoarthritis
REVIEW OF RELATED LITERATURE
Section A: Studies related to overview and risk factors of
osteoarthritis.
Review of studies conducted to estimate the lifetime risk of
symptomatic knee osteoarthritis overall and stratified by sex, race
education, history of knee injury and body mass index (BMI). A
longitudinal study of black and white women and men age > or =
45years living in rural North Carolina. Radiographic and
sociodemographic and symptomatic knee data measured at baseline
and first follow-up were analyzed. The result showed lifetime risk rose
with increasing BMI with a risk of 75% among those who were obese.
Nearly half of the adults will develop symptomatic knee osteoarthritis
by age 85 yrs with life time risk highest among obese persons.40
Population based study conducted in North California to
estimate the prevalence of knee related osteoarthritis outcomes in
African American and Caucasians aged more than 45 years. 3018
participants have been selected. Kellegran and Lawrence radiographic
grading was used. 28% had radiographic knee osteoarthritis, 16% had
symptomatic knee osteoarthritis and 8% had severe radiographic knee
osteoarthritis. Higher prevalence was seen in older individuals
especially among women and African Americans than Caucasians.13
Comparative study conducted with the aim of examining the
relationship between knee osteoarthritis with body weight in
osteoarthritis with body weight in Moroccan sample of clients.
Interviews were obtained from 95 cases with knee osteoarthritis and
control taken from general population. The risk of knee osteoarthritis
increased with higher body mass index, odds ratio=3.12(p<0.001)
overweight is risk factor for knee osteoarthritis. 14
Population based survey conducted to document the association
of floor activities with pattern and severity of knee osteoarthritis 288
women and 288 men more than 40 years from southern Thailand have
been studied. 3 common positions in floor activities squatting side
knee bending and kneeling were recorded. Multinomial logistic
regression analysis was used. The results showed that squatting and
side knee bending positions had increased the relative risk of moderate
to severe knee pain and radio graphic knee osteoarthritis. 15
In order to identify the risk of osteoarthritis associated with
occupational factors, four relevant epidemiological studies showed a
correlation between osteoarthritis of knee joint and knee flexion under
physiological stresses. Mechanical stress leads to degeneration of
osteophytes and early onset of tibio femoral osteoarthritis in the
elderly.16
Retrospective study conducted to investigate the association
between squatting and the prevalence of knee osteoarthritis. A random
sample of 72 Beijing residents more than 60 years were enquired about
duration of squatting. Knee radiographs were taken. Among the study
subjects, 40% of the men and 68% of the women reported squatting
one hour per day. Prevalence of tibio - femoral osteoarthritis was found
to be increased in both men and women who squatted more than 30
minutes per day compared to subjects who squatted less than 30
minutes per day. 17
Descriptive study conducted to determine the health concerns
of men with osteoarthritis from Missouri hospital were selected by
39. Rasker JJ. (2000). Effect of cryotheraphy on articular temperature.
American Journal of Nursing. Vol.XV: No.2. Pp.37 – 40.
40. Murphy L.Schwartz et al (2008). Life time risk of symptomatic
knee osteoarthritis. Journal of Arthritis Rheumatology. Pp. 1207– 13.
41. Maly MR. et al (2007). Personal Experience of living with knee
osteoarthritis in older adults. Journal of Disability
Rehabilitation .Pp.1423 - 33.
42. Cetin et al (2008), Comparing hot pack. Journal of Am J Phys
medical Rehabilitation. Pp. 443-451.
43. Odabasi et al (2008). Reveal the efficacy of heated mud pack
treatment. Journal of J Altern complement Medicine Pp.559-565.
44. Seto H.et al (2008).Evaluate the effectiveness of the dry heat sheet.
Journal of J.Orthopaedic science Pp.187-191.
9 SIGNATURE OF THE CANDIDATE
10 REMAARK OF THE GUIDE
11NAME AND DESIGNATION OF(IN BLOCK LETTERS)
11.1 GUIDE
11.2 SIGNATURE
11.3 CO-GUIDE
11.4 SIGNATURE
11.5 HEAD OF THE DEPARTMENT
11.6 SIGNATURE
12 REMARKS OF THE CHAIRMAN AND PRINCIPAL
12.1 SIGNATURE
Rajiv Gandhi University of Health Sciences, KarnatakaCurriculum Development Cell
CONFIRMATION FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
Registration No. : 05_N006_7165Name of the Candidate : J Rose JenilaAddress : #1/253, Mouleeswarar Nager, Moulivakkam, ChennaiName of the Institution : AECS Pavan College of Nursing, KolarCourse of Study and Subject : MSc Nursing in Medical Surgical NursingDate of Adimission to Course : 22/05/2008
Title of the Topic
: A Study to assess the effectiveness of hot and cold application on arthritic pain and mobility status among clients with osteoarthritis in selected hospitals at kolar district.
Brief resume of the intended work : Attached
Signature of the Student :
Guide Name : Mrs. ManoranjithamRemarks of the Guide : GoodSignature of the Guide :
Co-Guide Name : Mrs. Shiyamala Rani TSignature of the Co-Guide :
HOD Name : Mrs. ManoranjithamSignature of the HOD :
Principal Name : Principal Mobile No. : Principal E-mail ID : Remarks of the Principal :