ABSTRACT OF PLAN OF THESISTitle A quasi – experimental study to assess the effectiveness of mustard plaster application on knee joint pain among elderly in selected rural areas, Hoshiarpur, Punjab.Degree Master of Science in Nursing (Community Health Nursing)Name of the candidate Ms. Chanchal LataM.Sc. (N) 1st yearSupervisor Mrs. Prabhjeet KaurAssistant professorShri Guru Ram Dass College of Nursing Hoshiarpur, Punjab, IndiaCo- supervisor Ms. Rachana Assistant professorShri Guru Ram Dass College of Nursing Hoshiarpur, Punjab, IndiaInstitute Shri Guru Ram Dass College of Nursing Hoshiarpur – 146001, Punjab, IndiaUniversity Baba Farid University of Health Sciences, Faridkot, Punjab, IndiaA quasi-experimental study will be conducted to assess the effectiveness of mustard plaster application on knee joint pain among elderly in selected rural areas, Hoshiarpur, Punjab. Purposive sampling technique will be used to select 60 samples of elderly with one group pretest posttest design. Tool will be comprised of numeric pain rating scale to assess the intensity of pain among elderly before and after the intervention. The collected data will be analyzed and interpreted by using descriptive and inferential statistics. From the results, conclusion will be drawn about the effect of mustard plaster application on knee joint pain among elderly in selected rural areas, Hoshiarpur, Punjab. A QUASI – EXPERIMENTAL STUDY TO ASSESS THEEFFECTIVENESS OF MUSTARD PLASTERAPPLICATION ON KNEE JOINT PAINAMONG ELDERLY IN SELECTEDRURAL AREAS, HOSHIARPUR,PUNJAB.A synopsisSubmitted for the partial fulfillment of the requirement for the degree ofMASTER OF SCIENCE IN NURSING(Community Health Nursing)ofBaba Farid University of Health Sciences,Faridkot, Punjab2018Chanchal LataShri Guru Ram Dass College of Nursing, Hoshiarpur, 146001, Punjab (India) A QUASI – EXPERIMENTAL STUDY TO ASSESS THEEFFECTIVENESS OF MUSTARD PLASTERAPPLICATION ON KNEE JOINT PAINAMONG ELDERLY IN SELECTEDRURAL AREAS, HOSHIARPUR,PUNJAB. A synopsisSubmitted for the partial fulfillment of the requirement for the degree ofMASTER OF SCIENCE IN NURSING(Community Health Nursing) ofBaba Farid University of Health Sciences,Faridkot, Punjab2018Chanchal LataName & signature Name & signatureof supervisor of Co-Supervisor Mrs. Prabhjeet Kaur Ms. Rachana Shri Guru Ram Dass College of Nursing, Hoshiarpur,146001, Punjab (India)INDEX OF CONTENTS.No. Content Page No.IIIIIIIV BACKGROUND OF THE STUDYIntroductionNeed of the studyResearch problemAim of the studyObjectivesOperational definitionHypothesisDelimitationsREVIEW OF LITERATUREMETHODOLOGYResearch approachResearch designVariablesResearch settingTarget populationSample and sample techniqueCriteria for sample selectionDevelopment and description of toolValidity of toolsEthical considerationsPilot studyReliability of toolsData collection procedurePlan for data analysisREFERENCES 1-51-22-44445556-78-1288899999-10101111111I1112-14 CHAPTER IBACKGROUND OF THE STUDYINTRODUCTION Ageing is the natural process. Old age is a crucial phase where the physiological, psychological and socio-cultural changes take place. It should be considered as a normal, inevitable biological phenomenon. Geriatrics is the medical specialty that deals with the health and social care of the elderly. Gerontology refers to the study of all aspects of the ageing process, including economic, social, clinical and psychological factors, and their effect on the older adult and on society.1The increase in the elderly population between 1951 and 1991 (38 per cent) was greater than the general population (18.9 per cent). More than four times older persons live in the rural areas of India than in urban areas. Ageing is associated with the decline in physiological effectiveness, which affects us all eventually and is an intrinsic part of growing old. However, multiple pathology is a characteristic feature of old age.2There are currently 580 million elderly all over in the world and of these 355 million live in developed countries; and the life expectancy at birth has increased from 41 years in the early 1950’s to 62 years in 1990. In the year 2020, life expectancy has become a health determinant due to the resulting effects made on social life and health care delivery system. There are 81million older people in India, 11 lakh in Delhi itself.3Most of the older, population in India are suffering from Knee joint pain with the age group of above 60 years, 95% of them are less than 85 years. In this 87% are having acute illness and96% are having chronic illness. Knee pain can be a result of injury or disease of the knee joint. Injury can affect any of the internal structures like ligaments, menisci, synovium and cartilage inside the knee joint. The complexity of the design of the knee joint and the fact makes the knee one of the most commonly injured joints.4Knee pain can also occur from diseases or conditions like obesity ,constant weight bearing etc involving the soft tissues and bones surrounding the knee and the nerves that supply sensation to the knee area. In fact, the knee joint is the most commonly involved joint in rheumatic diseases, rheumatoid arthritis, reactive arthritis, systemic lupus erythematosus, as well as osteoarthritis. Diseases that cause knee pain can lead to swelling, synovial with effusion redness, warmth, weakness, tenderness, and stiffness of the joint instability.5 In order to manage pain & the functional disability various treatment modalities are used. The pharmacological management varies from administering acetaminophen, NSAID drugs, steroids, to weak opioids. Under one umbrella of non pharmacological measures are rest, joint protection by assistive devices such as cane, weight reduction programme, exercise, external application of oil, mustard plaster, heat and cold application. Diet has major role in prevention of joint pain. Practices like intake of calcium, vitamin D and milk, vitamin A, C. magnesium, zinc in green leafy vegetables helps very well.6India being agriculture based country; people over here widely use mustard. They use it starting from cooking to external application. It is available easily and readily. It is naturally occurring plant product which has anti fungal, anti microbial, counter irritant, anticongestant properties. Elderly in our country are not interested to spend more money for their health especially in rural parts. Mustard can be beneficial to such elderly where they need not to be dependent economically on present generation.7NEED OF THE STUDY Pain is pain, but it is not all the same. It is complex and defies our ability to establish a clear definition. Pain is a complex dilemma of emotions, culture, experience, spirit and sensations. It sblocks our sensations and pleasures. Pain, even if it is mild and if it is associated with joints, causes some restrictions to movements; it seriously affects the quality of life, as well as the activities of daily living.8 Aging is a natural process. It is an inevitable developmental phenomenon that brings about a number of changes in the physical, psychological, hormonal and social conditions. The aged citizens become increasingly dependent on others. As man grows, his reduced activities, income and consequent decline in the position of the family and society makes his life more vulnerable.8Older elderly have fewer acute illnesses than younger adults do when older elderly become ill with acute illness, they usually require longer period of recovery and experience more complications than younger people experience. As a normal process of aging, changes occur that slow nerve impulses, lengthen healing time and reduce the body’s ability to fend off disease.9The world wide increase in the older population coupled with economic, social and other changes have inevitably affected the needs for health care. The recent Indian census (2011) shows that among 1.2 billion, 60 million are above the age of 65years. Old age is the resting period of life after years of long tough journey; the body needs to have a calm and comfortable period of rest. But around 40 % of the geriatric population are suffering from different types of non- communicable diseases, in a gross reduction in the quality of life.10 The most common distressing old age problems such as severe joint pain and impaired mobility necessitate the dependence on others. Usually health care professionals and family members neglect these problems as a part of old age wear and tear leading to severe reduction in the quality of life. Most of the analgesics may cause severe pyrosis and gastritis. Already food intake and appetite is decreased in old age. All these together may add other severe problems to old age leading to severe reduction in the quality of life.11The world – wide Statistics in 2008 shows that, among the total population, 40% of the people at the age of 60years, suffer from severe joint pain, 80% of the population have some degree of limitations of movements and 25% cannot perform daily activities. According to Indian Rheumatology Association statistics 2010, 49.8% of the total population is over the age of 60years, suffering from severe joint pain, 70% of the population has some degree of limitations of movement and 10% cannot perform daily tasks.12 Mustard is an easily available and comparatively cheap material. Mustard is well known for its counter irritant, anti-congesting property. It has antifungal and anti microbial activity. Substance in mustard is allyl-isothiocyanates. Isothocyanates can inhibit carcinogenesis in breast, colon and lung (journal of traditional knowledge 2009). Practices have proven that it increases circulation and reduces pain at application site2008). Mustard application works primarily through chemical action and secondarily by the action of heat. It reduces the muscle stiffness. They will improve the quality of life for people with knee pain and their families. Sinclair has demonstrated clinical application of mustard plaster for joint pain relief in frozen shoulder. In her book of hydrotherapy she has indicated the use for knee joint pain. Now days the young generation migrate to distant places for job, to establish their households at their work place. Sometimes they take the elderly along with them but in most cases, the aged are left behind and sometimes they are even left as destitute. The community health nurse has great part in caring such elderly; especially with those suffering from pain. Mustard can be very well used by community nurse during their home visit. The easy availability, affordability and safety, mustard is best choice. Thus, researcher is interested to assess the effectiveness of mustard plaster upon knee joint pain to reduce the dependence of elderly on the Over the Counter (OTC) medications to reduce joint pain by introducing the home remedies, thereby reducing the side effects of the Over The Counter drugs and to improve the quality of life.13RESEARCH PROBLEMA quasi-experimental study to assess the effectiveness of Mustard Plaster Application on knee joint pain among elderly in selected rural areas, Hoshiarpur, Punjab.AIM OF THE STUDYThe aim of the present study is to assess the effectiveness of mustard plaster on knee joint pain among elderly in selected rural areas at Hoshiarpur, Punjab.OBJECTIVES1. To assess the level of knee joint pain among elderly in experimental and control group.2. To compare the level of knee joint pain among elderly in experimental and control group.3. To find out the relationship of knee joint pain among elderly in experimental and control group with selected demographic variables.