Thesis PDF

“A COMPARATIVE STUDY TO ASSESS THE EFFECTIVENESS OF
WARM WATER THERAPY VERSUS CONTRAST WATER THERAPY

ON JOINT PAIN AMONG ELDERLY PATIENT WITH ARTHRITIS IN
SELECTED OLD AGE HOME AT DELHI NCR”.
BY
DILPREET KAUR
NIGHTINGALE INSTITUTE OF NURSING, NOIDA.
DISSERTATION SUBMITTED IN PARTIAL FULLFILMENT OF THE

REQUIREMENTS FOR THE HIGHEST DEGREE OF MASTER OF SCIENCE IN
NURSING
CHAUDHARY CHARAN SINGH UNIVERSITY
MEERUT (U.P)
2020
“A COMPARATIVE STUDY TO ASSESS THE EFFECTIVENESS OF
WARM WATER THERAPY VERSUS CONTRAST WATER THERAPY
ON JOINT PAIN AMONG ELDERLY PATIENT WITH ARTHRITIS IN
SELECTED OLD AGE HOME AT DELHI NCR”.
BY
DILPREET KAUR
Dissertations submitted to the
Chaudhary Charan Singh University

Meerut (U.P)
In partial fulfillment for the requirements of the degree of
Master of Science in Nursing
In
Medical Surgical Nursing
Under the guidance of
Mrs. Sibi Samuel
Assist Professor
Department of Medical Surgical Nursing
Nightingale Institute of Nursing
Noida
2020
DECLARATION BY THE CANDIDATES
I hereby declare that this dissertation / thesis entitled “A comparative study to assess the
effectiveness of warm water therapy versus contrast water therapy on joint pain among
elderly patient with arthritis in selected old age home at Delhi NCR” is a bonafide genuine
research work carried out by me under the guidance of Mrs. Sibi Samuel, Assistant professor
Department of Medical Surgical Nursing at Nightingale Institute of Nursing Noida.
Date: Signature of the Candidate
Place: Ms. Dilpreet Kaur
Msc. Nursing
CERTIFICATE BY THE GUIDE
This is to certify that the dissertation entitled “A comparative study to assess the effectiveness
of warm water therapy versus contrast water therapy on joint pain among elderly patient
with arthritis in selected old age home at Delhi NCR” is a bonafide research work done by
Ms. Dilpreet Kaur in partial fulfillment of the requirement for the degree of Master of science
in Nursing from Chaudhary Charan Singh University Meerut (U.P)
Date: Signature of the guide
Place: Mrs. Sibi Samuel
Assistant Professor
Medical Surgical Nursing

ENDORSEMENT BY THE PRINCIPAL/ HEAD OF THE
INSTITUTION
This is to certify that the dissertation entitled “A comparative study to assess the
elderly patient with arthritis in selected old age home at Delhi NCR” is a bonafide research
work done by Ms. Dilpreet Kaur in partial fulfillment of the requirement for the degree of
Master of science in Nursing from Chaudhary Charan Singh University Meerut (U.P)
Signature of the HOD Signature of the principal

Mrs. Sibi Samuel Prof. Lavanya Nandan
Assistant professor Master of Science in Nursing
Nightingale Institute of Nursing, Nightingale Institute of Nursing
Noida Noida
Date: Date:
Place: Place:
ACKNOWLEDGEMENT
This thesis owes its existence to the help, support and inspiration of several people. Firstly
and foremost, I thank God Almighty for his grace and blessings, showered upon me throughout
this study.
I would like to express my heartfelt gratitude to Mr. Ashok Jain, Chairman, Nightingale
Institute of Nursing, Noida for allowing me to be a part of this prestigious institution.
I express my sincere and deepest sense of gratitude to Prof. (Mrs.) Lavanya Nandan,
director, and Principal of Nightingale Institute of Nursing, Noida (U.P) for providing
guidance and encouragement for successful completion of this research study throughout.
I would like to express my heartfelt gratitude to Mrs. Sushma Sharma, HOD and HR of
Administration department, Nightingale Institute of Nursing, Noida (U.P) for providing the
administration support and facilities for successful completion of this study.
I would like to express my sincere appreciation and gratitude to Mrs. Sibi Samuel, Assistant
Professor at Nightingale Institute of Nursing, Noida (U.P) for her guidance during my
research study. Her support and inspiring suggestions have been precious for the development of
this dissertation.
I would like to express my sincere appreciation and gratitude to Mrs. Kapeelta Th.
Associate professor at Nightingale Institute of Nursing, Noida (U.P) for her guidance during
my research study. Her support and inspiring suggestions have been precious for the
development of this dissertation.
Sincere thanks are especially expressed to the entire Master Nursing Faculty of Nightingale
Institute of Nursing, Noida (U.P) for the encouragement, support and guidance towards the
successful completion of this research work.
I am extremely grateful to whole Library staff of Nightingale Institute of Nursing, Noida

(U.P) for providing me with all the necessary library facilities.
I express my gratitude to the Management of old age people for granting permission to
conduct pilot study and main study.
My heartfelt thanks to all experts who spared their time for content validation of the tool that
are used in this study.
Word of acknowledge remains incomplete if I do not express my sincere deep of
indebtedness to my father in law Mr. Kirpal Singh, and Mother in law Mrs. Paramjeet Kaur
and my husband Mr. Sukhpreet Singh for their constant love and support throughout my
studies.
A special word of thanks to my father Mr. Gurmeet Singh and my mother Mrs. Gurwinder
Kaur who helped me during my study.
And lastly, I want to thank each and every classmate of mine, especially Sakshi Sood, Anju
Singh, Shailendra Verma and Shivani Thakur for always been helpful and supportive
throughout my study.
Date:
Place: Noida Dilpreet Kaur
ABSTRACT
A comparative study to assess the effectiveness of warm water therapy versus contrast
water therapy on joint pain among elderly patient with arthritis in selected old age home at Delhi
NCR, towards partial fulfillment of the requirement for the degree of Master of Nursing at
Nightingale Institute of Nursing, Chaudhary Charan Singh University, Meerut (U.P) during the
year of 2019-2020. The objectives of the study is to assess and evaluate the joint pain and
compare the effectiveness of warm water therapy versus contrast water therapy on joint pain
among elderly patient with arthritis. A quasi experimental- nonequivalent pretest posttest design
was adopted and non probability Purposive sampling technique was used for selecting the
samples for study. The sample consists of 30 elderly patients with arthritis (15 for warm water
therapy and 15 for contrast water therapy) at old age home i.e Guru Vishram Vridh Ashram,
Delhi NCR. A pre assessment was done on the 1st day and both therapies were administered
continuously till 10 days and on the 11 day post assessment was done. Tools developed and used
for data collection were: structured interview schedule and Modified Pain Assessment scale to
check the level of joint pain. The researcher found that which therapy is more effective to reduce
the joint pain. The data was analyzed and interpreted as per objectives and the research
hypothesis stated. Descriptive and inferential statistics were used for data analysis. Results shows
that there was significant difference between mean post test scores of elderly patient with
arthritis in warm water therapy (40) and contrast water therapy ( 32.26) for joint pain score as
obtained unpaired ‘t’ value (4.44) was higher than the tabulated value(2.05)for df (28) at 0.05
level of significance. The fisher’s exact test value showed that there was a significant association
between post test score of elderly patient after receiving the warm water therapy and contrast
water therapy with demographic variables as ‘p’ value obtained is less then at 0.05 level of
significance. The conclusion of the study revealed that contrast water therapy was having more
effectiveness than warm water therapy for reducing the joint pain of elderly patient with arthritis.
Key words: warm water therapy, contrast water therapy, elderly patient, arthritis
LIST OF ABBREVATIONS USED
OA - Osteoarthritis
RA - Rheumatoid Arthritis
CB- Contrast Bath

TABLE OF CONTENT
CHAPTER CONTENT PAGE NO
I. INTRODUCTION
Background of the study
Need of the study
Statement of the problem
Objectives of the study
Hypothesis
Operational definition
Assumptions
Delimitations
Conceptual framework of the study
Summary
Organization of the study
II. REVIEW OF LITERATURE
Literature related to arthritis pain in old age
Literature related to effectiveness of warm
water therapy on joint pain
Literature related to effectiveness of contrast
water therapy on joint pain
Summary
III. RESARCH METHODOLOGY
Resarch Approach
Resarch Design
Variables under study
Setting of the study
Population
Sample
Sample size
Sampling technique
Inclusion criteria
Exclusive criteria
Data collection tools and techniques
Development of tool
Description of tool
Content validity of tool
Try out of tool
Reliability of the tool
Pilot study
Procedure for final data collection
Plan for data analysis
Summary
IV. ANALYSIS AND INTERPRETATION OF DATA
Organization and interpretation of data
Section I :Finding related to frequency and percentage
distribution of elderly patient with arthritis in terms
of demographic variables.
Section II:Finding related to frequency and percentage
distribution of pain assessment score before and
after administration of warm water therapy
• Finding related to frequency and percentage distribution
of pain assessment score before and after administration
of contrast water therapy
Section III:Finding related to effectiveness of warm
water therapy on joint pain among the elderly patient
with arthritis
• Finding related to effectiveness of contrast water therapy
on joint pain among elderly patient with arthritis
Section IV:Finding related to difference between pain
assessment score among elderly patient receiving warm
water therapy and contrast water therapy.
Section V:Finding related to association of post test
Pain assessment score in warm water therapy with
demographic variables
• Finding related to association of post test pain
assessment score among elderly patient in
receiving contrast therapy demographic variables
V. RESULTS
Major findings of the study.
VI. DISCUSSION SUMMARY CONCLUSION
Discussion
Summary
Conclusion
Nursing Implications
Limitations
Recommendations
REFERENCES
APPENDICES
LIST OF TABLES
SR. TABLES PAGE NO

NO
1. Symbolic representation of resarch design
2. Frequency and Percentage distribution of elderly

patient with arthritis in term of demographic variables
in warm water therapy versus contrast water therapy
3. Frequencies and Percentage distribution of pain assessment

score before and after administration of warm water therapy
4. Frequencies and percentage distribution of pain assessment

score before and after administration of contrast water
therapy
5. Mean, Mean Difference, Standard Deviation and “t” Value

of effectiveness of Warm Water Therapy on Joint Pain
among the elderly people with arthritis
6. Mean, Mean Difference, Standard Deviation and “t” value

of effectiveness of contrast water therapy on joint pain
among the elderly people with arthritis
7. Mean, Mean Difference, Standard Deviation and Unpaired“t”

value of warm water therapy versus contrast water therapy
on joint pain among the elderly people with arthritis
8. Fisher’s exact test was used to describe the association

between the joint pain after receiving warm water
therapy with the selected demographic variable.
9. Fisher’s exact test was used to describe the association

between the joint pain after receiving contrast water
therapy with the selected demographic variable.
LIST OF FIGURES
SR.NO FIGURES PAGE NO
1. Conceptual framework
2. Schematic representation of resarch design
3. Bar diagram showing percentage distribution of sample
according to their Age
4. cylindrical diagram showing percentage distribution
of sample according to their gender
according to their educational qualification
according to their religion
according to their dietary pattern
8. Cylindrical diagram showing percentage distribution
of sample according to their family history
according to their types of arthritis
according to their years of suffering from arthritis
11. Con diagram showing percentage distribution of sample
according to their regular exercise
according to their medicine intake
13. Con diagram showing percentage distribution ofsample
according to taking any analgesic
14. Bar diagram showing distribution of pre test and post
test score of joint pain in warm water therapy
15. Bar diagram showing distribution of pre test and post
test score of joint pain in contrast water therapy
LIST OF APPENDICES
S.NO TITLE PAGE NO
1. Letter seeking permission for pilot study

2. Letter granting permission to conduct pilot study
3. Letter seeking permission for final study
4. Letter granting permission to conduct final study
5. 5.1 letter seeking expert’s opinion for content validity
Of tool
5.2 criteria checklist for content validity
6. list of experts for tool validation
7. Informed consent
8. Research tool
8.1 Tool-1 Demographic tool
8.2 Tool- 2 Numerical Rating pain scale
9. Interpretation of scoring
10. Master data sheet
11. Photography
CHAPTER-I
INTRODUCTION
CHAPTER-I
INTRODUCTION
“A man too busy to take care of his health is like, a mechanic too busy to take care of his
tools1”.
Spanish Proverb
Arthritis is an inflammation of a joint. It can affect one or multiple joints. There are many
different types of arthritis and related conditions. The most common form of arthritis is
osteoarthritis. Other common rheumatic conditions related to arthritis include gout,
fibromyalgia, and rheumatoid arthritis (RA). It is most common among women and occurs
more frequently as people get older, but can also affect children. About one in 1,000 children
develop arthritis, often called as juvenile idiopathic arthritis (JIA).2
World Health organization (2014) The most prevalent form of arthritis, Osteoarthritis
has been affecting 15 million adults annually with a prevalence ranging 22% to 39% in India.
Other common joint conditions affecting Indians are gout and rheumatoid arthritis. An
autoimmune disease, this mainly affects tissues around the joints. Most frequent in adults, it
afflicts between 0.5%-1 percent of the population in India. Women are three to four times
more frequently affected than men. Onset generally occurs in the 35-55 year age group.3
There are risks and side effects associated with medications and surgery that are not
associated with some remedies such as superficial heat or cold applications. The periodic
application of superficial heat or cold is relatively safe and low cost treatment that can be
recommended in isolation or in combination with other treatment.4
BACKGROUND OF THE STUDY
WHO Older Adult Health( Older people are generally defined according to a range of
characteristics including: chronological age, change in social role and changes in functional
abilities. In high-resourced countries older age is generally defined in relation to retirement
from paid employment and receipt of a pension, at 60 or 65 years. With increasing longevity
some countries define a separate group of oldest people, those over 85 years. In low-
resourced situations with shorter life-spans, older people may be defined as those over 50
years. The age of 50 years was accepted as the definition of older people for the purpose of
the WHO Older Adult Health.5
Ruth Benita .f (2016) About 1% of the world population is affected by rheumatoid

arthritis, women are three times more often than men. Onset is more frequent between the
ages of 40 and 50.It can be disabling and painful, which can lead to substantial loss of
functioning and mobility. Some complications of arthritis include joint stiffness, social
complications, reduced physical activity, reduced leisure activity etc. Rheumatoid arthritis
affects the quality of the life. The complications of Rheumatoid arthritis include joint
distraction, heart failure, lung disease, low or high platelets, spine instability etc. Affected
joints may worsen the ordinary tasks of the day to day life. Rheumatoid arthritis
complications of this disease may shorten survival in some individuals.6
Johns Hopkins (2019) Osteoarthritis (OA) is the most common form of arthritis, affecting
nearly 30 million nationwide. OA is a degenerative joint disease often described as “wear and
tear” arthritis. A common complaint from patients is pain in the weight-bearing joints such as
the hips, knees and spine as well as involvement in the finger joints. Osteoarthritis increases
with age. Repetitive movement and prior injuries also contribute to the disease, and elderly
people are increasingly affected.7
Babak Shadgan, Amir H. Pakravan, Alison Hoens, and W. Darlene Reid (2018)
Contrast baths (CB) is a thermal treatment modality used to reduce upper and lower limb
pain, soft tissue inflammation and muscle spasm and joint stiffness at sub acute phases and to
facilitate recovery from training. It is an accessible, safe, non invasive, simple, and
inexpensive modality with a long history in musculoskeletal therapy. Besides its application
in rehabilitation and musculoskeletal medicine. Contrast Bath is commonly used by athletes
to promote recovery and reduce muscle damage and the pain associated with delayed-onset
muscle soreness. Its describes the repeated immersion of a limb in hot and then cold water for
a specified timing, duration, and temperature. It is thought that alternating the application of
hot and cold water causes intermittent vasoconstriction and vasodilatation that induce a
vascular pumping effect, which results in increased tissue blood flow and oxygenation that
improve healing, enhances tissue waste-product transportation that reduces edema, improves
limb function, and promotes a quicker recovery. Hot whirlpool has also been reported to
result in reduced joint stiffness and increased extensibility of soft tissue, which causes
haemoglobin to release oxygen more readily into the tissues. The hand, wrist, elbow, forearm,
foot, ankle, knee, and lower leg are frequent sites for Contrast bath treatment, and rheumatoid
arthritis, diabetes, carpal tunnel syndrome, foot and ankle sprains, and soft tissue trauma are
among the common conditions that have been reported to benefit from CB treatment.8
Warm water can be so helpful in fighting the pain and stiffness of arthritis, Warm water
gets blood flow moving throughout stiffened muscles and joints, according to the Arthritis
Foundation. This helps loosen up the synovial fluid and get the joints moving more
comfortably, which in turn helps shake out the inflammation.9
Centres for Disease Control and Prevention (CDC), 54.4 million adults in the United
States have received a diagnosis of some form of arthritis. Of these, 23.7 million people have
their activity curtailed in some way by their condition.10 Osteoarthritis affects more than
3.8% of people while rheumatoid arthritis affects about 0.24% of people.11 Gout affects about
1–2% of the Western population at some point in their lives.12 In Australia about 15% of
people are affected, while in the United States more than 20% have a type of arthritis.13
NEED FOR THE STUDY
“The art of life is the art of avoiding pain" -William Hazlin
Arthritis affects 15% people i.e. over 180 million people in India. This prevalence is
higher than many well known diseases such as diabetes, AIDS and cancer. Osteoarthritis
primarily affects the elderly population. It is a major cause of disability in older adults
worldwide.14 According to World Health Organization (WHO) 9.6% of men and 18.0% of
women aged over 60 years has symptomatic osteoarthritis worldwide. 80% of those with
osteoarthritis have limitations in movement, and 25% cannot perform their major daily
activities of life. Rheumatoid arthritis (RA) affects about 0.92% of adult population in
India.15
“Shyni Augustine” (2010) A study was conducted in Rheumatoid arthritis patients

admitted in Harsha hospital Nelamagala, India. Its affects commonly middle aged population
who are still active and still earning their livelihood especially women folks who used to
carry the burden of the family and children who become highly susceptible and thereby the
whole family system /activity may be affected. Even though it is a progressive disease its
symptoms especially joint pain can be reduced (severity) by adopting various modalities or
minor changes in day today lives which will not only decrease the severity of symptoms but
may slow down the progression of Rheumatoid Arthritis and is a key approach to
Rheumatoid Arthritis in today’s highly active life style16.
“Nisha j. Maneknancy e. Lane”(2000)A study was conducted in osteoarthritis seek

medical attention because of pain. The safest initial approach is to use a simple oral analgesic
such as acetaminophen (perhaps in conjunction with topical therapy). If pain relief is
inadequate, oral non steroidal anti-inflammatory drugs or intra-articular injections of
hyaluronic acid–like products should be considered. Intra-articular corticosteroid injections
may provide short-term pain relief in disease flares. Alleviation of pain does not alter the
underlying disease. Attention must also be given to non pharmacologic measures such as
patient education, hydrotherapy and exercise. Relief of pain and restoration of function can
be achieved in some patients with early osteoarthritis, particularly if an integrated approach is
used.17
“Ramesh Narula”,(2014)A prospective study was undertaken to compare the two

different modalities of non operative treatment: Non- invasive conservative methods:
NSAID’s, Soft Insoles, Stretching and Contrast baths versus local Steroid injection therapy
at a Tertiary health care centre after approval from institutional ethical committee in a period
of two year from January 2012 till December 2013 in Bareilly, India .Total 200 patients were
taken up for the study that completed the follow-up. Patients by random sampling were
divided in two groups. Group A as: Conservative group and Group B as Local Steroid
Injections group, 100 patients in each. Patients were assessed as per Visual Analogue Scale
(VAS) at the start of treatment and then after 4 wk and 8 wk duration on follow up. The
difference in the distribution of subjects belonging to either of the treatment modalities
regarding the treatment outcome at four and eight week was found to be statistically
insignificant. As both treatment modalities are at par on comparison of their treatment
outcome it is better to go for conservative approach because this can save the patients from
the complications of steroid therapy.18
“Linda Pecke” (2017) The study was conducted in Rheumatoid Arthritis among the
elderly can be attributed to two main factors: 1) patients diagnosed with young-onset
Rheumatoid Arthritis (YORA) are living longer due to better management; and 2) increasing
numbers of patients are being diagnosed with elderly-onset Rheumatoid Arthritis (EORA). In
a 2017 retrospective study from Japan, investigators reported that the mean age of onset had
rapidly increased over the previous decade from 55.8 years in 2002-2003 to 59.9 years in
2012-2013, with a corresponding shift in peak age from 50-59 to 60-69 years during that
same period of time.19
In recent times, it is impossible for their children to take care of their parents much. It
might result in depression. In addition with this, old people are not able to do all their work.
They need an assistance of their family members and friends to fulfil their personal needs. In
the absence of their children, it might be difficult for them to maintain their daily activity.
From the above studies it is quite evident that both Warm water therapy and contrast bath
therapy is one of the best metod of treat the arthritis. The warm water therapy and contrast
water therapy does not take much time and no requires any special equipments, except the
water and comfortable place to the both therapies. It is a simplest and easy method, which is
considered to be appropriate for low socio-economic status, and easily applicable for the old
age people. Therefore, this study was undertaken to find out which therapy is comperatively
most effective for managing the arthritis pain among elderly people.20
STATEMENT OF THE PROBLEM
A comparative study to assess the effectiveness of warm water therapy versus contrast
water therapy on joints pain among elderly patient with arthritis in selected old age
home at Delhi NCR”.
OBJECTIVES OF THE STUDY
❖ To assess the joint pain among elderly patient with arthritis in selected old age home
at Delhi NCR.
❖ To evaluate the effectiveness of warm water therapy on joint pain among elderly
patient with arthritis in selected old age home at Delhi NCR.
❖ To evaluate the effectiveness of contrast water therapy on joint pain among elderly
❖ To compare the effectiveness of warm water therapy versus contrast water therapy on
joint pain among elderly patient with arthritis in selected old age home at Delhi NCR.
❖ To determine the association between joint pain after receiving warm water therapy
with the selected demographic variable.
❖ To determine the association between joint pain after receiving contrast water therapy
HYPOTHESIS OF THE STUDY
➢ H1-There is a significant difference between the joint pain assessment score among
elderly patient with arthritis before and after administration of warm water therapy as
measured by numerical rating pain scale at 0.05 level of significant.
elderly patient with arthritis before and after administration of contrast water therapy
as measured by numerical rating pain scale at 0.05 level of significant.
➢ H3-There is a significant difference between joint pain assessment score among
elderly patient receiving warm water therapy versus contrast water therapy as
➢ H4-There is a significant association between joint pain among elderly patient after
receiving warm water therapy with selected demographic variables at 0.05 level of
significant.
receiving contrast water therapy with selected demographic variables at 0.05 level of
significant.
OPERATIONAL DEFINITIONS
• Assess: It is the organized, systematic and continuous process of collecting data from
the elderly patient regarding the level of pain.
• Effectiveness: In this study effectiveness refers to which therapy has more beneficial
for arthritis pain as measured by pain assessment scale.
• Warm water therapy: Warm water can be so helpful in fighting the pain and
stiffness of arthritis, Warm water gets blood flow moving throughout stiffened
muscles and joints. In warm water (90-100°F) for 20 minutes.
• Contrast water therapy: It refers to the alternative immersion of the feet in warm
water (100°-105° F) for 3 minutes and cold water (60°-70°F) for 1 minute
alternatively which was repeated for 5 cycles with a total duration of 20 minutes.
• Arthritis: Arthritis is inflammation of one or more joints in old age carrying joint
pain.
• Joint Pain: Joint pain can be discomfort, pain or inflammation arising from any part
of a joint including cartilage, bone, ligaments, tendons or muscles. In this study joint
pain refers lower limbs and upper limbs.
• Elderly: In this study it refers to group who belongs to the age group between 60-80
years.
• Old age home: In this study it refers to the residence housing facility intended for the
elderly in Delhi NCR.
ASSUMPTIONS
• The old age people lacks adequate knowledge regarding arthritis pain
• Warm water therapy and Contrast bath therapy both relieves pain among the
arthritis patients.
DELIMITATION
The study will be delimited to elderly people.
• The old age patients who were suffering with Arthritis joint pain
• Who are belongs to age group 60-80 years.
• Who are available and willing to participate.
• Who are living in old age home in Delhi NCR.
CONCEPTUAL FRAMEWORK OF THE STUDY
Conceptual framework is a theoretical approach to the study of a problem that is scientifically

based as which lays emphasis on the selection, arrangement and classification of its concepts.
According to Sharma S. (2012), “Conceptual framework refers to the interrelated concepts

or abstractions that are assembled together in some rational scheme by virtue of their
relevance to a common theme.”
According to Polit and Hungler (1999), “Conceptual framework is a cohesive, supportive

linkage of selection interrelated concepts. It is a device for organization ideas and in turn
bringing order to related objects, observations, events and experience. It serves as a guide to
research and a springboard for the generation of a research. The conceptual framework
represents logically constructed concepts to provide general explanation of the relationship
among the concepts of the research study21”.
This present study is based on “Modified Ida Jean Orlando”- Nursing Process Theory”
This theory refers that patient suffering from joint pain and therapeutic care is given to
reduce the joint pain. Therefore the framework of the study deals with certain concept which
is put together by the investigator by virtue of their relevance to the theme understudy. These
concepts are as follows:
The role of a nurse is to assess the joint pain of the patient. The patients presenting
behavior may be a plea for help nurse to use their perception and knowledge to explore with
patient the meaning of their behavior. This process helps nurses find out the nature of distress
and what helps the patient needs.
The theoretical basis of the study is the “Nursing Process Model” and its essential element
of the nursing process that is Assessing, Planning, Implementation, and Evaluation. This
model was conceptualized by “Ida Jean Orlando in 1972.”23
ASSESSMENT
Nursing assessment is a deliberate, systematic and logical collection of subjective and

objective data that are helpful to identify and define problem of the client, before the nurse
proceeds to plan the care.
In the present study, assess the joint pain through such as Flexion and extension of fingers,
Abduction and adduction of fingers, Flexion and extension of hands, Twisting and pivoting
of wrist, Flexion and extension of elbow, While standing, Walking on flat surface, Walk
upstairs and downstairs, Rotation of ankles, Flexion of feet ,Eversion and inversion of feet of
the elderly patient with arthritis.
DIAGNOSIS
This is the second phase of nursing process. Diagnosis is the clinical act of identifying
problems.
It was observed that the patient with arthritis had having joint pain after assessment.
PLANNING
Planning is essential to provide the nursing care that the needs of the client in a timely
manner, because it provides direction for nursing care and identifies nursing interventions
that will meet the goal of care.
The study is based on warm water therapy and contrast water therapy to reduce the joint
pain of patient with arthritis. The intervention is given one time a day for duration 20 minutes
for 10 consecutive days.
IMPLIMENTATION
This is the action phase of the nursing process. It is the actual initiation of the plan and
documenting the nursing actions. Implementation means to carry out, to perform to intervene,
or to do something.
The warm water therapy and contrast water therapy both is administered to 20 minutes for
10 days for each elderly patient with arthritis.
EVALUATION
Evaluation is the process of determining the extent up to which the goal of nursing care has
been attained. It refers to rating, grading and judging. The plan of care provided forms the
basis for evaluation.
The framework of the study comprise the arthritis receiving warm water therapy and
contrast water therapy for 20 minutes each day for 10 consecutive days. Comparison is done
on the basis of pre test to find out the effectiveness of intervention. After giving intervention
to the arthritis patient it is effective in reduce the joint pain.
ASSESSMENT
DEMOGRAPHIC SIGNS PLANNING IMPLIMENTA- EVALUATION

VARIABLES Assessment of joint pain by TION
using NUMERICAL Positive
➢ Age, Evaluating the
RATING PAIN SCALE Administration Result
➢ Gender Administered joint pain by
❖ Flexion and of warm water
➢ Education warm water using the Joint pain
extension of fingers therapy to 15 reduced
Qualification therapy for 20 Numerical
❖ Abduction and elderly
➢ Religion minutes in 10 Rating Pain
adduction of fingers patients with
➢ Dietary consecutive Scale in warm
❖ Flexion and arthritis
pattern days for each water therapy
extension of hands Feedback
➢ Family Administration elderly patient among elderly
❖ Twisting and
history of contrast with arthritis patient with
pivoting of wrist
➢ Types of water therapy arthritis Negative
❖ Flexion and
arthritis extension of elbow to 15 elderly Administered Result
Evaluating the
➢ Years of ❖ While standing patients with of contrast joint pain by Joint Pain
suffering ❖ Walking on flat arthritis water therapy using the not
from arthritis surface for 20 minutes Numerical reduced
➢ Exercise ❖ Walk upstairs and in 10 Rating Pain
➢ Taking any downstairs Rotation consecutive Scale in contrast
medication of ankles days for each water therapy
➢ Taking any ❖ Flexion of feet elderly patient Included in study
among elderly
analgesic ❖ Eversion and with arthritis patient with Not included in study
inversion arthritis
Figure:1 Conceptual framework based on “ Modified Ida Jean Orlando” Nursing Process Theory
SUMMARY
This chapter deals with the introduction, need for the study, and statement of the problem,
objectives, operational definitions, hypothesis, assumptions, delimitations and conceptual
framework.
ORGANIZATION OF THE REPORT
Further, the report of the study follows in five chapters besides the preceding chapter-I
Chapter-II is devoted to review of related research and non-research literature relevant to the
present study.
Chapter-III presents the methodology adopted for the present study which includes the research
approach, research design, setting, sample and sampling technique, development and description
of the data collection tools, data collection procedure and plan for data analysis.
Chapter IV would deals with the analysis and interpretation of data.
Chapter-V presents the result finding of the study.
Chapter-VI offers a brief summary of the study, discussion and conclusion drawn by the
researcher, limitation of the study as well as the implications and recommendations of the study.
This report will end with selected references and appendices.

CHAPTER-II
REVIEW OF
LITERATURE
CHAPTER-II
REVIEW OF LITERATURE
Review of literature is one of the most important steps in research process done and the
knowledge and idea that have been already established on a particular topic of. The main purpose
of literature review is to convey to readers about the work already research review of literature is
defined as broad.
S.K. Sharma “Literature review is defined as a broad, comprehensive, in depth, systematic

and critical review of scholarly publication, unpublished printed or audio visual materials and
personal communication23.”
A literature review is a text of a scholarly paper, which includes the current knowledge
including substantive findings as well as theoretical and methodological contributions to a
particular topic.
This chapter presents the review of a selected research and non-research literature, relevant
either directly or indirectly to a study. The exercise helped the investigator to visualize the extent
of the problem, to justify the research for propose problem, in collecting information, to know
the methodology, used in exploring the problem and conclusion drawn from the studies
The literature of review has been organized and presented under the following headings:
Section -I: Review of literature related to Prevalence of arthritis among the old age people
Section-II: Review of literature related to effectiveness of warm water therapy on joint

pain
Section-III: Review of literature related to effectiveness of contrast water therapy on joint

pain
SECTION -I: Review of literature related to Prevalence of arthritis among the old age
people
Manish M. Patel (2017) A study was conducted for Arthritis, mainly focused on
Osteoarthritis (OA) and Rheumatoid Arthritis (RA), to check the prevalence, awareness,
severity, probable causes, drug utilization and evaluate efficiency of different therapies in
population of North Gujarat. Detailed questionnaires were designed to collect data randomly
from 260 patients of rural and urban area of Palanpur and Mehsana districts. Prevalence of OA
was found to be 3.11% where as that of RA was 0.06%. Prevalence of OA and RA is
significantly higher in urban area than in rural area. Family history for OA and RA patients was
found 20% and 28.57% respectively indicating hereditary factor for diseases. More numbers of
parts affected in RA patients than that of OA suggesting severity and systemic effect of RA.
Hence awareness of RA patients for pharmacological as well as non pharmacological treatment,
knee replacement like surgery is higher than OA patients. Most of OA patients are just taking
pain killer drugs (NSAIDs) irregularly without taking any therapy. So it is reasonable to
conclude that OA and RA both are most common inflammatory and chronic arthritis, which are
responsible for high morbidity in the patients. So proper awareness, patient counselling and
proper therapies are necessary for the better treatment of OA and RA.24
Nicola Veronese, Caterina Trevisan (2016) The possible relevance of osteoarthritis (OA)
as a cardiovascular disease (CVD) risk factor is still debated. The aim of this study was to
investigate the association between OA and the onset of CVD in older individuals. Among a
sample of 3,099 elderly subjects, 2,158 were identified as having no CVD at baseline and were
followed up for a mean 6SD 4.461.2 years. During the follow-up, 47.8% of the subjects with OA
developed a new CVD event, compared to 41.3% of those without OA. The association between
OA and CVD was stronger when the hip or knee was affected, and also was stronger in women
than in men and when more than 2 joints were involved. Considering single CVD outcomes, the
presence of OA significantly increased the risk of new coronary artery disease, heart failure, and
hospitalization for CVD. OA may be a significant predictor of the onset of CVD in elderly
individuals, particularly in women with OA and when OA affects the lower limbs or more than 2
joints are involved.25
Rheumatic disease clinic of North America (2012) Osteoarthritis is the most prevalent form
of arthritis in the United States, affecting more than 70% of adults between 55 and 78 years of
age. Women are affected more than men. Hip osteoarthritis is more common in Western
populations, suggesting that race and environmental factors might also be important. The
incidence of symptomatic knee osteoarthritis is 1% per year, with a radiographic incidence of 2%
per year. The rate of radiographic progression has been estimated at about 4% per year.
Osteoarthritis (OA) is estimated to affect 630 million people worldwide - 15% of all the people
on the globe.26
Lena, et al. (2009) conducted a cross-sectional study on problems among 231 elders in
Udupi Taluk, Karnataka. The result of the study showed that a majority of them had problems
such as hypertension followed by arthritis, diabetes, asthma,. Among them, 68% of the patients
suffered with joint pain. Joint pain was found to be more common among female. A survey
conducted by the investigator in the Anderson pet village, Chennai (2009) showed the total
number of old age people as 160, among them 90% reported joint pain in either one or both
joints.27
Bhatia & Verma (2007) conducted an epidemiological study in correlated joint pain in 362
old age people aged more than 65 years in the urban and rural areas of Chandigarh, India. The
study revealed that the overall prevalence of joint pain among old age as 56.6% in rural areas, it
was 32.6% and in urban it was 60.3%. Joint pain was more in females compared to males (70.1%
Vs 41.6%). depict that as the age increased prevalence of osteoarthritis also increased. Osteo-
arthritis 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 osteo-arthritis 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.28
SECTION -II: Review of literature related to effectiveness of warm water therapy on joint
pain
G Sathiyabama, S Benitta Thanaseeli (2019), conducted a study to assess the effectiveness

of hot water and cold water therapy among the elderly people with joint pain living at selected
area in chennai, India. 100 samples were selected who comes under the inclusive criteria by
using simple random technique. Data was collected by using demographic variables which
includes age, gender, weight, education, marital status, residential area, physical activity, type of
family, family history, food habits and by the modified WOMAC scale. In experimental group
post test values is higher then the pre test of mean (14.56) and SD(9.92) and in control group,
post test values of mean (29.88) and SD (7.99) and unpaired t-value is 8.5046, p-value is 0.0001
and the post test is statistically significant. The study indicate that application of hot water and
cold water therapy is effective on joint pain among elderly people.29
Bhawna, Anney Avarachan, Jincy Daniel (2019) conducted a study to assess the
effectiveness of hot water application with Epsom salt and hot water application on joint pain
among adults suffering from arthritis in selected urban area of New Delhi. Aim of the study was
to assess the pain level and to compare the effectiveness between hot water application with
Epsom salt and hot water application on joint pain among adults with mild or moderate arthritis.
60 samples were included using purposive sampling technique in which 30 samples were
selected for hot water application with Epsom salt and 30 samples were selected for hot water
application. Tool used were Oxford Knee Score and Numeric Pain Rating. The data was
analysed using SPSS IBM Version 21. The study revealed that both the treatment i.e. hot water
application with Epsom salt (p=0.000) and hot water application (p=0.000) were effective in
decreasing joint pain among adults suffering from arthritis however, the mean post test scores of
experimental group 1 (1.60) is less than the mean post test scores of experimental group 2 (2.70)
which shows that hot water application with Epsom salt is more effective in reducing joint
pain.30
Ruth Benita. F (2016) conducted a study to assess the effectiveness of Hot water with Epsom
salt among old age patients with Rheumatoid Arthritis joint pain admitted at ortho ward in Spine
Arthroscopic and Joint Replacement Centre, Coimbatore. The research design adopted was an
experimental pre test and post test control group design. The population was old age patients in
the age group of 60-80 years with Rheumatoid Arthritis joint pain. The study has adopted simple
random sampling technique and the estimated sample size was 60 Patients. From the result of
the study, it was concluded that hot water application with Epsom salt was effective in reducing
Rheumatoid Arthritis joint pain among Old age patients. Therefore the investigator felt that,
more importance should be given for hot water with Epsom salt for reducing Rheumatoid
arthritis joint pain among old age patients.6
Yildirim , N., Filiz Ulusoy, M., & Bodur, H. ( 2010) conducted a study to evaluate the
effect of hot application on pain, stiffness, physical function and quality of rheumatoid Arthritis
the faculty of health sciences, Cumhuriyet university, turkey. The intervention group received 20
minute hot application every day for four weeks in addition to routine medication. It was found
that hot application decreased pain and disability of the patients with rheumatoid arthritis. Hot
application was found to improve the sub dimensions of quality of life scores of physical
function, pain and general health perception of patients.31
Parminder Kaur, et.al. (2007) conducted a study to assess the effect of moist heat
application on the intensity of joint pain among the geriatric population residing in Dadu Majra
colony, Chandigarh. The sample size considered of 87 subjects, 43 in the experimental and 44 in
the control group. Intensity of joint pain was assessed on the 1st and the 8th day of the
intervention among both experimental and control group. Moist heat was applied at the joint
twice a day for seven days in the experimental group. The results show that the intensity of joint
pain and intake of painkiller was reduced significantly in the experimental group as compared to
the control group.32
SECTION-III: Review of literature related to effectiveness of contrast water therapy on

joint pain
Mimi Mohammed Mekkawy (2019) Osteoarthritis (OA) is the most prevalent and far
common debilitating form of arthritis which can be defined as a degenerative condition affecting
synovial joint. Physical agents can fight the painful process such as cold or contrast
hydrotherapy. The study was conducted at Assuit University Hospital in out patients’ clinics.
The 180 adult patients with knee osteoarthritis were selected four tools Tool I: Bio-socio
demographic characteristics Tool II: 0-10 Numeric pain rating scale. Tool II1: health assessment
questionnaire. Decreased mean of pain score between contrast group than cold group
respectively, improve mean HAQ disability index score intervention between cold and contrast
hydrotherapy respectively and increasing mean between contrast group than cold group
regarding all domain of quality of life. It Conclusion the greater pain relief and functional
improvements found when subjects used contrast therapy.33
DR. M.G.R (2016) conducted a true experimental pre-test post-test control group design for
this Study. The study was conducted in Aranarai and Elambalur area at Perambalur.60
participants were selected by simple random sampling technique and 30 were recruited to each
group. The tool used for data collection was Knee injury and osteoarthritis outcome score scale
to assess the knee related symptoms. Hot application to experimental group-I and contrast
therapy to experimental group-II for twice a day for ten days was given to both groups. The post-
test mean score of experimental group I was higher than that of experimental group II The study
proved that contrast therapy was effective than the hot application on reduction of knee related
symptoms among patients with knee osteoarthritis.34
Zohreh Shafizadegan (2016) The purpose of this study is to investigate the effect of
contrast bath on circulation of contra lateral lower limb in women with type 2diabetes mellitus
compared to healthy subjects. Fifteen diabetic females aged between 30-60 years, who were
diagnosed with type 2 diabetes, and 30 matched control females participated in this research.
These results were evaluated prior to, immediately and 10 minutes after the contrast bath. The
contrast bath protocol included the immersion of the right foot in the warm bath (38-440C) for
four minutes and then in the cold bath (10-180C) for one minute. These processes were repeated
five times as the total duration of the intervention was 24 minutes. The dorsalis pedis pulse was
significantly higher at all times of the measurements except between immediately post the
contrast bath and after 10 minutes of applying it in the diabetic group (P=0.58). The results of
this study showed that contrast bath can increase circulation in the contra lateral limb.35
Amal E. Shehata and Manal E. Fareed. (2013) this study was carried out to Compare the
effect of cold, warm and contrast therapy on controlling knee osteoarthritis associated problems.
The study was carried out in orthopaedic outpatient clinics of Menoufia University and teaching
Hospitals, Egypt. A convenient sample of 60 adult patients with unilateral knee osteoarthritis.
Three tools used to collect data were an interviewing questioning, Knee Injury and Osteoarthritis
Outcome Score (KOOS), Numeric pain rating scale.The Conclusions revealed that all of the
three methods of therapy resulted in improvement in all knee symptoms and pain but the most
appropriate protocol of treatment to relive symptoms and pain was contrast therapy.36
Donna E. Breger Stanton et al (2012) conduced a systematic review among 28 clinical

research articles on contrast bath from 1938 onwards in which 10 met the inclusive criteria set by
the authors to know the effectiveness of contrast bath on diagnosis of rheumatoid arthritis and
diabetes ,to address the physiological changes of hot and cold on blood flow, intramuscular
temperature, subcutaneous temperature, the influence of room temperature , pain and age. The
definitive conclusions was made that the contrast bath increases superficial blood flow and skin
temperature in foot which relieves pain.34
SUMMARY
This chapter dealt with a review of literature related to the present study. Literature review
has enabled the investigator to select the tool, independent variables, and data collection
techniques and decide the plan of statistical analysis with deeper insight and knowledge.
The next chapter presents methodology of research study.

CHAPTER-III
RESARCH
METHODOLOGY
CHAPTER - III
METHODOLOGY
Research methodology is a way to systematically solve the research problem. It is a science

that deals with various steps that are generally adopted by a researcher in studying research
problem along with the logics behind it.
This chapter deals with the methodology selected by investigator to study assess the
effectiveness of warm water therapy versus contrast water therapy on joint pain among elderly
patient with arthritis in selected old age home at Delhi NCR”. It include research approach,
research design, research variables, setting, sample and sampling technique, description of tools
and self instructional module, reliability of tools, validity of tools and self instructional module,
data collection procedure and plan for data analysis.
RESEARCH APPROACH
Research approach indicates the basic procedures for conducting research. It is the broad
basic procedure for collecting data in research study. The choice of the appropriate approach
depends on the purpose of the study
According to Polit and Hungler (1999) "An evaluative research is an applied form of
research that involves finding out how well a programme, practice or policy is working. The
main goal is to assess or evaluate the success of programme37."
According to Sharma S.K. (2011) “evaluative research studies are applied form of research
study. Which involve the judgment about how well a specific programme practice, procedure or
policy is working21”.
In the present study, evaluative approach was adopted to accomplish the objectives of the
study and to determine the effectiveness of warm water therapy versus contrast water therapy on
joint pain among elderly patient with arthritis in selected old age home at Delhi NCR”.
RESEARCH DESIGN
Research design is the skeleton of the study. The term refers to how the researcher puts a
research study together to answer a question or a set of questions. Research design works as a
systematic plan outlining the study. The research design spells out the strategies that the
researcher adopts to develop information that is accurate, objective and interpretable.
The research design is concerned with the overall framework for conducting the study. It
helps the investigator in the selection of subjects, manipulation of independent variables,
observations to be made and the types of statistical analysis to be used to interpret the data.
Selection of research design depends upon the purpose of experiment, variables to be
manipulated and the conditions under which the experiment may be conducted.
According to Best J W (1992) “experimental research design is the blue print of the
procedure that enables the researcher to test the hypothesis by reaching a valid conclusion about
the relationship between dependent and independent variables.”
According to Sharma S.K(2011) “research design is the master plan specifying the methods
and procedures for collecting and analyzing the needed information in a research study23”.
Group Pre - test Intervention Post –test

Warm water therapy O1 X1 O2
Contrast water O1 X2 O2
therapy
Keywords:
O1 – Pre test Observation
O2- post test observation
X1- warm water therapy
X2- contrast water therapy
TABLE 1: SYMBOLIC REPRESENTATION OF RESARCH DESIGN
Group Day 1 Day Day11

1,2,3,4,5,6,7,8,9,10
Warm water therapy Pre assessment of Administration of Post assessment of
Elderly patient with joint pain using warm water therapy joint pain using the
arthritis in old age Numerical Rating Numerical Rating
home pain Scale pain Scale
Contrast water Pre assessment of Administration of Post assessment of

therapy joint pain using contrast water joint pain using the
Elderly patient with Numerical Rating therapy Numerical Rating
arthritis in old age pain Scale pain Scale
home
RESEARCH RESEARCH DESIGN VARIABLE
APPROACH
Quasi experimental- non Attribute variable: Demographic
Quantitative research equivalent pre test post test characteristic
approach design
Dependent variable: Joint pain of the
elderly people
Independent variable: warm water

therapy and contrast water therapy
SAMPLE AND SAMPLE POPULATION STUDY SETTING

SIZE
Elderly people who are Selected old age home
Total- 30 having arthritis Delhi/ NCR
Warm water therapy- 15
Contrast water therapy-15
DATA COLLECTION
SAMPLE TECHNIQUE TOOL AND TECHNIQUE FINDINGS,
Non Probability purposive Demographic variables CONCLUSION,

Sample Technique Modified pain assessment SUMMARY
scale
Figure: 2 Schematic representation of the research design

VARIABLES UNDER STUDY
A Variable as the name implies, is something that varies.
According to Polit and Beck (2018), in quantitative studies, concepts are usually variables".
A variable is as the name implies something that varies It is an attributes of a person or object
that varies Le it takes on different values.
According to Abdellah and Levine, “variables are the characteristics traits or attributes of
the person or thing observed under a study37.
INDEPENDENT VARIABLE
According to BT Basavanthappa (2007) “The independent variable is the variable that is

purposely manipulated or changed by the researcher also called the manipulated variable. The
independent variable is the condition or characteristic manipulated by the researcher38”.
In this study the independent variable is administration of warm water therapy versus
contrast water therapy on joint pain among elderly patient with arthritis.
DEPENDENT VARIABLE
According to BT Basavanthappa (2007), “The dependent variable is the variable that

changes as the independent variable is manipulated by the researcher sometimes called the
criterion variable Dependent variable are the outcome variable of interest, the variable that are
hypothesized to depend on or be caused by another variable, the attribute variable38”.
The dependent variable is the condition or characteristic that appears or disappears as a result
of independent variables. In this study the dependent variable which the investigator is finding
out was the effectiveness of dependent variables; Joint pain of elderly people.
SETTING OF THE STUDY
The selection of appropriate setting is important because the setting can influence the way
that people behave, feel and how they respond. The researcher needs to decide where the
investigation will be implemented and where the data will be collected.
According to Polit and Hungler (1999), “The researcher needs to decide where the
investigations will be implemented and where the data will be collected”.
In the Present study, the research setting was Guru Vishram Vridh Ashram old age home at
New Delhi, NCR.
POPULATION
Population is the total number of people or elements of defined set who met the criteria, the
research has established for a study from whom the sample will be selected and whom the
findings will be generalized.
According to Polit and Beck (2008) described "Population is an entire set of the individuals
having some common characteristics and are of interested to the researcher. The need for
identifying a population for the research project arises from the requirement to specify up to
which results of study will be applied. In this study, population comprised of elderly people with
arthritis37”.
In the present study population comprised of elderly patient who are having arthritis at Guru
Vishram Vridh Ashram old age home at New Delhi, NCR.
SAMPLE AND SAMPLE SIZE
A sample is a subset of the population selected for the study. In the present study sample
comprised of elderly patient with arthritis staying in selected old age home, Delhi, NCR. For the
main study samples were divided into two groups:
Warm water therapy- 15 elderly people

Contrast water therapy- 15 elderly people
SAMPLING TECHNIQUE
Sampling is a process of selecting representative units from entire population of a study.

Sampling is necessary because it is more economical and efficient to work with a small group of
elements23.
According to Polit and Beck (2008) states that "sample is the subset of population selected
to participate in the research study37." Sample will be those who are having arthritis. The sample
size of the study is 30.
According to Abdellah and Levine(2013), “the choice of sampling technique depends on
the Nature of the problem, kind of variables included in the study, the type of research and
number of sampling units"
In the present study sample selection was done by non probability purposive sampling technique.
INCLUSION CRITERIA
• Those who were willing to participate in the study.

• Those who were available at the time of the data collection.
• Those who were taking medicine during the time of study.
EXCLUSION CRITERIA
• Those who were not available at the time of data collection.

• Those who were not willing to participate in the study.
DATA COLLECTION TOOLS AND TECHNIQUES
The most important and crucial aspect of any investigation is the collection of appropriate
information, which provides necessary data for the study.
According to Polit and Beck (2008) “States that the instrument selected in research should be
as far as possible be the vehicle that would best elicit data for drawing conclusions pertinent to
the study and at the same time add to the body of knowledge in a discipline37”.
SELECTION OF TOOLS
According to Treece and treece (2013), “the instrument selection in a research should as far
as possible be the vehicle that would best obtaining data for conclusion pertinent of the study38.
According to Polit and hungler(2014), “the task of selection or developing an appropriate

method for collecting data is among the most challenging task in research process41.
Based on the objectives of the study the following tools were used by the researcher.
DESCRIPTION AND DEVELOPMENT OF THE TOOL

Selection and preparation of tool was based on:
1. A Review of research and non research literature was carried out in area related to warm
water therapy and contrast water therapy for arthritis for elderly people.
2. Discussion with guide, experts in the related fields.
3. Experts opinions sought to determine the clarification and appropriateness of the items.
4. Tools Validation
5. Establishing reliability of the tool by applying suitable statistical procedure.
6. Tryout: administering the tool for clarity.
7. Final draft of the tool.
DESCRIPTION AND DEVELOPMENT OF THE TOOL FOR THE STUDY
Part – 1: Interview schedule for demographic data
This tool was prepared to collect data of the elderly patient with arthritis staying in old age
home. It consists of age, sex, education, income, dietary pattern, types of arthritis, family history,
and medicine.
Part -2: Numerical rating Pain scale
This rating scale was developed to assess the level of pain before and after the intervention.
There were 11 physical activity such as (flexion and extension of fingers, abduction and
adduction of fingers ,twisting and pivoting of wrist etc). A four point scale( none, mild,
moderate, severe) were provided to record the response before and after intervention.
SCORING INTERPRETATION
SR.NO PAIN SCALE SCORING
1. 1-36 Mild
2. 37-73 Moderate
3. 74-110 Severe
40
CONTENT VALIDITY OF THE TOOL
According to Treece and Treece, “Validity refers to an instrument or test actually testing
what it is supposed to be testing38.”
According to Polit and Hungler, “Validity refers to the degree to which an instrument
measures what it is supposed to be measuring40.”
For the content validity of tools, criteria rating scales were prepared which consist of items
with three responses for rating against each criterion like "fully met", "mostly met" and "to some
extent" with the remark column for each criterion. The tools along with request letter, statement
of problem, objectives and criteria rating scale was submitted to 10 experts from the different
fields of nursing for validation Based on expert suggestions necessary modifications were made.
The tools were found to be valid for the purpose of the study
TRY OUT OF THE TOOL
After obtaining formal administrative approval, the try out was done on 30 elderly people in
selected old age home, Delhi, NCR. from 16th December 2019 to 4 January 2010. Try out of the
tool was conducted with experimental warm water therapy group and experimental contrast
water therapy group by non probability Purposive sampling technique.
It was done to check for the clarity of items, relevance and effectiveness of interventions. The
subjects chosen were similar in characteristics to those of the population under the study
RELIABILITY OF TOOL
The numerical rating pain scale was used to assess the joint pain among the elderly patient with
arthritis. After try out on 5 warm water therapy and 5 contrast water therapy sample, the
reliability co-efficient of the rating scale was calculated by using Split half reliability spearman
brown . The reliability valve was found 0.79, thus the tool was found to be reliable.
PILOT STUDY
A pilot study is a preliminary trial of research which is essential to the development of an

extensive program.
According to Treece and Treece(1996) “Pilot study is the miniature trail run of the
methodology, planned for a major project. The purpose of pilot study is twofold: to make
improvements in the research project and to detect a problem that must be eradicated before the
major study is attempted39”.
According to Polit and Beck (2012) a pilot study often involves a small scale of the entire
study, testing not only the instrument but also the sampling plan, intervention, the study
procedure and so on”.
Pilot study was conducted on elderly patient with arthritis staying in old age home by
purposive sampling technique with 10 elderly patients (5 warm water therapy and 5 contrast
water therapy) as per research design. The finding of pilot study showed that it was feasible
conduct final study. The data of the pilot study were analyzed. After obtaining formal
administrative approval, the pilot study was conducted in Bhagwat Dham old age home, Mayur
Vihar,Delhi from 16th October to 27th October 2019.
After obtaining formal administrative approval from Bhagwat Dham old age home, Mayur
Vihar, the pilot study was conducted on 10 elderly patients with arthritis.
PROCEDURE FOR PILOT STUDY
❖ Self introduction was given and rapport was established.

❖ Non-probability purposive sampling technique was used to select 10 arthritis elderly
people.
❖ Introduction to the nature of the study was given and informed and signed consent is
taken.
❖ On the day 1, pre assessment was done and started the intervention regularly.
❖ On the day 11th, post assessment was done.
❖ The data of the pilot study was analyzed by using descriptive and inferential statistics.
PROBLEM FACED DURING PIOLT STUDY
There was no problem faced during the data collection. Elderly people were cooperative.
ETHICAL CONSIDERATION
Formal permission was taken from the Principal of Nightingale Institute of Nursing.
➢ Ethical permission from ethics committee of Nightingale Institute of Nursing.

➢ Informed written consent was taken from all subjects before administrating the warm
water therapy and contrast water therapy.
➢ Anonymity and confidentiality of the participant has been maintained.
PROCEDURE OF FINAL DATA COLLECTION
Formal administrative was obtained from Guru Vishram Vridh Ashram old age home, New
Delhi, and data was collected.
Data was collected in following steps:
GROUP DAY 1 DAY DAY 11

1,2,3,4,5,6,7,8,9,10,
Warm water therapy Pre assessment of Administration of Post assessment of
Elderly patient with joint pain using warm water therapy joint pain using
arthritis in old age Numerical rating pain Numerical rating pain
home scale scale
Contrast water Pre assessment of Administration of Post assessment of

therapy joint pain using contrast water therapy joint pain using
Elderly patient with Numerical rating pain Numerical rating pain
arthritis in old age scale scale
home
PLAN FOR DATA ANALYSIS
The data collected will be analysed through descriptive and inferential statistics. The analysis
of data involves the translation of collected information into interpretable and manageable form.
The findings are presented according to the objectives set for the study. The data will be
organized under the following headings.
SECTION I: Finding related to frequency and percentage distribution of elderly patient with
arthritis in terms of demographic variables.
Frequency and Percentage distribution of elderly patient with arthritis in term of demographic
variables in warm water therapy versus contrast water therapy.
SECTION II: Finding related to frequency and percentage distribution of pain assessment score
before and after administration of warm water therapy.
Frequencies and Percentage distribution of pain assessment score before and after administration
of warm water therapy.
• Finding related to frequency and percentage distribution of pain assessment score before
and after administration of contrast water therapy.
Frequencies and percentage distribution of pain assessment score before and after administration
of contrast water therapy.
SECTION III: Finding related to effectiveness of warm water therapy on joint pain among the
elderly patient with arthritis.
Mean, Mean Difference, Standard Deviation and “t” Value of effectiveness of Warm Water
Therapy on Joint Pain among the elderly people with arthritis.
• Finding related to effectiveness of contrast water therapy on joint pain among elderly
patient with arthritis
Mean, Mean Difference, Standard Deviation and “t” value of effectiveness of contrast water
therapy on joint pain among the elderly people with arthritis.
SECTION IV: Finding related to difference between pain assessment score among elderly
patient receiving warm water therapy and contrast water therapy.
Mean, Mean Difference, Standard Deviation and Unpaired “t” value of warm water therapy
versus contrast water therapy on joint pain among the elderly people with arthritis.
SECTION V: Finding related to association of post assessment pain score among elderly patient
in receiving warm water therapy with demographic variables.
Fisher’s exact test was used to describe the association between the joint pain after receiving
warm water therapy with the selected demographic variable.
• Finding related to association of post assessment pain score among elderly patient in
receiving contrast therapy demographic variables
Fisher’s exact test was used to describe the association between the joint pain after receiving
contrast water therapy with the selected demographic variable.
SUMMARY
This chapter on methodology dealt with the research approach, research design, and variable
of the study, setting of the study population, sample and sampling technique Development of tool
and description of data collection tools, content validity, try out of tool, procedure for data
collection and plan for data analysis.
The next chapter presents the analysis and interpretation.

CHAPTER- IV
ANALYSIS AND
INTERPRETATION OF
DATA
CHAPTER- IV
ANALYSIS AND INTERPRETATION OF DATA

This chapter deals with the analysis and interpretation of the data collection to assess the
effectiveness of warm water therapy versus contrast water therapy on joint pain among elderly
patient with arthritis in selected old age home at Delhi NCR. The purpose of analysis is to reduce
the data to an interpretable form, so that the research problem can be studied and tested. The
research analyst has broken down the data in constituent parts to obtain answer to the research
questions and to test the research hypothesis.
According to Polit and hungler (1999) Data analysis is the systematic organization and
synthesis to research data and testing of research hypothesis using the data41.
Analysis and interpretation of data collected from 15 elderly patients in warm water therapy
and 15 elderly patients in contrast water therapy with arthritis.
Analysis and interpretation of the data are based on the objectives of the study and
hypothesis to be verified.
❖ To assess the level of joint pain among elderly patient with arthritis in selected old age
home at Delhi NCR.
❖ To evaluate the effectiveness of warm water therapy on joint pain among elderly patient
with arthritis in selected old age home at Delhi NCR.
❖ To determine the association between joint pain after receiving warm water therapy with
the selected demographic variable.
elderly patient with arthritis before and after administration of contrast water therapy as
➢ H3-There is a significant difference between joint pain assessment score among elderly
patient receiving warm water therapy versus contrast water therapy as measured by
numerical rating pain scale at 0.05 level of significant.
significant.
significant.
ORGANIZATION AND PRESENTATION OF DATA
The findings are presented according to the objectives set for the study. The data are
organized under the following headings.
SECTION I
• Finding related to frequency and percentage distribution of elderly patient with arthritis
in terms of demographic variables.
SECTION II
and after administration of warm water therapy
and after administration of contrast water therapy
SECTION III
• Finding related to effectiveness of warm water therapy on joint pain among the elderly
• Finding related to effectiveness of contrast water therapy on joint pain among elderly
SECTION IV
• Finding related to difference between pain assessment score among elderly patient
receiving warm water therapy and contrast water therapy.
SECTION V
receiving warm water therapy with demographic variables
receiving contrast therapy with demographic variables
SECTION-I
FINDING RELATED TO FREQUENCY AND PERCENTAGE DISTRIBUTION OF

ELDERLY PATIENT WITH ARTHRITIS IN TERMS OF DEMOGRAPHIC
VARIABLES
This section describes the demographic characteristics of the sample subjects under the
study. The sample consisted of patients. The data obtained described the characteristics
pertaining to their age, gender, educational qualification, religion, dietary pattern, and types of
arthritis, family history, and years of suffering from arthritis, exercise, taking any underlying
medication regularly. Frequency and percentage were computed for describing the sample
characteristics. Table 2 represents the characteristics of samples.
TABLE-2
Frequency and percentage distribution of elderly patient with arthritis in terms of

demographic variables in warm water therapy versus contrast water therapy.
N=30
WARM WATER CONTRAST WTAER

SR. THERAPY THERAPY
NO ITEMS
Frequency Percentage Frequency Percentage
N= 15 % N= 15 %
1 Age
a) 61-65 years 3 20% 1 7%
b) 66-70 years 3 20% 5 33%
c) 71-75 years 4 27% 6 40%
d) 76-80 years 5 33% 3 20%
2 Gender
a) Male 6 40% 7 47%
b) Female 9 60% 8 53%
3. Educational Qualification
a) Illiterate 6 40% 5 33%
b) Primary 4 27% 3 20%
c) Secondary 3 20 5 33%
d) Graduation and above
2 13% 2 13%
4. Religion
a) Hindu 13 87% 13 87%
b) Muslim
c) Sikh 2 13% 1 7%
d) Christian 0 0 1 7%
e) Others 0 0 0 0
0 0 0 0
Dietary pattern
5. a) Vegetarian food 7 47% 6 40%
b) Non vegetarian food 3 20% 2 13%
c) Mixed
5 33% 7 47%
6. Family history
a) Yes 9 60% 9 60%
b) No 6 40% 6 40%
7. Types of arthritis
a) Osteoarthritis 13 87% 13 87%
b) Rheumatoid arthritis 2 13% 2 13%
c) Gout 0 0 0 0
d) Others 0 0 0 0
8. Years of suffering from

arthritis
a) <1 year 0 0 0 0
b) 1-3 year 3 20% 2 13%
c) 3-5 year 2 13% 4 27%
d) >5 year 10 67 % 9 60%
9. (i) Exercise
a) Yes 9 60% 10 67%
b) No 6 40% 5 33%
(ii) if yes which among this do
you follow
a) Active 5 33% 5 33%
b) Passive 4 27% 5 33%
10. Taking any underlying

Medication regularly
a) Allopathic 0 0 0 0
b) Ayurvedic 9 60% 8 53%
c) Allopathic and 6 40% 7 47%
Ayurvedic
d) Other medication 0 0 0 0
11. (i) Taking any analgesic

a) Yes 6 40% 7 47%
b) No 9 60% 8 53%
(ii) If yes then specify
Data presented in Table-2show that:
➢ Considering the age in warm water therapy revealed that maximum of the sample i.e.
5(33%) elderly arthritis patient were under the age group of 76-80years, 4(27%) were
under the age group 71-75years and 3(20%) were under the age group (61-70) years,
Whereas In contrast water therapy it was maximum of the sample 6(40%) elderly arthritis
patient were under the age group of 71-75 years,5(33) were under the age group 66-70
years, 3 (20%) were in the age group (76-80) and 1(7%) were under the age group 61-65
years.
➢ Regarding the gender in warm water therapy majority of the sample i.e.9 (60%) were
female and 6(40%) were male, whereas in contrast water therapy majority of the sample
i.e. 8 (53%) were female and 7(47%) were male.
➢ In warm water therapy maximum educational qualification of the sample i.e. 6(40%) were
illiterate, 4(27%) were primary, 3(20%) were secondary and 2 (13%) were graduation and
above, whereas in contrast water therapy maximum of the sample i.e. 5(33%) Illiterate and
secondary educational patient both were equally, 3 (20%) were primary and 2 (12%) were
graduation.
➢ In warm water therapy majority of the sample i.e. 13(87%) were Hindu religion and 2
(13%) were muslim religion, whereas in contrast water therapy majority of the sample i.e.
13(87%) were Hindu religion and 1 (7%) were Muslim and Sikh.
➢ Considering the dietary pattern in warm water therapy maximum of the sample i.e 7(47%)
were Vegetarian, 5 (33%) were mixed dietary pattern and 3(20%) were non
vegetarian,where as in contrast water therapy maximum of the sample i.e 7 (47%) were
mixed diatery pattern, 6 (40%) were vegetarian and 2(13%) were non vegetarian.
➢ In warm water therapy majority of the sample 9 (60%) were having Family history and 6
(40%) were not having family history, whereas in contrast water therapy 9 (60%) were
having the family history and 6 (40%) were not having family history.
➢ Considering the types of arthritis in warm water therapy the majority of the sample 13
(87%) were having osteoarthritis and 2 (13%) were rheumatoid arthritis, whereas in
contrast water therapy 13(87%) were having osteoarthritis and 2 (13%) were rheumatoid
arthritis.
➢ Regarding the years of the suffering from arthritis in warm water therapy majority of the
sample 10(67%) were suffering from more than 5 years, 3 (20%) were having 1-3 years
and 2 (13%) were having 3-5 years, whereas in contrast water therapy 9 (60%) were
suffering from more than 5 years, 4 (27%) were having 3-5 years and 2 (13%) were
having 1-3 years.
➢ Considering the Regular Exercise in warm water therapy majority of the sample 9(60%)
were doing exercise and 6 (40%) were not doing exercise, whereas in contrast water
therapy 10(67%) were doing exercise and 5 (33%) were not doing exercise.
➢ Considering the taking of medication in warm water therapy majority of the 9(60%) were
taking ayurvedic and 6 (40%) were taking allopathic and ayurvedic, whereas in contrast
water therapy majority of the sample 8 (53%) were taking ayurvedic and 7 (47%) were
taking allopathic and ayurvedic.
1. DISTRIBUTION OF SAMPLE BASED ON AGE
45%
40%
40%
35% 33% 33%
30% 27%
25%
20% 20% 20%
20% Warm water therapy
15% Contrast water therapy
10% 7%
5%
0%
61-65 66-70 71-75 76-80
years years years years
FIGURE.3. Bar diagram showing percentage distribution of sample according to their Age
2. DISTRIBUTION OF SAMPLE BASED ON GENDER
70% 60%
60% 53%
47%
50% 40%
20%
10%
0%
MALE FEMALE
FIGURE.4. cylindrical diagram showing percentage distribution of sample according to
their gender
3. DISTRIBUTION OF SAMPLE BASED ON EDUCATION EQUALIFICATION
45%
40%
35%
30%
25%
10%
5%
0%
Illiterate Primary Secondary Graduation
and above
FIGURE.5. Bar diagram showing percentage distribution of sample according to their

educational qualification
4. DISTRIBUTION OF SAMPLE BASED ON RELIGION
100%
87%
87%
90%
80%
70%
60%
30%
20% 13%
7% 7%
10%
0 0 0 0 0
0%
Hindu Muslim Sikh Christen other

religion
5. DISTRIBUTION OF SAMPLE BASED ON DIETARY PATTERN
50% 47%
45% 40%
40%
35% 33%
30%
20% 20%
15% 13%
10%
5%
0%
Vegetarian Non vegetarian Mixed

dietary pattern
6. DISTRIBUTION OF SAMPLE BASED ON FAMILY HISTORY
70% 60%
60%
60%
50% 40%
40%
20%
10%
0%
yes No
FIGURE.8. Cylindrical diagram showing percentage distribution of sample according to

their family history
7. DISTRIBUTION OF SAMPLE BASED ON TYPES OF ARTHRITIS
100% 87%87%
90%
80%
70%
60%
50%
40%
30% 13%13%
20%
10% 0% 0% 0 0 Warm water therapy
0%
Contrast water therapy

types of arthritis
8. DISTRIBUTION OF SAMPLE BASED ON YEARS OF SUFFERING FROM

ARTHRITIS
80%
70% 67%
60%
60%
50%
30% 27% Contrast water therapy
20%
20% 13% 13%
10%
0% 0%
0%
< 1 YEARS1-3YEARS3-5 YEARS> 5 YEARS
FIGURE. 10. Bar diagram showing percentage distribution of sample according to their
years of suffering from arthritis
9. DISTRIBUTION OF SAMPLE BASED ON REGULAR EXERCISE
67%
70% 60%
60%
50% 40%
40% 33% Warm water therapy
20%
10%
0%
Yes No
FIGURE.11. Con diagram showing percentage distribution of sample according to their

regular exercise
10. DISTRIBUTION OF SAMPLE BASED ON MEDICINE INTAKE
70%
60%
60% 53%
50% 47%
40% 40%
40%
10%
0% 0%
0%
Allopathic Ayurvedic Allopathic other
and medications
Ayurvedic

medicine intake
11. DISTRIBUTION OF SAMPLE BASED ON TAKING ANY ANALGESIC
80%
60%
53%
60% 47%
40%
Contrast water
20% therapy
0%
Yes No
FIGURE.13. Con diagram showing percentage distribution of sample according to their

taking any analgesic
SECTION-II
FINDING RELATED TO FREQUENCY AND PERCENTAGE DISTRIBUTION

OF PAIN ASSESSMENT SCORE BEFORE AND AFTER ADMINISTRATION
OF WARM WATER THERAPY
This section describes the findings related to pain assessment score of elderly patient with
arthritis before and after administration of warm water therapy. The joint pain was assessed
using Numerical Rating pain scale for both before and after administration. The data was
analyzed using t- test for testing the hypothesis H1.The data have been presented in table 3.
TABLE-3
Frequencies and percentage distribution of pain assessment score before and after
administration of warm water therapy
N=15
Grading Grading of Pre test Post-test

of Joint pain Frequency Percentage Frequency Percentage
Scores (f) (%) (f) (%)
1-36 Mild 0 0 3 20%
37-73 Moderate 6 40% 12 80%
74-110 Severe 9 60% 0 0
Maximum score- 110
Minimum score-1
Data presented in the Table 3 shows that:
In Pre-test Majority of sample i.e. 9(60%) were having severe joint pain and 6(40%) were
having moderate joint pain. Whereas in Post Test 12(80%) were having moderate joint pain and
3(20%) were having mild joint pain. which indicates warm water therapy was effective for joint
pain.
DISTRIBUTION OF PRE TEST AND POST TEST SCORE OF JOINT PAIN IN WARM
WATER THERAPY
100%
80%
80%
60%
60% Mild pain
40%
40% Moderate pain
20% Severe pain
20%
0% 0%
0%
Pre test Post test
FIGURE 14: Bar diagram showing distribution of pre test and post test score of joint pain
in warm water therapy
FINDING RELATED TO FREQUENCY AND PERCENTAGE DISTRIBUTION OF

PAIN ASSESSMENT SCORE BEFORE AND AFTER ADMINISTRATION OF
CONTRAST WATER THERAPY
This section describes the findings related to pain assessment score of elderly patient with
arthritis before and after administration of contrast water therapy. The joint pain was assessed
using Numerical Rating pain scale for both before and after administration. The data was
analyzed using t- test for testing the hypothesis H01.The data have been presented in table 4.
TABLE-4
FREQUENCIES AND PERCENTAGE DISTRIBUTION OF PRE-TEST AND POST

TEST JOINT PAIN SCORE CONTRAST WATER THERAPY
N=15
Grading Grading of Pre test Post-test

of Joint pain Frequency Percentage Frequency Percentage
Scores (f) (%) (f) (%)
1-36 Mild 0 0 13 87%
37-73 Moderate 4 27% 2 13%
74-110 Severe 11 73% 0 0
Maximum score- 110
Minimum score-1
Data presented in the Table 4 shows that :

In Pre-test Majority of sample i.e. 11(73%) were having severe joint pain and 4(27%) were
having moderate joint pain. Whereas in Post Test 13(87%) were having mild joint pain and
2(13%) were having moderate joint pain. which indicates contrast water therapy was effective
for joint pain.
PERCENTAGE DISTRIBUTION OF PRE TEST AND POST TEST SCORE OF JOINT

PAIN IN CONTRAST WATER THERAPY
100% 87%
80% 73%
60% Mild pain

40% Moderate pain
27%
20% 13% Severe pain
0% 0%
0%
Pre test Post test
FIGURE 15.Bar diagram showing percentage distribution of pre test and post test score of
joint pain in Contrast water therapy
SECTION-III
FINDING RELATED TO EFFECTIVENESS OF WARM WATER THERAPY ON

JOINT PAIN AMONG THE ELDERLY PATIENT WITH ARTHRITIS
This section describes the findings related to assess the effectiveness of warm water therapy
on joint paint of elderly patient with arthritis before and after administration of Warm water
therapy. The joint pain was assessed using Numerical Rating pain scale for both before and after
administration. The data was analyzed using t- test for testing the hypothesis H01.The data have
been presented in table 5.
H01- There is a no significant difference between score of joint pain among elderly patient with
arthritis before and after administration of warm water therapy as measured by the Numerical
rating pain scale at 0.05 level of significant.
Table-5
Mean, Mean difference, Standard Deviation and “t” value of effectiveness of warm water
therapy on joint pain among the elderly people with arthritis
N=15
S.NO MEAN MEAN SD ‘t’ VALUE
DIFFERENCE
Pre test 77.6 6.91

37.6 41.57*
4.19
Post test 40
df (14)= 2.15 at 0.05 level of significance
1. The mean Post test joint pain score of elderly patient is (40) which is lower than the mean
Pre test (77.6), with the mean difference of 37.6. The obtained mean difference was
found to be statistically significant.
2. The calculated “t” value is 41.57 which are greater than the table value at 0.05 level of
significance at df (14).
3. Hence, null hypothesis H01 was rejected and research hypothesis was accepted. It is
concluded that the warm water therapy was effective in decreasing the joint pain among
the elderly patient with arthritis.
SECTION-III
FINDING RELATED TO EFFECTIVENESS OF CONTRAST WATER THERAPY ON
JOINT PAIN AMONG THE ELDERLY PATIENT WITH ARTHRITIS
This section describe the findings related to assess the effectiveness of Contrast water
therapy on joint paint of elderly patient with arthritis before and after administration of Contrast
water therapy. The joint pain was assessed using Numerical Rating pain scale for both before and
after administration. The data was analyed using t- test for testing the hypothesis H02.The data
have been presented in table 6.
H02--There is a no significant difference between score of joint pain among elderly patient before
and after administration of contrast water therapy as measured by the pain scale at 0.05 level of
significant.
Table-6
Mean, Mean Difference, Standard Deviation and “t” value of effectiveness of contrast
water therapy on joint pain among the elderly people with arthritis
N=15
S.NO MEAN MEAN SD ‘t’ VALUE
DIFFERENCE
Pre test 75.13 8.47

42.87 33.30*
Post test 32.26 5.30
The Data presented in Table 6 shows that:
1. The mean Post test joint pain score of elderly patient is (32.26) which is lower than the
mean Pre test (75.13), with the mean difference of 42.87. The obtained mean difference
was found to be statistically significant.
2. The calculated “t” value is 11.83 which are greater than the table value at 0.05 level of
significance at df (14).
3. Hence, null hypothesis H02 was rejected and research hypothesis H1 is accepted it is
concluded that the contrast water therapy was effective in decreasing the joint pain
among old age people.
SECTION IV
FINDING RELATED TO DIFFERENCE BETWEEN POST INTERVENTIONAL
SCORE IN WARM WATER THERAPY AND CONTRAST WATER THERAPY OF
ELDERLY PATIENT WITH ARTHRITIS.
This section describes the finding related to difference between post interventional score in warm
water therapy and contrast water therapy of elderly patient with arthritis. This was assessed by
using Numerical Rating Pain Scale for comparison of post test score in both the group. The data
was analyzed using unpaired t-test for testing hypothesis H03. The data have been presented in
table 7.
H03- There is no significant difference between the score of level of joint pain among elderly
patient receiving warm water therapy versus contrast water therapy as assessed by the pain scale
at 0.05 level of significant.
Table-7
Mean, Mean Difference, Standard Deviation and Unpaired” value of warm water therapy
versus contrast water therapy on joint pain among the elderly people with arthritis
N=30
S.NO MEAN MEAN SD UNPAIRED

DIFFERENCE ‘t’ VALUE
Warm water 40 4.19

therapy 7.74 4.44*
Contrast 32.26 5.30

water
therapy
The Data presented in Table 7 shows that:
➢ In warm water therapy mean post test of joint pain score (40) of elderly patient is more
than contrast water therapy mean post test of joint pain score (32.26), with the mean
difference of 7,74. The obtained mean difference was found to be statistically significant
at 0.05 levels. The calculated unpaired ‘t’ value is 4.44 at 0.05 level of significance which
is the higher than the table value at df (28).
➢ Hence, it can be inferred that obtained mean difference of 7.74 is not by chance it is a
true difference, thus null hypothesis H03 was rejected. So, it can conclude that contrast
water therapy is more effective than warm water therapy for joint pain in elderly patient
with arthritis.
SECTION-V
FINDING RELATED TO ASSOCIATION OF POST ASSESSMENT PAIN SCORE IN
WARM WATER THERAPY WITH DEMOGRAPHIC VARIABLES
This section describes the association between demographic variables and pain assessment
score of warm water therapy in elderly patient with arthritis. To determine the association
between the post assessment pain score of elderly patient with arthritis with demographic
variables fisher’s exact test was calculated. The data have been presented in table 8.
H04: There is no significant association difference between the joint pains after receiving warm
water therapy with the selected demographic variable at 0.05 level of significance
Table-8
Fisher’s exact test was used to describe the association between the joint pain after
receiving warm water therapy with the selected demographic variable.
N=15
BELOW ABOVE ‘P’ S/NS

N=15 DEMOGRAPHIC DATA MEDIAN MEDIAN VALUE
S. NO
1 Age
a) 61-65 years 1 2
b) 66-70 years 1 2 0.39 N.S
c) 71-75 years 2 3
d) 76-80 years 0 4
2 Gender
a) Male: 2 4 0.41 N.S
b) Female: 3 6
a) Illiterate 0 5
b) Primary 0 4 0.04 S
c) Secondary 2 2
d) Graduation and above 1 1
4. Religion
a) Hindu 3 10
b) Muslim 1 1 1.00 N.S
c) Sikh 0 0
d) Christian 0 0
e) Others 0 0
Dietary pattern
5. a) Vegetarian food 3 4
b) Non vegetarian food 1 1 0.94 N.S
c) Mixed 2 4
6. Family history
a) Yes 6 3 0.36 N.S
b) No 5 1
a) Osteoarthritis 4 8
b) Rheumatoid arthritis 0 3 1.00 N.S
c) Gout 0 0
d) Others 0 0
arthritis
a) <1 year 0 0 0.36 N.S
b) 1-3 year 3 0
c) 3-5 year 0 2
d) >5 year 8 2
9. (i) Exercise
a) Yes 3 6 0.36 N.S
b) No 1 5
(ii) if yes which among this
do you follow
a) Active 2 3 1.32 N.S
b) passive 1 3
a) Allopathic 0 0
b) Ayurvedic 2 7 0.39 N.S
c) Allopathic and 2 4
Ayurvedic
d) Other medication 0 0
a) Yes 2 4 0.39 N.S
b) No 2 7
(ii) If yes then specified
NS=Not Significant, S= Significant
❖ The data presented in table 8 shows that fisher ‘s exact test value obtained to find out the
association between post test score of elderly patient receiving warm water therapy with
demographic variables. On computation it was found that there was significant
association between post test score of elderly patient in warm water therapy group with
demographic variables i.e educational qualification from arthritis as P value obtained is
less than at 0.05 level of significant. Hence, research hypothesis is partially accepted for
the demographic variables in educational qualification from arthritis in term of
assessment of joint pain.
❖ Whereas it was found that demographic variables age, sex, income, dietary pattern, types
of arthritis, family history, and medicine regarding arthritis were found non- significant
which shows there is no significant association between post test score with these
variables as the ‘P’ value obtained is greater than 0.05.
FINDING RELATED TO ASSOCIATION OF POST ASSESSMENT PAIN SCORE IN

CONTRAST WATER THERAPY WITH DEMOGRAPHIC VARIABLES
This section describes the association between demographic variables and pain assessment
score of Contrast water therapy in elderly patient with arthritis. To determine the association
between the post assessment pain score of elderly patient with arthritis with demographic
variables fisher’s exact test was calculated. The data have been presented in table 9.
H05: There is no significant difference between the joint pain after receiving contrast water
therapy with the selected demographic variable at 0.05 level of significance.
Table-9
Fisher’s exact test was used to describe the association between the joint pain after
receiving contrast water therapy with the selected demographic variable.
N=15
BELOW ABOVE ‘P’ S/NS

S. NO DEMOGRAPHIC DATA MEDIAN MEDIAN VALUE
1 Age
a) 61-65 years 1 0
b) 66-70 years 2 3 0.39 N.S
c) 71-75 years 4 2
e) 76-80 years
1 2
2 Gender
a) Male 2 5 0.09 N.S
b) Female 6 2
a) Illiterate 3 2
b) Primary 1 2 0.38 N.S
c) Secondary 4 1
0 2
4. Religion
a) Hindu 6 7
b) Muslim 1 0 0.53 N.S
c) Sikh
1 0
d) Christian
e) Others 0 0
0 0
Dietary pattern
5. a) Vegetarian food 0 2
b) Non vegetarian food 1 0 0.30 N.S
c) Mixed
1 1
6. Family history
a) Yes 2 0 0.29 N.S
b) No 0 3
a) Osteoarthritis 1 2
b) Rheumatoid arthritis 1 1 1.00 N.S
c) Gout
0 0
d) Others
0 0
arthritis
a) <1 year 0 0 0.26 N.S
b) 1-3 year
0 1
c) 3-5 year
d) >5 year 0 0
2 2
9. (i) Exercise
a) Yes 2 2 0.16 N.S
b) No 0 1
(ii) if yes which among this
do you follow
a) Active 1 3 0.00 S
b) Passive 1 0
a) Allopathic 2 2
b) Ayurvedic 0.04 S
0 0
c) Allopathic and
Ayurvedic 0 1
d) Other medication 0 0

a) Yes 1 2 0.39 N.S
b) No 1 1
NS=Not Significant, S= Significant
❖ The data presented in table 9 shows that fisher ‘s exact test value obtained to find out the
association between post test score of elderly patient receiving contrast water therapy with
demographic variables. On computation it was found that there was significant association
between post test score of elderly patient in contrast water therapy group with demographic
variables i.e exercise, taking and underlying medication regularly as P value obtained is less
than at 0.05 level of significant. Hence, research hypothesis is partially accepted for the
demographic variables exercise, taking and underlying medication regularly in from arthritis
in term of assessment of joint pain.
❖ Whereas it was found that demographic variables age, gender, income, dietary pattern, types
of arthritis, family history, arthritis were found non- significant which shows there is no
significant association between post test score with these variables as the ‘P’ value obtained is
greater than 0.05.
SUMMARY
This chapter deals with the analysis and interpretation of the data collection and evaluated
for the effectiveness of joint pain for arthritis staying in old age home Delhi NCR. The next
chapter presents a summary of the study, major findings, conclusion, discussion, implications,
limitations and recommendation.
The next chapter present the Resultsof the study

CHAPTER-V
RESULTS
CHAPTER-V
RESULTS
PROBLEM STATEMENT
A comparative study to assess the effectiveness of warm water therapy versus contrast water
therapy on joint pain among elderly patient with arthritis in selected old age home at Delhi NCR.
❖ To assess the joint pain among elderly patient with arthritis in selected old age home at
Delhi NCR.
HYPOTHESIS
significant.
significant.
MAJOR FINDINGS OF THE STUDY

The data was collected, analyzed and interpreted in items of objectives, descriptive and
inferential statistics were used for analysis of the data. The level of significance set for testing
hypothesis was 0.05 using’ test.
SECTION 1
Finding Related To Demographic Characteristics
years.
graduation.
(13%) were muslim religion, whereas in contrast water therapy majority of the sample i.e.
were Vegetarian, 5 (33%) were mixed dietary pattern and 3(20%) were non
vegetarian,where as in contrast water therapy maximum of the sample i.e 7 (47%) were
mixed diatery pattern, 6 (40%) were vegetarian and 2(13%) were non vegetarian.
arthritis.
having 1-3 years.
➢ It was observed that therapy majority of the sample 9(60%) in warm water were doing
Regular Exercise and 6 (40%) were not doing exercise, whereas in contrast water therapy
10(67%) were doing exercise and 5 (33%) were not doing exercise.
➢ Out of 15 sample in warm water therapy majority of them 9(60%) were taking ayurvedic
medications and 6 (40%) were taking both allopathic and ayurvedic, whereas in contrast
SECTION II
Finding related to frequencies and percentage distribution of pain assessment score before
and after administration of warm water therapy of elderly patient with arthritis
The data depicted in the table-3 shows that the frequencies and percentage distribution of pre-test
and post test score of joint pain in warm water therapy of elderly patient with arthritis
maximum were lying in severe grading of joint pain 74-110 (60%) and moderate grading of joint
pain 37-73(40%) before intervention(pre test) and after continuous intervention( post test)
majority were lying in moderate grading of joint pain 37-73(80%) and mild grading of joint pain
1-36(20%).
Finding related to frequencies and percentage distribution of pain assessment score before
and after administration of contrast water therapy of elderly patient with arthritis
The data depicted in the table- 4 shows that the frequencies and percentage distribution of pre-
test and post test score of joint pain in warm water therapy of elderly patient with arthritis
maximum were lying in severe grading of joint pain 74-110 (73%) and moderate grading of joint
pain 37-73(27%) before intervention(pre test) and after continuous intervention( post test)
majority were lying in moderate grading of joint pain 37-73(13%) and mild grading of joint pain
1-36(87%).
SECTION III
Finding related to effectiveness of warm water therapy on joint pain among the elderly
The data represented in the table-5 shows that in warm water therapy mean Post test joint pain
score of elderly patient is (40) which is lowest the mean Pre test (77.6), with the mean difference
of 37.6. The obtained mean difference was found to be statistically significant. The calculated “t”
value is 41.57* which are greater than the table value at 0.05 level of significance at df (14).
Hence, null hypothesis H01 was rejected. It is concluded that the warm water therapy was
effective in decreasing the joint pain among the elderly patient with arthritis.
Finding related to effectiveness of contrast water therapy on joint pain among the elderly
The data represented in the table -6 show that in contrast water therapy mean Post test joint pain
score of elderly patient is (32.26) which is lowest the mean Pre test (75.13), with the mean
difference of 42.87. The obtained mean difference was found to be statistically significant. The
calculated “t” value is 11.83 which are greater than the table value at 0.05 level of significance at
df (4). Hence, null hypothesis H02 was rejected it is concluded that the contrast water therapy was
effective in decreasing the joint pain among old age people
SECTION IV
Finding related to difference between post interventional score in warm water therapy and
contrast water therapy of elderly patient with arthritis.
The data depicted in the table- 7 shows that in warm water therapy mean post test of joint pain
score (40) of elderly patient is more than contrast water therapy mean post test of joint pain score
(32.26), with the mean difference of 7,74. The obtained mean difference was found to be
statistically significant at 0.05 levels. The calculated unpaired‘t’ value is 4.44* at 0.05 level of
significance which is the higher than the table value at df (28).
Hence, it can be inferred that obtained mean difference of 7.74 is not by chance it is a true
difference, thus null hypothesis H03 was rejected. So, it can conclude that contrast water therapy
are more effective then warm water therapy to reducing the joint pain of elderly patient with
arthritis.
SECTION V
Finding related to association of post assessment pain score in warm water therapy
The data depicted in the table- 8 shows that the fisher ‘s exact test value find out the association
between post test score of elderly patient receiving warm water therapy with demographic
variables shows that there was significant association between post test score of elderly patient in
warm water therapy group with demographic variables i.e educational qualification from arthritis
as P value obtained is less than at 0.05 level of significant. Hence, research hypothesis is
partially accepted for the demographic variables in educational qualification from arthritis in
term of assessment of joint pain. Whereas it was found that demographic variables age, sex,
income, dietary pattern, types of arthritis, family history, and medicine regarding arthritis were
found non- significant which shows there is no significant association between post test score
with these variables as the ‘P’ value obtained is greater than 0.05.
Finding related to association of post assessment pain score in Contrast water therapy
The data presented in table 9 shows that fisher ‘s exact test value find out the association
between post test score of elderly patient receiving contrast water therapy with demographic
variables shows that there was significant association between post test score of elderly patient
in contrast water therapy group with demographic variables i.e exercise, taking and underlying
medication regularly as P value obtained is less than at 0.05 level of significant. Hence, research
hypothesis is partially accepted for the demographic variables exercise, taking and underlying
medication regularly in from arthritis in term of assessment of joint pain. Whereas it was found
that demographic variables age, gender, income, dietary pattern, types of arthritis, family history,
arthritis were found non- significant which shows there is no significant association between post
test score with these variables as the ‘P’ value obtained is greater than 0.05.
SUMMARY
This chapter deals with major findings of the study. The next chapter deals with discussion,
summary, conclusion, limitation and recommendation.
CHAPTER-VI
DISSCUSSION,
SUMMARY,
CONCLSION, NURSING
IMPLICATIONS,
LIMITATION AND
RECOMMENDATIONS
CHAPTER-VI
DISSCUSSION, SUMMARY, CONCLUSION, NURSING IMPLICATIONS,

LIMITATION AND RECOMMENDATIONS
This chapter deals with discussion, summary, conclusion, implication for nursing practice.
Recommendations for future research in the field of nursing have been presented.
DISSCUSSION
The present study was focused on the effectiveness of warm water therapy versus contrast water
therapy on joint pain among elderly patient with arthritis in selected old age home at Delhi NCR.
A number of studies have been included in the chapter dealing with review of literature.
Mimi Mohammed Mekkawy (2019) Osteoarthritis (OA) is the most prevalent and far
common debilitating form of arthritis which can be defined as a degenerative condition affecting
synovial joint. Physical agents can fight the painful process such as cold or contrast
hydrotherapy. The study was conducted at Assuit University Hospital in out patients’ clinics.
The 180 adult patients with knee osteoarthritis were selected four tools Tool I: Bio-socio
demographic characteristics Tool II: 0-10 Numeric pain rating scale. Tool II1: health assessment
questionnaire. Decreased mean of pain score between contrast group than cold group
respectively, improve mean HAQ disability index score intervention between cold and contrast
hydrotherapy respectively and increasing mean between contrast group than cold group
regarding all domain of quality of life. It Conclusion the greater pain relief and functional
improvements found when subjects used contrast therapy.
Ruth Benita. F (2016) conducted a study to assess the effectiveness of Hot water with
Epsom salt among old age patients with Rheumatoid Arthritis joint pain admitted at ortho ward
in Spine Arthroscopic and Joint Replacement Centre, Coimbatore. The research design adopted
was an experimental pre test and post test control group design. The population was old age
patients in the age group of 60-80 years with Rheumatoid Arthritis joint pain. The study has
adopted simple random sampling technique and the estimated sample size was 60 Patients.
From the result of the study, it was concluded that hot water application with Epsom salt was
effective in reducing Rheumatoid Arthritis joint pain among Old age patients. Therefore the
investigator felt that, more importance should be given for hot water with Epsom salt for
reducing Rheumatoid arthritis joint pain among old age patients.
SUMMARY
The present study was conducted with the aim to assess effectiveness of warm water therapy
versus contrast water therapy on joint pain among elderly patient with arthritis in selected old
age home at Delhi NCR.
PROBLEM STATEMENT
A comparative study to assess effectiveness of warm water therapy versus contrast water therapy
on joint pain among elderly patient with arthritis in selected old age home at Delhi NCR.
❖ To assess the level of joint pain among elderly patient with arthritis in selected old age
home at Delhi NCR.
significant.
significant.
The conceptual framework adopted for the study was based on Modified Ida Jean
Orland’s “Nursing Process Theory” which deals with assessment, planning, intervention and
evaluation.
ASSESSMENT
Nursing assessment is a deliberate, systematic and logical collection of subjective and
objective data that are helpful to identify and define problem of the client, before the nurse
proceeds to plan the care.
DIAGNOSIS
This is the second phase of nursing process. Diagnosis is the clinical act of identifying
problems.
PLANNING
Planning is essential to provide the nursing care that the needs of the client in a timely manner,
because it provides direction for nursing care and identifies nursing interventions that will meet
the goal of care.
IMPLIMENTATION
This is the action phase of the nursing process. It is the actual initiation of the plan and
documenting the nursing actions. Implementation means to carry out, to perform to intervene, or
to do something.
EVALUATION
Evaluation is the process of determining the extent up to which the goal of nursing care have
been attained. It refers to rating, grading and judging. The plan of care provided forms the basis
for evaluation.
The literature review further enable the researcher to develop a conceptual framework,
methodology, tool for data collection and plan for data analysis.
The research approach for the study was experimental in nature. The research design used
was comparative. The study was conducted in selected old age home in New Delhi,NCR The
independent variable are warm water therapy and contrast water therapy and dependent variable
is joint pain.
The study was conducted at elderly patient with arthritis from Guru Vishram Vridh Ashram
old age home at Gautampuri phase-1, Badarpur, New Delhi, were selected by the purposive non
probability sampling technique was used. To select the 30 elderly patients having arthritis.
The tool used for data collection was MODIFIED PAIN ASSESSMENT SCALE. The
content validity of tool was submitted to nine experts in field of medical surgical nursing. Based
on expert suggestions, necessary modification was made. The tool was found to be valid for the
purpose of the study.
The final study was conducted from 19 to 30 December 2019 at Guru Vishram Vridh Ashram
old age home at Gautampuri phase-1, Badarpur, New Delhi, NCR. The data were analyzed and
interpreted in terms of objectives and the research hypothesis stated. Descriptive and inferential
statistics were used for the data analysis.
The researcher found that contrast water therapy is more effective then warm water therapy in
joint pain of the elderly patient with arthritis.
CONCLUSION
The following conclusion were drawn from the finding of the study
Data shows that:-
years.
graduation.
(13%) were Muslim religion, whereas in contrast water therapy majority of the sample i.e.
were Vegetarian, 5 (33%) were mixed dietary pattern and 3(20%) were non vegetarian,
where as in contrast water therapy maximum of the sample i.e 7 (47%) were mixed dietary
pattern, 6 (40%) were vegetarian and 2(13%) were non vegetarian.
arthritis.
having 1-3 years.
➢ Considering the Regular Exercise in warm water therapy majority of the sample 9(60%)
were doing exercise and 6 (40%) were not doing exercise, whereas in contrast water
therapy 10(67%) were doing exercise and 5 (33%) were not doing exercise.
➢ Considering the taking of medication in warm water therapy majority of the 9(60%) were
taking ayurvedic and 6 (40%) were taking allopathic and ayurvedic, whereas in contrast
NURSING IMPLICATION
The nurses are the part of case term in hospital and community setting for assessing, planning
and evaluating the outcome of any kind of treatment to patients. These study findings will help
the nursing staff, nursing students and other health personnel to understand the effectiveness of
warm water therapy versus contrast water therapy and need based education on arthritis in
elderly people. So that they can give proper health advice and create health awareness among
elderly people and their family members.
The implication drawn from the present study id of vital concern to the health team including
the professional nurse practitioners, nurse administrators, nurse educators and research.
NURSING PRACTICE
 With increasing advances in health science including nursing science, there is a rising
need for updating knowledge and develop new skills in order to provide best quality care
to patients.
 Concentrated efforts must be made by all nurses in hospital and community to create
awareness regarding the effect of warm water therapy versus contrast water therapy in
reducing the joint pain for elderly people.
 The proper dissemination of information and education on warm water therapy versus
contrast water therapy is essential to help public to develop correct and healthy attitudes.
 The nurses are the key persons of health team who plays a vital role in the promotion and
maintains of health, they should provide adequate teaching to both parents and family
members regarding alternative pain modality.
NURSING EDUCATION
 Student’s interest in Nursing research should be emphasis to updated their knowledge
and practice in Nursing Profession.
 Alternative methods of management of arthritis should be included in Nursing
Curriculum.
 Through In- Service education nurse’s can become better equipped to understand and
assist the vulnerable group of society to attain there optimal level of emotional and
physical.
 Nurses should take more responsible role in diagnosis, interventions and management of
elderly patient with arthritis at hospital, community and health centre.
 Nurses also need to serve as a system and community agent to educate other
professional and general public.
NURSING ADMINISTRATION
 Nurses should be encouraged to participate in such program by the Nurse administrator

to be a part of such health awareness and smooth functioning of the management by
saving time, money, material and energy.
 The Nurses administration to change the norms and rules of inculcating the non
pharmacological management like complementary therapy (warm water therapy and
Contrast water therapy) among elderly people.
 The Nurses administration should plan to conduct awareness programme for arthritis
patient and their relatives about the complementary therapy (warm water therapy and
Contrast water therapy) as a management of pain.
 Nurse administration should develop teaching material and self instructional modules
related to pain management among elderly patient. This would enable the nurse to update
their knowledge and skills to improve the quality of care among elderly people.
NURSING RESEARCH
 The study provides base line data for conducting other research studies.
 The study will be motivation for budding researchers to conduct a same study on larger
scale.
 Adequate knowledge, motivation and encouragement by the management and authorities
of the organization can enable various research activities. This could be the quest of
many novice nurses, when motivated to indulge in research activity could improve the
body of knowledge of the profession.
 The findings of the study help the professional nurses to develop enquiring by providing
a base. This study helps the nurse’s researcher to develop insight into development of
teaching module and material towards the promotion of health.
 The further research work can be conducted with every medical condition, to identify
most effective pain strategies.
LIMITATION
➢ The study was limited to elderly patient with arthritis in selected old age home to limited
time frame for data collection.
➢ The study was conducted on the elderly patient with arthritis which is a generalization of
the study.
➢ The study was limited to the experience of the researcher.
➢ The relevant the study was scanti as selected joints were included as selected body parts
(joints) were included in present study.
RECOMMENDATION
❖ A similar study can be replicated on large sample size from various other categories of
community, old age home to generalize the finding.
❖ The study can be also conducted in adult group of people.
❖ Similar kind of study can be replicated using maximum time for warm water therapy and
contrast water therapy.
❖ A study can be done to assess intervention costs and their possible effect on health care
resources. More research is needed on how efficacious interventions can be delivering in
cost effective manner.
❖ A similar study can be done using different research design (block design) to see the
more effectiveness.
SUMMARY
This chapter dealt with the discussion, summary, conclusion, implication for nursing practice,
Recommendations for future research in the field of nursing have also been presented.
REFERENCES
REFERENCES
1. Proverb Spanish, “thoughts of study” Available from:

http://www.quotationspage.com/quote/4424.html
2. Macon Brindles Lee and Lauren Reed-Guy, “Introduce the Arthritis”14, August 2017.
Available From: https://www.healthline.com/health/arthritis
3. Chronicle Deccan, Prevalence of arthritis rising among Indians, 2017. Available from:
https://www.deccanchronicle.com/lifestyle/health-and-wellbeing/121017/prevalence-of-
arthritis-rising-among-indians.html
4. Denegar Craig R, Devon R Dougherty, Jacob E Friedman, Preferences for heat, cold, or
contrast in patients with osteoarthritis affect treatment response, 2010. Available from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2920200/
5. World confederation for physical therapy, “Definition of an older or elderly person”
2010. Available from: https://www.wcpt.org/node/47941
6. Benita Ruth .F, “Background of the arthritis” April 2016, Available from
http://repository-tnmgrmu.ac.in/2418/1/3001232ruthbenitaf
7. Hopkins Johns “ Introduction of the osteoarthritis” September 2019, Available from
:https://www.hopkinsarthritis.org/arthritis-research
8. Babak Shadgan, Amir H. Pakravan, and Alison Hoens, et al. “Contrast Baths,
Intramuscular Hemodynamic, and Oxygenation as Monitored by Near-Infrared
Spectroscopy”. Journal of Athletic Training: August 2018, Vol. 53, No. 8, pp. 782-787.
https://natajournals.org/doi/10.4085/1062-6050-127-17
9. Arthritis Foundation Report, “Warm water gets blood flow moving throughout stiffened
muscles and joints” ,http://www.kten.com/story/39223811/warm-water-is-the-
rheumatoid-arthritis-home-remedy-youre-not-using-but-should
10. Nichols Hannah, “Centres for Disease Control and Prevention (CDC)”November 2018,
Available from: https://www.medicalnewstoday.com/articles/7621
11. March L, Smith EU, Hoy DG, Cross MJ, Sanchez-Riera L, et al."Burden of disability due
to musculoskeletal (MSK) disorders". Best Practice & Research. Clinical Rheumatology.
June 2014, 28 (3): 353–66. Available from: https://doi:10.1016/j.berh.2014.08.002.
PMID 25481420
12. P Richette, Bardin T "Gout". January 2010, Lancet. 375 (9711): 318–28. Available from:
https://doi:10.1016/S0140-6736 (09)60883-7. PMID 19692116
13. Pirotta M, "Arthritis disease - the use of complementary therapies", September 2010.
Australian Family Physician. 39 (9): 638–40 Available from:
https://pubmed.ncbi.nlm.nih.gov/20877766/
14. Dr. Wagh Shrikant, “prevalence rate of arthritis” November 2019. Available from:
http://www.arthritis-india.com/
15. Chandra Deepak, “prevalence rate of osteoarthritis” Feb 16, 2017. Available from:
https://www.nhp.gov.in/disease/musculo-skeletal-bone-joints-/osteoarthritis
16. Augustine Shyni, “Arthritis on the rise among women more than men in India” Indo Asian News
Service, 2017. Available from: https://www.indiatoday.in/lifestyle/health/story/world-
arthritis-day-indian-women-affected-rheumatoid-joint-pain-overweight-lifest-1062971-
2017-10-12
17. J. Nisha. Maneknancy e. Lane, “current-concepts-in-diagnosis-and-management”
American Family Physician, March 2000. Available from:
https://ucdavis.pure.elsevier.com/en/publications/osteoarthritis-current-concepts-in-
diagnosis-and-management
18. Ramesh Narula, Iradi Aftab Ahmed, N.Kausum et al, “Non-Invasive Conservative
Treatments with Local Steroid Injection in the Management of Planter Fasciitis,
September 2014. Available from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4225922/
19. Pecke Linda, “Rheumatoid-arthritis-in-the-elderly-a-new-problem-or-an-old-one”
February2018. Available from:
https://www.rheumatologyadvisor.com/home/rheumatoid-arthritisadvisor/rheumatoid-
arthritis-in-the-elderly-a-new-problem-or-an-old-one/
20. Wong Cathy, “Types and benefits of hydrotherapy” December 2019. Available from:
https://www.verywellhealth.com/different-types-of-hydrotherapy-89993#citation-5
21. Sharma S.K, “Nursing Research and Statistics” 8nd edition, Elsevier publisher, New
Delhi2011.p.30,93,125
22. Basavanthappa BT, “Nursing Theories”, 1st edition, Jaypee Publications New
Delhi.p.150-152
23. Sharma S.K, “Nursing Research and Statistics” 3rd edition, Elsevier publisher.p.117
24. Patel M. Manish. “Epidemiological Survey of Arthritis” International Journal of
Pharmaceutical Sciences And Research, 2017. Available from :https://ijpsr.com/bft-
article/an-epidemiological-survey-of-arthritis-in-the-population-of-north-gujarat-
india/?view=fulltext
25. Veronese Nicola, Trevisan Caterina, Rui Marina De, “Association of Osteoarthritis With
Increased Risk of other Diseases in the Elderly” Vol. 68, No. 5, May 2016, pp 1136–1144.
Available from: https://onlinelibrary.wiley.com/doi/pdf/10.1002/art.39564
26. Rheumatic disease clinic of North America, “prevalence rate of arthritis in the United
States” 2012’. Available From: https://www.cdc.gov/arthritis/data_statistics/arthritis-
related-stats.htm
27. Lena. A, Ashok. K et.al, “Health and social problems of the elderly” Indian Journals of
community Medicine, Volume 34 ,2009 , pp.131-134. Available from:
http://www.ijcm.org.in/article.asp?issn=0970-
0218;year=2009;volume=34;issue=2;spage=131;epage=134;aulast=Lena
28. Bhatia, Verma, S.K Sharma, Kaur G, “An epidemiological study of correlates of osteo-
arthritis in geriatric population” Indian Journals of community Medicine,
Volume 32 ,2007 , pp.77-78. Available from :
http://www.ijcm.org.in/article.asp?issn=0970
0218;year=2007;volume=32;issue=1;spage=77;epage=78;aulast=Sharma
29. G. Sathiyabama, S. Benitta Thanaseeli, “Assess the effectiveness of hot water and cold-
water therapy among elderly people with joint pain” International Journal of Science and
Research (IJSR) 8(9):236. Available From:
https://www.researchgate.net/publication/336604648_A_STUDY_TO_ASSESS_THE_E
FFECTIVENESS_OF_HOT_WATER_AND_COLD-
WATER_THERAPY_AMONG_ELDERLY_PEOPLE_WITH_JOINT_PAIN_LIVING_
AT_SELECTED_AREAS
30. Bhawna, Anney Avarachan, Jincy Daniel, “ Effectiveness of hot water application with
Epsom salt and hot water application on joint pain among adults suffering from
arthritis”International Journal of Scientific and Research Publications, Volume 9, Issue
10, October 2019 827 ISSN 2250-3153. Available From: http://www.ijsrp.org/research-
paper-1019/ijsrp-p94105.pdf
31. Yildirim , Ulusoy N.,Filiz, M., and Bodur, H. “The effect of hot application on pain,
stiffness, physical function and quality of life in patients with osteoarthritis” 2010
Apr;19(7-8):1113-20. doi: 10.1111/j.1365-2702.2009.03070.x. Available from :
https://www.ncbi.nlm.nih.gov/pubmed/20492056
32. Kaur Parminder, Walia Indarjit, Saini Sushma Kumari, “Application of Moist Heat'
among geriatric population” volume 3, October 2017. Available from :
http://medind.nic.in/nad/t07/i4/nadt07i4p162.pdf
33. Mekkawy Mimi Mohammed, “Effect of Cold Application Versus Contrast Hydrotherapy
On Patients Knee Osteoarthritis” American Journal of Nursing Science,Volume 8, Issue
4, August 2019, Pages: 145-152. Available from:
http://www.sciencepublishinggroup.com/journal/paperinfo?journalid=152&doi=10.11648
/j.ajns.20190804.14
34. Dr. M.G.R, “study to compare the effectiveness of hot application versus contrast therapy
on osteoarthritis “2016. Available from : http://repository-
tnmgrmu.ac.in/2861/1/3001222301411704rajapriyag.pdf
35. Shafizadegan Zohreh, “The Comparison of the Effects of Contrast Bath on Circulation of
Contralateral Lower Limb” Journal of Rehabilitation Sciences and Research, 2016.
Available from : https://journals.indexcopernicus.com/search/article?articleId=1550906
36. Shehata Amal E. and Fareed Manal E, “Effect of Cold, Warm or Contrast Therapy on
Controlling Knee Osteoarthritis Associated Problems” World Academy of Science,
Engineering and Technology International Journal of Medical and Health Sciences Vol:7,
No:9, 2013. Available from:
https://www.researchgate.net/publication/331375149_Effect-of-Cold-Warm-or-Contrast-
Therapy-on-Controlling-Knee-Osteoarthritis-Associated-Problems
37. Polit DF and Beck, “Nursing research” 5th edition, Lippincott publication, New Delhi.
P.130
38. Basavanthappa BT, “Essentials of Nursing Research”, 1st edition, Jaypee Brothers
Medical Publishers p.
39. Treece and Treece, “Elements of research in nursing”4th edition, Philadeiphia Mosby
publisher 1986.p. 95-98
40. Burns N and Grove S.K, “Understanding Nursing research. 4th edition. Elsevier
publication, New Delhi 2007. P. 381
41. Polit Denis F, Beck Chery Tatano, “Essential of Nursing Resarch” 7th edition, New
Delhi: Wolters Kulwer Pvt Ltd :2010. p, 177,222,338,377
42. Suddharth and Brunner, “Medical Surgical Nursing” 11th edition New Delhi Wolters
Kulwer,2011 p, 1165-1189
43. Hoognboom J Barba, “Musculoskeletal Intervention”, 3rd edition, Elsvier publisher.
p.1165-1172
APPENDICES
LETTER SEEKING PERMISSION FOR PILOT RESEARCH STUDY
1128/NIN/PRI/RS/2019 Date ………..
To,
Bhagwat Dham Old Age Home
Mayur Vihar, Phase 1
New Delhi
SUB: LETTER SEEKING PERMISSION FOR RESEARCH STUDY
Dear Sir/Madam,
This is to introduce Ms. Dilpreet kaur a final year M.Sc. (Nursing) student in this
college. She is planning to conduct a research project, which is to be submitted to the Ch.
Charan Singh University, Meerut for the partial fulfilment of university requirement for the
award of M.Sc. (N) degree.
Topic: “A comparative study to assess effectiveness of warm water therapy versus contrast
water therapy on joint pain among elderly patient with arthritis in selected old age home at
Delhi/NCR”.
We request your esteem support and co-operation as she is interested in conducting pilot
study in your institution.
This is to request you to kindly extend necessary facilities to work on the proposed
research study during tentative dates i.e. 16/10/2019 to 26/10/2019
Student will furnish further information if required regarding the research.
Thanking you,
Prof. Lavanya Nandan
Principal
Nightingale Institute of Nursing, Noida
LETTER SEEKING PERMISSION FOR FINAL RESEARCH STUDY
1128/NIN/PRI/RS/2019 Date ………..
To,
Guru Vishram Vridh Ashram
Gautampuri
New Delhi
SUB: LETTER SEEKING PERMISSION FOR RESEARCH STUDY
Dear Sie/Madam,
This is to introduce Ms. Dilpreet Kaur a final year M.Sc. (Nursing) student in this
college. She is planning to conduct a research project, which is to be submitted to the Ch.
Charan Singh University, Meerut for the partial fulfilment of university requirement for the
award of M.Sc. (N) degree.
Topic: “A comparative study to assess effectiveness of warm water therapy versus

contrast water therapy on joint pain among elderly patient with arthritis in selected old age
home at Delhi/NCR”
We request your esteem support and co-operation as she is interested in conducting main
study in your institution.
This is to request you to kindly extend necessary facilities to work on the proposed
research study during tentative dates i.e.19/12/2019 to 29/12/2019
Student will furnish further information if required regarding the research.
Thanking you
Prof. Lavanya Nandan

Principal
Nightingale Institute of Nursing, Noida
LETTER SEEKING EXPERTS OPINION AND SUGGESTIONS FOR CONTENT
VALIDITY OF RESEARCH TOOLS
To
Subject: Letter seeking expert opinion on content validity of warm water therapy versus
contrast water therapy
Dear Sir/Madam
I am Ms. Dilpreet Kaur M.Sc. Nursing, II Year student of Nightingale
Institute of Nursing Noida. I have selected under mentioned topic for my research project to be
submitted to Chaudhary Charan Singh University, Meerut, as a partial fulfilment of University
requirement for the award of M.Sc. Nursing degree.
Topic:
“A comparative study to assess effectiveness of warm water therapy versus contrast water
therapy on joint pain among elderly patient with arthritis in selected old age home at
Delhi/NCR.”
The following objectives were selected for the study:
❖ To assess the joint pain among elderly patient with arthritis in selected old age home at
Delhi NCR.
In this connection I have prepared demographic tools and structured Pain assessment pain
I request you to kindly go through the tool which includes demographic tools and
Structured pain assessment scale and give your expert opinion and suggestions for any
modification and improvement in the content. Your esteemed opinions and critical comments
will provide the required direction and contribute immensely to be quality content of my final
research.
Looking forward for your valuable guidance and suggestions.
Thanking you
Ms. Dilpreet Kaur
M.sc 2nd year
Nightingale Institute of Nursing,
Noida
Enclosure:
Tool for validation

1. Demographic tool,
2. Modified pain assessment scale
Content Validity Certificate
I hereby certify that I have validated the tool of Ms. Dilpreet Kaur, II YearM.Sc Nursing
student of Nightingale Institute of Nursing who is undertaking a study on:
“A comparative study to assess effectiveness of warm water therapy versus contrast water
therapy on joint pain among elderly patient with arthritis in selected old age home at
Delhi/NCR”.
Date: Signature of the expert

Place: Name:
Designation:
DEMOGRAPHIC PROFORMA
Instructions:
The evaluator is requested to go through the criteria listed below for evaluation of the
data collection tool. In the criteria checklist there are 3 main columns and a remark column. The
validation is done in terms of appropriateness, relevance and accuracy.
In each sub column: column I Agree, column II Disagree
Kindly place a ( √ ) mark in the chosen response column and remarks in the remark
Appropriateness Relevance Accuracy

Item No. Remarks
I II I II I II
1
2
3
4
5
6
7
8
9
10
Any suggestions:
1.
2.
3.
Signature of the Validator

Name:
Designation:
A CRITERIA RATING SCALE FOR EXPERT OPINION REGARDING CONTENT
VALIDITY OF RESEARCH TOOLS
INSTRUCTION
Please go through the criteria listed below which has been formulated to (Purpose of the
study).
There are three alternative response columns given. Kindly put a tick (√) mark in the
appropriate column.
COLUMN I- Strongly Agree.

COLUMN II -Agree.
COLUMN III-Disagree.
Kindly report your responses with appropriate comments/remarks and suggestions in the
remark column, as your valuable comment will help the researcher to improve his / her effort.
S.No. I
II III
Criteria Strongly Remarks
Agree Disagree
Agree
1. Formulation of Objectives
a) Comprehensive enough for the
participants
b) Realistic to achieve
c) Objectives are in terms of
respondents
2. Selection of the content

a) Content provides accurate
information as per the
objectives
b) Content is relevant.
c) Content is appropriate
d) Content is according to the
level of the respondents.
3. Organization of contents
a) Logical sequence.
b) Maintains correlation.
c) Integration of the content.
4. Language
a) Simple and easy to understand.
b) Scientific terms explained.
5. Feasibility / Practicability
a) The tool content acceptable to
the participants
b) The tool content is to the level
of the participants
understanding.
c) The tool content is conventional
to handle and conduct.
d) The tool content is interesting to
the participants.
e) The tool content is economical
in terms of cost effort and time
Suggestions:
Signature of the Validator

LIST OF EXPERTS FOR TOOL VALIDATION
1. Mr. Eke Lama Tamang , M.Sc in Medical Surgical Nursing,

HOD of Medical Surgical Nursing,
Jamia Hamdard College of Nursing,
New Delhi
2. Mr. Naseem Mencherian, M.Sc in Medical Surgical Nursing,

Nursing Tutor,
Jamia Hamdard College of Nursing,
New Delhi
3. Mr. Mahesh Rajput, M.Sc in Medical Surgical Nursing,

Assisstant Professor,
Metro College of Nursing,
Greater Noida
4. Ms. Simrat Kaur, M.Sc in Medical Surgical Nursing,

Assisstant Professor,
GalgotiaUniversity,
Greater Noida
5. Prof. Justin, M.Sc in Medical Surgical Nursing,

GalgotiaUniversity,
Greater Noida
6. Prof. Kiran Sharma, P.hD in Medical Surgical Nursing,

Sharda University,
Greater Noida
7. Ms. Mamta Rawat, M.Sc in Medical Surgical Nursing,

Assissstant Professor,
Rohilkhand College Of Nursing ,
Bareilly
8. Mr. Manoj Kumar Sharma, M.Sc in Medical Surgical Nursing,

Assissstant Professor,
Rohilkhand College Of Nursing ,
Bareilly
INFORMED CONSENT
I am giving my consent to participate in the resarch study, “A study to assess the

elderly patient with arthritis in selected old age home at Delhi NCR”.
I have been informed that my participation is entirely voluntary and that even after the study
begins can refuse to answer(or) participate at any point of time during the study have been
fully informed about the nature of the study, the researcher responsibility and likely benefits
from this study.
Date:
Place:
Signature of the participant

RESARCH TOOLS
PART- 1 DEMOGRAPHIC DATA
1. Age
a) 61-65years
b) 66-70years
c) 71-75 years
d) 76-80 years
2. Gender
a) Male
b) Female
3. Educational qualification
a) illiterate
b) Primary
c) Secondary
4. Religion
a) Hindu
b) Muslim
c) Sikh
d) Christian
e) Others
5. Dietary pattern
a) Vegetarian food
b) Non vegetarian food
c) Mixed
6. Family history
a) Yes
b) No
a) Osteoarthritis
b) Rheumatoid arthritis
c) Gout
d) Others
8. Years of suffering from arthritis
a) <1 year
b) 1-3 year
c) 3-5 year
d) >5 year
9. Exercise
a) Yes
b) No
10. Taking any underlying Medication regularly
a) Allopathic
b) Ayurvedic
c) Allopathic and Ayurvedic
d) Other medication
a) Yes
b) No
PART-II NUMERICAL RATING PAIN SCALE
MODIFIED PAIN ASSESSMENT SCALE
S. CONTENT NONE MILD MODERATE SEVERE

NO
1. Flexion and extension of
fingers
2. Abduction and adduction of
fingers
hands
4. Twisting and pivoting of
wrist
elbow
6. While standing
7. Walking on flat surface
8. Walk upstairs and
downstairs
9. Rotation of ankles
10. Flexion of feet
11. Eversion and inversion of
feet
INTERPRETATION OF SCORNING
MILD 1-36
MODERATE 37-73
SEVERE 74-110
MASTER SHEET FOR DEMOGRAPHIC VARIABLES (WARM WATER THERAPY)
SAMPLES/ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
DEMOGRAPHIC VARIABLES
1. Age
e) 61-65years √ √ √
f) 66-70years √ √ √
g) 71-75 years √ √ √ √
h) 76-80 years √ √ √ √ √
2. Gender
c) Male √ √ √ √ √ √
d) Female √ √ √ √ √ √ √ √ √
e) illiterate √ √ √ √ √ √
f) Primary √ √ √ √
g) Secondary √ √ √
h) Graduation and above √
√
4. Religion
f) Hindu √ √ √ √ √ √ √ √ √ √ √ √ √
g) Muslim √ √
h) Sikh
i) Christen
j) Others
5. Dietary pattern
d) Vegetarian food √ √ √ √ √ √ √
e) Non vegetarian food √ √ √
f) Mixed
√ √ √ √ √
6. Family history
c) Yes √ √ √ √ √ √ √ √ √
d) No √ √ √ √ √ √
e) Osteoarthritis √ √ √ √ √ √ √ √ √ √ √ √
f) Rheumatoid arthritis √ √ √
g) Gout
h) Others
e) <1 year
f) 1-3 year √ √ √
g) 3-5 year √ √
h) >5 year √ √ √ √ √ √ √ √ √ √
9. (i)Regular Exercise
c) Yes √ √ √ √ √ √ √ √ √
d) No √ √ √ √ √ √
(ii) if yes which among this do you
follow
√ √
a) Active √ √ √
a) passive √ √ √ √
10. Taking any underlying Medication
regularly
e) Allopathic
f) Ayurvedic √ √ √ √ √ √ √ √ √
g) Allopathic and Ayurvedic √ √ √ √ √ √
h) Other medication
c) Yes √ √ √ √ √ √
d) No √ √ √ √ √ √ √ √ √
MASTER SHEET FOR DEMOGRAPHIC VARIABLES (CONTRAST WATER THERAPY)
SAMPLES/ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
DEMOGRAPHIC VARIABLES
1. Age
i) 61-65years √
j) 66-70years √ √ √ √ √
k) 71-75 years √ √ √ √ √ √
l) 76-80 years √ √ √
2. Gender
e) Male √ √ √ √ √ √ √
f) Female √ √ √ √ √ √ √ √
i) illiterate √ √ √ √ √
j) Primary √ √ √
k) Secondary √ √ √ √ √
l) Graduation and above √ √
4. Religion
k) Hindu √ √ √ √ √ √ √ √ √ √ √ √ √
l) Muslim √
m) Sikh √
n) Christen
o) Others
5. Dietary pattern
g) Vegetarian food √ √ √ √ √ √
h) Non vegetarian food √ √
i) Mixed √ √ √ √ √ √ √
6. Family history
e) Yes √ √ √ √ √ √ √ √ √
f) No √ √ √ √ √ √
i) Osteoarthritis √ √ √ √ √ √ √ √ √ √ √ √ √
j) Rheumatoid arthritis √ √
k) Gout
l) Others
i) <1 year
j) 1-3 year √ √
k) 3-5 year √ √ √ √
l) >5 year √ √ √ √ √ √ √ √ √
9. (i)Regular Exercise
e) Yes √ √ √ √ √ √ √ √ √ √
f) No √ √ √ √ √
(ii) if yes which among this do you
follow
√
b) Active √ √ √ √
b) passive √ √ √ √ √
10. Taking any underlying Medication
regularly
i) Allopathic
j) Ayurvedic √ √ √ √ √ √ √ √
k) Allopathic and Ayurvedic √ √ √ √ √ √ √
l) Other medication

e) Yes √ √ √ √ √ √ √
f) No √ √ √ √ √ √ √ √
PRE-TEST SCORE OF WARM WATER THERAPY
SAMPLE 1 2 3 4 5 6 7 8 9 10 11 TOTAL
1 5 5 5 6 6 6 6 8 7 8 7 69
2 6 6 6 8 8 8 8 9 8 8 8 83
3 6 6 7 7 7 8 8 9 8 8 8 82
4 6 6 6 7 7 6 6 8 7 7 7 74
5 6 6 6 7 7 7 7 8 7 8 7 76
6 7 7 7 8 8 7 8 9 9 8 8 86
7 6 6 6 8 8 7 7 9 8 8 8 81
8 6 5 5 7 6 6 6 8 7 7 7 70
9 6 6 7 8 7 7 7 9 8 8 8 81
10 7 7 7 9 8 8 9 9 8 9 9 90
11 5 5 5 6 6 7 6 8 8 8 8 72
12 6 5 5 7 6 6 6 8 6 6 6 67
13 6 6 6 7 7 6 6 8 7 7 7 73
14 7 7 7 9 8 8 8 9 8 8 8 87
15 6 6 6 7 7 7 7 7 7 7 7 73
TOTAL=1164
POST-TEST SCORE OF WARM WATER THERAPY
SAMPLE 1 2 3 4 5 6 7 8 9 10 11 TOTAL
1 2 2 2 4 4 3 3 4 4 3 3 34
2 3 3 3 4 4 4 3 4 4 4 4 40
3 3 3 3 4 4 4 4 5 4 4 4 42
4 3 3 3 4 4 3 3 4 4 4 4 39
5 2 2 2 3 3 4 4 4 4 4 4 36
6 3 3 3 4 4 3 3 4 4 4 4 39
7 2 2 2 4 4 3 3 5 5 5 5 40
8 2 2 2 3 3 3 3 4 4 4 4 34
9 3 3 3 4 4 4 4 5 5 5 5 45
10 3 3 3 4 4 5 5 6 6 6 6 51
11 3 3 3 4 4 3 3 5 5 5 5 43
12 2 2 2 4 4 3 3 5 4 4 4 37
13 3 3 3 4 4 3 3 4 4 4 4 59
14 3 3 3 4 4 4 4 5 4 4 4 42
15 3 3 3 4 4 3 3 4 4 4 4 39
TOTAL = 600
PRE-TEST SCORE OF CONTRAST WATER THERAPY
SAMPLE 1 2 3 4 5 6 7 8 9 10 11 TOTAL
1 6 7 7 8 8 7 8 9 8 7 7 82
2 5 6 5 7 6 7 7 9 6 6 7 71
3 6 7 6 8 7 6 6 9 8 7 7 77
4 4 4 4 6 5 6 5 7 6 6 6 59
5 7 7 8 8 7 8 8 9 8 8 7 85
6 5 6 6 8 7 7 7 9 8 7 7 77
7 6 6 6 7 7 7 7 8 8 7 7 76
8 5 5 5 6 6 7 7 9 8 7 6 71
9 6 7 7 8 8 8 7 9 8 7 7 82
10 5 6 6 7 6 7 7 9 8 8 7 76
11 6 6 6 7 7 7 7 8 8 8 8 78
12 6 6 6 7 6 9 9 9 9 8 8 83
13 5 6 6 7 7 7 7 9 9 8 8 79
14 4 4 4 5 5 5 5 6 4 4 4 53
15 6 6 6 7 7 7 7 9 8 7 8 78
TOTAL=1127
POST-TEST SCORE OF CONTRAST WATER THERAPY
SAMPLE 1 2 3 4 5 6 7 8 9 10 11 TOTAL
1 2 2 2 3 3 3 3 4 4 4 4 34
2 2 3 2 3 2 3 3 4 4 4 4 34
3 3 3 3 4 4 2 2 4 4 4 3 36
4 1 1 1 2 2 1 2 3 2 2 2 19
5 3 3 4 4 4 3 3 4 4 4 4 40
6 2 2 2 4 3 3 3 4 4 3 3 33
7 2 2 2 4 3 3 3 4 4 3 3 33
8 2 2 2 3 3 3 4 4 4 4 4 35
9 2 2 2 3 4 3 3 5 5 4 4 37
10 2 2 2 3 3 3 3 4 3 3 3 31
11 2 2 2 3 2 3 3 4 3 4 4 32
12 2 2 2 3 3 3 3 4 4 3 3 32
13 2 2 2 4 3 3 3 4 4 4 4 35
14 1 1 1 2 2 2 2 3 3 2 2 21
15 2 2 2 3 3 3 3 4 4 3 3 32
TOTAL = 484
PHOTOGRAPHY
WARM WATER
THERAPY
CONTRAST WATER
THERAPY

Thesis PDF

Hochgeladen von

Dokumentinformationen

Originaltitel

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

Thesis PDF

Hochgeladen von

Copyright:

Verfügbare Formate

“A COMPARATIVE STUDY TO ASSESS THE EFFECTIVENESS OF

WARM WATER THERAPY VERSUS CONTRAST WATER THERAPY

NIGHTINGALE INSTITUTE OF NURSING, NOIDA.

DISSERTATION SUBMITTED IN PARTIAL FULLFILMENT OF THE

CHAUDHARY CHARAN SINGH UNIVERSITY

Dissertations submitted to the

Chaudhary Charan Singh University

Date: Signature of the Candidate

Place: Ms. Dilpreet Kaur

Date: Signature of the guide

Place: Mrs. Sibi Samuel

Medical Surgical Nursing

Signature of the HOD Signature of the principal

I am extremely grateful to whole Library staff of Nightingale Institute of Nursing, Noida

CB- Contrast Bath

CHAPTER CONTENT PAGE NO

SR. TABLES PAGE NO

1. Symbolic representation of resarch design

2. Frequency and Percentage distribution of elderly

3. Frequencies and Percentage distribution of pain assessment

4. Frequencies and percentage distribution of pain assessment

5. Mean, Mean Difference, Standard Deviation and “t” Value

6. Mean, Mean Difference, Standard Deviation and “t” value

7. Mean, Mean Difference, Standard Deviation and Unpaired“t”

8. Fisher’s exact test was used to describe the association

9. Fisher’s exact test was used to describe the association

SR.NO FIGURES PAGE NO

S.NO TITLE PAGE NO

1. Letter seeking permission for pilot study

BACKGROUND OF THE STUDY

Ruth Benita .f (2016) About 1% of the world population is affected by rheumatoid

“The art of life is the art of avoiding pain" -William Hazlin

“Shyni Augustine” (2010) A study was conducted in Rheumatoid arthritis patients

“Nisha j. Maneknancy e. Lane”(2000)A study was conducted in osteoarthritis seek

“Ramesh Narula”,(2014)A prospective study was undertaken to compare the two

STATEMENT OF THE PROBLEM

OBJECTIVES OF THE STUDY

CONCEPTUAL FRAMEWORK OF THE STUDY

Conceptual framework is a theoretical approach to the study of a problem that is scientifically

According to Sharma S. (2012), “Conceptual framework refers to the interrelated concepts

According to Polit and Hungler (1999), “Conceptual framework is a cohesive, supportive

Nursing assessment is a deliberate, systematic and logical collection of subjective and

DEMOGRAPHIC SIGNS PLANNING IMPLIMENTA- EVALUATION

ORGANIZATION OF THE REPORT

Chapter IV would deals with the analysis and interpretation of data.

Chapter-V presents the result finding of the study.

This report will end with selected references and appendices.

S.K. Sharma “Literature review is defined as a broad, comprehensive, in depth, systematic

Section-II: Review of literature related to effectiveness of warm water therapy on joint

Section-III: Review of literature related to effectiveness of contrast water therapy on joint

G Sathiyabama, S Benitta Thanaseeli (2019), conducted a study to assess the effectiveness

SECTION-III: Review of literature related to effectiveness of contrast water therapy on

Donna E. Breger Stanton et al (2012) conduced a systematic review among 28 clinical

The next chapter presents methodology of research study.

Research methodology is a way to systematically solve the research problem. It is a science

Group Pre - test Intervention Post –test

TABLE 1: SYMBOLIC REPRESENTATION OF RESARCH DESIGN

Group Day 1 Day Day11

Contrast water Pre assessment of Administration of Post assessment of

Independent variable: warm water

SAMPLE AND SAMPLE POPULATION STUDY SETTING

Non Probability purposive Demographic variables CONCLUSION,

Figure: 2 Schematic representation of the research design