A Comparative study to assess the Effectiveness of
selected Nursing Strategies Vs Acupressure and the Quality of Life on
Osteoarthritis among Geriatric clients
residing in selected old age homes in Tamilnadu
–Pilot Study
Mrs. J.
Bharathi1, Prof. Dr. K. Menaka2, Prof. P. Padmavathi3
1Ph. D
Scholar, Dhanvantri College of Nursing, Ganapathypuram,
NO – 1 Ranganoor Road, Muniyappan
Kovil, Pallakkapalyam, Namakkal District – 637 303
2Research Guide and Principal, Padmasree
College of Nursing, Walajabad, Kanchipuram
District.
3Principal, Dhanvantri
College of Nursing, Ganapathypuram, NO – 1 Ranganoor Road, Muniyappan Kovil, Pallakkapalyam, Namakkal District – 637 303
*Corresponding Author’s
Email: Bharathijk78@gmail.com
ABSTRACT:
Background: Osteoarthritis is the most common cause of rheumatological problem and is most frequent joint disease
with high prevalence in India among geriatric clients. This is the most common
cause of loco motor disability in the elderly population. Objectives: To assess the
effectiveness of selected nursing strategies Vs acupressure on osteoarthritis
among geriatric clients. Design:
Two group pretest and post test true experimental design was adopted for the
study. Setting: Selected old age
homes in Tamilnadu.
Participants: 30 Geriatric
clients with Osteoarthritis fulfilling the inclusion criteria were selected by
cluster random sampling. Methods: A pretest was conducted by using WOMAC scale
and EQ-5D, QOL assessment scale.
Immediately after pre-test selected nursing strategies Vs acupressure
was given for 8 weeks and again post test was conducted to assess the
effectiveness of treatment. Collected
data was analyzed by using descriptive and inferential statistics. Results: In post mean score of the
experimental group I mean score was 55.40(SD=12.60) and the group II mean score
was 65.40(SD=10.53). This showed that
the selected nursing strategies was effective than acupressure in enhancing the
practice of the sample regarding Osteoarthritis and the quality of life of
geriatric clients. Conclusion: The findings imply the need for educating
geriatric clients on effective management of Osteoarthritis.
KEYWORDS: Effectiveness, selected
nursing strategies, acupressure, osteoarthritis, geriatric clients.
INTRODUCTION:
Osteoarthritis
is a disease characterized by degeneration of cartilage and its underlying bone
within a joint as well as bony overgrowth.
Disease onset is gradual and usually begins after the age of 40. There is currently no cure for OA. Treatment for OA focuses on relieving
symptoms and improving function, and can include a combination of patient
education, physical therapy, weight control, and use of medications.
Osteoarthritis
(OA) is a common condition which represents a major contribution to the burden
of physical disability. Prevalence increases with age, so that about 11% of all
women over the age of 60 yr have symptoms due to knee OA. Most knee OA is
managed by primary care physicians rather than rheumatologists.(Yuqing Zhang D.Sc.,)
The
global burden of osteoarthritis is substantial; more than 50% of people over 65
years of age have radiological evidence of osteoarthritis (Felson
and Zhang 1998). The pain and disability
associated with osteoarthritis affects approximately 10% of men and 18% of
women over 60 years of age. Based on
current trends, osteoarthritis is forecast to become the fourth leading cause
of disability worldwide by the year 2020 (Woof and Pfleger
2003).
In India Osteoarthritis was
present in only 50.2% of the elderly aged 65-74 years, whereas it was 97.7% in
elderly aged 84 years or older,
(p<0.001). Prevalence of osteoarthritis increased as body mass index
(BMI) increased. It was 51.36% amongst
elderly with BMI less than 25, whereas it increased to 100% amongst elderly
with BMI equal to or more than 40 (p<0.001).
The prevalence of osteoarthritis amongst anaemic
and non-anaemic males was 41.6% and 33.3%. The similar figures for elderly females were
71.5% and 50.0% respectively.
PROBLEM
STATEMENT:
A comparative study to
assess the effectiveness of selected nursing strategies vs acupressure and
the quality of life on osteoarthritis among geriatric clients residing in
selected oldage homes in Tamil Nadu.
OBJECTIVES:
·
To assess the
condition of osteoarthritis among experimental group I and II of geriatric
clients before and after selected nursing strategies versus acupressure.
·
To compare the
effectiveness of selected nursing strategies versus acupressure on
osteoarthritis among geriatric clients on both the groups.
·
To assess the
quality of life of geriatric clients with osteoarthritis before and after
selected nursing strategies versus acupressure.
·
To find out the
association between post test scores of osteoarthritis
among experimental group I and II of geriatric clients with their selected
demographic variables.
HYPOTHESIS:
H1: There will
be a significant difference in level of osteoarthritis among experimental group
I and II of geriatric clients before and after selected nursing strategies
versus acupressure.
H2: There will
be a significant effectiveness of selected nursing strategies versus
acupressure on osteoarthritis among geriatric clients on both the groups.
H3: There will
be a significant association between post test scores of osteoarthritis among
experimental group I and II of geriatric clients with their demographic
variables.
METHODOLOGY:
Research approach: Experimental evaluative research approach
Research design: True experimental design (two group pre and posttest
design)
Target population: Geriatric clients with Osteoarthritis
Accessible Population: Geriatric clients with Osteoarthritis residing in
selected old age homes in Tamilnadu.
Sampling technique and sample size: Cluster random samplings, 30 samples, out of 15 were experimental
group I and 15 were experimental group II
Independent
Variable: Selected Nursing strategies Vs
Acupressure
Dependent Variable: Quality of life of Geriatric clients with
Osteoarthritis
Tool : Section A: Demographic variables
·
Section B: WOMAC scale (Western Ontario MC Master
Universities Osteoarthritis Index Scale).
·
Section C: EQ-5D
QOL (European Quality-5 Dimension Quality of Life) scale used to assess the
quality of life of geriatric clients with Osteoarthritis.
Data collection procedure:
· Pretest was conducted by using by WOMAC Scale to
assess the level of Osteoarthritis and EQ-5D questionnaire to assess the
quality of life.
·
Implementing the
selected Nursing Strategies in experimental group I and Acupressure in
experimental group II for the duration of 20 minutes daily for 8 weeks.
·
Posttest was
conducted with same pretest tool after 8 weeks.
Plan for data analysis
· Descriptive Statistics: Percentage, Mean and Standard
Deviation
·
Inferential
Statistics: Paired ‘t’ test and repeated measures of Analysis of Variance
FINDINGS AND
INTERPRETATION:
Section A: Percentage of geriatric
clients with Osteoarthritis according to their demographic variables.
Experimental group-I and II shows that,
Ř Highest percentage (40% and
33.3%) of geriatric clients was in the age group of 60-65 years and 66-70
years.
Ř Gender wise distribution
shows that majority of 60% were females and 40% were males.
Ř 80% and 73.3% of geriatric
clients were Hindus.
Ř 60% and 66.7% of geriatric
clients belongs to rural region.
Ř 40% and 53.3% of them were
educated up to secondary and primary education.
Ř Marital status shows that
highest percentage 46.7% and 60% of geriatric people were married.
Ř Highest percentage of
geriatric client 86.7% and 60% were exposed to mass media through television.
Ř 73.3% and 86.7% of them
having history of joint pain.
Ř Similar percentage (46.7% ) of geriatric client were staying in oldage
home for the duration of above five years.
Ř Highest percentage 60% and
66.7% of geriatric clients experienced one knee joint pain.
Table:1 Frequency and
percentage distribution of pre and post test scores of level of Osteoarthritis
among experimental group I and II (WOMAC SCORE - CLASSIFICATION)
|
Geriatric Clients |
Pre Test score |
Post Score |
||||||||
|
Post 4th Week Score |
8th Week Score |
|||||||||
|
Mild |
Moderate |
Severe |
Mild |
Moderate |
Severe |
Mild |
Moderate |
Severe |
||
|
Exp. Gp I |
NO |
0 |
2 |
13 |
0 |
9 |
6 |
3 |
6 |
6 |
|
% |
0.0 |
13.3 |
86.7 |
0.0 |
60.0 |
40.0 |
20.0 |
40.0 |
40.0 |
|
|
Exp. Gp II |
NO |
0 |
0 |
15 |
0 |
4 |
11 |
2 |
7 |
6 |
|
% |
0.0 |
0.0 |
100.0 |
0.0 |
27.0 |
73.0 |
13.0 |
47.0 |
40.0 |
|
Table:2 Frequency and
percentage distribution of pre and post test scores of quality of life among experimental group I and II European QOL (CLASSIFICATION)
|
Group |
Pre Test Scores |
Post Test Scores |
|||||||||||
|
4th week |
8th week |
12th week |
|||||||||||
|
Low QOL |
Moderate QOL |
High QOL |
Low QOL |
Moderate QOL |
High QOL |
Low QOL |
Moderate QOL |
High QOL |
Low QOL |
Moderate QOL |
High QOL |
||
|
Exp Gp I |
NO |
7 |
6 |
2 |
8 |
3 |
4 |
0 |
10 |
5 |
0 |
2 |
13 |
|
% |
46.7 |
40.0 |
13.3 |
53.3 |
20.0 |
26.7 |
0.0 |
66.7 |
33.3 |
0.0 |
13.3 |
86.7 |
|
|
Exp Gp II |
NO |
5 |
10 |
0 |
5 |
10 |
0 |
0 |
14 |
1 |
0 |
12 |
3 |
|
% |
33.3 |
66.7 |
0.0 |
33.3 |
66.7 |
0.0 |
0.0 |
93.3 |
6.7 |
0.0 |
80.0 |
20.0 |
|
Table:3 Comparison of mean and
SD distribution of pre and post test scores among experimental group I and
II (WOMAC SCORE - CLASSIFICATION)
|
WOMAC scale scores |
Experimental Group I |
Experimental Group II |
||
|
Mean |
SD |
Mean |
SD |
|
|
Pre test |
68.67 |
14.40 |
74.40 |
8.70 |
|
4th week post test |
64.93 |
14.11 |
68.60 |
9.83 |
|
8th week post test |
55.40 |
12.60 |
55.40 |
12.60 |
Table:4
Comparison of mean and SD distribution of pre and post test scores among
experimental group I and II ( QOL Scale)
|
QOL scale scores |
Experimental Group I |
Experimental Group II |
||
|
Mean |
SD |
Mean |
SD |
|
|
Pre test |
4.20 |
1.86 |
4.00 |
0.93 |
|
4th week post test |
4.20 |
2.24 |
3.73 |
0.80 |
|
8th week post test |
5.73 |
1.79 |
5.07 |
0.96 |
|
12th week post test |
8.73 |
1.53 |
5.73 |
1.44 |
Table:
5 Comparison of group1- Selected Nursing Interventions and Group2 -
Acupressure for severity of Osteoarthrirtis and QOL
of geriartic clients
|
Measure |
Group |
Mean |
Std. Error |
95% Confidence Interval |
Mean Difference |
|
|
Lower Bound |
Upper Bound |
|||||
|
WOMAC |
Experimental group
I |
58.717 |
2.594 |
53.404 |
64.030 |
7.550* |
|
Experimental group
II |
66.267 |
2.594 |
60.954 |
71.580 |
||
|
QOL |
Experimental group I |
5.717 |
.319 |
5.063 |
6.370 |
1.083* |
|
Experimental group
II |
4.633 |
.319 |
3.980 |
5.287 |
||
*p<0.05
CONCLUSION:
By using the repeated measure of analysis of
variance the values was significant (p<0.05) which shows that selected
nursing strategies
group was better than acupressure group and by measuring the
Osteoarthritis severity by using WOMAC
scale, from the period of 8th week the Osteoarthritis severity was
declining and in 12th week onwards the Osteoarthritis clients Quality of Life was thriving which
was measured by using EQ-5D quality of life scale. The study result shows that,
· Highly significant
association was found between post tests scores of Osteoarthritis symptoms
among both the groups.
· No significant association
was found between post test and their demographic variables of both the groups
among geriatric clients with Osteoarthritis.
DISCUSSION:
In experimental group I the post test the mean score
was 55.40, in experimental group II the mean score was 65.40
which reveals the difference of 10%. The
reduction of severity
of Osteoarthritis symptoms was effective in selected nursing strategies group
than acupressure group. There was
significant difference between Osteoarthritis symptoms in experimental group I
compared to experimental group II (P<0.05).
Conclusion: It seems that
selected nursing strategies are effective in improvement of quality of life of
geriatric clients with Osteoarthritis.
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Received on 03.12.2015 Modified
on 25.12.2015
Accepted on 15.01.2016
© A&V Publication all right reserved
Int.
J. Adv. Nur. Management.
2016; 4(2): 107-110.
DOI:
10.5958/2454-2652.2016.00024.X