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
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE,

KARNATAKA

SYNOPSIS PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 NAME OF THE CANDIDATE MS.J.ROSE JENILA

AND ADDRESS I year M.Sc (N)
PAVAN College of Nursing
Bangalore – Chennai Bypass
Road
Kolar, Karnataka-563101

2 NAME OF THE INSTITUTION A.E & C.S. PAVAN College of

Nursing
Kolar.

3 COURSE OF THE STUDY I year M.Sc (N)

AND SUBJECT 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
convenient sampling technique. Arthritis Impact Measurement Scale 2
was used. The men were more concerned about pain, walking, bending
and stairs climbing. They predicted that in the next 10 years arthritis
would be a major health problem. So interventions should focus on
strategies to deal with pain and decreased mobility. 18
 Section B: Studies related to pain and mobility status in
osteoarthritis of knee.

Comparative study conducted to explore the gender differences

in pain experiences, pain control beliefs, pain coping strategies and
depressive tendency among Chinese elderly with knee
osteoarthritis.199 outpatients with osteoarthritis, in Taiwan were
selected. Female elder reported greater pain and depressive tendency
was a mediator in predicting overall pain intensity. But there was no
significant difference in gender with regard to pain control beliefs.19

An exploratory study conducted to understand the experience of

living with knee osteoarthritis in older adults. Nine interviews
conducted to participants with physician - diagnosed knee
osteoarthritis of different ages, sexes, cultural backgrounds and self-
perceptions. The results showed living with knee osteoarthritis
emerged experiencing knee pain is central to daily living experiencing
mobility limitations devalues self-worth, sharing the experience,
assessing our own health and managing chronic pain. 41

An experimental study conducted to determine whether knee

osteoarthritis reduces ambulatory capacity and impairs quality of life.
56 subjects were selected with and without knee osteoarthritis. A 6
minutes walk test results showed that vital oxygen peak was
significantly higher in the controls when compared with clients .The
subjects without knee osteoarthritis walked a significantly longer
distance than clients with knee osteoarthritis. A significant negative
correlation between pain and physical limitation was observed. 20

An article on osteoarthritis states that progresses the knee

pain, joint misalignments, restriction in knee mobility and reduced
walking occur frequently. Activities such as climbing stairs or sitting
for long periods with bent legs are named as sources of pain for clients
with patello femoral osteoarthritis. Medical or lateral osteoarthritis of
the knee was very probable. 21

Comparative study conducted at New York to investigate the

movement and muscle activation strategies during walking of
individuals with medial knee osteoarthritis. 28 cases and 26 controls
were participated. Knee instability was assessed with activities of daily
living scale and knee motion was assessed by motion analysis.
Independent’s test and regression analysis revealed that osteoarthritis
group used less knee motion and higher Muscle co-contraction during
weight acceptance which was found to be detrimental to joint
integrity.22

An experimental study conducted to assess the physical function

of older clients with clinical knee osteoarthritis. 106 sedentary subjects
more than 60 years (mean 69.4, standard deviation 5.9) with knee
osteoarthritis (mean 12.2, standard deviation 11.0) were participated in
the study. Mobility, joint flexibility and muscle strength were evaluated
by recording time to ascend 8 of descend 4 stairs, rise from sitting or
sit down from chair (5 times). Using Spearman correlation walking,
stairs climbing, chair rise were significantly correlated with each other
and with the pain rating scale index (p<0.001). 23

Descriptive study conducted from 1192 Africans and Caucasians

to evaluate pain severity and mobility limitations in osteoarthritis knee
clients. Multiple logistic regression analysis showed that 43% reported
difficulty in performing 1 task. Mild radiographic knee osteoarthritis
was associated with difficulty in mobility like mobility like climbing,
taking a tub bath, getting in and out of car. Moderate pain was
associated with difficulty in performing 17 out of 20 tasks, except
lifting a cup, opening car door, and turning faucets. Knee pain severity
was the strongest risk factor for self reported difficulty in performing
upper and lower extremity tasks. 24

Section C: Studies related to conservative therapy for

osteoarthritis.

Comparative study conducted to investigate the therapeutic

effects of physical agents administered before isokinetic exercise in
women with knee osteoarthritis. One hundred patients with bilateral
knee osteoarthritis were randomized in to five groups of 20 patients
each received hot packs and exercise with in addition of. Group 1
received short wave diathermy. The second group received
transcutaneous electrical nerve stimulation. Group three received
ultrasound. Group four received hot packs and isokinetic exercise and
group five served as controls and received only isokinetic exercise. The
results showed pain and disability index scores were significantly
reduced in each group. Patients in the study groups had significantly
greater reductions in their visual analog scale scores and scores on the
sequence index than did patients in the controls group. 42

An article on conservative therapy states that highly effective

measures as well as orthopedic aids are available for the knee
osteoarthritis. Thermotherapy, physiotherapy, Balneo therapy, pulse
signal therapy, magnetic field therapy, acupuncture, radiotherapy and
drug therapies control symptoms to different extents in osteoarthritis
management. 25

An experimental study conducted in Hong Kong to assess

the effectiveness of an arthritis self management programme with an
added exercise component among osteoarthritis clients. 88 and 94
subjects were assigned to an intervention group and control group
respectively. Mann Whitney U-test and Friedman test revealed that
there was a significant difference in reduction of pain (p=0.001),
fatigue (p=0.008), Increase duration of weekly light exercise practice
(p=0.001) and knee flexion (p=0.004) in between groups. Intervention
group had a positive effect in pain reduction and improvement of
functional status. 26

Studies on various modifiable risk factors for osteoarthritis

include obesity, occupational factors, sports, sports participation,
muscle weakness, nutritional factors and hormonal influence. Drug
therapies may reduce pain joint damage. For severely damaged joints,
partial or total replacement of the joint is performed. Rehabilitative
interventions are joint specific exercises, physical fitness, physical
modalities, education and self management. 27

The group randomized pattern controlled study conducted

to 38 participants were recruited from the community sources and
randomly assigned to 12 weeks aquatic programme of a non exercise
control condition. Data were collected at baseline, week 6 and week
12. Goniometry, 6 minutes walk test, health assessment questionnaire
and visual analog scale for pain used. Repeated measure analysis of
variance showed that aquatic exercise had a statistically significant
improvement in knee flexion, strength and aerobic fitness. 28

To explored the wide spectrum of treatment modality

including education, exercise, pharmacological agents and surgery. The
evidence for these treatments needs to be examined so that nurses can
have an evidence based practice. The importance of individual
characteristics and available resources need to be considered on
treatment selection. 29
 Descriptive study conducted to explore the perceived
importance of symptoms and treatment preferences of people with
osteoarthritis. 112 knee osteoarthritis clients were interviewed. The
results showed that pain, instability and disability in the joint were the
common symptoms. Oral drugs (90%), physical therapy (62%) and
aids (56%) were the common medical treatment. Surgery and intra-
articular injections were the most efficacious options. 30

Section D: Studies related to effectiveness of hot application for

osteoarthritis.

An experimental study conducted to reveal the efficacy of

heated mud pack treatment in patients with knee osteoarthritis and to
find the contribution of chemical factors to the build up of these
effects. 60 clients were randomly allocated in to 2 groups. The
intervention and followed up for 24 weeks at 4 weeks intervals. A
significant number of patients in the study group showed minimal
clinically important improvement as compared to the control group.
The result showed heat mud pack treatment significantly improved the
pain and functional status of patients with knee osteoarthritis. 43

A prospective randomized study conducted to evaluate the

effectiveness of the dry heat sheet. 37 patients using the heat steam
generating sheet and 17 using the dry heat generating sheets, who used
the sheets continuously for 4 weeks, were studied. The pain rating
scale score was used. The result showed significant improvement of
the total pain rating scores with heat generating steam group, but no
significant change was observed in the dry heat generating sheet
group.44

Comparative study conducted to assess the therapeutic benefits

of thermo care heat wrap combined with and education programme to
an education – only programme on reducing pain and disability in
osteoarthritis clients. 43 clients at US have been randomly assigned to
two groups. One group received education alone and the other group
received education and topical heat application 40 0C for 87 hours. The
results evaluated on day 4, 7 and 14 and it showed a significant
reduction in pain intensity, increased pain relief and improved
disability scores after treatment with heat therapy. 31

A research on prospective, researcher blinded, repeated measures,

and randomized complete block design. The researcher compared the
effects of moist heat pack and control treatment on hamstring muscle
strength. Participants received a 3 treatment sequence to the posterior
thigh. A mixed model analysis of variance with 3 pretest and 3 posttest
measures showed a significant difference between posttest scores of
the moist heat group and the control group. The heat therapy helps in
gaining flexibility of the hamstring musculature. 32

An experimental study conducted to assess the effectiveness

of transcutaneous nerve stimulation for managing osteoarthritis knee
pain, 24 subjects were randomly allocated in to 2 groups receiving
transcutaneous nerve stimulation (TENS) at 100 Hertz or a placebo.
Repeated measure analysis of variance and Pearson correlation were
used. By day 10, Transcutaneous nerve stimulation produced a
significantly increased maximum knee range of motion (p=0.067) than
placebo group (p=0.033). So transcutaneous nerve stimulation has
proved to improve knee function and knee range of motion. 33

An experimental study conducted to assess the effectiveness of

superficial heat 400C on quantifiable pain behaviors in osteoarthritis of
knee. Spontaneous pain behaviors, degree of weight bearing and joint
circumference were assessed. Heat treatment produced a small but
significant decrease in pain behavior (p=0.05). Acute arthritic pain can
be treated with superficial heat for reducing pain and guarding. 34

Section E: Studies related to effectiveness of cold application for

osteoarthritis.

Review of studies conducted to evaluated the physiological

responses to cold therapy Cryotherapy (ice pack) is prescribed for
reduction of pain, swelling and discomfort in osteoarthritis.
Cryotherapy inhibits signs of inflammation and skin temperature
decreases from 330C to 100C within 10 to 20 minutes. Cryotherapy
leads to vasoconstriction, reduction of edema, and diminished pain
perception, Ice packs are efficient techniques to cool tissues. 35

An experimental study conducted at Bangkok to compare the

skin surface temperature during cryotherapies. A repeated measures
design was used. 50 women receive each of the 4 cryotherapies (ice
pack, gel pack, frozen peas, mixture of alcohol and water). The mean
skin temperature for the above therapies was 10.2, 13.9, 14.4 and 10 0C
respectively. The ice pack and mixture of alcohol and water
significantly reduces the skin temperature (p<0.001) than the gel pack
and frozen peas. 36

Randomized controlled trial conducted at New York to determine

the effectiveness of cryotherapy in the treatment of knee osteoarthritis.
179 clients receive 20 minutes of ice massage for 3 weeks compared to
controls with a placebo treatment. Mean difference results showed
increase in quadriceps strength (29% relative difference), improves
knee flexion (8% relative difference) and functional status (11%
relative difference). 37
 An experimental study conducted at Chicago to test whether
significant pain relief could be achieved by whole body cold therapy.
120 consecutive clients with rheumatoid arthritis. Osteoarthritis, low
back pain, primary and secondary fibro myalgia were treated 2.5
minutes in the main chamber at -105 degrees C.ANOVA and paired t-
tests results showed that pain level decreases significantly and lasts for
about 90 minutes. 38

An experimental study conducted at Netherlands to evaluate and

compare the effects of locally applied cold treatments on skin and intra
articular temperature of osteoarthritis clients. 42 clients were divided
randomly into two treatment groups (ice chips and nitrogen cold air).
The results showed that the mean temperature of the surface skin after
3 hours dropped from 32.2 – 160C after application of the ice chips and
from 32.6 – 9.80C after nitrogen cold air; the mean intra articular
temperature decreased from 35.50C – 29.10C and from 35.80 C –
32.50C respectively after the therapies. 39
STATEMENT OF THE PROBLEM

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.

6.3 OBJECTIVES OF THE STUDY

1. To compare the pretest level of pain and mobility status

between hot and cold application groups clients with osteoarthritis.

2. To compare the posttest level of pain and mobility status

between hot and cold application groups clients with osteoarthritis.

3. To associate the posttest level of pain and mobility status with

their selected demographic variables of hot application group clients
with osteoarthritis.

4. To associate the posttest level of pain and mobility status with

their selected demographic variables of cold application group clients
with osteoarthritis.

6.4 OPERATIONAL DEFINITIONS:

Effectiveness:

It refers to the reduction of pain level and improvement of

mobility status after the application of hot and cold therapy over the
painful joint area.

Hot application:

It refers to the application of moist heat therapy over the

painful joint surface in the form of wringer rods wrung out of hot water
(450C) and allowed to remain for 15 minutes for 3 times a day with the
interval of 3hrs for 3 days

Cold application:

It refers to the application of moist cold therapy over the painful

joint surface in the form of gauze wrung out of cold water (16 0 -180C)
and allowed to remain for 15 minutes for three times a day with the
interval of three hours for three days.

Arthritic Pain:

It is a subjective expression of discomfort perceived by the

patient as a result of deterioration of the involved joint as measured by
Cincinnati knee rating scale for pain.

Mobility status:

It refers to the ability of the client to move the joint in its full
range of motion as elicited by WOMAC mobility assessment scale.

Clients:

It refers to those persons who have been admitted for Osteoarthritis.

Osteoarthritis:

It refers to a slow progressive non-inflammatory disorder of the

diarthroidal (synovial) joints.

6.5 HYPOTHESIS:

H0: There will be no significant difference in the posttest level of pain

and mobility status between hot and cold application group clients with
osteoarthritis.

6.6 VARIABLES UNDER STUDY

Independent variable:

o Application of hot therapy for 25clients.

 Application of cold therapy for 25 clients.

Dependent Variable:

Pain and Mobility status of hot and cold application group

clients with osteoarthritis.

Attributed Variables:

Age, Sex, education, work status, family income, dietary

pattern, duration of illness and previous mode of therapy.

7. MATERIALS AND METHODS:-

7.1 Source of data

Patients admitted in SNR and Devaraj hospitals.

7.2 Methods of data collection:

7.2.1 Research design:

The research design in this study is true experimental design and the
approach used is comparative approach.

R O1 X1 O2
R O1 X2 O2
R – Randomization

O1 -- Pretest level of pain and mobility status.

O2 -- Post test of pain and mobility status.

X1 - Application of hot therapy

X2 -- Application of cold therapy

7.2.2 Setting of the study:

 The study will be conducted in Sri Narasimha Raja (SNR) and
Devaraj hospitals; Kolar district. SNR hospital which is a 400 bedded
hospital situated 2km away from Pavan College of Nursing and
Devaraj hospital which is a 600 bedded hospital situated 4km away
from Pavan College of nursing .

7.2.3 Population:

Clients with osteoarthritis of both sex.

7.2.4 Sample:

Clients with osteoarthritis of both sex the age group between

30 - 60yrs in SNR and Devaraj hospitals at Kolar district.

7.2.5 Sample size:

50 .

7.2.6 Sampling technique:

The clients who satisfied the inclusive criteria will be included in

sampling framework and 50 samples will be selected by simple random
sampling technique (lottery method), out of which 25 samples will be
allotted to hot application group and 25 samples will be allotted to cold
application group.

7.2.7 Sampling criteria:

1.Inclusion Criteria:

 Clients who have been diagnosed to have Osteoarthritis of knee.

 Clients who are admitted for a period of at least 3 days.

 Clients who are willing to participate in the study.

 Clients who can understand Kannada and English.

2. Exclusion Criteria:
  Clients with neurological disorders, who is not able to perceive
pain.

 Clients with other joint inflammatory disorders or bone disorders.

 Clients who have undergone any ortho - surgical procedures.

 Clients who are under going physiotherapy.

 Clients who are on pain medications like morphine.

 Clients who are having contraindications for heat and cold

application

7.2.8 Tools of data collection:

The tool comprises of three sections.

Section – A:

Demographic variables are age, sex, weight, education, work

status, family income, dietary pattern, duration of illness and
previous mode of therapy.

Section – B:

Modified Cincinnati knee rating scale for pre and post test
level of pain assessment.

Section – c:

Modified WOMAC Mobility assessment scale for pre and

posttest level of mobility assessment on activities like standing,
bending to floor, sitting, walking on flat surface, rising from
sitting, getting on or off toilet and stairs climbing.

Scoring Key;

For pain scale:

0, 2 – Mild pain. 4, 6 – Moderate pain. 8, 10 – Severe pain.

 For mobility scale

>7 - 10 Mild difficulty. >3 - 7 Moderate difficulty.

0 - 3 Severe difficulty.

7.2.9 Methods of data collection:

Data pertaining to the demographic variables will be

collected by interview method. Prior to the study the purpose of
the study will be explained and consent of the participants will be
obtained to involve in the study. Before the original study a pilot
study will be conducted and then necessary modifications and
further refinement of the tools will be done. Researcher herself
will collect the data.

7.2.10 Data analysis and interpretation:

Descriptive and inferential statistical techniques such as frequency

distribution, central tendency measures (mean, median, and mode),
standard deviation, chi square and co-relation coefficient will be used
for data analysis and presented in the form of tables, graphs and
diagrams.

7.3 Does the study require any investigation or interventions to be

conducted on patients / sample populations / other humans or
animals?

The study will be conducted on clients of age between 30 and 60

years, admitted in the SNR and Devaraj hospitals, Kolar. Since the
study is the pre and post experimental study.

7.4 Has ethical clearance been obtained from your institutes?

Prior permission will be obtained from the concerned authorities

of SNR and Devaraj hospitals of Kolar district to conduct a study and
also from research committee of A.E & C.S Pavan College of nursing,
Kolar. The purpose of the study will be explained to the Osteoarthritis
patients who are admitted in the SNR hospital. Scientific objectivity of
the study will be maintained with honesty and impartiality.

8. LIST OF REFERENCES
1. Dottie Roberts. (2006). Textbook of Orthopedics and
Rheumatology. London. W.B.Saunders Company.
2. Global Burden of Disease Report (2005). Osteoarthritis as a major
Public health problem, Retrieved on May, 12th, 2006.
3. National Center for Health Statistics (2004). Prevalence of
osteoarthritis, Retrieved on May 12th 2006.
4. All India Institute of Medical Science Report (2004). Chronic
illness in India, Retrieved on September, 4th, 2007.
5. Lawrence, Kellegran. (2003). Textbook of orthopedics. Baltimore.
William and Wilkins Co. 11th edition.
6. Osteoarthritis Research Society International (2003). Quality of
life in osteoarthritis clients, Retrieved on May, 12th 2007.
7. Bone and Joint decade (2005). Treatment options for osteoarthritis,
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9 SIGNATURE OF THE CANDIDATE

10 REMAARK OF THE GUIDE

11
NAME 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