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DISSERTATION ON
“A STUDY TO ASSESS THE EFFECTIVENESS OF ZONE THERAPY IN IMPROVING ACTIVITIES OF DAILY LIVING AMONG RHEUMATOID ARTHRITIS CLIENTS ADMITTED IN
RHEUMATOLOGY WARD, RAJIV GANDHI GOVERNMENT GENERAL HOSPITAL, CHENNAI-03”
M.Sc (NURSING) DEGREE EXAMINATION BRANCH- I MEDICAL SURGICAL NURSING
COLLEGE OF NURSING
MADRAS MEDICAL COLLEGE, CHENNAI-600 003
A dissertation submitted to
THE TAMIL NADU Dr.M.G.R. MEDICAL UNIVERSITY, CHENNAI- 600 032
In partial fulfillment of the requirement for the award of d egree of
MASTER OF SCIENCE IN NURSING
OCTOBER – 2019
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“A STUDY TO ASSESS THE EFFECTIVENESS OF ZONE THERAPY IN IMPROVING ACTIVITIES OF DAILY LIVING AMONG RHEUMATOID ARTHRITIS CLIENTS ADMITTED IN
RHEUMATOLOGY WARD, RAJIV GANDHI GOVERNMENT GENERAL HOSPITAL, CHENNAI-03”
Examination : M.Sc. (Nursing) Degree Examination
Examination Month and Year : OCTOBER 2019
Branch & Course : I – MEDICAL SURGICAL NURSING
Register Number : 301711258
Institution : COLLEGE OF NURSING,
MADRAS MEDICAL COLLEGE, CHENNAI – 600 003.
Sd: __________________ Sd: ___________________
Internal Examiner External Examiner
Date: ____________ Date: ____________
THE TAMILNADU Dr. M.G.R MEDICAL UNIVERSITY,
CHENNAI – 600 032.
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CERTIFICATE
This is to certify that this dissertation titled
“A STUDY TO ASSESS THE EFFECTIVENESS OF ZONE THERAPY IN IMPROVING ACTIVITIES OF DAILY LIVING AMONG RHEUMATOID ARTHRITIS CLIENTS ADMITTED IN RHEUMATOLOGY WARD, RAJIV GANDHI GOVERNMENT GENERAL HOSPITAL, CHENNAI-03
” is a bonafide work done by D. UMA MAHESWARI, M.Sc. (N) II year student, College of Nursing, Madras Medical College, Chennai-03, submitted to The Tamil Nadu Dr.M.G.R Medical University, Chennai in partial fulfilment of the requirements for the award of degree of Master of Science in Nursing, Branch I- Medical Surgical Nursing, under our guidance and supervision during the academic period from 2017 – 2019.A. Thahira Begum, M.Sc.(N)., M.B.A.,M.Phil., Dr.R.Jayanthi, M.D., FRCP (Glasg) Principal, Dean,
College of Nursing, Madras Medical College, Madras Medical College, Chennai – 03.
Chennai – 03.
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A STUDY TO ASSESS THE EFFECTIVENESS OF ZONE THERAPY IN IMPROVING ACTIVITIES OF DAILY LIVING AMONG RHEUMATOID ARTHRITIS CLIENTS ADMITTED IN RHEUMATOLOGY WARD, RAJIV GANDHI GOVERNMENT GENERAL HOSPITAL, CHENNAI-03
Approved by dissertation committee on 24.07.2018 CLINICAL SPECIALITY GUIDE
Mrs. V.K.R. Periyar Selvi, M.Sc (N)., ____________
Reader in Medical Surgical Nursing, College of Nursing,
Madras Medical College, Chennai – 03.
HEAD OF THE DEPARTMENT
Mrs. A. Thahira Begum, M.Sc (N)., MBA., M.Phil.,
Principal, ____________
College of Nursing, Madras Medical College, Chennai – 03.
DEAN
Dr. R. Jayanthi, M.D, F.R.C.P. (Glasg)., ____________
Dean,
Madras Medical College, Chennai – 03.
A Dissertation submitted to
THE TAMILNADU Dr. M.G.R MEDICAL UNIVERSITY, CHENNAI – 600 032.
In partial fulfilment of the requirement for award of the degree MASTER OF SCIENCE IN NURSING
OCTOBER – 2019
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CERTIFICATE OF PLAGIARISM
This is to certify that the dissertation work titled, A STUDY TO ASSESS THE EFFECTIVENESS OF ZONE THERAPY IN IMPROVING ACTIVITIES OF DAILY LIVING AMONG
RHEUMATOID ARTHRITIS CLIENTS ADMITTED IN
RHEUMATOLOGY WARD, RAJIV GANDHI GOVERNMENT
GENERAL HOSPITAL, CHENNAI-03 of the candidate
UMAMAHESWARI.D, for the partial fulfilment of M.Sc Nursing Programme in the branch of Medical Surgical Nursing has been verified for plagiarism through relevant plagiarism checker. We found that the uploaded thesis file from introduction to conclusion pages and rewrite shows % of plagiarism ( % uniqueness) in this dissertation.
CLINICAL SPECIALITY GUIDE/SUPERVISOR Mrs. V.K.R. Periyar Selvi, M.Sc (N).,
Reader in Medical Surgical Nursing, College of Nursing,
Madras Medical College, Chennai – 03.
PRINCIPAL
Mrs. A. Thahira Begum, M.Sc (N)., MBA., M.Phil.,
Principal,
College of Nursing, Madras Medical College, Chennai – 03.
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ACKNOWLEDGEMENT
“THE WAY TO DEVELOP THE BEST IN A PERSON IS BY APPRECIATION AND ENCOURAGEMENT”
– Charles Schwab
Gratitude calls never expressed in words but this only to deep perceptions, which make words to flow from one’s inner heart.
First of all, I praise God Almighty, merciful and passionate, for providing me this opportunity and granting me the capability to complete this study successfully. I lift up my heart in gratitude to God Almighty, I feel the hand of God on me, leading me through thick and thin heights of knowledge. It is he who granted me the grace and the physical and mental strength behind all my efforts.
This dissertation appears in its current form due to the assistance and guidance of many professionals and non-professionals. The investigator is whole heartedly indebted to her research advisors for their comprehensive assistance in various forms.
I express my genuine gratitude to the Institutional Ethics Committee of Madras Medical College for giving me an approval to conduct this study.
I wish to express my sincere thanks to Dr.R.Jayanthi, M.D., FRCP (Glasg), Dean, Madras Medical College, Chennai for providing necessary facilities and extending support to conduct this study.
At the very outset, I express my whole hearted gratitude to my esteemed guide, Mrs.A.Thahira Begum M.Sc.(N), MBA., M.Phil., Principal, College of Nursing, Madras Medical College, Chennai, for her academic and professional excellence, treasured guidance, highly instructive research mentorship, valuable suggestions, prudent guidance, moral support and
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patience that has moulded me to conquer the spirit of knowledge for sculpturing my manuscript into thesis.
I would like to express my deepest sense of gratitude to Dr.R.Shankar Shanmugam, M.Sc. (N), MBA, Ph.D., Reader, H.O.D – Department of Nursing Research, College of Nursing, Madras Medical College, Chennai for his highly instructive research mentorship, his hard work, efforts, interest and sincerity to mould this study in a successful way. His easy approachability and understanding nature inspired me to laid strong foundation in research. It is very essential to mention their wisdom and helping nature made my research study a lively and everlasting one.
I am grateful to Mrs.T.R.Latha M.Sc. (N), Reader, Department of Medical Surgical Nursing, College of Nursing, Madras Medical College, for her valuable guidance, suggestions, motivation, timely insightful decision, and correction of the thesis with constant motivation and timely help and support throughout the completion of this study.
I am highly indebted to Mrs.V.K.R.Periyar Selvi, M.Sc. (N), Reader, Department of Medical Surgical Nursing, College of Nursing, Madras Medical College, for her great support, warm encouragement, constant guidance, thought provoking suggestions, brain storming ideas, timely insightful decision, correction of the thesis with constant motivation and willingness to help all the time for the fruitful outcome of this study.
I am extremely grateful to Mrs.C.S.V.Umalakshmi, M.Sc.(N), Lecturer, Mrs.J.Alamelumangai, M.Sc.(N), Lecturer, Mr.N.Muruganandan, M.Sc. (N), Lecturer, Mrs.D.Anandhi, M.Sc.(N), Nursing Tutor, Department of Medical Surgical Nursing for their encouragement, valuable suggestion, support and advice given in the study.
I am grateful to Dr.G.Mala, M.Sc.(N), MBA., Ph.D., (Retd. Nursing Tutor) and Mr.Kannan.K, M.Sc. (N), MBA, Nursing Tutor, Department of Nursing Research, College of Nursing, Madras Medical College, for their
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valuable guidance, suggestions, motivation and timely help and support throughout the completion of this study.
I am thankful to all the Faculty of College of Nursing, Madras Medical College, for their timely advice, encouragement and support.
I express my deep sense of sincere thanks to Dr. T.N.Tamil Selvam, M.B.B.S., M.D., D.M., (Rheumatology), Professor and Head of the Department, Institute of Rheumatology, Madras Medical College, Chennai-03, for his valuable suggestions and kind guidance.
It’s my duty to convey my thanks to all experts, Dr.Rama Sambasivam, M.Sc. (N), Ph.D, Principal, Mohamed Sathak A J College of Nursing ,Chennai; Dr.Tamilarasi, M.Sc.(N), M.Phil, Ph.D, Principal, Madha College of Nursing, Chennai, who validated the research tool and guided me with valuable suggestions and corrections, constructive judgments while validating the tool.
I have much pleasure of expressing my cordial appreciation and thanks to all the patients who participated in the study with interest and cooperation.
I owe my deepest sense of gratitude to Mr.A.Venkatesan, M.Sc.
(Statistics), P.G.D.C.A, Statistician for his suggestion and guidance in statistical analysis.
I thank our librarian Mr.S.Ravi., M.L.I.S, College of Nursing, Madras Medical College for his co-operation and assistance which built the sound knowledge for this study.
I thank Dr.J.Ebenezer, B.Ed., M.Ed., and Ph.D. Headmaster, Voorhees higher Secondary School, Vellore. for editing and providing certificate of English editing.
I thank Mr.A.J.Theodore Rajkumar, Asst.Professor and HOD, Department of Tamil for editing and providing certificate of Tamil editing.
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I owe my great sense of gratitude to Mr.Syed Hussain B.sc(Computer), Citi Dot Net for his excellence and sincere effort in aligning the manuscript with valuable computer skills and also bringing this study into a printed form and Mr.Ramesh, B.A., MSM Xerox for his enthusiastic help in photocopy work throughout the study period.
I extend my immense love and gratitude to Mr.K.Sivalingam and family for their loving support, encouragement, earnest prayer, which enabled me to accomplish my study.
A very special thanks to my Parents Mr.K.Dakshna moorthi, and my Mother Mrs.D.Bhavani, who laid the foundation of my higher studies and for their constant support, endless patience, unflagging love and motivation which helped me to complete my study successfully.
I extend my heartfelt thanks to my Teachers Mrs.Rajula, Mr.Sathya narayanan, Mrs.Lalitha purushothaman,for their motivation, support, patience and throughout my education journey.
I would also like to thank my beloved Friends for their constant encouragement towards the successful completion of my study.
I take this opportunity to thank all my Colleagues, Teaching and Non- Teaching Staff Members, Hostel Warden, of College of Nursing, Madras Medical College, Chennai, for their co-operation and help rendered in the completion of my study.
At final note, I extend my thanks to all those who have been directly and indirectly associated with my study at various stages not mentioned in this acknowledgement.
I thank the one above, omnipresent God, for answering my prayers, for giving me the strength to plod on each and every phase of my life.
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ABSTRACT
Rheumatoid Arthritis is a chronic inf lammatory,auto-immune disorder of Joints that affect the di-arthrodial ankles.It is a systemic disorder that affects the body by involving a combination of genetic,environmental and habitual factors such as smoking and alcoholism.Patients with Rheumatoid Arthritis performed significantly less non-vocational activities.Positive about their ability and enhanced activities can strengthern the future.
Reflexologists believes that pressure applied to reflex zones on the sole of the foot and hands can communicates with corresponding parts of the body via the nervous system,helping them to function well.
TITLE: “A study to assess the effectiveness of Zone therapy in improving Activities of Daily Living among Rheumatoid Arthritis Clients admitted in Rheumatology ward,Rajiv Gandhi Government General Hospital, Chennai-03”.
OBJECTIVES:
To assess the pre-test level of Activities of Daily Living among Rheumatoid arthritis clients in experimental and control group.
To evaluate the effectiveness of Zone therapy in Activities of Daily living among Rheumatoid Arthritis clients in experimental group.
To compare the pre- test and post -test level of activities of daily living among Rheumatoid Arthritis client in experimental and control group.
To associate the post-test score in experimental group with selected demographic variables.
METHODS AND MATERIALS: This study was conducted with 60 samples,30 clients in experimental groupand 30 clients in control group in quantitative approach, Quasi-experimental was used, sampling
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selection was done by Non-probability purposive sampling technique.
Pre-existing level of Activities of daily living was assessed by using standardized Barthel Index tool after the pre-test, Zone therapy was implemented three sessions for each day upto seven days, followed by admission in Rheumatology ward.After seven days of Zone therapy post-test was conducted by using the same tool for both experimental and control group.
RESULTS:Considering experimental group,in pre-test,clients are having 8.53score and in post-test they are having 12.50score,so the difference is 3.97,this difference is large and is significant.It was tes ted using student paired t-test.Considering control group,in pre-test,clients are having 8.90 score and in post –test they are having 9.37 score,so the difference is 0.47,this difference is small and it is not significant.
On an average, in experimental group,in post-test after having intervention,clients are gained 19.85% more score then pre -test score.In control group,on an average,in post-test without intervention,clients are gained 2.35% more score than pre-test score.This diffetence shows the effectiveness.
CONCLUSION: Nurses play a vital role in providing care to Rheumatoid Arthritis clients who depend on others for their Activities of daily living. The present study had been supported by a series of other studies which confirmed that clients under Zone therapy has increased level of Activities of daily living that promotes a positive Rheumatoid Arthritis outcome.
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INDEX
Chapter
No Title Page
No
I INTRODUCTION 1
1.1 Background of the study 3
1.2 Need for the study 6
1.3 Statement of the problem 13
1.4 Objectives of the study 13
1.5 Operational Definition 13
1.6 Hypotheses 14
1.7 Assumption 14
1.8 Limitation 14
1.9 Conceptual framework 15
II REVIEW OF LITERATURE 17
III RESEARCH METHODOLOGY 30
3.1 Research Approach 30
3.2 Study Design 30
3.3 Duration of the Study 31
3.4 Study Setting 31
3.5 Study Population 31
3.6 Sample 31
3.7 Sample Size 31
3.8 Sample Criteria 3.8.1 Inclusion Criteria 3.8.2 Exclusion Criteria
32
3.9 Sampling Technique 32
13 Chapter
No Title Page
No
3.10 Research Variables 32
3.11 Development and Description of Tool 3.11.1 Description of Tools
32
3.12 Content Validity 34
3.13 Reliability of Tool 34
3.14 Protection of Human Subjects 34
3.15 Pilot Study 35
3.16 Data Collection Procedure 35
3.17 Interventional Protocol 36
3.18 Data Entry and Analysis 36
IV ANALYSIS AND INTERPRETATION OF DATA
38
V DISCUSSION 62
VI SUMMARY, IMPLICATION, LIMITATION, RECOMMENDATION & CONCLUSION
73
6.1 Summary of the Study 73
6.2 Findings of the Study 73
6.3 Implication of the Study 78
6.4 Limitation 81
6.5 Recommendations 81
6.6 Conclusion 82
REFERENCES APPENDICES
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LIST OF TABLES
Table
No Title Page
No 3.2.1 Schematic Representation of the Research Design 30
3.11.2 Barthel score interpretation 34
3.16.3 Intervention protocol 36
4.1 Frequency and Percentage distribution of study participants based on demographic profile among Rheumatoid Arthritis clients in Experimental and control group.
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4.2 Frequency and Percentage distribution of study participants based on clinical profile among Rheumatoid Arthritis clients in Experimental and control group.
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4.3 Each Activity wise pre-test percentage of Barthel index score among Rheumatoid Arthritis clients.
45 4.4 Pre-test level of Activities of Daily Living sc ore in
Experimental and control group.
46 4.5 Each Activity wise post-test percentage of Barthel
index score among Rheumatoid Arthritis clients.
47 4.6 Post-test level of Activities of Daily Living score in
Experimental and control group.
48 4.7 Each Activity wise pre-test,post-test percentage of
Barthel index gain score among Rheumatoid Arthritis clients in Experimental and control group.
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4.8 Pre-test,post-test level of Activities of Daily Living score in Experimental group.
50 4.9 Pre-test,post-test level of Activities of Daily Living
score in Control group.
51 4.10 Comparison of pre-test,post-test Mean Barthel score in
Experimental and control group.
52 4.11 Comparison of pre-test,post-test Mean Activities of
Daily Living score in Experimental and control group.
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15 Table
No Title Page
No 4.12 Effectiveness of Zone therapy and generalization of
Activities of Daily Living among Rheumatoid Arthritis clients in Experimental and control group.
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4.13 Association Between Rheumatoid Arthritis clients post-test level of Activities of Daily Living score and their Demographic variables in Experimental group.
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4.14 Association Between Rheumatoid Arthritis clients post-test level of Activities of Daily Living score and their Clinical variable in Experimental group.
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4.15 Association Between Rheumatoid Arthritis clients post-test level of Activities of Daily Living score and their Demographic variables in Controlgroup.
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4.16 Association Between Rheumatoid Arthritis clients post-test level of Activities of Daily Living score and their Clinical variables in Controlgroup.
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LIST OF FIGURES
Figure
No Description
1.1 Statistical rate of global prevalence of Rheumatoid Arthritis 1.2 Disability Intervention Model For Adult with Rheumatoid
Arthritis
1.3 Conceptual framework based on Modified J.W.Kenny’s open system.
3.1 Schematic representation of the Research Methodology 4.1 Distribution of Study participants based on age group 4.2 Distribution of Study participants based on Gender
4.3 Distribution of Study participants according to educational status.
4.4 Distribution of Study participants according to Occupation of the head.
4.5 Distribution of Study participants according to Monthly income.
4.6 Distribution of Study participants based on the ir Marital status 4.7 Distribution of Study participants according to their Residential
Area.
4.8 Distribution of Study participants according to their Type of Family.
4.9 Distribution of Study participants based on the history of present systemic diseases.
4.10 Distribution of Study participants according to their Life -Style- Level of Activities.
4.11 Distribution of Study participants according to their Habits.
4.12 Distribution of Study participants based on the Family History of Rheumatoid Arthritis.
4.13 Distribution of Study participants according to any history of childhood illnesses.
17 Figure
No Description
4.14 Distribution of Study participants based on Number of years after diagnosing as Rheumatoid Arthritis.
4.15 Distribution of Study participants according to the body weigtht in kilograms.
4.16 Distribution of Study participants according to their physical findings.
4.17 Distribution of Study participants according to the presence of Joint stiffness.
4.18 Distribution of Study participants according to do you have pain in multiple joints.
4.19 Distribution of Study participants based on Factors Limiting Activities of Daily Living.
4.20 Distribution of Study participants based on Use of any kind of medications.
4.21 Distribution of Study participants based on do you e at Gluten and Red meat,Suger and Fried Foods and None.
4.22 Distribution of Study participants based on did you tried any complementary and alternative medicine.
4.23 Pre-test level of Activities of Daily Living score in Experimental and Control group.
4.24 Post-test level of Activities of Daily Living score in Experimental and Control group.
4.25 Pre-test,post-test level of Activities of Daily Living scorein Experimental group.
4.26 Pre-test,post-test level of Activities of Daily Living in Control group.
4.27 Simple Bar Diagram shows 2S Standard error which compares the Rheumatoid Arthritis clients pre-test,post-test Activities of Daily Living score in Experimental and control group.
4.28 Association between Rheumatoid Arthritis clients post -test level of Activities of Daily Living score and their demographic variable of Age.
18 Figure
No Description
4.29 Association between Rheumatoid Arthritis clients post -test level of Activities of Daily Living score and their demographic variable of Gender.
4.30 Association between Rheumatoid Arthritis clients post-test level of Activities of Daily Living score and their demographic variable of Life Style Level of Activities.
4.31 Association between Rheumatoid Arthritis clients post -test level of Activities of Daily Living score and their clinical variable Family history of Rheumatoid Arthritis.
4.32 Association between Rheumatoid Arthritis clients post -test level of Activities of Daily Living score and their clinical variable Number of years after Diagnosing as Rheumatoid Arthritis.
4.33 Association between Rheumatoid Arthritis clients post -test level of Activities of Daily Living score and their clinical variable Body weight in Kilograms.
4.34 Association between Rheumatoid Arthritis clients post -test level of Activities of Daily Living score and their clinical variable of Physical Fidings.
4.35 Association between Rheumatoid Arthritis clients post -test level of Activities of Daily Living score and their clinical variable presence of pain in multiple joints.
4.36 Association between Rheumatoid Arthritis clients post-test level of Activities of Daily Living score and their clinical variable Factors limiting Activities of Daily Living.
4.37 Association between Rheumatoid Arthritis clients post -test level of Activities of Daily Living score and their clinical variable Did you tried any Complementary and Alternative medicine.
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LIST OF APPENDICES
S.
No Description
I Certificate approval by Institutional Ethics Committee II. Certificate of content validity by Experts
III. Letter seeking permission to conduct the study IV. Certificate for Reflexology
V. Tool for data collection
Section A: Questionnaire regarding demographic variables Section B: Questionnaire regarding clinical variables
Section C: Barthel Index used to assess the level of Activities of Daily Living.
VI. Informed consent form- English VII. Informed consent form- Tamil VIII. Certificate of Tamil Editing
IX. Certificate of English Editing X. Photos
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LIST OF ABBREVATION
ABBREVATION EXPANSION
RGGGH Rajiv Gandhi Government General Hospital
NS Non-Significance
P Significance
SD Standard Deviation
RTCS Randomized Controlled Trails
WHO World Health Organisation
RA Rheumatoid Arthritis
OA Osteo Arthritis
ADL Activities of Daily Living
IADL Instrumental Activities of Daily Living
IRA Impact of Rheumatoid Arthritis
QOL Quality of Life
DMARDS Disease Modifying Anti-Rheumatoid Drugs ACPA Anti-Citrullinated Protein Antibody
GAT Grip Ability Test
HAQ Health Assessment Questionnaire
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Chapter-I Introduction
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CHAPTER-I INTRODUCTION
‘‘Bringing rheumatoid disease out of the shadows”
‘‘Let’s my gentle touch heals you”
Health is a fundamental human right and worldwide social goal. Health is necessary to realize the basic human needs. The goals of the healthy people are to enhance the life expectancy while improving the Activities of Daily Living. This burden has been recognized by World Health Organization(WHO, 2010) in endorsing the bone joint decade 2000-2010, among the chronic Musculo-skeletal diseases Osteoarthritis(OA), Rheumatoid Arthritis(RA)and low back pain are the most important causes of disability in both developed and developing countries.
Rheumatoid Arthritis continues to cause modest global disability with severe consequences in the individual.
Rheumatoid Arthritis is a chronic inflammatory, autoimmune disorder of joints that affects the di-arthrodial ankles. It is a systemic disorder that affects the body by involving a combination of genetic, environmental and habitual factors such as smoking and alcoholism. The mechanism involves the body’s immune system attacking the joints which results in inflammation and thickening of capsule and underlying bone and cartilage.
The symptoms include persisting of morning stiffness for at least 1 hour and typically resolves or decreases within 20-30minutes. The manifestations are rheumatoid nodules, formation of pain in the fingers, wrists, feet and ankles and extra- articular lesions formation, cardiomyopathy, bone marrow depression, pleural effusion. The diagnosis of the disease includes the presence of Rheumatoid factor in the blood, elevated erythrocyte sedimentation rate, c-reactive proteins rate, blood test, x-ray hands reveals the disease progression.
At present, there is no cure for Rheumatoid Arthritis, the management of Rheumatoid Arthritis is broadly divided into non-pharmacological, pharmacological
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and surgical treatment. Disease-Modifying Anti-Rheumatic Drugs (DMARDS) such as hydroxyl-chloroquine and methotrexate, and biological DMARDS are used when not respond to treatment. However these drugs produces greater rate of adverse effects. Surgeries are available to repair, replace helps in managing the Rheumatoid Arthritis. Some of the alternative therapy like strength training, aerobic exercises, water therapy and reflexology are effective in early management of Rheumatoid Arthritis.
Rheumatoid Arthritis alone is not fatal, fatality occurs due to complications associated with the inflammation caused by heart diseases, diabetes, stroke, cancer- especially lymphoma, respiratory conditions like Chronic Obstructive Pulmonary Disease (COPD), and infection.
Also people with Rheumatoid Arthritis has to find the balance between the rest and exercise and continuing to maintain strength and flexibility. Experiencing with dietary changes such as eliminating diet like gluten, decreasing sugar and increasing omega -3 fatty acids can also reduce the disease burden.
Patients with Rheumatoid Arthritis performed significantly less non- vocational activities. Positive about their ability and enhanced activities can strengthen the future.
National Rheumatoid Arthritis society conventional approaches to the management of Rheumatoid Arthritis the top six therapies were selected as acupuncture, copper bracelets, aromatherapy, massage, reflexology and homeopathy.
Rheumatoid Arthritis care which a person can do themselves with advice from the primary care team such as nurse, physiotherapist, occupational therapist and information leaflets. In adults with a recent onset of Rheumatoid Arthritis with the aspects of podiatry can minimize the impact of disease on symptoms, joint damage, joint functions Activities of Daily Living and quality of life.
Reflexology rest on ancient Chinese belief in qi (Prononced-“chee”) or vital energy, according to this belief, qi flows through each person. When a person feel stressed (diseased) there body blocks qi and this can cause imbalance in the body that
3
leads to illness. Reflexology aims to keep qi flowing through the body, by keeping it balanced and makes body and free from disease.
1.1 BACKGROUND OF THE STUDY
There are over 100 Rheumatological disorders classified by World Health Organization. The worldwide prevalence of Rheumatoid Arthritis among adult population has approximately 0.5% to1%.RA was highest prevalence in United states of about 10.7 per 1000 population.3.1 per 1000 in France,8.5 per 1000 in England, In developing countries like Oman, China, Argentina, Yugoslavia the prevalence 1.8 per 1000 in Yugoslavia,3.6 in Oman. In India 2.8 per 1000, the prevalence is 0.75% that is 7 million patients which is 1% of total adult population.
Generally Rheumatoid Arthritis starts between the age of 30-60 in women and somewhat later in men. The life time risk of developing Rheumatoid Arthritis is 3.6%
among women, and 1.7% in men. Women has three times high risk of developing Rheumatoid Arthritis than men because of increased rural population, decreased knowledge and decreased diagnosing facilities among Indian population. The damage caused by Rheumatoid Arthritis involves the heart, lungs, vascular system, eyes, skin, and blood (World Health Organization 2010)
The global prevalence of RA was 0.24%.Globally, of the 291 conditions RA was ranked as the 42nd highest contributor to global disability, just below malaria and just above iodine deficiency with severe consequences in the individuals. DALYS increased from 3.3million.This drastic increase was due to a growth in population and increase in aging.
According to Global Burden of Disease 2010 study, around 3% of the world’s Rheumatoid Arthritis. In Austrian population 2, 50,000 people has the inflammatory form of Rheumatoid Arthritis and 1% that is 80,000 people has Rheumatoid Arthritis .since these disease caused by auto immune conditions the wear and tear of joints.
(Colin mathers, Deborah synnmons2010)
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Report from Deccan chronicle, Rheumatoid Arthritis an autoimmune disease, that is mainly affects tissues around joints. Most frequently in adults, it affects between 0.5%-1% of population in India. Women are three to four times most frequently affected than men. Onset generally occurs in the 35-55 years of age group, India will emerge as capital of Arthritis by 2025 with more than 60 million to be likely to be affected.
Ironically, one of the main reasons is increasing longitivity of Indian population; another one is fast raising obesity. The alarmed that early signs should not be ignored, early diagnosis and treatment can save the joints. The report concluded that maintaining joint health should be the lifelong goal for everyone’s life in order to maintain good Activities of Daily Living and quality of life.
A clinical based study conducted among arthritis patients in India, the data is based on more than 6.4million sample received for bone health(Arthritis) testing over the last 3.5 years across the laboratories in India, Arthritis affects more than 180 million people in India, prevalence higher than many well-known diseases such as diabetes, AIDS, and cancer. Around 14% of the Indian seeks help every year for the joint disease.
The most prevalence form of arthritis, osteoarthritis has been affecting 15 million adults annually with the prevalence ranging 22% to39% in India. The other common joint conditions affecting Indians are gout and Rheumatoid Arthritis studies have observed that nearly 45% of women over the age of 65 years have symptoms while radiological evidence is found in 70% of those over 65 years (Narasingam 2018).
Historical treatments for Rheumatoid Arthritis includes rest, ice, compression and elevation, apple, diet, nutmeg, some light exercise, nettles, bee venom, copper bracelets, rhubarb diet, extraction of teeth, fasting, honey, vitamins, insulin, and electroconvulsive therapy.
According to National center for complementary and Alternative medicine, In the UK more than five million people adopt Complementary and Alternative
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medicine. Research shows that more than 180 different Complementary and Alternative medicine are available, however acupressure, aromatherapy, chiro- practice, homeopathy, hypnotherapy, osteopathy and reflexology are therapies most commonly provided by primary care providers like nurses, physiotherapist, and occupational therapist.(Helene langerin May 2019)
A person who suffers from Rheumatoid Arthritis finds difficulties in Activities of Daily Living which cause mild, moderate, severe and very severe disability. People with Rheumatoid Arthritis has right to get supportive therapy and the same level of respect, dignity.
1.1 Statistical rate of global prevalence of Rheumatoid Arthritis
Arthritis is one of the most common inflammatory joint diseases that require special care and a multidisciplinary team. The relief of symptom, preservation of joint function, prevention of joint damage and deformity, maintenance of an acceptable life style and patient education are the main goals of the nursing management and nurse plays a vital role within the multidisciplinary team, ensuring the highest quality of life.
Currently 580 million elderly aged 60 and over the world, in this 365 million live in the developing countries. Statistical data released by union ministry of health and family welfare’s life expectancy in India gone up by 5 years 62.3 years for male, 63.9 years for female in 2001-2005 to 67.3 years and 69.6 years respectively in 2011-2015.
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As the life expectancy increased in incidence of Chronic disease especially arthritis among 50% of the population chronic diseases or problems increased. (Martin et.al)
In Rajiv Gandhi Government Hospital about 500 clients with Rheumatoid Arthritis every week and approximately 10,000 clients in attending outpatients departments .moreover ,approximately 7000 cases get admitted and diagnosed with Rheumatoid Arthritis in, in -patients department with some manifestations ,among the Rheumatoid Arthritis clients female clients are in very high rates.
The disease becomes more prevalence after the age of 45 years; approximately 6 million people are diagnosed and improperly self -treated. The incidence of arthritis in woman is 3 times affected more than the men. Knee joint is one of the most sensitive and vulnerable joints in the body. Knee pain can be acute or chronic. Acute knee pains are generally caused when you fall and hurt your knee. Chronic Pains are more like an ache and they are not related to any specific event or time. Other causes of knee pain include ligament problems, fractures, dislocations, arthritis etc.
1.2 NEED FOR THE STUDY
According to World Health Organization out of every 100,000 people, 41 are diagnosed as Rheumatoid Arthritis every year, about 1.3million American are diagnosed by this triggering disease. (World Health Organization 2010)
The first known traces of Arthritis dated back at least as far as4500BC.
Arthritis is first noted in Native Americans, also in Europe before 17th century.
Rheumatoid Arthritis was first recognized as modern medicine in 1800 by French physician, Dr. Augustin Jacob Landre-Beauvais(1772-1840) in Paris. The name
“Rheumatoid Arthritis” was first coined by British Rheumatologist Dr. Alfred Baring Garrod in1859.
The word Rheumatoid Arthritis is derived from the Greek word, Rhuma means watery discharge, and cause swelling of the joints and the disease may worsen by wet weather. The causes of Rheumatoid Arthritis is unknown, but a number of risk factors can contribute such as heredity, environment, life style example
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smoking. Rheumatoid Arthritis may damage joints within three to six months after the onset of disease since it is considered as the disease of wear and tear.
Rheumatoid Arthritis is a long-term autoimmune disorder that primarily affects joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly the wrist and hands are involved. It typically involved on both sides of the body. The disease may also affect other parts of the body. This may result in low red blood cell count, inflammation and the lungs and inflammation around the heart. Fever and low energy may also present. (Wikipedia, 2019)
Patient with Rheumatoid Arthritis are at risk of work disability from the very start of these symptoms, risk factors for early work disability include a physically demanding job, older age and lower educational level, as well as the level of functional disability in daily activities. Work disability accounts for major fraction of costs of both Rheumatoid Arthritis patient and society, work disability require attention to social, economic, and political issues and also require medical management. The goal and treatment for Rheumatoid Arthritis is to reduce joint inflammation and pain and prevent joint destruction and deformity.
According to the center for Disease control and prevention, Arthritis and other rheumatic condition, are recognized as the leading cause of disability in united states.17million, or 38% report activity limitations attributable to Arthritis.
People who live with joint pain, swelling, and damage to weight-bearing joints (i.e hips, knees, ankles, feet) caused by arthritis have mobility issues which affects their ability to work and perform common daily tasks.
Climbing stairs, According to center for Disease control and prevention among adults in the United States 4.8 million report having difficulty in climbing stairs.7.8 million adults have significant limitation when kneeling, bending, or stooping.
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Grooming, simple thing like brushing the hair can cause great pain because of involvement of hand, elbow, shoulder and neck pain or stiffness can limit the range of motion.
Gripping of the fingers, gripping of fingers is ordinary task-Arthritis people can Ability to reach, are you able to bend down to pick up clothing from floor.
Cleaning house and other house works is a big challenge for people living with arthritis, movement required for sweeping, mopping, vacuuming and other cleaning tasks can worsen joint pain and swelling. (Robert R. Redfield, 2019)
Reflexology is based on ancient form of therapy. There is evidence of some forms of foot and hand therapy being practice in China as long ago as 2330B.C also in Egypt. The North American tribes of Indians are known to practice a form of foot therapy for hundreds of years.
The dictionary definition of a “Reflex” is an involuntary or instinctive movement in response to a stimulus or in the sense of reflection or mirror image. The reflexes on feet and hands act as mirror image of the body.
Zone Therapy was used as far back as 1500AD, American president, James Abram Garfield was said to apply pressure to his feet to relieve pain. During the 16 th century a number of books were published on Zone therapy, one was written by Dr.
Adamus and another by Dr. Ball in Leip zip.In 1917, Dr.Fitzgerald wrote ‘‘Zone therapy for relieving pain in the Home”. In 1919 he enlarged the book and published second title ‘‘Zone therapy for curing pain and disease.”
Zone therapy the recognition of reflexology as a specific type of treatment began with zone theory, in which the body is divided into 10 vertical zones. Each zone corresponds to fingers and toes top to heal. For example if you are standing up the thumb and great toe would be the zone. Working between 2 and 3 fingers points the eye.
There are 800 reflex points are found along long thin energy lines called meridians that run the length of entire body. In 1890’s, British scientists found that
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nerve connects the skin and internal organs. They also found that body’s entire nervous system tends to adjust to outside factors including touch. A reflexology touch may help to calm the central nervous system and promoting relaxation
Reflexology can benefit people of all ages and depending on length of time can improve or eliminate many ailments during the course of four to six weeks of treatment. Zone therapy is a complementary therapy that hinges on the belief that there are reflex areas in the feet and hands that correspond to the organs and glands of the body. Stimulating these areas correctly can create a positive effect in the corresponding part of the body.
Zone therapy is a noninvasive, non-pharmacological therapy; it can be applied as hand or foot reflexology or self- foot reflexology. Zone therapy is the existing research into the effectiveness of reflexology in treating arthritis has concentrated on its ability to reduce pain and need of the Analgesics. The Reflex Zone Therapy General Reactions are subdivided into, Immediate, Intermediate and Late reactions which gives a great experience to the patient after the pressure treatment.
Immediate reactions: When a patient is undergoing reflexology treatment, they will feel the experience of wellbeing immediately after the session. The patient can feel a pleasant warmth and relaxation experience during the treatment time. If the treatment is too vigorous, the patient might be experiencing pain, which is a different issue. But when the treatment is going smoothly, the patient will release his tension and soon falls into sleep.
Intermediate reactions: If the patient is not experiencing the immediate reaction, you might observe Intermediate reactions in his body after two or three days of treatment, these reactions encounter one or more of the following below reactions mentioned below.
An increase in the urinary output, An increase in the bulk and, sometimes, frequency of stools Occasionally, a feeling of mild pain and general malaise in the body, with or without fever, an increase in the activity of the skin, with increased
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perspiration, which is sometimes malodorous, an increase in the secretions from the mucous membranes of nose, pharynx and bronchi, signifying a cleansing process.
These are merely signs of a re-activation of body’s defense forces that are trying to eliminate toxins and waste materials accumulated in the body. These unpleasant reactions are purely temporary, do not permanently harm and, therefore, should cause no alarms. With the body progressively getting free of toxins, the above mentioned reactions rapidly diminish in intensity and ultimately disappear.
Late/Delayed reactions: Zone therapy promotes better sleep, so the patient would not be as aware of the pain and also it improves the quality of life. Through foot reflexology or zone therapy, by stimulating the reflex points 7000 nerves and 26 bones in the feet release blockage and rebalance energy flow in the body. This brings the body back into natural equilibrium, which promotes the body’s natural healing power. This is because the body contains an energy field, as invisible life force.
Complementary therapies are a new treatment option for the patients to improve their health status. During the clinical experience the investigator has experienced in the Rheumatology Department as the day to day the in-patient number of Rheumatic arthritis was increased and their inability to work the routine activity is affected, they need support of the family members. On investigator observation the Rheumatoid Arthritis clients are in the need of some other complimentary therapy. So investigator has selected this topic for dissertation.
According to National Rheumatoid Arthritis society, Nursing staff are pivotal to provide care to more than 10million people affected by Rheumatic conditions in United Kingdom, who are in need of support to manage their symptoms; Many Rheumatology nurse specialists have sole responsibility for patient care. The nurse incorporates many elements including making diagnosis, physical examination, starting treatments, prescription of medicines, improving physical, psychological and social function and referrals for investigations or for relevant specialist. Patients tells
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that Rheumatology nurse specialists helping them to manage and alleviate both the physical and psychological sufferings.
Clinical nurse specialists always have been hugely responsive and there supportive knowledge quickly helps to manage the needy and sudden flares. (Helene langerin may 2019)
Role of nurse in complementary and alternative medicine, a majority of the nurses had some knowledge more than half of therapy.
Respondents generally required more evidence judged as essential to use or recommend conventional therapy
Nurses judge the therapies helpful for treatment of variety of symptom.
Nurses explore the knowledge and education needed to administer specific complementary and alternative medicine.
Communicating interest in or use of complementary and alternative medicine.
Medicine is the first step in determining the need of the patients.
Nurse can relinquish their role as traditional providers of complementary and alternative therapy in providing safe, effective and holistic care at the bed side of Rheumatoid Arthritis.
The focus should be equally spread over safety issues.
Positivity can contribute to health, wellness and is quality of life, the challenges to face and adapt positive environment.
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Fig.1.2 Disability Intervention Model for Adults with Rheumatoid Arthritis
This model states that Disability is the limitation in performing personal and socially defined tasks expected in individuals with in a socio-cultural and physical environment. These roles and tasks are organized in spears of life activities. Several factors can contribute to situations and reactions. This study supports to understand the clients symptom experience, disablement process and ability to cope with daily activities during symptoms and flares. Nurses play a major role in understanding the impact of Rheumatoid Arthritis and can provide a comprehensive care on patient’s physical, cognitive, socio-economic, emotional health status in order to promote the well-being of the clients. In order to create awareness February 2nd is recognized as National Rheumatoid Awareness Day the theme is Bringing Rheumatoid Arthritis out of shadows and my goal is let’s my gentle touch heals you.
13 1.3 STATEMENT THE PROBLEM
“A STUDY TO ASSESS THE EFFECTIVENESS OF ZONE THERAPY IN IMPROVING ACTIVITIES OF DAILY LIVING AMONG RHEUMATOID ARTHRITIS CLIENTS ADMITTED IN RHEUMATOLOGY WARD, RAJIV GANDHI GOVERNMENT GENERAL HOSPITAL, CHENNAI-03”
1.4 OBJECTIVES
To assess the pre-test level of Activities of Daily Living among Rheumatoid Arthritis clients in experimental and control group.
To evaluate the effectiveness of Zone therapy in Activities of Daily Living among Rheumatoid Arthritis clients in experimental group.
To compare the pre- test and post -test level of Activities of Daily Living among Rheumatoid Arthritis client in experimental and control group.
To associate the post-test score in experimental group with selected demographic variables.
1.5 OPERATIONAL DEFINITIONS Assess
In this study it refers to estimate the effectiveness between pre and post level of Activities of Daily Living by zone therapy among Rheumatoid Arthritis Clients.
Effectiveness
It refers to the extent to which the zone therapy has achieved the desired effect among clients with Rheumatoid Arthritis. It is measured in terms of difference in pre- test and post-test score of Activities of Daily Living.
Zone therapy
Zone therapy is a complementary therapy that works on the principles that reflex areas in the feet and hands that correspond to the organs and glands of the body.
By stimulating these areas correctly can create a positive effect in the corresponding part of the body. The methods used are the finger pop method, press and slide, rubbing, pinching and finishing used for 7 days 15 minutes daily for each samples.
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Activities of Daily Living
Activities of Daily Living (ADLs) is house hold activities such as feeding, bathing, dressing, grooming, works, home making and leisure time activities.
Rheumatoid Arthritis clients
Person’s diagnosed as Rheumatoid Arthritis which is a chronic progressive inflammation in the joints and resulting in painful deformity and immobility, especially in the fingers, wrists, feet, and ankles.
Rheumatology ward
A specialized department offers the services for the client’s diagnosis, treatment appropriate to acute and chronic management of Rheumatoid Arthritis.
1.6 HYPOTHESES
H1: There will be a significant difference between pre-test and post test score of Activities of Daily Living among Rheumatoid Arthritis clients.
H2: There will be a significant association between demographic variables and post test scores of Activities of Daily Living among Rheumatoid Arthritis clients.
1.7ASSUMPTION It is assumes that
Rheumatoid Arthritis clients will have some limitations, restriction of Activities of Daily Living.
Zone therapy will enhance the Activities of Daily Living.
1.8 LIMITATIONS The study is limited to
Clients with Rheumatoid Arthritis.
The period of 4 weeks.
The sample size is 60 Rheumatoid Arthritis clients.
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1.9 CONCEPTUAL FRAMEWORK
Conceptual framework:
Conceptual frame works are inter-related concepts that assembled together in some rational scheme by virtue of their relevance to a common theme. Conceptual framework helps to stimulate research and the extension of knowledge by providing both direction and inputs. (Polit and Hungler et al 1999)
The present study is focused on the effectiveness of Zone therapy on Activities of Daily Living of Rheumatoid Arthritis clients. The study is based upon J.W.
Kenny’s Open system model. The system’s theory is concerned with changes due to interrelation between various factors in a situation. All living systems are open, in which there is a continual exchange of matter, energy and information. Open system have varying degrees of input and gives back output in form of matter, energy and information.
The concepts of Kenny’s open system model are input, throughput, output and feedback. Input refers to matters and information, which are continuously processed through the system and released as outputs. After processing the input, the system returns output (matter and information) to the environment in as altered state, affecting the environment for information to guide its operation. This feedback information of environment responses to the systems output is used by the system in adjustment correlation with the environment. Feedback may be possible, negative or neutral. In this study the concepts have been modified as follows:
INPUT:
Accordingly to J.W. Kenny’s input can be matter, energy and information from the environment from the environment. In the present study the input refers to the Activities of Daily Living of Rheumatoid Arthritis clients in experimental and control group.
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THROUGHPUT:
Throughput was the implementation of Zone therapy by using finger pop, rubbing, pinching for 7 days daily for the duration of 15 minutes.
OUTPUT:
The expected outcome was obtained by assessing the level of Activities of Daily Living through Barthel Index of Activities of Daily Living scale. The output was considered in terms of change in post -test level of Activities of Daily Living obtained through Barthel Index of Activities of Daily Living scale.
FEEDBACK:
Feedback was based on the analysis of post test scores the intervention strategy can be modified if necessary and the same pattern.
Chapter-II
Review Of Literatures
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CHAPTER-II
REVIEW OF LITERATURE
Review of literature is a key in the research process. Review of literature refers to an exhaustive, extensive and systematic examination of publication relevant to the research project. Before any research can be started whether it is single study or extended project, a literature review of previous studies and experiences related to the proposed investigations should be done. One of the most satisfying aspects of the literature review is contribution it makes to the new knowledge, insight and general scholarship of the researchers.
This section consists of four parts:
2.1.
Literature related to Rheumatoid Arthritis
2.2. Literature related to Rheumatoid Arthritis and Activities of Daily Living 2.3. Literature related to Rheumatoid Arthritis and Reflexology (zone therapy)
2.4. Literature related to effectiveness of Reflexology (zone therapy) and other disease conditions
2.1. Literature related to Rheumatoid Arthritis
MinnockP et al (2017) Nursing sensitive outcomes in patients with Rheumatoid Arthritis a randomized controlled trials and observational studies met the inclusion criteria.
The objective of this study was to identify and delineate relevant patient outcomes measured in studies that reported nursing interventions in patients with Rheumatoid Arthritis. These fitted into health intervention domains in keeping with the pre-specified conceptual framework for health: disease status, effectiveness, safety, function, knowledge, satisfaction, psychological status, quality of life, cost, death. A total of 59 measurement instruments were identified comprising patient reported outcome measures (n=31), and biologic measures and reports (n=28).
Ferrow et al (2017) Conducted a study on Rheumatoid Arthritis (RA) is a chronic disease characterized by inflammation of the synovial tissue in joints, which can lead to joint destruction. The primary goal of the treatment is to control pain and inflammation, reduce
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joint damage and disability, and maintain or improve physical function and quality of life.
The present review is aimed at providing a critical analysis of the recent literature on the novelties in the treatment of RA, with a particular focus on the most relevant studies published over the last year.
ClinImmunol et al (2017) Conducted a study on Biomarkers in connective tissue disease and concluded that Autoimmune connective tissue diseases are clinically variable, and This review describes select current biomarkers that aid in the diagnosis and treatment of several major systemic autoimmune connective tissue disorders: systemic lupus erythematosus, Rheumatoid Arthritis, systemic sclerosis, and anti-neutrophil cytoplasmic antibody-associated vasculitis and discussed about newly proposed biomarkers that target various stages in disease onset and progression. Newer approaches to overcome the diversity observed in patients with these diseases and to facilitate personalized disease monitoring and treatment are also addressed.
Panel et al (2016) Carried out a study on Arthritis patient education Arthritis in one of the most prevalent chronic diseases and the number one disabler of the elderly. Even though arthritis is a major cause of morbidity and a contributor to early mortality, relatively few studies have been undertaken to examine effects of arthritis patient education. This review was undertaken to (1) provide a summary of arthritis patient education studies, (2) summarize the effectiveness of arthritis patient education in changing knowledge, behavior, psychological status, and health status, (3) address critical issues/problems in arthritis patient education study methodology, and (4) suggest guidelines for future design, implementation, and evaluation of arthritis patient education programs.
Kutlu et al (2016) conducted a study on Rheumatoid Arthritis review article Rheumatoid Arthritis, an auto-immune disease in which body immune system, the formal defense mechanism of the body attacks body own cells that are found in the joints and certain organ. Thereby, causing an inflammatory reaction accompanied by pain. The severity of the disease various from patients to patients and by contrast, provide a summary of what the authors believe are the best and most relevant prior publications. The concept of "review article" is separate from the concept of reviewed literature.
Bellucci E et al (2016) Conducted a study on pathogenesis of Rheumatoid Arthritis.
Rheumatoid Arthritis (RA) is an autoimmune disease characterized by chronic synovial
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inflammation leading to joint destruction and bone erosions. The autoantigens in RA are neither tissue nor organ-specific, but comprise a broad. Better understanding of these processes will allow both earlier diagnosis of RA and identification of those healthy individuals that are at risk of developing disease, finally discussed as the iterative processes of innate and adaptive immunity responsible for the development of Rheumatoid Arthritis.
Klareskog et al (2016) worked out a study on Immunity to citrullinated proteins in Rheumatoid Arthritis to demonstrate that the criterion-based syndrome RA should be subdivided into at least two distinct subsets (ACPA-positive and ACPA-negative disease). A new etiological model is proposed for ACPA-positive RA, built on MHC class II-dependent activation of adaptive immunity. Fundamentals of this model include the following: (a) ACPA antedate onset of arthritis; (b) ACPA may aggravate arthritis in rodents; (c) ACPA are triggered in the context of genes that confer susceptibility to RA (HLA-DRB1 SE) and by environmental agents triggering RA (smoking or bacterial stimuli); (d) ACPA may complex with citrullinated proteins present in target tissue as part of a multistep process for arthritis development. The model provides a new basis for molecular studies on the pathogenesis of ACPA-positive arthritis.
R Handa et al (2016) has done a literature review of Rheumatoid Arthritis in India aims Rheumatoid Arthritis (RA) can lead to severe disability. Rheumatoid Arthritis (RA) is an autoimmune disease with a worldwide prevalence of approximately 0.5% to 1% among adults. RA investigators have noted that prevalence in North America and Europe may be higher than prevalence in Asia. It is unclear if this geographical variability exists due to genetic, environmental or study design differences. When RA is left uncontrolled, the RA patient may experience joint deterioration, severe disability, decreased quality of life, the onset of comorbidities and premature mortality.
Sheron et al (2016) conducted a cross sectional study by an Randomized controlled trials (RCTs) indicate that dietary supplementation with n-3 fatty acids provides modest symptomatic benefit in groups of patients with Rheumatoid Arthritis. A number of mechanisms through which n-3 fats may reduce inflammation have been identified. In a small number of patients with Rheumatoid Arthritis, other dietary manipulation such as fasting, vegan, and elimination diets may have some benefit. However, Concluded that dietary manipulation provides a means by which patients can a regain a sense of control over their
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disease. Dietary n-3 supplementation is practical and can be easily achieved with encapsulated or, less expensively, bottled fish oil.
Li wen poh et al (2016) illustrated a descriptive qualitative study among 16 adults in order to create an on impact on physical and psychosocial well-being. The purpose of this study was to explore the experiences and support needs of adult patients living with RA. The transcribed data were analyzed by thematic analysis. Five themes were identified as altered physical capacity and well-being, psychological and emotional challenges, changes in social life, coping strategies, and support received and further support needs. This study provided insights into the experiences and support needs of patients with RA in Singapore. Physical and psychosocial challenges experienced by patients affected their daily and social activities.
Patients’ needs for variety of support should be addressed.
AMJ Chorus et al (2015) Conducted a study on functioning abilities and quality of life (2015) on Rheumatoid Arthritis (RA), among Indian population by cross-sectional designs can lead to severe disability. This literature review assessed the descriptive epidemiology, comorbidities and extra-articular manifestations, functioning abilities and quality of life, and treatment patterns of RA patients in India and the results where twenty- eight studies were identified for data extraction. Seven described the descriptive epidemiology of RA, described comorbidities and extra-articular manifestations, nine described the functioning abilities and quality of life among patients, and provided information on treatments also conclusions for the entire Indian RA population cannot be drawn from only the current observational studies.
2.2. Literature related to Rheumatoid Arthritis and Activities of Daily Living
Ahlstrand I et al (2019) conducted a study on pain and Activities of Daily Living among Rheumatoid Arthritis, the aim of the study is to describe the experience of pain and its relationship to Activities of Daily Living among 33 men and women by seven semi- structured focus group discussion it expressed as pain limits the Activities of Daily Living and concluded that restriction and impairment are clinical importance and as to pay more attention on wide complex among Rheumatoid Arthritis clients.
James et al (2019) conducted a study on Trajectories of pain predict disabilities affecting daily living in Rheumatoid Arthritis, the purpose is to examine the disabilities in activities when adjusting with pain by retrospective studies with two aspects ADL and
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mobility and suggested that respondents in a trajectory of worsening pain limits their daily functioning and also concluded that after decreased in pain levels also patients has limitations in ADL and mobility and suggested that further intervention is required to alleviate the symptoms.
Berlin et al (2019) Support aids for people with Rheumatoid Arthritis conducted a study at Germany and other countries. There are a whole range of devices and gadgets to help people with Rheumatoid Arthritis in everyday life, ranging from walking frames and dressing aids to special cutlery. Even simple activities such as getting dressed or eating and drinking can then become a struggle. A wide variety of devices and aids have been developed to make it easier to live with Rheumatoid Arthritis. These are designed to compensate for physical limitations and help with daily activities. Different aids and devices are more suitable for different people.
Carol Eustice et al (2019) Conducted a quasi-experimental research design was used with 2- month follow-up. The study was conducted in the outpatient clinic of the RA Departments at Zagazig University Hospitals among 39 female adult patients diagnosed as having RA without deformity of bones or destruction of joints. The purpose of this work was to measure the effect reflexology has on pain and quality of life (QOL) in a patient with Rheumatoid Arthritis. Using an 8-week course of reflexology treatments were given to a patient who has RA and concluded that Rheumatoid Arthritis (RA) clients face considerable physical, social and emotional disabilities, this chronic disease, for which a cure is not yet available, improving patients' health, quality of life and reduce pain is of the utmost concern.
Carolyn, Neville et al (2017) conducted a study on The patient's perspective, The needs of patients with arthritis to identify concerns and learning interests of patients with arthritis and concluded that concerns and learning interests of persons with arthritis did not differ based on the center of treatment or the diagnosis, but can be predicted by the level of pain and simple measures of disability. Better understanding of the relationship between health status and patient‐perceived needs will result in improved patient‐centered care.
M Kauppi S Hartikainen et al (2016) conducted a population based study on Capability for daily activities in old people with Rheumatoid Arthritis, to describe the functional capacity for daily activities in old people with clinical Rheumatoid Arthritis. Sex and age adjusted results showed no statistical difference (ADL and IADL) between patients
