RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / Name of the candidate and address(in block letters) / MR.TITTU T. JACOB
I YEAR M. Sc. NURSING
MASOOD COLLEGE OF NURSING
BIKARNAKATTE, MANGALORE
2. / Name of the Institution / MASOOD COLLEGE OF NURSING
BIKARNAKATTE, MANGALORE
3. / Course of Study and Subject / M. Sc. NURSING
COMMUNITY HEALTH NURSING
4. / Date of Admission to the course / 16.06.2012
5. / Title of the Topic
“EFFECTIVENESS OF EDUCATIONAL PACKAGE ON KNOWLEDGE REGARDING MANAGEMENT AND HOME REMEDIES OF KNEE JOINT PAIN AMONG ELDERLY IN A SELECTED COMMUNITY AREA, MANGALORE”.
6. / Brief resume of the intended work
6.1 Need for the study
Aging is a lifelong process that begins at conception and is experienced by all living organisms. Healthy geriatric population makes major contribution to the health and development of the country. According to the healthy people 2000, the most important aspect of health promotion for the older people is to maintain health and functional independence. It was noted that a significant number of the health problems evidenced with aging are either preventable or can be controlled by preventive activities and the strong social support which is important in promoting the health of elderly.1
More than one million people will be over 60 years by 2025.With it the burden of chronic disease will increase. To help and tackle the public, the implications of aging, the WHO on 2004 launched an initiative named towards age friendly Primary Health Care, for better care of elderly in the community. This initiative is geared towards early detection, appropriate intervention, management and follow-up of chronic conditions in early. 2
According to the findings of the 60th National Sample Survey Round in 2006 reported that, the proportion of aged persons who cannot move and are confined to their bed or home ranges from 77 per 1000 in urban areas to 84 per 1000 in rural areas morbidity. It is currently estimated that adults over 60 years make up 8 percent of India’s population and by 2021 that number will be 137 million. India now has the second largest aged population in the world. The Indian traditional joint family structure is getting replaced by nuclear family structure, thus leaving elderly people unattended. This necessitates the need to give attention to the changing health care needs of the geriatric population.3
According to the report given by Mathur. A in 2007 the home health service, entailing home visits to detect health problems and also, a community-based health centre for the aged for educational and preventive activity will be initiated. This will be integrated with the National Rural Health Mission and an
allocation made specifically for geriatric care. The Accredited Social Health Activist (ASHA) will be trained in geriatric care and the out-patient medical service, which serves as the base for home health service, will be enhanced. One of the aspects of home health service for the geriatrics is health education about the home remedies of various health problems including knee joint pain.4
According to the report given by Srivastava in 2007 the elderly (people above the age of 60 years) comprise7.5 percent of India’s total population and making health care available and accessible to them is one of the health priorities of the country. The epidemiological data on health problems in elderly reported that in 2007 as follows: Poor vision (45.4%), Hypertension (38.2%), Arthritis (36.1%), Bowel complaints (31.6%), Depression (23.6%), Difficulty in hearing (20.5%), Weight loss (19.6%), Anaemia (16.8%), Urinary complaints (13.4%), Diabetes (13.3%), Fall (8.7%), IHD (7.7%), Asthma (6.6%), COPD (4.8%), and Tuberculosis (3.1%) were the common health problems highlighted by the study.5
According to the report given by Crook J, Rideout E, Browne G in 1984 almost all joint injuries and diseases produce a stiffness, aching pain, often referred to as “arthritis” pain. The prevalence of persistent pain increases with age. The old age is a incurable disease. In old age physiological process aging produces many changes in our body. These changes produce health problems and disabilities. Among the disabilities the problem in loco motor function is more common and makes the old age person slow, immobile and falls. The joint pain in old age is mainly associated with osteoarthritis, gout, joint stiffness and injuries.6
A study was conducted by to assess the effectiveness of hot herbal compression and knee exercises on knee joint pain reduction among elderly. Results of the study showed that both knee exercises and hot herbal compression had shown effectiveness in decreasing knee joint pain as well as difficulty in performing activities of daily living among elderly with chronic pain. Therefore both of the remedial measures should be recommended for the elderly to take care of themselves at home and for use in combination with medical treatment to reduce the usage of analgesics which could possibly cause adverse effects.7
According to The Hindu daily newspaper published in the month of march 2012 stated that of the 300 patients who visit the Orthopaedics Department at the State-run Bowring and Lady Curzon Hospital in Bangalore daily, nearly 30 percent report knee pain. Of late, orthopaedists in the city are seeing an increased number of patients, especially women over 40, for osteoarthritis. The most commonly affected are knee and hip joints. Women are more vulnerable than men to the condition, female sex and older age are the common risk factors. Other factors include excess body mass, specific occupations, repetitive knee bending or lifting heavy weights and a strong family history.8
A study was conducted on effect of moist heat as a home remedial measure for relief of knee joint pain. From his study he suggested that knee joint pain has been reported as the most frequent complaint among the aging population. Since elderly peoples are more prone to develop complications of non-steroidal anti-inflammatory drugs, home remedial measures should be given more importance. The study also determined that application of moist heat on knee had significantly helped in reducing the intensity of pain, instead of the intake of pain-killers.9
High prevalence of knee joint pain was reported by various authors, i.e., 46.7% among 60 years and above population and 40.7% among 65 years and above.10 Under treated or poorly managed knee joint pain can affect their physical, psychological, social, and emotional life. These real life consequences of knee joint pain need to be given adequate attention in the home care settings. So, there is a need to have home based management.11 Many researchers have studied and recommended the moist heat application for helping the people suffering from knee joint pain. Moist heat application is non-pharmacological, inexpensive and simplest approach which has a beneficial effect on knee joint pain. It causes vasodilatation and it penetrates deeper into the muscle and hence reduces the muscle spasm and pain.12
Above studies and the statements shows that the prevalence of knee joint pain is high among elders and there is a need to conduct a planned individual
teaching along with printed materials regarding the management and home remedies of knee joint pain. A community health nurse plays a major and vital role in teaching the elderly to arrive at the decision on the type of treatment and self-care strategy which will be best for the elderly with knee joint pain. Thus the researcher is motivated to conduct a planned individual teaching along with printed materials regarding knee joint pain among elderly in a selected community area, Mangalore.
6.2 Review of literature
A study was conducted in Framingham City to investigate the prevalence of osteoarthritis (OA) of the knee in elderly subjects. They studied the Framingham Heart Study cohort, a population-based group. Radiographs were obtained on 1,424 of the 1,805 subjects (79%). Their ages ranged from 63-94 years (mean 73). Radiographs were read by a radiologist who specializes in bone and joint radiology, and were graded 0-4 according to the scale described by Kellgren and Lawrence. Radiographic evidence of osteoarthritis increased with age, from 27% in subjects younger than age 70, to 44% in subjects age 80 or older. There was a slightly higher prevalence of radiographic changes of osteoarthritis in women than in men (34% versus 31%); however, there was a significantly higher proportion of women with symptomatic disease (11% of all women versus 7% of all men; P = 0.003).The study concluded that the prevalence of knee osteoarthritis increases with age throughout the elderly years.13
A community based cross-sectional study was carried out in an urban resettlement colony in South Delhi to study the prevalence of knee osteoarthritis causing knee joint pain in women aged more than 40 years and treatment seeking behaviour of women suffering from osteoarthritis. Osteoarthritis was diagnosed by using clinical criteria given by American College of Rheumatology for diagnosis of idiopathic osteoarthritis of knee joints. A total 260 women were interviewed out of which 123 (47.3%) women were found to be suffering from knee osteoarthritis causing knee joint pain. Prevalence of knee osteoarthritis found to be increased with age. Less than half of those with knee osteoarthritis
and knee joint pain underwent treatment. The study concluded that with this high prevalence of knee osteoarthritis, there is need to spread awareness about the disease, its prevention, management, home remedies and rehabilitation in the community.14
A study was conducted to determine the effectiveness of thermotherapy in the treatment of osteoarthritis of the knee. The outcomes of interest were relief of pain, reduction of oedema, and improvement of flexion or range of motion (ROM). Two independent reviewers selected randomized and controlled clinical trials with participants with clinical and/or radiological confirmation of osteoarthritis of the knee; and interventions using heat or cold therapy compared with standard treatment and/or placebo. The results shows that three randomized controlled trials, involving 179 patients, were included in this review. In one trial, administration of 20 minutes of ice massage, 5 days per week, for 3 weeks, compared to control demonstrated a clinically important benefit for knee osteoarthritis on increasing quadriceps strength (29% relative difference) and another trail with hot application. There was also a statistically significant improvement. Result showed that cold packs decreased knee oedema and the thermotherapy reduces the pain. The study concluded that more well designed studies with a standardized protocol and adequate number of subjects is needed to evaluate the effect of thermotherapy in the treatment of osteoarthritis of the knee.15
A experimental study was conducted in Hong Kong on the effectiveness of massage with aromatic ginger and orange essential oil for moderate-to-serve knee joint pain among the elderly. Fifty-nine subjects attending a community centre among senior citizens in Hong Kong. Samples were assigned to one of three groups-an experimental group, receiving a series of six massages with the ginger and orange oil blend over three weeks; a placebo control group, receiving the same massage intervention with olive oil only; and a control group receiving no intervention. Subjects were assessed at baseline, one week after treatment, and four weeks after the interventions were applied. One week after treatment, the experimental group showed improvement in physical function and pain compared
to the placebo and control group, but these improvements were not sustained four weeks after treatment. The study concluded that aroma-massage therapy seems to have potential alternative method for short-term knee joint pain relief.16
A study was conducted on effects of dietary interventions and quadriceps strengthening exercises on pain and function in overweight people with knee joint pain by randomized controlled trial. The study involved 389 subjects with Body Mass index of 28 or above with self-reported knee joint pain. They were randomly selected to dietary interventions plus quadriceps strengthening exercises; dietary intervention only; quadriceps strengthening exercises only; or an advice leaflet only. Interventions were delivered during home visits over two years. In total, 289 subjects completed the study trial. At the end of the trial there was a significant reduction in knee joint pain in the knee exercise groups compared to those in the non-exercise groups. Dietary intervention resulted in moderate sustained weight loss and reduced depression, but had no greater influence on knee joint pain. The study concluded that quadriceps strengthening exercise has effect on reducing the knee joint pain, dietary intervention can only result in moderate sustained weight loss and reduce depression.17
A study was conducted in India to investigate the therapeutic effect of Vitamin-E supplementation in knee osteoarthritis management in elderly. Antioxidant enzymes status, MDA, IL-6 and CRP levels were estimated by using standard methods in 40 healthy individuals (control group) and in 40 osteoarthritic patients aged 50–70 years before and after 3 months of vitamin E supplementation, i.e. group I (non- supplemented) and group II (200 mg/day vitamin E supplemented). The obtained values were compared statistically by using Student’s t-test. Marked alteration in antioxidant enzymes, MDA and inflammatory markers were observed in group I (p< 0.05) as compared with controls. These levels were ameliorated significantly after vitamin E supplementation (p< 0.05) in group II. Elevated levels of serum CRP and synovial fluid IL-6 (r = 0.034; p< 0.05) were decreased insignificantly (p< 0.1) after vitamin E supplementation in knee osteoarthritis patients. The study concluded that vitamin E is having a protective role against oxidative stress mediated deterioration in osteoarthritis.18
6.3 Statement of the problem
Effectiveness of educational package on knowledge regarding management and home remedies of knee joint pain among elderly in a selected community area, Mangalore.
6.4 Objectives of the study
The objectives of study are:
· assess the pre-test knowledge score regarding management and home remedies of knee joint pain among elderly.
· evaluate the effectiveness of educational package regarding management and home remedies of knee joint pain among elderly.
· find the association between pre-test knowledge scores regarding management and home remedies of knee joint pain among elderly and selected demographic variables.
6.5 Operational definitions
Effectiveness: In this study, it refers to the extent to which the structured educational package regarding management and home remedies of knee joint pain among elderly has achieved the desired effect in terms of gain in post-test knowledge scores as measured by structured knowledge questionnaire.