RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.

SYNOPSIS FOR REGISTRATION OF SUBJECT FOR

DISSERTATION.

1. NAME OF THE CANDIDATE Ms. SHRUTHI KEERTHI.G

AND ADDRESS D/O Mr. GANESH BABU. D

POORNIMA NILAYA DOOR NO

378/6 II BLOCK RAMAIAH

LAYOUT DODDA BOMMA

SANDRA BANGALORE-97.
2. NAME OF THE M.S.RAMAIAH INSTITUTE OF

INSTITUITION NURSING EDUCATION AND

RESEARCH.

M.S.R.I.T. POST,BANGALORE- 54
3. COURSE OF STUDY AND M.Sc NURSING

SUBJECT MEDICAL SURGICAL NURSING

DISSERTATION PROTOCOL
4. DATE OF ADMISSION 14-06-2010
5. TITLE OF THE STUDY:

EFFECTIVENESS OF FOOT BATH IN REDUCING SELECTED JOINT

PAIN.

6. BRIEF RESUME OF THE INTENTED WORK

INTRODUCTION

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 A human life is divided into five main stages namely infancy, childhood,

adolescence, adulthood and old age. In each of these stages an individual find himself

in different situations and face different problems. The old age is not without

problems. In old age physical strength deteriorates, mental stability diminishes;

money power becomes bleak coupled with negligence from the younger generation.1

The word Geriatrics comes from the Greek word “GERAS” which means the

“old man” and “IATROS” which means “the treatment of disease” thus Geriatrics is a

branch of medicine pertaining to the diagnosis, treatment, and prevention of disease in

the elder population.2

The definition of "elderly population" is a matter of debate. In many studies,

elderly population is been defined as people more than 65 years of age. However, in

developing countries, less than 10% of the population is more than 60 years of age

and age criterion for retirement from government services is also 60 years. Hence, the

elderly population is defined as "60 plus" in developing countries.3

Ageing is a normal, universal and inevitable which takes place even with the

best of nutrition and health care. It is a normal process of time related change that

occurs throughout the life. The naturally occurring changes that are bound to occur as

one ages, are as follows: the skin begins to wrinkle due to decreased body’s natural

ability to produce Elastin and collagen that are needed to keep the skin firm. The hair

roots lose their capacity to produce enough melanin leading to whitening of hair.

Hearing loss happens as the walls of the auditory canals of the ear thin out, with the

ear drums becoming thicker. The brain slows as one ages, due to the reduction in

neurons or messenger cells. The high levels of cholesterol, a fatty deposit on the walls

of the arteries, thinned out blood vessels contributes to many cardiovascular problems

among elderly people. Digestion takes time as the area within the intestine reduces

2
slightly with age and reduction in the chemicals secreted by the intestine to digest and

ferment the food; as a result digestion of food becomes a problem.4

A joint is a site at which two or more bones articulate. A typical synovial joint

is surrounded and enclosed by sleeves of fibrous tissue which holds the bones

together called as capsular ligament. Hyaline cartilage covers the part of the bones

which are in contact always. The synovial membrane composed of epithelial cells

covers all intracapular structures and secretes a sticky fluid of egg white consistency

known as synovial fluid.5

As one begins to age bones begin to lose their density and shrink. This is

evident in the height of old people decreasing by a couple of inches than their original

height. Due to decline in the body’s ability to absorb calcium bones becomes brittle

and are prone to fractures. Pain in the joints is the most common complain of elderly

people this is because of decline in the production of the synovial fluid, which acts as

a lubricator for the joints, without it the friction between joints increases, leading to

the pain.4

In India, the elderly people suffer from dual medical problems, i.e., both

communicable as well as non-communicable diseases. One among the non

communicable disease is the musculoskeletal problems.6

Musculoskeletal conditions associated with aging contribute to a heavy

functional and economic burden for the rapidly aging population. As the age advances

the changes in the musculoskeletal system have implications for movement, strength

and endurance. Restricted movements are most commonly seen in the arms, legs and

neck of the elderly people, who may demonstrate pain, stiffness, spasm, swelling and

limited range of motion.6

3
 Pain is referred to as the fifth vital sign, if undertreated pain can have serious

physical, psychological, and financial consequences that affect the person’s quality of

life. Because pain is subjective, no two person experience pain the same way so

accurate management of the pain is the first step in developing an effective treatment

plan to deal with pain.7

International Association for the Study of Pain (2006) defines pain as an

“unpleasant sensory and emotional experience associated with actual or potential

tissue damage”.7

One of the most common substances in the world is water. It is also one of the

cheapest thing in the world. The Traditional Indian system of medicine has been using

water, in different ways, for centuries to treat many diseases. The use of water at

different temperatures, in the treatment of various diseases, is known as Water

Therapy or Hydrotherapy. One way of delivering hydrotherapy is by the use of hot

foot bath.8

The blood maintains the heat of the body, destroys disease germs and repairs

the diseased or injured portions of the body. The circulation of the blood in any part of

the body can be controlled by the use of hot and cold water. Hot Footbath is one of the

oldest, cheapest and safest methods for treating common ailments. The hot foot bath

causes the blood vessels to dilate, as the blood vessels dilate, the blood rushes in from

other parts of the body, relaxes tense muscle which helps to relieve the pain.9

Cells consist of electrical charges and contain even proportion of positive and

negative ions. In this state the body functions by removing toxins and absorbing

nutrients from food, water and oxygen. When the body experiences ill health or

injury, the cells become more positively charged and a toxin begins to store. Foot bath

helps to remove toxins out of the body.9

4
 Thus hot footbath is a very soothing and relaxing form of water therapy that

increases blood flow through the entire skin surface, relieving congestion in internal

organs, boosts the immune system, relaxes tense muscles and relieves pain.

6.1. NEED FOR THE STUDY:

According to recent statistics related to elderly people in India, in the year

2001, the Indian aged population is currently the second largest in the world. The

absolute number of people over 60 years in India will increase from 7.6 million in

2001 to 137 million by 2021, thus India has acquired the label of "an ageing nation"

with 7.7% of its population being more than 60 years old.10

According to the United Nations projections, in 2000, the elderly account for

7.6% of India’s population. By 2025 the comparable figure will be 12.7% and by

2050 it will be 21.3%.11

According to the Registrar General’s projections, the proportion of the elderly

to the total population in 1951 was 5.4% while in 1991 it was 6.7%, the figure will be

8.9% in 2016.11

According to the official projections of the Registrar General, India, in 2001

the elderly population is estimated at 71 million, and 114 million by the year 2016.11

The United Nations projections (medium variant) put the estimated number of

elderly in India in 2000 at 77 million. The projection for the year 2025 is 168 million

and for 2050 it is 326 million.11

A study conducted on health problems and loneliness among the elderly by

Department of Community Medicine, Govt. Medical College, Chandigarh on a

sample size of 361 aged persons of age 65 years and above showed that main health-

related problems among the aged were that of the circulatory system (51.2%),

5
followed by that of the musculoskeletal system and connective tissues disorders

(45.7%).12

A study conducted on Morbidity Pattern among the Elderly Population in the

Rural Area of Tamil Nadu, at Pondicherry Institute of Medical Sciences, Kalapet on

a sample size of 320 rural elderly people concluded that Pain in the joints and joint

stiffness was the most common cause of morbidity (139) accounting for about

43.4%.13

A study conducted on morbidity pattern among geriatric population in an

urban area of Udaipur Rajasthan R.N.T. Medical College on a sample size of 300

elderly peoples having 60 and above age showed that musculoskeletal problem was

present in 11.6% and 20% males and females respectively.14

A longitudinal study conducted on joint pain among older people at United

Kingdom on 4804 subjects over 75 years concluded that joint pain is very common in

older people.15

Thus most common problem faced by elderly people in their old age is related

to musculoskeletal system like joint pain, aches and stiffness. By reviewing the

literature Foot bath is one of the oldest, cheapest and safest nursing intervention used

for psychological well being. No Indian study is conducted on foot bath. Hence the

student researcher felt to assess the effectiveness of footbath in reducing selected joint

pain among elderly people.

6.2. REVIEW OF LITERATURE:

6
 A comparison study was conducted on the effect of nursing care using

footbath, foot massage and foot massage combined with footbath for relaxation at

Japan Academy of Nursing Science, Osaka University. The purpose of this study was

to investigate the relaxation response of subjects to footbath, foot massage, and foot

massage combined with footbath compared with that of control group. Ten subjects’

(mean age 72) physiological data (heart rate and foot skin temperature) were

continuously measured and subjective comfort data were obtained before care,

immediately after care, and 120m after care. The comparisons were performed with

one way ANOVA, Tukey's test and the Friedman test. The study result suggested that

these forms of care generate the relaxation response as shown by the decrease in heart

rate and the increase in foot skin temperature contributing to psychological and

physiological well-being.16

A study was carried on Effects of the footbath on tympanic temperature, sweat

rate, blood pressure, and heart rate among the elderly person at Nagoya University

School of Health. The subjects of the study were nine elderly persons for foot bathing

(average 73.5 years old) and 10 elderly persons for full bathing (average 77.4 years

old). The tympanic temperature was measured using a thermistor, sweat rate using the

ventral capsule method, and blood pressure and heart rate using an autonomic

sphygmomanometer during control period 10 minutes before bathing, for 20 minutes

during bathing, and for 10 minutes after bathing. The study concluded that the

footbath is safe, does not cause any change in blood pressure and is expected to

provide mild warming for the elderly.17

A study was conducted on the effects of Wrapped Warm on the autonomic

nervous system and psychoneuroimmunological activities among terminal cancer

inpatients at Yokohama City University, Japan. The subjects of this study were 18

7
cancer inpatients divided into a footbath group (n=9) and a control group (n=9). The

subjects received the footbath for 30 min and the control group were measured in

supine position without the footbath. Heart rate variability (HRV) analysis by every

second with wavelet transformation was used for evaluation of the autonomic,

sympathetic and parasympathetic activities. Salivary secretory immunoglobulin

(sIgA) and salivary cortisol levels were used as neuroimmunological parameters.

Psychological conditions were measured using a Visual Analogue Scale (VAS) and

Face Scale (FS).The study concluded that the patients in the footbath group were

significantly relaxed and tended to be relieved from pain.18

The study was conducted to explore the effects of warm footbath on heart rate

variability and body temperature on seventeen middle aged female volunteers. A

cross-over comparison research design and convenience sampling methods were used.

Every subject underwent two-days-two-stages measurement of heart rate variability

and body temperatures (ear temperature, finger temperature, and infrared thermal

imager’s finger and foot temperature). There was no intervention on the first day of

experiment. On the second day, 20 minutes of 42°C footbath, heart rate variability and

body temperature measurements were recorded every 5 minutes for a total of 40

minutes. After collection of data, SPSS 12.0 Windows statistical software was used

for data processing and statistical analysis. The result of the study showed that warm

footbath can change heart rate variability and body temperature and the subjects

experienced relaxing, comfortable, and warm sensation.19

An article published on Foot bath in Amazing Health, an affiliated website of

Canada, which believe that "an ounce of prevention is worth a pound of cure provides

an Information regarding many natural remedies for managing the pain. One among

such method is the use of hot foot bath. A hot foot bath is a local immersion bath

8
covering the feet and ankles at temperatures ranging from 100° to 115° F (43°C-

46°C). Foot bath treatment can help to relieve pain anywhere in the body from

toothache to backache. Hot foot baths increase blood flow through the entire skin

surface, relieving congestion in internal organs and brain. This type of bath also

elevates the body temperature, relaxes tense muscles and there by relieves the pain.20

An article published in Hot Foot Bath – Good for Health states that a foot bath

relaxes the feet in addition to providing health benefits. Feet are soaked in a free-

standing foot bath in a container. Salts and essential oils can be added to foot bath for

additional therapeutic effects. Pain relief is a benefit of Warm foot bath.21

STATEMENT OF THE PROBLEM:

“A quasi experimental study to assess the effectiveness of foot bath in reducing

selected joint pain among elderly people, residing in selected urban community

areas, Bangalore”.

6.3. OBJECTIVES:

 To assess the pre test and post test level of selected joint pain among elderly

people of experimental and control group.

 To compare the difference between pretest and post test pain scores of

experimental group.

 To compare the difference between pretest and post test pain scores of control

group.

 To compare the difference between the post test level of selected joint pain

among experimental and control group.

 To find the association between post test level of pain and selected socio

demographic variables of experimental group.

9
  To find the association between post test level of pain and selected socio

demographic variables of control group.

6.4. HYPOTHESES:

H01: there is no statistically significant difference between the pre test and post

test level of selected joint pain among elderly people in experimental and

control group.

H02: there is no statistically significant difference between the pre test and post

test pain scores of experimental group.

H03: there is no statistically significant difference between the pre test and post

test pain scores of control group.

H04: there is no statistically significant difference between the post test pain

scores of experimental and control group.

H05: there is no statistically significant association between post test level of

pain and selected socio demographic variables of experimental group.

H06: there is no statistically significant association between post test level of

pain and selected socio demographic variables of control group.

6.5. OPERATIONAL DEFINITION:

Effectiveness: refers to the extent to which footbath reduces the level of joint

pain experienced by the elderly people, as observed by decrease in the post

test score, which is assessed using modified functional pain scale.

Foot bath: refers to the procedure which as follows:

a. Explain procedure to the patient.

b. Assemble the materials [foot tub or container or bucket, Thermometer

to test the water temperature (100° and 115° F),Sheet or blanket to

10
 drape, washcloth for cold compress, material for protection of the bed,

if needed).
c. Fill bucket with water of 100° F to 115° F (43°C- 46°C )
d. Elderly person is asked to drink 1-2 glasses of warm water.
e. Assist patient to immerse the legs up to the calf or knee in the warm

water in tub.
f. A blanket is wrapped around in order to prevent the heat loss and the

head is protected with a cold compress.

g. Treatment is carried out for about 15 minutes.
h. The feet is then washed with cold water and wiped with a towel.
Selected Joint Pain: refers to subjective reporting of the pain in the ankle

and/or knee joint by the elderly people residing in selected urban community

areas, Bangalore.
Elderly people: An individual whose age is 60 years and above of both

gender having ankle and/or knee joint pain residing at selected urban

community areas, Bangalore.

6.6. ASSUMPTIONS:

 Elderly people perceive that joint pain is common during old age.

 Foot bath may be effective in reducing selected joint pain among the

elderly people having joint pain.

 Selected Joint pain if not given attention may affect the activities of daily

living.

6.7. DELIMITATIONS:

 Study is delimited to people of age group of 60 years and above having

ankle and/or knee joint pain residing at selected urban community areas,

Bangalore.

 Study is delimited for a period of four weeks of data collection.

7. MATERIALS AND METHODS:

7.1. Source of Data:

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  People of age group of 60 years and above residing at selected urban

community areas, Bangalore.

7.2. Methods of data collection:

7.2.1. Type of study/Research approach: Evaluative study.

7.2.2. Research design: Non equivalent control group pre test post test design.

7.2.3. Variables:

Independent variable: Foot bath.

Dependent variable: Selected Joint pain.

Attribute variables: age, gender, marital status, religion, educational qualification,

occupation(if working), type of family, family monthly income, location of pain,

duration of pain, pain interfere with sleeping, pain interfere with activities of daily

living, pain interfere with social life (going out, eating with friends, etc.) .

7.2.4. Sampling technique: snow ball sampling.

7.2.5. Sample and Sample size: Total 30 elderly people with joint pain who fulfil the

selection criteria (15 elderly people in control group and 15 elderly people in

experimental group)

7.2.6. Selection criteria:

Inclusion criteria:

Elderly people who are:

 Willing to participate in the study.

 60 years and above.
 Having knee and/or ankle joint pain.
 Residing in selected urban community areas, Bangalore.
 Can read and respond either kannada or English.

Exclusion criteria:

Elderly people who are:

 Not available during the period of data collection.

12
  On analgesic medication.
 Diagnosed to have cardiovascular disease (Arteriosclerosis, vascular disease

of the feet and legs, or a loss of sensation in the feet or legs), Buerger’s

disease, Insulin-dependent diabetes, under gone any knee surgery, skin

diseases.

7.2.7. Follow up:

Post test will be conducted two weeks after pre test for both experimental group and

control group

7.2.8. Comparison parameter:

The pre test and post test level of selected joint pain will be compared with in

the group and between the groups.

7.2.9. Duration of the study: Four weeks of data collection.

7.2.10. Tools/Instruments:

Section A: Socio demographic variables which include age, gender, marital status,

religion, educational qualification, occupation(if working), type of family, family

monthly income, location of pain, duration of pain, pain interfere with sleeping, pain

interfere with activities of daily living, pain interfere with social life (going out, eating

with friends, etc.)

Section B: Modified Functional pain scale to assess the level of selected joint pain

among elderly people having joint pain.

7.2.11. Data collection procedure:

Formal permission will be obtained from the concerned authority. The student

researcher introduces self and purpose of the study. The elderly people having joint

pain will be selected using snow ball sampling and assigned to experimental and

13
control group. Written consent will be obtained from the elderly people. Pre test will

be conducted by using modified Functional pain scale for both the groups. Footbath

will be provided to the elderly people in the experimental group for three consecutive

days for about two weeks. Post test will be conducted for both groups using the same

scale after the two weeks of pre test.

7.2.12. Plan for statistical analysis:

The data obtained will be analysed in terms of the objective of the study using

descriptive and inferential statistics. The plan of data analysis is as follows.

Descriptive statistics:

 Frequency and percentage distribution will be used to describe the socio

demographic variables and level of pain.

 Mean, mean percentage and standard deviation will be used to describe pre

test and post test level of pain.

Inferential statistics:

 Paired t test will be used to compare pre test scores with the post test scores of

each group.

 Student t-test to compare pre test scores and post test scores of experimental

group with the control group.

 Chi-square will be used to determine association between post test level of

joint pain and selected socio demographic variables.

7.3. Does the study require any investigation or interventions to be conducted on

patients or others humans? If so, please describe briefly.

Yes, the Modified Functional pain scale is administered for both the groups to

assess the pre test and post test level of selected joint pain and foot bath will be

administered for the experimental group.

14
7.4. Has ethical clearance been obtained from your institution in case of 7.3?

Ethical clearance will be obtained from the ethical committee and written

consent will be taken from the elderly people. Confidentiality and anonymity of the

subjects will be maintained.

8. LIST OF REFERENCES

1. Ms.Yuman Hussain. The problem of old age in India [online]. 2010 [cited

2010 Nov 18]; Available from: URL:http://azadindia.org/social-

issues/problem-of-old-age-in-india.html

2. Laura Inverarity D.O. Physical therapy [Online]. 2005 Aug 13 [cited 2010

Nov 20]; Available from:

URL:http://physicaltherapy.about.com/od/abbreviationsandterms/g/Geriatrics.

htm

3. Rajiv Khandekar, Asiya Al Riyami, Mahmood Attiya, Magdi Morsi.

Prevalence and determinants of blindness, low vision, deafness and major

bone fractures among elderly. Indian journal of ophthalmology 2010 June

7;58(4):313-320.

15
4. Priyanka Parab. Changes in old age [Online]. [cited 2010 Nov 25]; Available

from: URL:http://www.medimanage.com/my-parents-health/articles/Changes-

in-old age.aspx
5. Ross and Wilson. Anatomy and Physiology in Health and Illness. 9th ed. New

York(London): Elsevier science limited; 2003. p. 415.

6. LindaWilliams S, PaulaHopper D. Understanding Medical Surgical Nursing.

2nd ed. United States of America: F. A. Davis Company; p. 210-211.

7. PatriciaDillon M. Nursing Health Assessment: A critical thinking Case studies

approach. 2nd ed. United States of America: Lisa B. Deitch publishers; 2007. p.

88-89.
8. Hydro therapy – Water Therapy. Indian Ayurveda Yoga [serial online] [cited

2010 Oct 25]; Available from: URL:http://indianayurvedayoga.com/methods-

procedures-used-in-ayurveda-treatments/hydro-therapy-water-therapy.html
9. Samm Kweku Richardson. Water as Medicine [Online]. 2010 Feb [cited 2010

Nov 13]; Available from:

URL:http://www.positivehealth.com/articles/naturopathy/2744
10. Gopal K Ingle, Anita Nath. Geriatric Health in India: Concerns and Solutions.

Indian Journal of Community Medicine [serial online]. 2008 Jul 1[cited 2010

Nov 23]; Available from: URL: http://www.ijcm.org.in/article.asp?issn=0970-

0218;year=2008;volume=33;issue=4;spage=214;epage=218;aulast=Ingle
11. Ashish Bose. Demographic transition [Online]. [cited 2010 Nov 26];

Available from:
URL:http://www.india seminar.com/2000/488/488%20bose.htm
12. Bhatia SPS, Swami HM, Thakur JS, Bhatia V. A study of health problems and

loneliness among the elderly. Indian Journal of Community Medicine 2007

May 4;32(4): 255-258.

13. Anil Jacob Purty, Joy Bazroy, Malini Kar, Kavita Vasudevan, Anita Veliath,

Purushottam Panda. Morbidity pattern among the elderly population in the

rural area of Tamil Nadu. Indian Journal of Community Medicine 2006;36(1):

45-50.

16
14. Rahul Prakash, S.K. Choudhary, Uday Shankar Singh. A study of morbidity

pattern among geriatric population in an urban area of Udaipur Rajasthan.

Indian Journal of Community Medicine 2004;29(1): 35-40.

15. Donald IP, Foy C. A longitudinal study of joint pain in older people. Oxford

Journals 2004 June 4;43(10): 1256-1260.

16. Nitta N, Aso Y, Kawabata K. A comparison of the effect of nursing care using

footbath, foot massage and foot massage combined with footbath for

relaxation. Science Links Japan 2002;22(4):55-63.

17. Miwa C, Sugimura K, Shiraishi N, Tanaka N, Kawamura Y, Deguchi A, et.al.

Effects of the footbath on tympanic temperature sweat rate, blood pressure,

and heart rate in the elderly person. Science Links Japan 2007;70(2): 84-8.
18. K. Yamamotoa, Y. Asob, S. Nagatac, K. Kasugaid, S. Maedae. The effects of

wrapped warm footbath on the Autonomic nervous and psycho neuro

immunological Activities in terminal cancer inpatients. Science Links Japan

2008; 14(3):195-203.

19. Chun-Hou Huang. Effect of Warm Footbath on Heart Rate Variability and

Body temperature in the Middle Women. Science Links Japan 2009.

20. Joe and Elsa Willis. Foot Bath [Online]. 2005 [cited 2010 Nov 28]; Available

from: URL:http://www.amazinghealth.com/AH-natural-remedies-

foot_bath.html.
21. Sarah Thomas. What Are the Benefits of a Footbath [Online]. 2010 July 22

[cited 2010 Oct 24]; Available from:

URL:http://www.ehow.com/list_6030078_benefits-foot bath_.html.

17
9. SIGNATURE OF THE

CANDIDATE:

10. REMARKS OF THE GUIDE: At present elderly population are

increasing. Musculoskeletal problem is
commonly seen among elderly people.
Foot bath is one of nursing intervention to
relieve the ankle and knee joint pain. It
improves the quality of life. The study is
suitable for community setting and it is
feasible and practicable.
11. NAME AND DESIGNATION Mrs. MALATHI

11.1 GUIDE: LECTURER,

MEDICAL SURGICAL NURSING

11.2 SIGNATURE:

11.3 Co-GUIDE(if any):

11.4 SIGNATURE:

11.5 HEAD OF THE Mrs. SALOME.P

DEPARTMENT: LECTURER,

MEDICAL SURGICAL NURSING

11.6 SIGNATURE:

18
12.1 REMARKS OF THE The present study is feasible and
practicable. Foot bath is one of the oldest,
PRINCIPAL:
safest and cheapest nursing intervention
for relieving the ankle and knee joint pain,
thus improving the psychological well
being of elderly people.
12.2 SIGNATURE:

19