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 !"#$%$

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA

SYNOPSIS PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

NAME OF THE CANDIDATE AND ADDRESS

MS.J.ROSE JENILA I year M.S !N" PAVAN C#$$e%e #& N'r()*% Ba*%a$#re + C,e**a) By-a(( R#a. K#$ar, Kar*a/a0a1234151

NAME OF THE INSTITUTION

A.E 7 C.S. PAVAN C#$$e%e #& N'r()*% K#$ar. I year M.S !N" Me.) a$ a*. S'r%) a$ N'r()*% 4115216559

COURSE OF THE STUDY AND SUBJECT DATE OF ADMISSION TITLE OF THE TOPIC

8 2

: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.

3.BRIEF RESUME OF THE INDENDED WORK INTRODUCTION :For all the happiness mankind can gain Is not in pleasure but relief from pain. Osteoart&ritis is 'ri(aril) a *egenerati+e, non infla((ator) *isor*er of (o+a,le -oints .&ara.teri/e* ,) an i(,alan.e ,et0een t&e s)nt&esis an* *egra*ation of 'arti.ular .artilage lea*ing to t&e .lassi. 'at&ologi. .&anges of 0earing a0a) an* *estru.tion of .artilages.$ Joint *iseases affe.t (illions of 'eo'le t&roug&out t&e 0orl*, .ausing 'ain an* *isa,ilit) 0it& great i('a.t on in*i+i*uals an* on so.iet) as a 0&ole. Osteoart&ritis is t&e (ost .o((on -oint *isease in t&e near future an* is 'ro-e.te* to rank se.on* for 0o(en an* fourt& for (en in t&e *e+elo'e* .ountries in ter(s of )ears li+e* 0it& *isa,ilit). Men are (ore often affe.te* t&an 0o(en ,efore t&e age of !%. 1o(en are affe.te* t0i.e as often as (en after t&e age of !%. El*erl) 'atients are (ost often affe.te* 2-oint *iseases a..ount for &alf of all .&roni. .on*itions in 'ersons age* "! )ears an* a,o+e3 an* ,e.ause t&e nu(,er of in*i+i*uals o+er t&e age of !% )ears is e4'e.te* to *ou,le 0orl* 0i*e ,et0een $55% an* 6%6%, t&e glo,al ,ur*en of osteoart&ritis 0ill in.rease *rasti.all). Osteoart&ritis in t&e ageing 'o'ulation 0ill generate a glo,al a+alan.&e of .osts an* *isa,ilit).6

7&e 're+alen.e of osteoart&ritis +aries a..or*ing to t&e (et&o* use* to *ete.t it. Ra*iogra'&i. 're+alen.e s&o0e* t&at 8!9 of 0o(en in t&e age grou' of !% : 8% )ears &a* e+i*en.e of osteoart&ritis of *istal inter '&alangeal -oints of &an* 're+alen.e rate of all -oint sites stu*) in.rease* (arke*l) 0it& age in ,ot& (en an* 0o(en 0&ere as osteoart&ritis knee is (ore .o((on in 0o(en 0&ere as osteoart&ritis of &i' is (ore .o((on in (en Alt&oug& osteoart&ritis is 0orl*0i*e 'ro,le(, geogra'&i. an* et&ni. *ifferen.es &a+e ,een re'orte*. 7&e 're+alen.e of &an* an* knee osteoart&ritis is si(ilar a(ong Euro'eans an* A(eri.ans. 7&ere is a lo0er rate of &i' osteoart&ritis in Afri.an ,la.ks. Asians, In*ians an* ;on Kong C&ines.# Most of t&e 'o'ulation in In*ia is a,o+e t&e age grou' of "% )ears. 5!9 of t&e( are less t&an <! )ears. In t&is <89 are &a+ing a.ute illness an* 5"9 are &a+ing .&roni. illness. ;)'ertension, .atara.t an* osteoart&ritis 0ere t&e # (ost .o((on illnesses a(ong ol*er 'o'ulation in In*ia.= 7&e 'ain fro( osteoart&ritis is t&e first 'resenting .o('laint of .lients an* is lo.ali/e*, *ee' *ull a.&e. 7&e 'ain is *ue to su,.&on*ral ,one .&anges, stret.&ing of liga(ents or ner+e en*ings in 'eriosteu( an* infla(e* or *isten*e* -oint .a'sule. Client also e4'erien.e 'ain 0it& a.ti+it) *ue to ,one on ,one .onta.t at t&e ti(e of 0eig&t ,earing. <%9 of t&e .lients 0it& knee osteoart&ritis re'orte* 'ro,le(s relate* to (us.le fun.tion i.e., (us.le strengt&, en*uran.e an* ,alan.e .o or*ination. ! >isa,ilit) *ue to &i' an* knee osteoart&ritis is as great as t&at attri,utes &eart *isease. 1&ile osteoart&ritis affe.ts (an) -oints of t&e ,o*), t&e knee is t&e (ost .o((onl) in+ol+e* -oint asso.iate* 0it&

*isa,ilit). Knee art&ritis .auses (an) li(itations, 0&i.& in.lu*e *iffi.ult) in floor le+el a.ti+ities, as.en*ing an* *es.en*ing stairs, s?uatting, et.. ;ig& i('a.t a.ti+ities, t&at in.lu*e running or -u('ing .an ,e *etri(ental an* 'ainful. 7&ese *iffi.ulties or li(itations .an signifi.antl) re*u.e t&e ?ualit) of life in an a.ti+e in*i+i*ual." No .urati+e treat(ent &as )et ,een foun* for knee osteoart&ritis an* treat(ent is *ire.te* to0ar*s s)('to( relief an* 're+enting of furt&er fun.tional *eterioration. Current (o*es of treat(ent &el's to *e.rease 'ain an* i('ro+e fun.tioning range fro( infor(ation, e*u.ation, '&)si.al t&era') an* ai*s, analgesi.s, non steroi*al anti infla((ator) *rugs, -oint in-e.tions an* knee re'la.e(ent 'ro.e*ures in 0&i.& all or 'art of t&e -oint is re'la.e* 0it& 'lasti., (etal or .era(i. i('lants.8 7&er(o t&era'ies &a+e ,een use* in t&e .onser+ati+e (anage(ent of osteoart&ritis, t&e lo.al sti(ulations of te('erature sensiti+e re.e'tors in t&e skin, i('ulses tra+el fro( t&e 'eri'&er) to t&e &)'ot&ala(us an* t&e .ere,ral .orte4. 7&e &)'ot&ala(us t&en initiates &eat 'ro*u.ing or &eat re*u.ing lo.ation of t&e ,o*). 7&e .ons.ious sensations of te('erature are arouse* in t&e .ere,ral .orte4. 7&ese inter+entions are effe.ti+e ,) *e.reasing 'ain t&roug& &ot a''li.ations an* in.reasing large *ia(eter ner+e fi,re in'ut to ,lo.k s(all *ia(eter 'ain fi,re in'ut to ,lo.k s(all *ia(eter 'ain fi,re (essages ,) .ol* an* &ot a''li.ation.<

3.1 NEED FOR THE STUDY @A '&)si.all) a.ti+e in*i+i*ual li+es (u.& &ealt&ier an* a.ti+e life t&an 'eo'le 0&o are '&)si.all) ina.ti+eA. 7&is is true for e+er) one ,ut es'e.iall) for 'eo'le 0it& osteoart&ritis. In A(eri.a #6.5 (illion A(eri.ans 2a,out 6# 9 of a*ult 'o'ulations3 &a* so(e t)'e of art&ritis. In t&is $!9 of t&e 'o'ulation e4'erien.e long ter( .o('li.ations *ue to osteoart&ritis relate* .on*itions. Pain an* stiffness are t&e (ain features of osteoart&ritis an* it (a) result in *efor(it) an* *isa,ilit). 5 7&e ;ealt& statisti.s re'ort state* t&at, osteoart&ritis of knee ,ase* on ra.ial .ategories : 68 9 of Cau.asian 'o'ulation, 6.$9 of A(eri.an 'o'ulation an* $9 of 'eo'le .lassifie* in Bot&erC ra.ial .ategories. It 0as re'orte* t&at (ore t&an 6% (illion A(eri.ans &a+e s)('to(ati. osteoart&ritis. 1o(en &a* &ig&er rates of in.i*en.e t&an (en es'e.iall) after age of =% )ears. In t&e DS, osteo art&ritis nu(,ers se.on* to Is.&e(i. &eart *isease as a .ause of 0ork *isa,ilit) in (en o+er t&e age of !% )ears. In DK it affe.ts A''ro4i(atel) 6.!9 of t&e 'o'ulations. In In*ia 'ri(ar) osteoart&ritis 0as (ore .o((on t&an se.on*ar) osteoart&ritis. $% Osteoart&ritis .an &a+e serious effe.ts on a 'ersonCs life an* 0ell ,eing. Current treat(ent strategies in.lu*e 'ain Relie+ing *rugs, a ,alan.e* rest an* e4er.ise, .ost effe.ti+e s)('to(ati. (anage(ent inter+entions, .lient e*u.ations an* su''ort 'rogra(s allo0 (ore 'eo'le 0it& t&is *isor*er to lea* an a.ti+e an* 'ro*u.ti+e life.$$ Pain an* stiffness are t&e (ain features of Osteoart&ritis an* it (a) results in *efor(it) an* *isa,ilit) if 'ro'er .are is not taken. Ee.ause of t&e .&roni. an* 'rogressi+e nature of t&e *isease, &ot an* .ol* a''li.ation (a) ,e re?uire* 'erio*i.all) for 0eeks or e+en )ears

*e'en*ing u'on t&e .ourse of t&e *isease an* t&e in*i+i*ual 'atient. 7&era') &as a great influen.e on t&e kno0le*ge of re&a,ilitation, 0&i.& &el's in re*u.ing *isa,ilit) or *efor(it) t&us i('ro+ing t&e ?ualit) of life. Pain 'arti.ularl) e4'erien.e* ,) ort&o'ae*i. 'atient is one of t&e (ost .o((on .lini.al sti(ulation en.ountere* ,) &ealt& 'rofessionals es'e.iall) ,) nurses. 7&e nurse is (ost effe.ti+e in 'ro+i*ing .o(fort ,) un*erstan*ing t&e nature of 'ain an* .lientCs 'er.e'tion an* 0orking .losel) 0it& t&e .lients to fin* out t&e ,est relief (easures. ;ot or .ol* a''li.ations (a) relie+e 'ain t&roug& a .ounter irritant effe.t as 0ell as ,) *ire.t effe.t on 'eri'&erals an* free en.o*ing. ;ot a''li.ations 'ro(ote (us.le rela4ation an* *e.rease 'ain fro( s'as( or stiffness 0&ere as .ol* a''li.ation *e.reases ner+e .on*u.tion +elo.it), in*u.e nu(,ness or 'arest&esia. Eefore a''l)ing &ot an* .ol* t&era'ies, t&e nurse &as to asses t&e '&)si.al .on*ition for signs of 'otential intoleran.e to &eat an* .ol*. 7&e nurse is legall) res'onsi,le for safe a*(inistration of &ot an* .ol* a''li.ation. $6 >uring t&e in+estigatorCs .lini.al 'ra.ti.e in t&e fiel* of nursing, t&e in+estigator foun* t&at (an) .lients atten*ing ort&o'e*i. out 'atient *e'art(ent an* in'atient *e'art(ent .lients un*ergoing total knee re'la.e(ent &a* +arious *egrees of osteoart&ritis 0it& se+ere 'ain an* li(itations in (o,ilit). 7&e .lients e4'resse* t&at t&e) nee* an inter+ention to relie+e 'ain an* i('ro+e t&eir (o,ilit) status. Ease* on t&e re+ie0 of literature +arious t&era'ies like &ot an* .ol* a''li.ations &a+e ,enefi.ial effe.t in re*u.ing -oint 'ain an* i('ro+ing t&e (o,ilit) status. Pain is su,-e.ti+e feeling an* so it is e4tre(el) i('ortant for t&e nurse to assess, inter+ene an* e+aluate ea.& .lients *is.o(fort on an in*i+i*ual ,asis. So t&e in+estigator 0oul* like to .on*u.t su.& a stu*) on osteoart&ritis.

3.6 REVIEW OF LITERATURE Re+ie0 of literature is a s)ste(ati. sear.& of literature to gain infor(ation a,out a resear.& to'i. .It &el's to gain an insig&t in to t&e resear.&. Pro,le( an* 'ro+i*es infor(ation of 0&at &as ,een *one 're+iousl). It &el's t&e resear.&er to ,e fa(iliar 0it& t&e e4isting stu*ies an* also 'ro+i*es ,ase for (et&o*olog) tool for *ata .olle.tion an* resear.& *esign. 7&e literature re+ie0 is ,ase* on an e4tensi+e sur+e) of ,ooks, -ournals an* arti.les. 7&e rele+ant stu*ies are organi/e* in to t&e follo0ing .ategories ,ase* on o,-e.ti+es. It is *i+i*e* into ! se.tions as follo0sF Se /)#* A; Stu*ies relate* to o+er +ie0 an* risk fa.tors of osteoart&ritis Se /)#* B; Stu*ies relate* to Pain an* (o,ilit) status in osteoart&ritis of knee Se /)#* C; Stu*ies relate* to .onser+ati+e t&era') for osteoart&ritis Se /)#* D; Stu*ies relate* to effe.ti+eness of &ot a''li.ations for osteoart&ritis Se /)#* F; Stu*ies relate* to effe.ti+eness of .ol* a''li.ations for osteoart&ritis REVIEW OF RELATED LITERATURE Se /)#* A; S/'.)e( re$a/e. /# #<er<)e= a*. r)(0 &a /#r( #& #(/e#ar/,r)/)(. Re+ie0 of stu*ies .on*u.te* to esti(ate t&e lifeti(e risk of s)('to(ati. knee osteoart&ritis o+erall an* stratifie* ,) se4, ra.e e*u.ation, &istor) of knee in-ur) an* ,o*) (ass in*e4 2EMI3. A longitu*inal stu*) of ,la.k an* 0&ite 0o(en an* (en age G or H

=!)ears

li+ing

in

rural

Nort&

Carolina.

Ra*iogra'&i.

an*

so.io*e(ogra'&i. an* s)('to(ati. knee *ata (easure* at ,aseline an* first follo0 u' 0ere anal)/e*. 7&e result s&o0e* lifeti(e risk rose 0it& in.reasing EMI 0it& a risk of 8!9 a(ong t&ose 0&o 0ere o,ese. Nearl) &alf of t&e a*ults 0ill *e+elo' s)('to(ati. knee osteoart&ritis ,) age <! )rs 0it& life ti(e risk &ig&est a(ong o,ese 'ersons.=% Po'ulation ,ase* stu*) .on*u.te* in Nort& California to esti(ate t&e 're+alen.e of knee relate* osteoart&ritis out.o(es in Afri.an A(eri.an an* Cau.asians age* (ore t&an =! )ears. #%$< 'arti.i'ants &a+e ,een sele.te*. Kellegran an* La0ren.e ra*iogra'&i. gra*ing 0as use*. 6<9 &a* ra*iogra'&i. knee osteoart&ritis, $"9 &a* s)('to(ati. knee osteoart&ritis an* <9 &a* se+ere ra*iogra'&i. knee osteoart&ritis. ;ig&er 're+alen.e 0as seen in ol*er in*i+i*uals es'e.iall) a(ong 0o(en an* Afri.an A(eri.ans t&an Cau.asians.$# Co('arati+e stu*) .on*u.te* 0it& t&e ai( of e4a(ining t&e relations&i' ,et0een knee osteoart&ritis 0it& ,o*) 0eig&t in osteoart&ritis 0it& ,o*) 0eig&t in Moro..an sa('le of .lients. Inter+ie0s 0ere o,taine* fro( 5! .ases 0it& knee osteoart&ritis an* .ontrol taken fro( general 'o'ulation. 7&e risk of knee osteoart&ritis in.rease* 0it& &ig&er ,o*) (ass in*e4, o**s ratioH#.$62'I%.%%$3 o+er0eig&t is risk fa.tor for knee osteoart&ritis. $= Po'ulation ,ase* sur+e) .on*u.te* to *o.u(ent t&e asso.iation of floor a.ti+ities 0it& 'attern an* se+erit) of knee osteoart&ritis 6<< 0o(en an* 6<< (en (ore t&an =% )ears fro( sout&ern 7&ailan* &a+e ,een stu*ie*. # .o((on 'ositions in floor a.ti+ities s?uatting si*e knee ,en*ing an* kneeling 0ere re.or*e*. Multino(ial logisti. regression anal)sis 0as use*. 7&e results s&o0e* t&at s?uatting an*

si*e knee ,en*ing 'ositions &a* in.rease* t&e relati+e risk of (o*erate to se+ere knee 'ain an* ra*io gra'&i. knee osteoart&ritis. $! In or*er to i*entif) t&e risk of osteoart&ritis asso.iate* 0it& o..u'ational fa.tors, four rele+ant e'i*e(iologi.al stu*ies s&o0e* a .orrelation ,et0een osteoart&ritis of knee -oint an* knee fle4ion un*er '&)siologi.al stresses. Me.&ani.al stress lea*s to *egeneration of osteo'&)tes an* earl) onset of ti,io fe(oral osteoart&ritis in t&e el*erl).$" Retros'e.ti+e stu*) .on*u.te* to in+estigate t&e asso.iation ,et0een s?uatting an* t&e 're+alen.e of knee osteoart&ritis. A ran*o( sa('le of 86 Eei-ing resi*ents (ore t&an "% )ears 0ere en?uire* a,out *uration of s?uatting. Knee ra*iogra'&s 0ere taken. A(ong t&e stu*) su,-e.ts, =%9 of t&e (en an* "<9 of t&e 0o(en re'orte* s?uatting one &our 'er *a). Pre+alen.e of ti,io fe(oral osteoart&ritis 0as foun* to ,e in.rease* in ,ot& (en an* 0o(en 0&o s?uatte* (ore t&an #% (inutes 'er *a) .o('are* to su,-e.ts 0&o s?uatte* less t&an #% (inutes 'er *a). $8 >es.ri'ti+e stu*) .on*u.te* to *eter(ine t&e &ealt& .on.erns of (en 0it& osteoart&ritis fro( Missouri &os'ital 0ere sele.te* ,) .on+enient sa('ling te.&ni?ue. Art&ritis I('a.t Measure(ent S.ale 6 0as use*. 7&e (en 0ere (ore .on.erne* a,out 'ain, 0alking, ,en*ing an* stairs .li(,ing. 7&e) 're*i.te* t&at in t&e ne4t $% )ears art&ritis 0oul* ,e a (a-or &ealt& 'ro,le(. So inter+entions s&oul* fo.us on strategies to *eal 0it& 'ain an* *e.rease* (o,ilit). $<

Se /)#* B; S/'.)e( re$a/e. /# -a)* a*. >#?)$)/y (/a/'( )* #(/e#ar/,r)/)( #& 0*ee. Co('arati+e stu*) .on*u.te* to e4'lore t&e gen*er *ifferen.es in 'ain e4'erien.es, 'ain .ontrol ,eliefs, 'ain .o'ing strategies an* *e'ressi+e ten*en.) a(ong C&inese el*erl) 0it& knee osteoart&ritis.$55 out'atients 0it& osteoart&ritis, in 7ai0an 0ere sele.te*. Je(ale el*er re'orte* greater 'ain an* *e'ressi+e ten*en.) 0as a (e*iator in 're*i.ting o+erall 'ain intensit). Eut t&ere 0as no signifi.ant *ifferen.e in gen*er 0it& regar* to 'ain .ontrol ,eliefs.$5 An e4'lorator) stu*) .on*u.te* to un*erstan* t&e e4'erien.e of li+ing 0it& knee osteoart&ritis in ol*er a*ults. Nine inter+ie0s .on*u.te* to 'arti.i'ants 0it& '&)si.ian *iagnose* knee osteoart&ritis of *ifferent ages, se4es, .ultural ,a.kgroun*s an* self 'er.e'tions. 7&e results s&o0e* li+ing 0it& knee osteoart&ritis e(erge* e4'erien.ing knee 'ain is .entral to *ail) li+ing e4'erien.ing (o,ilit) li(itations *e+alues self 0ort&, s&aring t&e e4'erien.e, assessing our o0n &ealt& an* (anaging .&roni. 'ain. =$ An e4'eri(ental stu*) .on*u.te* to *eter(ine 0&et&er knee osteoart&ritis re*u.es a(,ulator) .a'a.it) an* i('airs ?ualit) of life. !" su,-e.ts 0ere sele.te* 0it& an* 0it&out knee osteoart&ritis. A " (inutes 0alk test results s&o0e* t&at +ital o4)gen 'eak 0as signifi.antl) &ig&er in t&e .ontrols 0&en .o('are* 0it& .lients .7&e su,-e.ts 0it&out knee osteoart&ritis 0alke* a signifi.antl) longer *istan.e t&an .lients 0it& knee osteoart&ritis. A signifi.ant negati+e .orrelation ,et0een 'ain an* '&)si.al li(itation 0as o,ser+e*. 6% An arti.le on osteoart&ritis states t&at 'rogresses t&e knee 'ain, -oint (isalign(ents, restri.tion in knee (o,ilit) an* re*u.e* 0alking o..ur fre?uentl). A.ti+ities su.& as .li(,ing stairs or sitting

for long 'erio*s 0it& ,ent legs are na(e* as sour.es of 'ain for .lients 0it& 'atello fe(oral osteoart&ritis. Me*i.al or lateral osteoart&ritis of t&e knee 0as +er) 'ro,a,le. 6$ Co('arati+e stu*) .on*u.te* at Ne0 Kork to in+estigate t&e (o+e(ent an* (us.le a.ti+ation strategies *uring 0alking of in*i+i*uals 0it& (e*ial knee osteoart&ritis. 6< .ases an* 6" .ontrols 0ere 'arti.i'ate*. Knee insta,ilit) 0as assesse* 0it& a.ti+ities of *ail) li+ing s.ale an* knee (otion 0as assesse* ,) (otion anal)sis. In*e'en*entCs test an* regression anal)sis re+eale* t&at osteoart&ritis grou' use* less knee (otion an* &ig&er Mus.le .o .ontra.tion *uring 0eig&t a..e'tan.e 0&i.& 0as foun* to ,e *etri(ental to -oint integrit).66 An e4'eri(ental stu*) .on*u.te* to assess t&e '&)si.al fun.tion of ol*er .lients 0it& .lini.al knee osteoart&ritis. $%" se*entar) su,-e.ts (ore t&an "% )ears 2(ean "5.=, stan*ar* *e+iation !.53 0it& knee osteoart&ritis 2(ean $6.6, stan*ar* *e+iation $$.%3 0ere 'arti.i'ate* in t&e stu*). Mo,ilit), -oint fle4i,ilit) an* (us.le strengt& 0ere e+aluate* ,) re.or*ing ti(e to as.en* < of *es.en* = stairs, rise fro( sitting or sit *o0n fro( .&air 2! ti(es3. Dsing S'ear(an .orrelation 0alking, stairs .li(,ing, .&air rise 0ere signifi.antl) .orrelate* 0it& ea.& ot&er an* 0it& t&e 'ain rating s.ale in*e4 2'I%.%%$3. 6# >es.ri'ti+e stu*) .on*u.te* fro( $$56 Afri.ans an* Cau.asians to e+aluate 'ain se+erit) an* (o,ilit) li(itations in osteoart&ritis knee .lients. Multi'le logisti. regression anal)sis s&o0e* t&at =#9 re'orte* *iffi.ult) in 'erfor(ing $ task. Mil* ra*iogra'&i. knee osteoart&ritis 0as asso.iate* 0it& *iffi.ult) in (o,ilit) like (o,ilit) like .li(,ing, taking a tu, ,at&, getting in an* out of .ar. Mo*erate 'ain 0as asso.iate* 0it& *iffi.ult) in 'erfor(ing $8 out of 6% tasks, e4.e't

lifting a .u', o'ening .ar *oor, an* turning fau.ets. Knee 'ain se+erit) 0as t&e strongest risk fa.tor for self re'orte* *iffi.ult) in 'erfor(ing u''er an* lo0er e4tre(it) tasks. 6= Se /)#* C; S/'.)e( re$a/e. /# #*(er<a/)<e /,era-y &#r #(/e#ar/,r)/)(. Co('arati+e stu*) .on*u.te* to in+estigate t&e t&era'euti. effe.ts of '&)si.al agents a*(inistere* ,efore isokineti. e4er.ise in 0o(en 0it& knee osteoart&ritis. One &un*re* 'atients 0it& ,ilateral knee osteoart&ritis 0ere ran*o(i/e* in to fi+e grou's of 6% 'atients ea.& re.ei+e* &ot 'a.ks an* e4er.ise 0it& in a**ition of. Lrou' $ re.ei+e* s&ort 0a+e *iat&er(). 7&e se.on* grou' re.ei+e* trans.utaneous ele.tri.al ner+e sti(ulation. Lrou' t&ree re.ei+e* ultrasoun*. Lrou' four re.ei+e* &ot 'a.ks an* isokineti. e4er.ise an* grou' fi+e ser+e* as .ontrols an* re.ei+e* onl) isokineti. e4er.ise. 7&e results s&o0e* 'ain an* *isa,ilit) in*e4 s.ores 0ere signifi.antl) re*u.e* in ea.& grou'. Patients in t&e stu*) grou's &a* signifi.antl) greater re*u.tions in t&eir +isual analog s.ale s.ores an* s.ores on t&e se?uen.e in*e4 t&an *i* 'atients in t&e .ontrols grou'. =6 An arti.le on .onser+ati+e t&era') states t&at &ig&l) effe.ti+e (easures as 0ell as ort&o'e*i. ai*s are a+aila,le for t&e knee osteoart&ritis. 7&er(ot&era'), '&)siot&era'), Ealneo t&era'), 'ulse signal t&era'), (agneti. fiel* t&era'), a.u'un.ture, ra*iot&era') an* *rug t&era'ies .ontrol s)('to(s to *ifferent e4tents in osteoart&ritis (anage(ent. 6! An e4'eri(ental stu*) .on*u.te* in ;ong Kong to assess t&e effe.ti+eness of an art&ritis self (anage(ent 'rogra((e 0it& an a**e* e4er.ise .o('onent a(ong osteoart&ritis .lients. << an* 5= su,-e.ts 0ere assigne* to an inter+ention grou' an* .ontrol grou'

res'e.ti+el). Mann 1&itne) D test an* Jrie*(an test re+eale* t&at t&ere 0as a signifi.ant *ifferen.e in re*u.tion of 'ain 2'H%.%%$3, fatigue 2'H%.%%<3, In.rease *uration of 0eekl) lig&t e4er.ise 'ra.ti.e 2'H%.%%$3 an* knee fle4ion 2'H%.%%=3 in ,et0een grou's. Inter+ention grou' &a* a 'ositi+e effe.t in 'ain re*u.tion an* i('ro+e(ent of fun.tional status. 6" Stu*ies on +arious (o*ifia,le risk fa.tors for osteoart&ritis in.lu*e o,esit), o..u'ational fa.tors, s'orts, s'orts 'arti.i'ation, (us.le 0eakness, nutritional fa.tors an* &or(onal influen.e. >rug t&era'ies (a) re*u.e 'ain -oint *a(age. Jor se+erel) *a(age* -oints, 'artial or total re'la.e(ent of t&e -oint is 'erfor(e*. Re&a,ilitati+e inter+entions are -oint s'e.ifi. e4er.ises, '&)si.al fitness, '&)si.al (o*alities, e*u.ation an* self (anage(ent. 68 7&e grou' ran*o(i/e* 'attern .ontrolle* stu*) .on*u.te* to #< 'arti.i'ants 0ere re.ruite* fro( t&e .o((unit) sour.es an* ran*o(l) assigne* to $6 0eeks a?uati. 'rogra((e of a non e4er.ise .ontrol .on*ition. >ata 0ere .olle.te* at ,aseline, 0eek " an* 0eek $6. Lonio(etr), " (inutes 0alk test, &ealt& assess(ent ?uestionnaire an* +isual analog s.ale for 'ain use*. Re'eate* (easure anal)sis of +arian.e s&o0e* t&at a?uati. e4er.ise &a* a statisti.all) signifi.ant i('ro+e(ent in knee fle4ion, strengt& an* aero,i. fitness. 6< 7o e4'lore* t&e 0i*e s'e.tru( of treat(ent (o*alit) in.lu*ing e*u.ation, e4er.ise, '&ar(a.ologi.al agents an* surger). 7&e e+i*en.e for t&ese treat(ents nee*s to ,e e4a(ine* so t&at nurses .an &a+e an e+i*en.e ,ase* 'ra.ti.e. 7&e i('ortan.e of in*i+i*ual .&ara.teristi.s an* a+aila,le resour.es nee* to ,e .onsi*ere* on treat(ent sele.tion. 65

>es.ri'ti+e stu*) .on*u.te* to e4'lore t&e 'er.ei+e* i('ortan.e of s)('to(s an* treat(ent 'referen.es of 'eo'le 0it& osteoart&ritis. $$6 knee osteoart&ritis .lients 0ere inter+ie0e*. 7&e results s&o0e* t&at 'ain, insta,ilit) an* *isa,ilit) in t&e -oint 0ere t&e .o((on s)('to(s. Oral *rugs 25%93, '&)si.al t&era') 2"693 an* ai*s 2!"93 0ere t&e .o((on (e*i.al treat(ent. Surger) an* intra arti.ular in-e.tions 0ere t&e (ost effi.a.ious o'tions. #% Se /)#* D; S/'.)e( re$a/e. /# e&&e /)<e*e(( #& ,#/ a--$) a/)#* &#r #(/e#ar/,r)/)(. An e4'eri(ental stu*) .on*u.te* to re+eal t&e effi.a.) of &eate* (u* 'a.k treat(ent in 'atients 0it& knee osteoart&ritis an* to fin* t&e .ontri,ution of .&e(i.al fa.tors to t&e ,uil* u' of t&ese effe.ts. "% .lients 0ere ran*o(l) allo.ate* in to 6 grou's. 7&e inter+ention an* follo0e* u' for 6= 0eeks at = 0eeks inter+als. A signifi.ant nu(,er of 'atients in t&e stu*) grou' s&o0e* (ini(al .lini.all) i('ortant i('ro+e(ent as .o('are* to t&e .ontrol grou'. 7&e result s&o0e* &eat (u* 'a.k treat(ent signifi.antl) i('ro+e* t&e 'ain an* fun.tional status of 'atients 0it& knee osteoart&ritis. =# A 'ros'e.ti+e ran*o(i/e* stu*) .on*u.te* to e+aluate t&e effe.ti+eness of t&e *r) &eat s&eet. #8 'atients using t&e &eat stea( generating s&eet an* $8 using t&e *r) &eat generating s&eets, 0&o use* t&e s&eets .ontinuousl) for = 0eeks, 0ere stu*ie*. 7&e 'ain rating s.ale s.ore 0as use*. 7&e result s&o0e* signifi.ant i('ro+e(ent of t&e total 'ain rating s.ores 0it& &eat generating stea( grou', ,ut no signifi.ant .&ange 0as o,ser+e* in t&e *r) &eat generating s&eet grou'.== Co('arati+e stu*) .on*u.te* to assess t&e t&era'euti. ,enefits of t&er(o .are &eat 0ra' .o(,ine* 0it& an* e*u.ation 'rogra((e to

an e*u.ation : onl) 'rogra((e on re*u.ing 'ain an* *isa,ilit) in osteoart&ritis .lients. =# .lients at DS &a+e ,een ran*o(l) assigne* to t0o grou's. One grou' re.ei+e* e*u.ation alone an* t&e ot&er grou' re.ei+e* e*u.ation an* to'i.al &eat a''li.ation =%%C for <8 &ours. 7&e results e+aluate* on *a) =, 8 an* $= an* it s&o0e* a signifi.ant re*u.tion in 'ain intensit), in.rease* 'ain relief an* i('ro+e* *isa,ilit) s.ores after treat(ent 0it& &eat t&era'). #$ A resear.& on 'ros'e.ti+e, resear.&er ,lin*e*, re'eate* (easures, an* ran*o(i/e* .o('lete ,lo.k *esign. 7&e resear.&er .o('are* t&e effe.ts of (oist &eat 'a.k an* .ontrol treat(ent on &a(string (us.le strengt&. Parti.i'ants re.ei+e* a # treat(ent se?uen.e to t&e 'osterior t&ig&. A (i4e* (o*el anal)sis of +arian.e 0it& # 'retest an* # 'osttest (easures s&o0e* a signifi.ant *ifferen.e ,et0een 'osttest s.ores of t&e (oist &eat grou' an* t&e .ontrol grou'. 7&e &eat t&era') &el's in gaining fle4i,ilit) of t&e &a(string (us.ulature. #6 An e4'eri(ental stu*) .on*u.te* to assess t&e effe.ti+eness of trans.utaneous ner+e sti(ulation for (anaging osteoart&ritis knee 'ain, 6= su,-e.ts 0ere ran*o(l) allo.ate* in to 6 grou's re.ei+ing trans.utaneous ner+e sti(ulation 27ENS3 at $%% ;ert/ or a 'la.e,o. Re'eate* (easure anal)sis of +arian.e an* Pearson .orrelation 0ere use*. E) *a) $%, 7rans.utaneous ner+e sti(ulation 'ro*u.e* a signifi.antl) in.rease* (a4i(u( knee range of (otion 2'H%.%"83 t&an 'la.e,o grou' 2'H%.%##3. So trans.utaneous ner+e sti(ulation &as 'ro+e* to i('ro+e knee fun.tion an* knee range of (otion. ## An e4'eri(ental stu*) .on*u.te* to assess t&e effe.ti+eness of su'erfi.ial &eat =%%C on ?uantifia,le 'ain ,e&a+iors in osteoart&ritis of knee. S'ontaneous 'ain ,e&a+iors, *egree of 0eig&t ,earing an* -oint .ir.u(feren.e 0ere assesse*. ;eat treat(ent 'ro*u.e* a s(all ,ut

signifi.ant *e.rease in 'ain ,e&a+ior 2'H%.%!3. A.ute art&riti. 'ain .an ,e treate* 0it& su'erfi.ial &eat for re*u.ing 'ain an* guar*ing. #=

Se /)#* E; S/'.)e( re$a/e. /# e&&e /)<e*e(( #& #$. a--$) a/)#* &#r #(/e#ar/,r)/)(. Re+ie0 of stu*ies .on*u.te* to e+aluate* t&e '&)siologi.al res'onses to .ol* t&era') Cr)ot&era') 2i.e 'a.k3 is 'res.ri,e* for re*u.tion of 'ain, s0elling an* *is.o(fort in osteoart&ritis. Cr)ot&era') in&i,its signs of infla((ation an* skin te('erature *e.reases fro( ##%C to $%%C 0it&in $% to 6% (inutes. Cr)ot&era') lea*s to +aso.onstri.tion, re*u.tion of e*e(a, an* *i(inis&e* 'ain 'er.e'tion, I.e 'a.ks are effi.ient te.&ni?ues to .ool tissues. #! An e4'eri(ental stu*) .on*u.te* at Eangkok to .o('are t&e skin surfa.e te('erature *uring .r)ot&era'ies. A re'eate* (easures *esign 0as use*. !% 0o(en re.ei+e ea.& of t&e = .r)ot&era'ies 2i.e 'a.k, gel 'a.k, fro/en 'eas, (i4ture of al.o&ol an* 0ater3. 7&e (ean skin te('erature for t&e a,o+e t&era'ies 0as $%.6, $#.5, $=.= an* $% %C res'e.ti+el). 7&e i.e 'a.k an* (i4ture of al.o&ol an* 0ater signifi.antl) re*u.es t&e skin te('erature 2'I%.%%$3 t&an t&e gel 'a.k an* fro/en 'eas. #" Ran*o(i/e* .ontrolle* trial .on*u.te* at Ne0 Kork to *eter(ine t&e effe.ti+eness of .r)ot&era') in t&e treat(ent of knee osteoart&ritis. $85 .lients re.ei+e 6% (inutes of i.e (assage for # 0eeks .o('are* to .ontrols 0it& a 'la.e,o treat(ent. Mean *ifferen.e results s&o0e* in.rease in ?ua*ri.e's strengt& 2659 relati+e *ifferen.e3, i('ro+es knee fle4ion 2<9 relati+e *ifferen.e3 an* fun.tional status 2$$9 relati+e *ifferen.e3. #8

An e4'eri(ental stu*) .on*u.te* at C&i.ago to test 0&et&er signifi.ant 'ain relief .oul* ,e a.&ie+e* ,) 0&ole ,o*) .ol* t&era'). $6% .onse.uti+e .lients 0it& r&eu(atoi* art&ritis. Osteoart&ritis, lo0 ,a.k 'ain, 'ri(ar) an* se.on*ar) fi,ro ()algia 0ere treate* 6.! (inutes in t&e (ain .&a(,er at $%! *egrees C.ANOVA an* 'aire* t tests results s&o0e* t&at 'ain le+el *e.reases signifi.antl) an* lasts for a,out 5% (inutes. #< An e4'eri(ental stu*) .on*u.te* at Net&erlan*s to e+aluate an* .o('are t&e effe.ts of lo.all) a''lie* .ol* treat(ents on skin an* intra arti.ular te('erature of osteoart&ritis .lients. =6 .lients 0ere *i+i*e* ran*o(l) into t0o treat(ent grou's 2i.e .&i's an* nitrogen .ol* air3. 7&e results s&o0e* t&at t&e (ean te('erature of t&e surfa.e skin after # &ours *ro''e* fro( #6.6 : $"%C after a''li.ation of t&e i.e .&i's an* fro( #6." : 5.<%C after nitrogen .ol* airM t&e (ean intra arti.ular te('erature *e.rease* fro( #!.!%C : 65.$%C an* fro( #!.<% C : #6.!%C res'e.ti+el) after t&e t&era'ies. #5

STATEMENT OF THE PROBLEM A stu*) to assess t&e effe.ti+eness of &ot an* .ol* a''li.ation on art&riti. 'ain an* (o,ilit) status a(ong .lients 0it& Osteoart&ritis in sele.te* &os'itals at Kolar *istri.t. 3.4 OBJECTIVES OF THE STUDY $. 7o .o('are t&e 'retest le+el of 'ain an* (o,ilit) status ,et0een &ot an* .ol* a''li.ation grou's .lients 0it& osteoart&ritis. 6. 7o .o('are t&e 'osttest le+el of 'ain an* (o,ilit) status ,et0een &ot an* .ol* a''li.ation grou's .lients 0it& osteoart&ritis. #. 7o asso.iate t&e 'osttest le+el of 'ain an* (o,ilit) status 0it& t&eir sele.te* *e(ogra'&i. +aria,les of &ot a''li.ation grou' .lients 0it& osteoart&ritis. =. 7o asso.iate t&e 'osttest le+el of 'ain an* (o,ilit) status 0it& t&eir sele.te* *e(ogra'&i. +aria,les of .ol* a''li.ation grou' .lients 0it& osteoart&ritis. 3.8 OPERATIONAL DEFINITIONS; E&&e /)<e*e((F It refers to t&e re*u.tion of 'ain le+el an* i('ro+e(ent of (o,ilit) status after t&e a''li.ation of &ot an* .ol* t&era') o+er t&e 'ainful -oint area. H#/ a--$) a/)#*; It refers to t&e a''li.ation of (oist &eat t&era') o+er t&e 'ainful -oint surfa.e in t&e for( of 0ringer ro*s 0rung out of &ot 0ater

2=!%C3 an* allo0e* to re(ain for $! (inutes for # ti(es a *a) 0it& t&e inter+al of #&rs for # *a)s

C#$. a--$) a/)#*F It refers to t&e a''li.ation of (oist .ol* t&era') o+er t&e 'ainful -oint surfa.e in t&e for( of gau/e 0rung out of .ol* 0ater 2$"% $<%C3 an* allo0e* to re(ain for $! (inutes for t&ree ti(es a *a) 0it& t&e inter+al of t&ree &ours for t&ree *a)s. Ar/,r)/) Pa)*; It is a su,-e.ti+e e4'ression of *is.o(fort 'er.ei+e* ,) t&e 'atient as a result of *eterioration of t&e in+ol+e* -oint as (easure* ,) Cin.innati knee rating s.ale for 'ain. M#?)$)/y (/a/'(F It refers to t&e a,ilit) of t&e .lient to (o+e t&e -oint in its full range of (otion as eli.ite* ,) 1OMAC (o,ilit) assess(ent s.ale. C$)e*/(; It refers to t&ose 'ersons 0&o &a+e ,een a*(itte* for Osteoart&ritis. O(/e#ar/,r)/)(; It refers to a slo0 'rogressi+e non infla((ator) *isor*er of t&e *iart&roi*al 2s)no+ial3 -oints. 3.2 HYPOTHESIS; H5; 7&ere 0ill ,e no signifi.ant *ifferen.e in t&e 'osttest le+el of 'ain an* (o,ilit) status ,et0een &ot an* .ol* a''li.ation grou' .lients 0it& osteoart&ritis. 3.3 VARIABLES UNDER STUDY

I*.e-e*.e*/ <ar)a?$e; o A''li.ation of &ot t&era') for 6!.lients. A''li.ation of .ol* t&era') for 6! .lients. De-e*.e*/ Var)a?$e; Pain an* Mo,ilit) status of &ot an* .ol* a''li.ation grou' .lients 0it& osteoart&ritis. A//r)?'/e. Var)a?$e(; Age, Se4, e*u.ation, 0ork status, fa(il) in.o(e, *ietar) 'attern, *uration of illness an* 're+ious (o*e of t&era'). 9. MATERIALS AND METHODS;1 9.1 S#'r e #& .a/a Patients a*(itte* in SNR an* >e+ara- &os'itals. 9.6 Me/,#.( #& .a/a #$$e /)#*; 9.6.1 Re(ear , .e()%*; 7&e resear.& *esign in t&is stu*) is true e4'eri(ental *esign an* t&e a''roa.& use* is .o('arati+e a''roa.&. R R R : Ran*o(i/ation O$ O6 N$ N6 Pretest le+el of 'ain an* (o,ilit) status. Post test of 'ain an* (o,ilit) status. A''li.ation of &ot t&era') A''li.ation of .ol* t&era') O$ O$ N$ N6 O6 O6

9.6.6 Se//)*% #& /,e (/'.y;

7&e stu*) 0ill ,e .on*u.te* in Sri Narasi(&a Ra-a 2SNR3 an* >e+ara- &os'italsM Kolar *istri.t. SNR &os'ital 0&i.& is a =%% ,e**e* &os'ital situate* 6k( a0a) fro( Pa+an College of Nursing fro( Pa+an College of nursing . 9.6.4 P#-'$a/)#*; Clients 0it& osteoart&ritis of ,ot& se4. 9.6.8 Sa>-$e; Clients 0it& osteoart&ritis of ,ot& se4 t&e age grou' ,et0een #% "%)rs in SNR an* >e+ara- &os'itals at Kolar *istri.t. 9.6.2 Sa>-$e ()@e; !% . 9.6.3 Sa>-$)*% /e ,*)A'e; 7&e .lients 0&o satisfie* t&e in.lusi+e .riteria 0ill ,e in.lu*e* in sa('ling fra(e0ork an* !% sa('les 0ill ,e sele.te* ,) si('le ran*o( sa('ling te.&ni?ue 2lotter) (et&o*3, out of 0&i.& 6! sa('les 0ill ,e allotte* to &ot a''li.ation grou' an* 6! sa('les 0ill ,e allotte* to .ol* a''li.ation grou'. 9.6.9 Sa>-$)*% r)/er)a; 1.I* $'()#* Cr)/er)a; Clients 0&o &a+e ,een *iagnose* to &a+e Osteoart&ritis of knee. Clients 0&o are a*(itte* for a 'erio* of at least # *a)s. Clients 0&o are 0illing to 'arti.i'ate in t&e stu*).
Clients 0&o .an un*erstan* Kanna*a an* Englis&.

an*

>e+ara- &os'ital 0&i.& is a "%% ,e**e* &os'ital situate* =k( a0a)

6. EB $'()#* Cr)/er)a;

 Clients 0it& neurologi.al *isor*ers, 0&o is not a,le to 'er.ei+e 'ain. Clients 0it& ot&er -oint infla((ator) *isor*ers or ,one *isor*ers.
Clients 0&o &a+e un*ergone an) ort&o surgi.al 'ro.e*ures.

Clients 0&o are un*er going '&)siot&era').

Clients 0&o are on 'ain (e*i.ations like (or'&ine.

Clients 0&o are &a+ing .ontrain*i.ations for &eat an* .ol* a''li.ation 9.6.C T##$( #& .a/a #$$e /)#*; 7&e tool .o('rises of t&ree se.tions. Se /)#* + A; >e(ogra'&i. +aria,les are age, se4, 0eig&t, e*u.ation, 0ork status, fa(il) in.o(e, *ietar) 'attern, *uration of illness an* 're+ious (o*e of t&era'). Se /)#* + B; Mo*ifie* Cin.innati knee rating s.ale for 're an* 'ost test le+el of 'ain assess(ent. Se /)#* + ; Mo*ifie* 1OMAC Mo,ilit) assess(ent s.ale for 're an* 'osttest le+el of (o,ilit) assess(ent on a.ti+ities like stan*ing, ,en*ing to floor, sitting, 0alking on flat surfa.e, rising fro( sitting, getting on or off toilet an* stairs .li(,ing. S #r)*% KeyD F#r -a)* ( a$e;

%, 6 : Mil* 'ain. =, " : Mo*erate 'ain. <, $% : Se+ere 'ain. F#r >#?)$)/y ( a$e G8 $% Mil* *iffi.ult). G# 8 Mo*erate *iffi.ult).

% # Se+ere *iffi.ult). 9.6.E Me/,#.( #& .a/a #$$e /)#*; >ata 'ertaining to t&e *e(ogra'&i. +aria,les 0ill ,e .olle.te* ,) inter+ie0 (et&o*. Prior to t&e stu*) t&e 'ur'ose of t&e stu*) 0ill ,e e4'laine* an* .onsent of t&e 'arti.i'ants 0ill ,e o,taine* to in+ol+e in t&e stu*). Eefore t&e original stu*) a 'ilot stu*) 0ill ,e .on*u.te* an* t&en ne.essar) (o*ifi.ations an* furt&er refine(ent of t&e tools 0ill ,e *one. Resear.&er &erself 0ill .olle.t t&e *ata. 9.6.15 Da/a a*a$y()( a*. )*/er-re/a/)#*; >es.ri'ti+e an* inferential statisti.al te.&ni?ues su.& as fre?uen.) *istri,ution, .entral ten*en.) (easures 2(ean, (e*ian, an* (o*e3, stan*ar* *e+iation, .&i s?uare an* .o relation .oeffi.ient 0ill ,e use* for *ata anal)sis an* 'resente* in t&e for( of ta,les, gra'&s an* *iagra(s. 9.4 D#e( /,e (/'.y reA')re a*y )*<e(/)%a/)#* #r )*/er<e*/)#*( /# ?e #*.' /e. #* -a/)e*/( F (a>-$e -#-'$a/)#*( F #/,er ,'>a*( #r a*)>a$(G 7&e stu*) 0ill ,e .on*u.te* on .lients of age ,et0een #% an* "% )ears, a*(itte* in t&e SNR an* >e+ara- &os'itals, Kolar. Sin.e t&e stu*) is t&e 're an* 'ost e4'eri(ental stu*). 9.8 Ha( e/,) a$ $eara* e ?ee* #?/a)*e. &r#> y#'r )*(/)/'/e(G

Prior 'er(ission 0ill ,e o,taine* fro( t&e .on.erne* aut&orities of SNR an* >e+ara- &os'itals of Kolar *istri.t to .on*u.t a stu*) an* also fro( resear.& .o((ittee of A.E & C.S Pa+an College of nursing, Kolar. 7&e 'ur'ose of t&e stu*) 0ill ,e e4'laine* to t&e Osteoart&ritis 'atients 0&o are a*(itte* in t&e SNR &os'ital. S.ientifi. o,-e.ti+it) of t&e stu*) 0ill ,e (aintaine* 0it& &onest) an* i('artialit). C. LIST OF REFERENCES $.
6.

>ottie Ro,erts. 26%%"3. 7e4t,ook of Ort&o'e*i.s an* R&eu(atolog). Lon*on. 1.E.Saun*ers Co('an). Llo,al Eur*en of >isease Re'ort 26%%!3. Osteoart&ritis as a (a-or Pu,li. &ealt& 'ro,le(, Retrie+e* on Ma), $6t&, 6%%". National Center for ;ealt& Statisti.s 26%%=3. Pre+alen.e of osteoart&ritis, Retrie+e* on Ma) $6t& 6%%". All In*ia Institute of Me*i.al S.ien.e Re'ort 26%%=3. C&roni. illness in In*ia, Retrie+e* on Se'te(,er, =t&, 6%%8. La0ren.e, Kellegran. 26%%#3. 7e4t,ook of ort&o'e*i.s. Ealti(ore. 1illia( an* 1ilkins Co. $$t& e*ition. Osteoart&ritis Resear.& So.iet) International 26%%#3. Oualit) of life in osteoart&ritis .lients, Retrie+e* on Ma), $6t& 6%%8. Eone an* Joint *e.a*e 26%%!3. 7reat(ent o'tions for osteoart&ritis, Retrie+e* on Ma), =t&, 6%%8. Sue. C >elaune 26%%%3. 7&er(ot&era') in t&e (anage(ent of A(eri.an A.a*e() of Ort&o'e*i. Surgeons 26%%!3. Osteoart&ritis Pre+alen.e an* Co('li.ations, Retrie+e* on Se'te(,er, =t&, 6%%8.

#.

=.

!.

".

8.

<.

osteoart&ritis. Journal of Clini.al Nursing. Vol.NIFNo.$.P'.$!# : $"6.

5.

$%. National Centre for ;ealt& Statisti.s 26%%=3. Pre+alen.e of

osteoart&ritis, Retrie+e* on Ma) $6t& 6%%".

$$. Vo&aranio 26%%63. Inter+ention for osteoart&ritis. Journal of Ort&o'e*i.s. P'. $6% : $6!.
$6. Potter an* Perr) 26%%$3. Nursing inter+ention an* .lini.al skill.

St.Louis. Mos,) Co('an). =t& e*ition. $#. Jor*an JM. et al. 26%%83 Pre+alen.e of knee s)('to(s. Journal of R&eu(atolog). Vol.NNNIVFNo.$. P'.$86 : $<%.
$=. Mouna.&. A. et al. 26%%%3 Risk fa.tors of knee osteoart&ritis.

Clini.al r&eu(atolog) nursing. Vol.NI F No#.'' $" : $5.

$!. Leater AJ. Et al. 26%%83. ;a,itual floor a.ti+ities in.rease risk of

knee

osteoart&ritis.

Clini.al

ort&o'e*i.

relate*

resear.&.

Vol.NNNNVF No.=.

P'.$=8 : $!=

$". 1eter . M 26%%83. Risk of Osteoart&ritis asso.iate* 0it&

o..u'ational fa.tors, Vol.CNNNNVF No.=, P'.$8 : #%, Port&o' I&re Lren/ge,. Retrie+e* on Se'te(,er, =t&, 6%%8.
$8. Lieu CM

et al 26%%83.s?uatting 0it& 're+alen.e of knee

osteoart&ritis . Journal of ort&o'ae*i. nursing. Vol.NNVIIIF No.6.P'. $88 $85. $<. Eurk K. 26%%63. ;ealt& .on.erns of (en 0it& osteoart&ritis of knee. Ort&o'e*i. Nurse. Vol.NNIF No.=.P'.6< : #=. $5. 7sai PJ. et al. 26%%83 Len*er *ifferen.e in 'ain e4'erien.es. Journal of Lerontologi. Nursing. Vol.NNVIIIFNo.!. P'.< : $6. 6%. Sut,e)a/ S7. et al. 26%%83. Effe.t of osteoart&ritis on e4er.ise a(,ulator) .a'a.it). Journal of R&eu(atolog). Vol.NNNIIIF No.5. P'.$<#! : $<=%. 6$. Je/ussek >. et al. 26%%83. Clini.al 'i.ture an* *iagnosis of knee osteoart&ritis. Journal of Clini.al Nursing. Vol.LCNNNNINF No.6". P'.6< : #%.

66. S.&(itt LC. 26%%83. Mo+e(ent an* (us.le a.ti+ation strategies

*uring (o,ilit) of osteoart&riti. .lients. National Clini.al Pra.ti.e R&eu(atolog). Vol.IIIF No.6.P'.8< : <!. 6#. Lin KC. et al. 26%%$3. 7est for '&)si.al fun.tion of t&e el*erl) 0it& &i' an* knee osteoart&ritis. Journal of Me*i.al S.ien.e. Vol.NIFNo.!.P'.6<% : 6<". 6=. Jor*en J. et al. 2$5583. Knee 'ain an* knee osteoart&ritis se+erit). Journal of R&eu(atolog). Vol.NNIVF No.8.P'.$#== : $#=!.
6!. S.&ul/ .A et al 26%%83. Conser+ati+e t&era') of knee osteoart&ritis,

Vol.CNNNNINF No.6", P'.#$ : #6. Retrie+e* on Se'te(,er, 6%%8, &tt'F

6". Ki, K E 26%%83. I('a.t of an art&ritis self (anage(ent

=t&,

'rogra((e an* 'atient e*u.ation .ounseling, Vol.LNVFNo.$, P'.$$# : $6$, Retrie+e* on Se'te(,er, =t&, 6%%8. 68. Ei-ls(a J1. Et al.26%%83. Strategies for t&e 're+ention an* (anage(ent of osteoart&ritis of knee. Journal of Clini.al Nursing. Vol.NIF No.$. P'.!5 : 8". 6<. 1ang 7J. Et al. 26%%83. Effe.t of a?uati. e4er.ise 'rogra((e. Journal of A*+an.e Nursing. Vol.LVIIF No.6. P'.$=$ : $!6. 65. Lu.as E. 26%%!3. 7reat(ent o'tion for 'atients 0it& osteoart&ritis of knee. Eritis& Journal of Nursing. Vol.NIVFNo.<.P'.58" : 5<$. #%. 7allon >. et al. 26%%#3. S)('to(s an* treat(ent of 'referen.es of osteoart&ritis. Journal of P&)si.al Me*i.ine Re&a,ilitation. Vol.LNNVFNo.".P'.=%< : =$%. #$. Eerna.ki EJ. 26%%83. Continuous &eat t&era') for a.ute (us.ular 'ain. Journal of O..u'ational En+iron(ental Me*i.ine. Vol.NNNNVIIF No.$6. P'. $65< : $#%".

#6. Cosgra) NA. et al. 26%%=3. Effe.t of &ealt& (o*alities on ;a(string lengt& Journal of Ort&o'e*i. S'orts an* P&)siot&era'). VolNNNIVF No.8. P'.#88 : #<=. ##. La0 PP. et al. 26%%=3. 7ENS in knee osteoart&ritis. Journal of Clini.al Nursing. Vol.NFNo.". P'.65! : 658.
#=. Sluka KA. et al. 2$5553. Effe.t of Su'erfi.ial &eat on 'ain

,e&a+iors in osteoart&ritis. Journal of Ort&o'e*i.s. Vol.LNNNVIIFNo.$6. P'.$! : $<. #!. Lreenstein .L 26%%83. 7&era'euti. effi.a.) of .ol* t&era') in osteoart&ritis. Journal of Ort&o'e*i. Nursing, Vol.NNVF #". Kanla)an'&ot'orn R. et al. 26%%!3. Co('arison of skin surfa.e te('erature *uring .r)ot&era'). Journal of Ort&o'e*i. Nursing. Vol.LNNNVIF No.8. P'.$=$$ : $=$!. #8. Erosseau. et al.26%%#3. Cr)ot&era') for treat(ent of osteoart&ritis. Ar.&ie+es of P&)si.al Me*i.al Re&a,ilitation. Vol.LNNNVIIFNo.". P'.8=5 : 8!". #<. Met/ger >. et al. 26%%%3. 1&ole ,o*) .r)ot&era'). Journal of Re&a,ilitation Nursing. Vol.NNNINF No.6. P'.5# : $%%. #5. Rasker JJ. 26%%%3. Effe.t of .r)ot&era'&) on arti.ular te('erature. A(eri.an Journal of Nursing. Vol.NVF No.6. P'.#8 : =%.
=%. Mur'&) L.S.&0art/ et al 26%%<3. Life ti(e risk of s)('to(ati.

knee osteoart&ritis. Journal of Art&ritis R&eu(atolog). P'. $6%8: $#.

=$. Mal) MR. et al 26%%83. Personal E4'erien.e of li+ing 0it& knee

osteoart&ritis in ol*er a*ults. Journal of >isa,ilit) Re&a,ilitation .P'.$=6# ##.

=6. Cetin et al 26%%<3, Co('aring &ot 'a.k. Journal of A( J P&)s

(e*i.al Re&a,ilitation. P'. ==# =!$.

=#. O*a,asi et al 26%%<3. Re+eal t&e effi.a.) of &eate* (u* 'a.k

treat(ent. Journal of J Altern .o('le(ent Me*i.ine P'.!!5 !"!.

==. Seto ;.et al 26%%<3.E+aluate t&e effe.ti+eness of t&e *r) &eat s&eet.

Journal of J.Ort&o'ae*i. s.ien.e P'.$<8 $5$.

SIGNATURE OF THE CANDIDATE

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REMAARK OF THE GUIDE

NAME AND DESIGNATION OF !IN BLOCK LETTERS"

11.1 GUIDE 11.6 SIGNATURE

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CO1GUIDE SIGNATURE HEAD OF THE DEPARTMENT SIGNATURE

REMARKS OF THE CHAIRMAN AND PRINCIPAL 16.1 SIGNATURE

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CONFIRMATION FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

Registration No.
Na(e of t&e Can*i*ate A**ress Na(e of t&e Institution Course of Stu*) an* Su,-e.t >ate of A*i(ission to Course 7itle of t&e 7o'i. Erief resu(e of t&e inten*e* 0ork Signature of t&e Stu*ent Lui*e Na(e Re(arks of t&e Lui*e Signature of t&e Lui*e Co Lui*e Na(e Signature of t&e Co Lui*e ;O> Na(e Signature of t&e ;O> Prin.i'al Na(e Prin.i'al Mo,ile No. Prin.i'al E (ail I> Re(arks of t&e Prin.i'al

; 52IN553I9132
; J R#(e Je*)$a F Q$R6!#, Moulees0arar Nager, Mouli+akka(, C&ennai F AECS Pa+an College of Nursing, Kolar F MS. Nursing in Me*i.al Surgi.al Nursing F 66R%!R6%%< F A Stu*) to assess t&e effe.ti+eness of &ot an* .ol* a''li.ation on art&riti. 'ain an* (o,ilit) status a(ong .lients 0it& osteoart&ritis in sele.te* &os'itals at kolar *istri.t. F Atta.&e* F F Mrs. Manoran-it&a( F Loo* F F Mrs. S&i)a(ala Rani 7 F F Mrs. Manoran-it&a( F F F F F

Prin.i'al Signature