ASSOCIATION OF JOINT HEALTH STATUS WITH FUNCTIONAL

INDEPENDENCE AMONG PATIENTS WITH HEMOPHILIA

In the fulfilment of the requirement for the degree of

DOCTOR OF PHYSICAL THERAPY (DPT)

Department of Allied Health Sciences,

University of Sargodha

Session (2018-2023)
Submitted by;

MIAN SAQIB AMIN 1709

ZULQARNAIN ALI 1711

AINI GHORI 1801

HASNAT AHMAD FAHAD 1804

GHAZALA FAROOQ 1810

RIMSHA ARSHAD 1824

AMISH SAEED 1837

 CERTIFICATE OF ORIGINALITY

It is stated that the research work reported in the research report “ASSOCIATION OF JOINT
HEALTH STATUS WITH FUNCTIONAL INDEPENDENCE AMONG PATIENT WITH
HEMOPHILIA” is original, and nothing has been stolen/copied/plagiarized from any source.
The research work has been completed according to the guidelines of the University of
Sargodha, Sargodha, Pakistan.

____________________________

Student Name and Roll NO ;

MIAN SAQIB AMIN 1709

ZULQARNAIN ALI 1711

AINI GHORI 1801

HASNAT AHMAD FAHAD 1804

GHAZALA FAROOQ 1810

RIMSHA ARSHAD 1824

AMISH SAEED 1837

Registration #

Institute/College Name:

LAHORE COLLEGE OF PHARMACEUTICAL SCIENCES(LCPS)

 RESEARCH COMPLETION CERTIFICATE

It is certified that the research work contained in the research report entitled “ASSOCIATION
OF JOINT HEALTH STATUS WITH FUNCTIONAL INDEPENDENCE AMONG
PATIENT WITH HEMOPHILIA” submitted by ---------------------------------, Reg. No.
------------------------------------------------ has been carried out under our supervision in partial
fulfilment of the requirement for the award of the degree of DPT and is hereby approved for
submission. It is further certified that the scholar's research work is original, and nothing has
been stolen/copied/plagiarized from any source. The research work has been completed as per
requirement for the award of degree Doctor of Physical Therapy (DPT) under my supervision
according to the guidelines of the University of Sargodha, Sargodha, Pakistan.

Supervisor Name:

DR AMINA RIAZ

Institute/College Name:

LAHORE COLLEGE OF PHARMACEUTICAL SCIENCES(LCPS)

Sign:

Date:
 PLAGIARISM EVALUATION REPORT

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RESEARCH REPORT WRITING EVALUATION

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and does it summaries the topic's current state with
references to relevant literature?
Is the research question formulated by explicitly stating the
study's aim/objective?
Literature Literature review shares relevant information and thorough
review knowledge of the field and gaps in the literature.
Methods Is the study design employed relevant and appropriate
Is the statistical analysis and outcome measures accurate and
reliable?
Results Are the results presented accurately in a concise, logical and
well-organized form?
Discussion Provides a summary of the findings and perspectives for
interpretation
Are the salient results logically interpreted with justification
from literature?
References Are the citations accurate, up to date and provide sufficient
context to allow for critical analysis of the study?
Presentation Is the presenter well-prepared, and the purpose is
communicated clearly?
Is the presenter responded effectively to the examiner's
questions/comments?
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#----------------------Registration #-------------------------------------- student of DPT has made all
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 DEDICATIONS

STUDENT NAME & ROLL NO

MIAN SAQIB AMIN 1709

ZULQARNAIN ALI 1711

AINI GHORI 1801

HASNAT AHMAD FAHAD 1804

GHAZALA FAROOQ 1810

RIMSHA ARSHAD 1824

AMISH SAEED 1837

LIST OF ABBREVIATION
HJHS Hemophilia joint health score

FISH Functional Independence score in hemophilia

ROM
ROM Rangeof
Range ofmotion
motion

HAL Hemophilia activities list

VAS Visual
Visualanalogue
analoguescale
scale

ICC Intraclass correlation coefficient

 CHAPTER 1:

INTRODUCTION

Hemophilia is the most common severe congenital blood disorder.(1)In hemophilic patients
factor VIII deficiency results in Hemophilia A while hemophilia B is the results of factor IX
deficiency. There is a less common form of hemophilia known as hemophilia C which occurs
due to deficiency of clotting factor XI.(2) Hemophilia is identify by recurrent intramuscular and
intra articular bleeding events results in disfunction of joint and soft tissue leading to
musculoskeletal impairment and arthropathy(3) Hemophiliac patients frequently exposure to
pain and functional disability due to arthropathy.(4)

The global prevalence of hemophilia according to UNICEF at birth is approximately 20,000

hemophiliac child per year.(5) Hemophilia is acquired through an X-linked recessive pattern. So
there are 50% chance of having affected males and 50% chance of having carrier females in a
female carrier mothers.(6)

In hemophilic patients the major symptoms are hemorrhagic symptoms which are easy bruising
and hemarthrosis along with prolonged bleeding after traumatic injury and soft tissue hematoma.
(7) Patients also shows some unprovoked hemorrhagic symptoms such as cutaneous bleeding,
nose bleeds and gum bleeding. Patients also have prolonged bleeding after simple non-surgical
tooth extractions. Hemophilic women or carrier females shows frequent excessive menstrual
bleeding and prolonged vaginal bleeding after delivery or miscarriages.(8) Most complicated
cases are of intracranial hemorrhage, GI bleeding and nerve palsy. In hemophilic patients
hemarthrosis events become sever with age.(7)

Repeated joint bleeding and hematoma formation in hemophiliac patients leads to progressive
degenerative and chronic changes in joints knowns as hemophiliac arthropathy. This arthropathy
results in reduced range of motion, loss in proprioceptive and biomechanical senses, gate
disturbance, and atrophy of effected musculature. As an outcome, patients complain about
chronic pain and loss of function. (9)Most commonly effected joints are ankles, elbows and
knees.(10) Uncertain bleeding, Joint pain and restricted movement of effected joints due to
Hemophilia effect people’s daily life activities.(11)

Classification of severity of Hemophilia is divided into mild, moderate and severe on the bases
of bleeding symptoms. Anyhow classifications Include with person <1% factor as severe, 1-6%
or 1-7% as moderately severe and >6% or 7% as mild. At the same time classification also
include the persons with factor Vlll or factor lX level. <1% shows mild and spontaneous
bleeding and appear to be clinically moderate and mild with procoagulant activities of 1-% that
shows frequently bleeding and appear clinically as severe. Factor Vlll and Factor 1X can be used
for the classification of Hemophilia rather than plasma procoagulant levels.(12)

Muscular malfunction can be detected by clinical and radiological joint score. Functional
Independence score in hemophilia[FISH] is a particular tool to evaluate musculoskeletal role in
hemophiliac patients.(13) Functional Independence score in hemophilia can be used to evaluate
level of disfunction of weight bearing activities such as movements, stair climbing and five
others in moderate and severe hemophiliac patients.(3) Hemophilia joint health score[HJHS] is
an authentic tool to detect arthropathy (14) Regular evaluation of joint health is beneficial for
management, for this purpose Hemophilia joint health score is being used and on the other hand
Joint disfunction score can also be draw out by using Hemophilia joint health score.(15)

Treatment of hemophilia direct to reduce structural injury to joints and boost patient functional
independence and quality of life.(16) The treatment of hemophilia varies according to activity of
factor level. First aid such as icepacks, pressure and bandages used to slow down minor
bleedings.(17) The most perfect way to treat hemophilia is to replace the lost blood clotting
factor so that the blood can clot properly. There are some medications also present to prevent
clots from being destroyed. Fibrin sealants can be applied to directly to open sites to assist
healing and clotting. Physical therapy is used to help ease sign and symptoms of damaged joints
due to internal bleeding and for betterment of post bleeding complications.(18) If physical
therapy is given in early ages then it would be highly beneficial. Physical therapy helps to
improve range of motion, reduce pain and disability of effected joints. Suitable physical therapy
united with factor replacement therapy enhance musculoskeletal function.(19)
This study will be helpful to understand the level of functional disability and quality of life
(QOL) in hemophiliac patients. Functional disability refers to a body that has reduction in its
ability to move and it’s ADL’s performance. This study will be helpful to improve the joint
health, thought and self-confidence. In hemophiliac patients we can provide the awareness to
improve the joint health status and prevent functional disability and ultimately improve the
quality of life.

OBJECTIVES: To determine the association of joint health status with functional

independence in patients with hemophilia.

OPERATIONAL DEFINATION:

Functional Independence Score in Hemophilia [FISH]:

Functional Independence Score in Hemophilia is a performance based tool which is used to

measures patient's independence in seven activities under three categories: self-care [eating and
grooming, dressing and bathing] , mobility [walking and step climbing] and transfers [floor and
chair].(13)

The Hemophilia Joint Health Score (HJHS):

Hemophilia Joint Health Score is an authentic end result tool developed for assessing joint health
of hemophiliac patients. This joint score assesses 9 items in 6 index joints. The 9 items which are
assessed to evaluate the status of a joint include swelling, duration of swelling, muscle
atrophy, crepitus of motion, range of motion [extension and flexion loss], joint pain, strength and
gait. (20)
 CHAPTER 2:

LITERATURE REVIEW
In 2023 a study conducted by Mabrouk, et al. in which they assess hemophilic joints in
individuals with hemophilic arthropathy clinically, radiographically, and functionally.
This cross-sectional study included 50 children with severe hemophilia A who were
selected from the pediatric hematology clinic. All children were assessed
for Hemophilia Joint Health Score [HJHS]. Joint assessed functionally by Functional
Independence Score in Hemophilia [FISH] and radiologically by plain x-ray and scored
by the Peterson scoring system. The mean FISH score among the studied patients was
26.8±4.2, the mean HJHS was 16.8±12.8, and the Peterson score was 4.9±2.7. The
number of affected joints showed a significant negative correlation to the FISH score and
a significant positive correlation to HJHS. The frequency of hemarthrosis/month showed
a significant positive correlation to HJHS. The number of affected joints showed a
significant negative correlation to the FISH score and a significant positive correlation to
HJHS. Frequency of hemarthrosis/month showed a significant positive correlation to
HJHS.(21)
A study conducted by P. M. Poonnoose, et al in which they assess musculoskeletal
function of patients with hemophilia, they developed Functional Independence Score in
Hemophilia [FISH], a performance-based instrument. FISH measures the patient's
independence in performing seven activities under three categories: self-care [grooming
and eating, bathing and dressing], transfers [chair and floor] and mobility [walking and
step climbing]. Each function is graded from 1 to 4 depending on the amount of
assistance needed in performing the function. The conclusion of this study is that FISH
appears to be a promising disease-specific instrument for assessing overall
musculoskeletal function in hemophilia.(13)
A prospective study has been conducted by Vikas PayPal et al to determine the joint health
status in Hemophilia patients and draw their joint disability score by using HJHS. Out of total
56 cases 51 cases were diagnosed as hemophilia A while 5 cases were diagnosed as
hemophilia B. According to their factor level 44 % cases had severe, 36 % had moderate and
20 % had mild disease. Knee joint was the predominant joint affected by hemarthrosis in
followed by ankle joint, elbow joint, hip joint, shoulder joint and proximal
metacarpophalangeal joint. Out of total 37.5 % patients of hemophilia had developed target
joint. Maximum number of patients had HJHS score of zero. The mean HJHS score was
6.78 ± 9.04. HJHS score showing significant positive correlation with age of patient. Most
risky period and hemophilic joint damage start from 7 years of age. Therefore, treatment
decisions, such as starting prophylaxis, should be tailored according to bleeding pattern and
age of patients rather than based on the clotting factor activity levels.(15)

Alberto Tlacuilo-Parra MD, et al. conducted a cross sectional study in which they determine
the Functional Independence Score in Hemophilia [FISH] is a performance-based assessment
tool used to measure the patient’s functional ability so far only used in patients with severe
hemophilia. Its aim is to determine if FISH is useful in patients with mild and moderate
disease. Patients between 5 and 16 years of age were selected each patient was evaluated in
seven activities under three categories: self-care [grooming and eating, bathing, and
dressing], transfers [chair and squat], and locomotion [walking and step climbing]. Each
activity was graded from 1 to 4 according to the amount of assistance required to perform the
activity with total scores ranging from 7 to 28. The conclusion of this study that a significant
decrease in functional ability was demonstrated according to the severity of hemophilia,
especially for those activities involving weight-bearing demands like locomotion and step
climbing.(3)

A cross sectional study conducted by Smriti Gupta et al at SPMCHI Jaipur, India. In which
they assessed 98 patients of severe, moderate and hemophilia A with history of hemarthrosis.
In this study FISH is used to measure musculoskeletal function and index joints were
assessed radiologically by Patterson score. The results showed a noteworthy relationship
between mean Patterson score and mean FISH score in the cases of knee and elbow but not
in the cases of ankle. This study concluded that FISH and Peterson’s score is extremely
useful and reliable tool for detecting joint damage and functional independence in patients
with hemophilia A.(22)

Alexander Jorge, et al conducted a study on hemophilic patients of Brazilian hemophilic

center to access functional and joint performance with one year follow up as well its
association with attending scheduled consultation and prophylactic treatment. HJHS and
FISH of 69 patients assessed at first consultation and after one year follow up. Mean age was
22.5 ±4.5 years, primary prophylaxis was given to 29 patients. A positive relation between
HJHS and age while negative relation between age and FISH has been shown. This study
concluded that the HJHS become worse in older patients and if older patients have
arthropathies FISH become worse in them. Patients receiving primary prophylaxis show
better results in HJHS and FISH instead of patients receiving secondary prophylaxis.(23)

A study conducted by K. Fischer, et al to assess the reliability and validity of the HJHS in
hemophilic young adults and teenagers. 22 hemophilic patients from which 15 with severe
hemophilia were assessed using the HJHS1.0, Hemophilia Activities List [HAL], SF36 and
self-evaluation was performed using a Visual Analogue Scale [VAS] scale.]. They assessed
the validity by Pearson's correlation with all end result frameworks and recent Peterson
scores. End result shows median HJHS and VAS score of patients and shows maximum
scores for HAL and SF36 physical functioning for the maximum patients. While the Peterson
scores were low. On the other hand, Interobserver reliability was good with limits of
agreement of ±7.2 points. The ICC remain unaffected by different score calculation methods.
22 patients showed weak association of HJHS scores with patients' VAS and HAL while it
shows strong link with SF36-PF and Peterson scores. The results of this study suggest that
interobserver reliability of the HJHS 1.0 is excellent in teenagers and young adults with
limited joint damage.(24)
 HYPOTHSIS:

Null Hypothesis:

There will be no association of joint health status with functional independence in patients with
hemophilia.

Alternate Hypothesis:

There will be association of joint health status with functional independence in patients with
hemophilia.
 CHAPTER 3:

MATERIALS & METHODS

Study Design:

It will be cross sectional study.

Study Population:

Data will be collected from the Hemophilia patient’s welfare society [HPWS] of Lahore.

Study Duration:

6 months after the approval of synopsis.

Sample Size:

A sample size of 200 will be calculated by Epitool sample size.

Sampling Method:

Random sampling considering the hemophilia patients.

Ethical Issues:

During the whole period of study, the ethics will be kept in consideration. The personal
information of individual’s will be kept hidden and secured. The study did not affect the
individual’s ethical values and Researcher follows all ethics of medical field.
 Eligibility criteria:

Inclusions:

 Patients between age group of 7 to 25.

 All hemophilia types.
 Both Male and female participants will be included.

Exclusion:

 Peoples with poor mental status.

 Peoples who will not agree to participate in study.
 People with recent surgeries.
 DATA COLLECTION PROCEDURE:

It will be a cross-sectional study that will be completed in six-month duration. The data will be
collected from Hemophilia patient’s welfare society of Lahore. The study will start after the
approval of synopsis.

The sample size of this study will be almost 200 taken from hemophilic patients of various cities
which come here for treatment. The patients will be selected by simple random sampling. The
whole populations will be included while the persons with poor mental status, physical
disabilities, recent surgeries and who will not willing to participate in study will be excluded.
Ethics will be kept in consideration during the whole period of study. Hemophilia Joint Health
Score [HJHS] and Functional Independence score in hemophilia [FISH] will be used to assess
the joint health status and functional disabilities of patients. The data will be taken by the
patients after the informed consent. The personal information of individual’s will be kept hidden
and secured. The study will not affect the ethical values of involved participants. We will
evaluate data Based on previous records and by obtaining history& physical examination, target
joints will be assessed using.

Hemophilia joint health and functional scoring assessed as per Functional Independence score in
hemophilia and Hemophilia Joint Health Score scoring system. A detailed questionnaire
assessing various factors which could influence the scores will be taken into account, and the
final association will be established between them.
 CHAPTER 6

Reference:

1. Salen P, Babiker HM. Hemophilia A. 2017.

2. Ibrahiem OA, Thabet AF, Tony SS, Kerollos KMN, Moeen SM. Assessment of quality of life by
functional independence score in hemophilic patients: a single-center experience. The Egyptian Journal
of Internal Medicine. 2022;34(1):1-9.
3. Tlacuilo‐Parra A, Villela‐Rodriguez J, Garibaldi‐Covarrubias R, Soto‐Padilla J, Orozco‐Alcala J.
Functional independence score in hemophilia: A cross‐sectional study assessment of Mexican children.
Pediatric blood & cancer. 2010;54(3):394-7.
4. Kempton CL, Buckner TW, Fridman M, Iyer NN, Cooper DL. Factors associated with pain severity,
pain interference, and perception of functional abilities independent of joint status in US adults with
hemophilia: Multivariable analysis of the Pain, Functional Impairment, and Quality of Life (P‐FiQ) study.
European journal of haematology. 2018;100:25-33.
5. Hemophilia WFo. Report on the annual global survey. World Federation of Hemophilia
Montreal, QC, Canada; 2015.
6. Bertamino M, Riccardi F, Banov L, Svahn J, Molinari AC. Hemophilia care in the pediatric age.
Journal of clinical medicine. 2017;6(5):54.
7. Kim KY, Yang CH, Cho MJ, Lee M. Comprehensive clinical and statistical analysis of hemophilia in
Korea. Journal of Korean medical science. 1988;3(3):107-15.
8. Lambert C, Meité ND, Sanogo I, Lobet S, Adjambri E, Eeckhoudt S, et al. Hemophilia carrier’s
awareness, diagnosis, and management in emerging countries: a cross-sectional study in Côte d’Ivoire
(Ivory Coast). Orphanet Journal of Rare Diseases. 2019;14(1):1-7.
9. Ucero-Lozano R, López-Pina JA, Ortiz-Pérez A, Cuesta-Barriuso R. Quality of life and its predictors
among adult patients with haemophilic arthropathy. An observational study. BMC Musculoskeletal
Disorders. 2021;22(1):1-8.
10. Hmida J, Hilberg T, Ransmann P, Tomschi F, Klein C, Koob S, et al. Most subjectively affected
joints in patients with haemophilia–what has changed after 20 years in Germany? Haemophilia.
2022;28(4):663-70.
11. Banchev A, Batorova A, Faganel Kotnik B, Kiss C, Puras G, Zapotocka E, et al. A cross-national
survey of people living with hemophilia: impact on daily living and patient education in Central Europe.
Patient preference and adherence. 2021:871-83.
12. White G, Rosendaal F, Aledort L, Lusher J, Rothschild C, Ingerslev J. Recommendation of the
scientific subcommittee on factor VIII and factor IX of the scientific and standardization committee of the
International Society on Thrombosis and Haemostasis. Thromb Haemost. 2001;85(3):560.
13. Poonnoose P, Manigandan C, Thomas R, Shyamkumar N, Kavitha M, Bhattacharji S, et al.
Functional Independence Score in Haemophilia: a new performance‐based instrument to measure
disability. Haemophilia. 2005;11(6):598-602.
14. St‐Louis J, Abad A, Funk S, Tilak M, Classey S, Zourikian N, et al. The hemophilia joint health
score version 2.1 validation in adult patients study: a multicenter international study. Research and
practice in thrombosis and haemostasis. 2022;6(2):e12690.
15. Payal V, Sharma P, Chhangani N, Janu Y, Singh Y, Sharma A. Joint health status of hemophilia
patients in Jodhpur region. Indian Journal of Hematology and Blood Transfusion. 2015;31:362-6.
16. Poonnoose PM, Srivastava A, editors. Functional assessment of arthropathy—an international
perspective. Seminars in hematology; 2006: Elsevier.
17. Weyand AC, Pipe SW. New therapies for hemophilia. Blood, The Journal of the American Society
of Hematology. 2019;133(5):389-98.
18. Hoots WK, Shapiro A. Treatment of bleeding and perioperative management in hemophilia A
and B. Up To Date, Section Upto Date Inc Available from: http://uptodate com [Accessed on
20/05/2019]. 2021.
19. Gurcay E, Eksioglu E, Ezer U, Cakir B, Cakci A. A prospective series of musculoskeletal system
rehabilitation of arthropathic joints in young male hemophilic patients. Rheumatology international.
2008;28:541-5.
20. Ribeiro T, Abad A, Feldman BM. Developing a new scoring scheme for the Hemophilia Joint
Health Score 2.1. Research and practice in thrombosis and haemostasis. 2019;3(3):e12212.
21. Mabrouk AG, Abbas MA-B, Ezzat DA, Sayed MT, Ali FM. Hemophilia Joint Health Score,
Functional Independence Score in Hemophilia, and Pettersson Score in Pediatric Patients With Severe
Hemophilia A. Journal of Pediatric Hematology/Oncology. 2023:10.1097.
22. Kuijlaars IA, van der Net J, Feldman BM, Aspdahl M, Bladen M, de Boer W, et al. Evaluating
international Haemophilia Joint Health Score (HJHS) results combined with expert opinion: options for a
shorter HJHS. Haemophilia. 2020;26(6):1072-80.
23. Ribeiro AJT, Amorim FF, Soares BMD, Santana LA, Imoto AM. Functional and joint evaluation in a
prospective cohort of patients with severe haemophilia. Haemophilia. 2021;27(2):314-20.
24. Fischer K, De Kleijn P. Using the Haemophilia Joint Health Score for assessment of teenagers and
young adults: exploring reliability and validity. Haemophilia. 2013;19(6):944-50.
 CHAPTER 7

APPENDIX B

RESEARCH REPORT CONTRIBUTION FORM

Name Roll Concept Literature Data Statistical Drafting
no. & Design Search collection Analysis

Please fill the above form according to the following criteria

No contribution = ×, Minimal contribution= √, Moderate contribution= √√,

Significant contribution = √√√

Supervisor Name:
DR AMINA RIAZ

Institute/College Name:

LAHORE COLLEGE OF PHARMACEUTICAL SCIENCES(LCPS)

Sign:

Date:

Note:

 Include any questionnaires or other materials used in the research report as an annexure

 Include Turnitin's report at the end of the annexure.

APPENDIX B

1: CONSENT FORM

CONSENT FORM IN ENGLISH

Description of the Research and Your Participation
_____________________________________________________________________________

You are invited to participate in a research study conducted the purpose of this research was to
determine
___________________________________________________________________________

Risks and Discomforts:

There are no known risks associated with this research.

Potential Benefits:

You were provided an opportunity to participate in an important research/study that was

beneficial for all individuals.

Protection of Confidentiality:

We were do everything we can to protect your privacy. Your identity was not be revealed in any
publication resulting from this study.
Voluntary Participation:

Your participation in this research study is voluntary. You may choose not to participate and you
may withdraw your consent to participate at any time. You were not be penalized in any way
should you decide not you participate or to withdraw from this study.

CONSENT:

I have read this consent form and have been given the opportunity to ask questions. I give
my consent to participate in this study.

Participant’s Signature: __________________ Date: ____________________

A copy of this consent form should be given to the participant.

 ‫تق‬
‫‪CONSENT FORM‬‬ ‫ق‬
‫‪IN URDU‬‬
‫ن ش ن‬ ‫ن‬ ‫ن‬
‫ے‬ ‫ں‬ ‫ہ‬ ‫ہ‬ ‫د‬ ‫ا‬ ‫کا‬ ‫ف‬ ‫ک‬ ‫ا‬ ‫صان‬
‫ق‬
‫کے‬ ‫سم‬ ‫سی‬ ‫ک‬ ‫سے‬ ‫ق‬ ‫ق صان ات اور ک ف‪ :‬اس ح‬
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‫ق‬ ‫ت‬
‫ق‬ ‫لن‬ ‫ہ ح‬ ‫ف‬
‫ن ئ‬
‫ے کا مو عہ دی ا ج اۓ گا۔‬‫ممک ہ وا د‪ :‬آپکو ای ک ا م ی ق می ں حصہ ی‬

‫‪Title:‬‬

‫ت‬ ‫تع ٹ‬ ‫تق‬ ‫ت‬ ‫ت ف‬ ‫ت ف‬

‫ل‬ ‫م‬
‫ے ہ ی ں۔ ی ق کے ق اک ہی یک ی گيی مام‬‫ح‬ ‫س‬ ‫ہ‬ ‫ج‬ ‫رازداری کا ئ ح ظ‪ :‬م آپ کی لومات کے تظ کے لی‬
‫ح‬ ‫ع‬ ‫م‬ ‫ہ‬
‫ے وہ سب کچ ہ کری ں گے تو م کر ک‬
‫ست‬ ‫شنخ‬ ‫ت‬ ‫ع‬ ‫اے گا۔ ڈ ٹ ا ان ٹ‬ ‫نت خف‬
‫کے دوران آپ کے م لق وہ مام معلومات ج ن سے نآپ کی ا ت ہ و ک ی‬ ‫ے‬
‫ش ئ ن‬ ‫ی‬ ‫ز‬ ‫ج‬ ‫اور‬ ‫ری‬‫ت‬ ‫ن‬ ‫ی‬ ‫ق‬ ‫ت‬ ‫ج‬ ‫ا‬‫ھ‬ ‫ک‬‫ر‬ ‫ہ‬ ‫ی‬ ‫لومات کو ا ہا ی‬
‫خ‬
‫مع‬
‫ظ‬ ‫شنخ‬ ‫ش‬ ‫ح‬ ‫ت‬
‫ے می ں ا ع ہ وے والی کسی ب ھی ا اعت می ں آپ کی ا ت کو اہ ر ہی ں ک ی ا ج اے گا۔‬ ‫ہ و کو م کر دی ا ج اے گا۔ است ی ق کے یج‬
‫ن‬ ‫ق ق‬ ‫ش‬
‫رکت ن ہ کر ے شاور ک سی ب ھی‬
‫ش‬
‫کو‬ ‫آپ‬ ‫ے۔‬ ‫ہ‬ ‫ر ض اکارا ن ہ مو ی ت‪ :‬اس حت ی ی م طا عہ م ں آپ کی ش رکت ر ض اکارا ن‬
‫ن‬ ‫ہ‬ ‫ن‬ ‫لش ی‬ ‫ق‬ ‫ل ن‬ ‫ق‬
‫ش‬ ‫خ‬ ‫ے اس ح‬ ‫غ‬
‫ے۔ نرکت ن ہ کر ے ی ا اس م ی ں مو ل ی ت کو‬ ‫ئی ہ‬ ‫ار‬ ‫ت‬ ‫ا‬ ‫کا‬ ‫ے‬ ‫ھوڑ‬ ‫چ‬ ‫کو‬ ‫ت‬ ‫لی‬ ‫مو‬ ‫ں‬ ‫م‬
‫ن ی ی‬‫ق‬ ‫و ت پ ی ر وج ہ ب ت ا‬
‫خ‬
‫چ ھوڑ ے کی صورت م ی ں آپ کے الف کو ی کاروا ي ی ہ ی ں کی ج اے گی‬
‫خن‬ ‫ش م ن‬ ‫ت ق‬
‫ے ا وں می ں درج کری ں۔‬ ‫ے گی‬ ‫ے پ ڑھی ں اور ان کا ج واب دی‬ ‫درج ذی ل مع لومات ح ی ق می ں ا ل ہ وے والوں کے لی‬

‫‪‬‬ ‫میں نے معلوماتی شیٹ جو کہ تحقیق کی وضاحت کر رہی ہے کو سمجھ لیا ہےاورمجھے تحققیق کے سواالت‬ ‫‪1‬‬
‫کرنے کا موقع دیا گیا تھا‬

‫‪‬‬ ‫میں سمجھ گیا‪/‬گيی ہوں کہ میری شرکت رضاکارانہ ہے اور یہ کہ میں کسی بھی وقت اپنا ارادہ بدل سکتا‪/‬سکتی‬ ‫‪2‬‬
‫ہوں اور تحقیق سے دستبردار ہو سکتا‪/‬سکتی‬

‫‪‬‬ ‫‪/‬میں سمجھ گیا‪/‬گیی ہوں کہ میرے جوابات خفیہ رکھے جاءیں کے۔ میں محقیقیين کو اس بات کی اجازت دیتا‬ ‫‪3‬‬
‫دیتی ہوں کے وہ جوابات کو جانچ سکیں۔‬

‫‪‬‬ ‫میں سممجھ گیا‪/‬گی ہوں کے معلومات میرے نام کے بجاے نمبر کی صورت میں محفوط کی جائيں گی۔ تا کہ میں‬ ‫‪4‬‬
‫نتائج کی اشاعت کے دوران کسی بھی طرح سے شناخت نہ کیا جا سکوں۔ میں اس بات سے رضامند ہوں کے جو‬
‫معلومات مجھ سے لی جائہيں گی وہ تحقیق میں استعمال ہوں گی‬

‫‪‬‬ ‫میں اوپر بتایی گی تحقیق میں شامل ہونے کے لیے رضامند ہوں اور محقیقین کو اپنا پتہ تبدیل ہونے کی صورت‬ ‫‪5‬‬
‫میں مطلع کروں گا‪/‬گ‬

‫رضا مندی‪:‬ميں نے يہ اجازت نامہ پڑھا ہے اور مجھے سوال پوچھنے کا موقع ديا گيا ہے۔ ميں اس‬
‫ے راضی ہوں۔‬
‫سٹڈی ميں شرکت کے لی‬
 ‫___________ شرکت کنندہ کا نام __________________ دستخط_______________ تاريخ‬

‫______________ اجازت لينے والے کا نام ________________ دستخط _______________تاریخ‬

‫اس اجازت نامہ کی ايک نقل آپکو دی جانی چاہے۔‬

 APPENDIX C
PROFORMA/QUESTIONNAIRE