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PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
M.MUTHU LAKSHMI
I YEAR M. Sc NURSING
MEDICAL SURGICAL NURSING
YEAR 2010 -2011
IKON NURSING COLLEGE, BIDADI
BANGALORE - MYSORE ROAD
RAMANAGARAM TALUKA
BANGALORE – 562109
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1NAME OF THE CANDIDATE AND ADDRESS
M.MUTHU LAKSHMII YEAR M. Sc NURSING IKON NURSING COLLEGENO.32. BEEMANHALLIBIDADI – 562109BANGALORE- MYSORE ROADRAMANAGARAM TALUKA
2 NAME OF THE INSTITUTION IKON NURSING COLLEGE,Bangalore
3 COURSE OF THE STUDY AND SUBJECT
I Year M.Sc NursingMedical Surgical Nursing
4 DATE OF ADMISSION 10:05:2010.
5 TITLE OF THE TOPIC “A study to Assess the Effectiveness of Structured Teaching Programme on Knowledge and skill regarding the life style practices of individual with lower limb fracture in selected hospital”, Bangalore.
1
6 BRIEF RESUME OF THE INTENDED WORK
6.1 INTRODUCTION:
The lower leg is the bottom segment of the leg: the part below the knee. The lower leg
contains two long bones. The larger of these two bones is the tibia, the smaller one the fibula.
The tibia is familiarly known as the shinbone. "Tibia" is a Latin word meaning both shinbone
and flute. It is thought that "tibia" refers to both musical instrument because flutes were once
fashioned from the tibia. The fibula runs alongside the tibia. The word "fibula" is a Latin word
that designates a clasp or brooch. The fibula was likened by the ancients to a clasp attaching it
to the tibia to form a brooch.
Lower leg fractures include fractures of the tibia and fibula. Of these two bones,
the tibia is the only weight bearing bone. Fractures of the tibia generally are associated with
fibula fracture, because the force is transmitted along the inter osseous membrane to the
fibula.1
The skin and subcutaneous tissue are very thin over the anterior and medial tibia and
as a result of this,a significant number of fractures to the lower leg are open. Even in closed
fractures, the thin, soft tissue can become compromised. In contrast, the fibula is well covered
by soft tissue over most of its course with the exception of the lateral malleolus.
Drugs used to treat fractures include non steroidal anti-inflammatory agents and
analgesics. In addition, administer proper antibiotics and tetanus prophylaxis for open
fractures.
Mechanisms of injury for tibia-fibula fractures can be divided into 2 categories:
Low-energy injuries such as ground levels falls and athletic injuries
High-energy injuries such as motor vehicle injuries, pedestrians struck by motor
vehicles, and gunshot wounds.
2
Patient may report a history of direct (motor vehicle crash or axial loading) or indirect
(twisting) trauma. Patient may complain of pain, swelling, and inability to ambulate with tibia
fracture. Ambulation is possible with isolated fibula fracture.
When examining a patient for a lower leg fracture one should first examine the patient
for edema, ecchymosis, and point tenderness. Gross deformities should be noted and splinted.
A careful neurovascular assessment should be performed, and an emergent fracture reduction
should be performed if neurovascular deficits are present. A careful examination should be
performed for open wounds. Open fractures require antibiotics and an emergent orthopedic
consultation.The techniques for the stabilisation of these fractures include immobilization in
a cast, external fixators and internal fixation with plates and screws or intramedullary (IM)
nailing. The risks and benefits of each method of fixation are discussed. Wound management
should involve orthopaedic and plastic surgeons.2
Once the patient is stable an assessment of the limb can be made. The wound should
be carefully inspected and a photograph of the wound taken. Gross contamination should be
noted and blistering, contusion, crushed areas of the skin and burns reflect the transfer of large
amounts of energy to the limb (Olson 1996).
The vascular and neurological status of the limb should be assessed as open fractures
are more commonly associated with neuro-vascular damage. This should include examination
of limb colour and warmth, an examination of the pulses distal to the injury, a measurement of
the capillary refill time (normally <3 seconds) and a record of any active bleeding from the
wound site (Giannoudis 2006). A detailed neurological examination should determine the
sensory and motor function. . The environmental exposure should be recorded. It is important
to document the history and physical findings properly, and to prevent further contamination
the wound should remain covered with sterile dressing, until the is taken to the operation
theatre.3
3
Many studies have looked at the treatment of open fractures with antibiotics and the
benefit of antibiotic therapy (Giannoudis 2006). The current recommendations are a second
generation cephalosporin for 48 to 72 hours for type I fractures. For type II and III fractures a
combination of second-generation cephalosporin with an aminoglycoside offers the best
protection against most Gram positive and Gram negative bacteria. The addition of penicillin
is recommended for fracture.
The treatment of open fractures requires the simultaneous management of both
skeletal and soft tissue injury. Controlling the instability of the bone provides a number of
benefits. Options include immobilisation in a cast, external fixators and internal fixation with
plates and screws or intramedullary (IM) nailing The management of the wound should be
carried out by a Consultant Plastic Surgeon and the management of open tibial fractures
requires cooperation between consultant orthopaedic surgeon and plastic surgeon Optimal
treatment involves appropriate initial evaluation and administration of antibiotics, urgent
operative debridement and skeletal stabilisation (usually by IM nailing or external fixator).
Repeated soft tissue debridement may be required and soft tissue closure or flap coverage.3
6.2. NEED FOR THE STUDY:
. Road traffic crashes (RTCs) are a growing problem worldwide accounting for around
1.2 million deaths and over 50 million injuries annually. It is expected that by the year 2020
they will rank third in the Global Burden of Diseases . To emphasize on the growing
importance of preventing RTCs, World Health Organization had declared "Safe Roads" as the
theme for World Health Day 2004.
India has just 1% of the total vehicles in the world but it contributes to 6% of the global
RTCs Estimates suggest that Delhi has the highest number of road crash fatalities in India.
Data regarding the socio-demographic and injury profile of victims of RTCs in Delhi may
therefore, help policy makers to evolve programmes aimed at prevention of RTCs and
provision of immediate care for victims of RTCs.4
4
In United States Fractures of the tibia are the most common long bone fractures. The
annual incidence of open fractures of long bones is estimated to be 11.5 100,000 persons, with
40% occurring in the lower limb.The most common fracture of the lower limb occurs at the
tibial diaphysis. Limb loss may occur as a result of severe soft-tissue trauma, neurovascular
compromise, popliteal artery injury, compartment syndrome, or infection such as gangrene or
osteomyelitis. Popliteal artery injury is a particularly serious injury that threatens the limb and
is easily over looked.5
Open fractures require debridement and irrigation in operating room. Inpatient
admission may be advised to observe development of compartment syndrome. Continuous
compartment pressure monitoring in asymptomatic patients with tibia fractures is not
recommended. Patient should see primary care physician or be referred to an orthopedic
surgeon within 1week for further evaluation and treatment of isolated fibula fractures.
Reconstruction of osseous and soft tissue defects after high-energy lower extremity
trauma remains a challenge in trauma surgery. . A variety of local, regional, and even free
microvascular flaps are available for acute wound closure in such cases. Staged reconstruction
with initial external fixation and vacuum-assisted wound closure is recommended for severe
contaminated wounds and extended defects with a modern therapeutic strategy limb salvage
with an adequate function after reconstruction of lower extremity fractures with soft tissue
defects can be achieved in the majority of patients.
Open lower extremity fractures with exposed bone and extensive soft tissue defect have
a high incidence of mal-union, infection and non-union. Severe wound contamination is the
main indication of a staged soft tissue reconstruction. In those cases, a primary thorough
debridement and vacuum-assisted sponge closure is preferable in order to decrease the rate of
severe soft tissue complications. The use of vacuum-assisted closure therapy has increased
dramatically within the past few years. Its main advantages are the removal of excessive
edema, the increase in blood flow, the decrease of the amount of bacteria, and the increased
rate of granulation tissue formation.
5
This 28-year old male suffered from significant soft and bone defects after a
vehicle accident. Primary attempts to reconstruct the bone and soft tissue led to wound
infection resulting in a 15 cm bone loss and significant skin defect . Soft tissue reconstruction
was performed with a latissimus dorsi free flap. The artery and vein were connected to the
distal femoral vessels above the knee joint. The bone defect was closed with segmental bone
transfer using an intramedullary nail in combination with external fixation After 4 months the
bone defect was closed. Full weight bearing could be achieved after another 8months.This 16-
year-old male suffered from a motor vehicle accident. Primary surgical procedures could not
prevent soft tissue infection and loss of 17 cm bone.3
Falls and fall-related injuries, such as fractures, are a growing problem among
older adults, often causing longstanding pain, functional impairments, reduced quality of life
and excess health-care costs and mortality. These problems have led to a variety of single
component or multi component intervention strategies to prevent falls and subsequent injuries.
The most effective physical therapy approach for the prevention of falls and fractures in
community-dwelling older adults is regular multi component exercise; a combination of
balance and strength training has shown the most success.
Home-hazard assessment and modification, as well as assistive devices, such as canes
and walkers, might be useful for older people at a high risk of falls. Hip protectors are
effective in nursing home residents and potentially among other high-risk individuals. In
addition, use of anti-slip shoe devices in icy conditions seems beneficial for older people
walking outdoors. To be effective, multi factorial preventive programs should include an
exercise component accompanied by individually tailored measures focused on high-risk
populations.
In this Review, we focus on evidence-based physical therapy approaches, including
exercise, vibration training and improvements of safety at home and during periods of
6
mobility. Additionally, the benefits of multifaceted interventions, which include risk factor
assessment, dietary supplements, elements of physical therapy and exercise, are addressed.6
A prospective one year outcome study of 64 patients, average age 46years
treated by routine methods showed that about 50% of patients still had functional limitations
due to the fracture and also had reduced quality of life parameters with 42% of patients
experiencing problems with employment and 65% struggling with leisure activities. This
disability was not correlated to specific complications, which were rare.
The frequency of open long bone fractures is approximately 11.5 per 100 000 persons
per year (Court-Brown 1998). The majority of these fractures are open tibial diaphyseal
fractures, of which about 60% are Gustilo type III . If one accepts the British Orthopaedic
Association figure of about 241 000 patients for each District General Hospital in the UK and
that surgeons have a 1:5 on-call rota the average orthopaedic surgeon will see five open long
bone fractures annually, of which two will be of the tibial diaphysis and one will be Gustilo
type IIIb in severity . The leading causes of open fractures of the tibial diaphysis is motor
vehicle accidents followed by falls and accidents on the stairs.7
Nonunion is a fairly common complication of fracture management, with an overall
rate of about 3% for the skeleton as a whole and 9% for the tibia. High-energy injury fractures
have a nonunion rate as high as 75%. Other factors that may lead to nonunion are
inappropriate treatment, infection, and preexisting disease. Plain radiographs and tomograms,
computed tomograms, and contrast imaging may be used to confirm non healing. Radionuclide
imaging can help determine the presence of infection, an impaired blood supply, or impaired
osteogenic activity at the fracture site. The treatment of ununited fractures is based on the
principles of good fracture management: adequate immobilization, asepsis and soft tissue
cover,osteoconduction,osteoinduction,and metabolic well-being.8
So the investigator’s main intension or motive behind this study is that there are clients
with lower limb fracture clients have lack of knowledge and skill regarding life style practices
to manage their all needs by themselves. So the investigator took interest to do some
7
investigation in this side by which she can assess the knowledge and skill of the lower limb
fracture clients.
6.3 STATEMENT OF THE PROBLEM
“A study to assess the effectiveness of structured teaching programme on
knowledge and skill regarding the life style practices of individual with lower limb
fracture in selected hospital,Bangalore.
6.4 OBJECTIVES
To assess the knowledge and skill level of lower limb fracture clients regarding life
style practices.
.
To administer the structured teaching programme for the lower limb fracture clients in
selected hospitals about life style practices.
To evaluate the effectiveness of structured teaching programme on knowledge and skill
regarding life style practices during lower limb fracture.
To find out the association between knowledge and skill regarding life style practices
during lower limb fracture among the clients with selected socio demographic
variables.
6.5 OPERATIONAL DEFINITIONS
Assessment:
8
It is to assess the level of knowledge and skill regarding life style practices.
Effectiveness:
It refers to the extent to which the structured teaching programme on life style
practices achieved. The desired effect in improving the knowledge and practices of
lower limb fracture clients as evident from gain in the knowledge and change in the
practice.
Structured Teaching Programme:
It refers to systematically developed instruction designed to provide
information regarding life style practices of lower limb fracture clients.
Life style adaptations:
Life style adaptation means adopting activities that control the fracture
complications, improving clients knowledge and of lower limb fracture clients self care
practices.
.
Lower limb fracture:
Fracture is a distruption or break in the continuity of the structure of bone.
Based on anatomic location of fracture in the involved bone, lower limb fracture
indicates the fracture occurred in lower limb bones.
6.6 ASSUMPTIONS OF THE STUDY
1. Fracture clients may have limited knowledge and practice related to life style
modifications. 9
2. Lower limb fracture client’s knowledge and practice can be modified through
structured teaching programme.
3. The level of lower limb fracture client’s knowledge and practice can be measured by
using a structured interview schedule.
6.7 HYPOTHESIS
H1: There will be significant difference between pretest and post test knowledge score
regarding life style practices during lower limb fracture.
H2: There will be significant association between the knowledge of the lower limb
fracture clients with selected demographic variables regarding life style practices .
6.8 REVIEW OF LITERATURE
The literature review involves the systematic identification, location,
scrutiny and summary of written material that contains information or the
research problem. The investigator followed these steps in review of related
research and non research literature to broaden the understanding and to gain a
better insight into the selected problem under study.
Literature review done for the study is presented under the following heading:
1. Studies related to general information regarding the orthopedic trauma.
2. Studies related to risk factors and nutritional needs for lower limb fractures.
3. Studies related to knowledge regarding treatment modalities for lower limb fracture.
10
1. Studies related to general information regarding the orthopedic trauma:
Some recent studies have suggested that certain types of orthopedic trauma result in
ongoing disability and that factors other than injury severity or location may influence
outcome. This study aimed to evaluate outcome 12 months and 2 years after severe orthopedic
trauma, as measured on the Short Form-36 Health Survey, relative to a control group, to
examine change over time and to examine which demographic data, injury- related and
psychological factors are associated with persisting disability. Results indicated presence of
significant ongoing disability in all SF-36 physical and mental health domains, significant
ongoing psychologic adjustment problems, including post traumatic disorder symptoms, and
pain, with little or no improvement between 1 or 2 years post injury, although those with lower
limb fractures had greater pain and poorer physical outcomes that those with fractures in other
locations.9
A study was conducted to estimate the incidence of lower limb fractures in the
United Kingdom and assess the relative importance of various risk factors for lower limb
fractures. Individuals registered with these general practices who were at risk for a first time
lower limb fracture from 1 January1990 to 31 December 2001. Overall, the risk of lower limb
fracture was 17% higher in women than in men. Within age groups, men and women had
generally similar proportions of fractures at specific sites in the lower limb. Among the risk
factors evaluated, road collisions were associated with the highest relative risk for lower limb
fracture, but only accounted for 3.1% or less of the population attributable risk for specific
fracture types in any age group. The relative risk for lower limb fracture associated with a
diagnosis of dementia was 2.3 (95% confidence interval 2.0 to 2.6), while relative risk
estimates for other medical diagnoses were less than 2. Fracture risk was increased among
current users of corticosteroids, antipsychotics, antidepressants, and hypnotic/sedatives, but the
population attributable risks for each of these drug classes within fracture and age specific
strata were only 3.0% or less.10
11
A study concentrated on analysis of the arterial/venous relationship on the most distal
vessels on the medial aspect of the lower limbs (the vascular basis for the commonly used
distally based fasciocutaneous flap). The researchers found that 25 of these arteries were
accompanied by one perforating vein whereas 12 were accompanied by two or more veins.
When there was a single vein this was usually larger than the artery in external diameter and
lay inferior to the artery 76% of the time. When there were two veins or more, there was an
interconnection between the two around the artery in over half of the samples (7/12).
Surprisingly, three vessels did not have any accompanying vein. This study sheds some light
on the variation in venous drainage important to the initial survival of these flap transfers.11
2. Studies related to risk factors and nutritional needs for lower limb fracture:
A study was conducted regarding improving lower limb salvage following fractures
with vascular injury. Lower limb fractures with vascular injuries are associated with a high
rate of secondary amputation. Reducing ischaemic time for limb salvage. A total of 101 cases
described in 10 publications [median age:31 ;range:2.5-76]were suitable for analysis. The
mean MESS was 4.2.The limb-salvage rate with an ischemic time of less than 6h was 87%,
falling to 61% when ischaemic time exceeded 6h.The rate of re-vascularisation within 6h
improved from 46% to 90% with the use of a shunt, with a mean ischaemic time of 3.8h.The
amputation rate of 27% was reduced to 13% by using shunts. Early recognition of vascular
injury is vital. A vascular shunt can significantly reduce ischaemic time,enabling unhurried
assessment of the feasibility of limb salvage, debridement of demonstrably non-variable tissue
and safe skeletal fixation prior to definitive vascular and soft-tissue repair.12
A study was conducted regarding physiological responses to exercise in patients
folowing fracture of the lower limb.25 patients with healed fractures of the lower limb and 9
control subjects were measured anthropometrically and during maximal and sub maximal one-
and two leg exercise. Oxygen intake at a given sub maximal work level of 450 kmp min-1 and
cardiac frequency at an oxygen intake of 1.51 min-1 were significantly higher in the injured
compared with the uninjured limbs of the patients and normal subjects. The maximum aerobic
power of the injured and uninjured limbs of the patients were 18.8% and 25.6% respectively
12
lower than the right and left legs of the control subjects. The corresponding value for 2-leg
work was 17.6%.The deterioration in 1-leg performance of the patients was associated with a
concomitant decrease in leg muscle volume.13
A cross-sectional and longituidinal study was conducted in a population-based sample
of 1077 women aged 75y. At baseline, protein consumption was measured with a food-
frequency questionnaire, and bone mass and structure were measured by using quantitative
ultrasound of the heel. One year later, bone mineral density [BMD] was measured by using
dual-energy X-ray absorptiometry. Subjects consumed a mean of 80.5g to 108.3g protein per
day. Regression analysis showed a positive correlation between protein intake and bone
mineral density after adjustment for age, body mass index, and other nutrients.14
A study was conducted to provide a detailed evaluation of adherence to nutrition
supplements by patients with a lower limb fracture.These descriptive data are from 49
nutritionally “at-risk” patients aged 70+ years admitted to the hospital after a fall-related lower
limb fracture and allocated to receive supplementation as part of a randomized, controlled trial.
Supplementation commenced on day 7 and continued for 42 days. Prescribed volumes aimed
to meet 45% of individually estimated theoretical energy requirements to meet the shortfall
between literature estimates of energy intake and requirements. Median daily percent of the
supplement consumed averaged over the 42 days was 67%. There was no difference in
adherence for gender, accommodation, cognition, or whether the supplement was self-
administered or supervised. Twenty-three participants took some supplement every day, and a
further 12 missed <5 days. For these 35 “nonrefusers,” adherence was 82% (IQR, 65–93), and
they lost on average 0.7% (SD, 4.0%) of baseline weight over the 6 weeks of supplementation
compared with a loss of 5.5% (SD, 5.4%) in the “refusers” (n = 14, 29%), p = .003.15
A study was conducted to examine factors influencing return to work (RTW) following
severe fracture to a lower extremity. This prospective cohort study followed 312 individuals
treated for a lower extremity fracture at 3 level-1 trauma centers. After accounting for the
extent of impairment, characteristics of the patient that correlated with higher rates of RTW
included younger age, higher education, higher income, the presence of strong social support,
and employment in a white-collar job that was not physically demanding: Despite relatively
13
high rates of recovery, one quarter of persons with lower extremity fractures did not return to
work by the end of 1 year. The study was conducted to find out the socio-demographic profile,
pattern and severity of injuries sustained in road traffic crashes.16
A cross-sectional study was performed in the first six months of 2008 through
questionnaire on a sample of children from an outpatient clinic for pediatric fractures.
Differences in gender, anatomic site, circumstances and location of fracture occurrence,
behavioural lifestyle, and calcium intake were investigated among three different age classes
(pre-school children, school children, and adolescents).The sample consisted of 382 subjects
(2-14 years of age) sustaining a fracture after low or moderate trauma. Males were at a higher
risk of fractures than females; greater than two-thirds of injuries occurred after low-energy
trauma and the upper limb was more frequently involved. Fractures most frequently occurred
in homes (41.6%), followed by playgrounds and footpaths (26.2%), sports facilities (18.3%),
and educational facilities (13.9%), with gender differences existing only in adolescence.
Twenty-three percent of the subjects sustained one or more fractures in the past. The
percentage of recurrent fractures increased with age (p = 0.001), with a similar trend in both
genders.17
3. Studies related to knowledge regarding treatment modalities for lower limb fracture:
A study was conducted on Locked Intramedullary nailing for complex non-union of the
tibia fracture. A Ten patients with complex non-union of the tibia were treated by locked
intramedullary nailing. These patients had scarred skin as a result of initial severe open
fractures, multiple debridement or fasciotomies with external fixators and skin grafts applied.
Seven of the patients also had previous osteomyelitis or pin track infections. Fully pain-free
walking was achieved in all patients and radiological union in nine patients without the need
for a bone graft. Four patients developed infection after nailing, of which three resolved with
treatment.18
A study was conducted on the management in the author's vascular surgery unit of 32
patients who had arterial injuries associated with bone fractures in upper and lower extremities
14
have been reviewed. The majority (87.5%) were young patients: 24 had blunt and 8
penetrating injuries. 11 patients had life-threatening injuries, 17 had limb-threatening
ischemia and 4had neglected arterial injuries. 22 patients underwent preoperative
arteriography. A totalof 38 arteries and 20 major veins were treated by autogenous vein
interposition grafting(22); polytetrafluoroethylene grafts -(4); end-to-end anastomosis (19);
venous patch (6);ligation (8); arterial lavage with fasciotomy (8). Primary nerve repair was
performed in(5) out of (17) injured nerves. Skeletal fixation preceded vascular repair in 26
patients.The limb salvage rate was 85%.19
.
A study was conducted on 83 patients treated with intra medullary nailing followed up
for at least 3 years showed that bony healing was straight forward in 77% of patients but that
nearly a quarter needed 2 or more operations. 35% had knee pain at rest, 71% had difficulty
kneeling, and 16% still had some fracture site pain. The conclusion was that about 70% of
patients had “excellent” results. Looking at the more severe injuries, those with major soft
tissue damage, the results are worse. At an average of 7 years follow up, physical and
psychosocial functioning deteriorated, so that the functional results of saving and
reconstructing a badly damaged leg were no better than those for patients who had amputation
and prosthetic fitting.20
A study was conducted on the best long-term results of patients treated with hybrid
fixation using external fixation and screws are still not very good. At a minimum of 5 years
after surgery, 5 of 40 ankles (12.5%) had undergone a fusion operation for osteoarthritis.
Limited physical recreational activity was the norm (87% unable to run), and 50% of patients
had changed their job as a result of the injury. In a large study of 80 patients followed up for a
mean of 3.2 years, general heath as measured by SF-36 was poorer than age and sex-matched
controls. Significant stiffness, swelling, and pain were each reported in about a third of
patients. 43% of patients employed at the time of injury were unemployed post-injury, mostly
due to the fracture.15
A cross-sectional study was conducted on 185 road traffic crash victims at the casualty
of Lok Nayak Hospital from May 2003 to December 2003. The patients were interviewed
regarding their socio-demographic profile and the severity of injuries was judged using the 15
Injury Severity Scale Majority of subjects were between 15 to 44 years (63.8%) and males
(77.8%). Maximum number of cases were pedestrians (37.3%). Head and Neck injuries were
most common (57.3%) followed by lower extremity (52.4%). Fracture, dislocation, sprain or
strain was the most common pattern of injury among all the age groups, both sexes, all the
three types of road users, in all modes of accident and in all types of vehicles. About 92% of
the subjects had an injury severity score less than 25. Severity of injuries was greater among
pedestrians and in accidents involving an over speeding vehicle.21
After the study the researcher will know the level of knowledge of lower limb
fracture clients on the life style practices.Based on the study result,researcher can give
structured teaching progrmme regarding the topic and it will help to enhance the
knowledge of the samples.
7. MATERIALS AND METHODS
7.1 SOURCES OF DATA
The lower limb fracture clients admitted in the selected hospital, Bangalore.
7.2 METHODS OF COLLECTION OF DATA
Research Design: One group pretest and post test Quasi-experimental design
Research Variable
Dependent Variables : Knowledge of selected group regarding Life style practices.
Independent Variables : It includes the base line information such As age, sex,
religion, marital status, family income, family living area and previous information on lifestyle
practices of Lower limb fracture.
16
Setting of the study: Lower limb fracture clients who are admitted in
selected Hospital, Bangalore , Karnataka.
Population : Lower limb fracture clients those who are admitted in selected hospital,
Bangalore.
Sample Size : 60 clients
Criteria for sample selection :
Inclusion criteria
The lower limb fracture clients who are admitted in medical and
surgical ward in selected hospital.
The lower limb fracture clients who are willing to participate.
who can read and write Kannada or English
who are available during the time of data collection
Exclusion criteria
The lower limb fracture clients who are not willing to participate
who cannot read and write Kannada or English
who are not available during the time of data collection
Sampling Technique: Non probability convenience sampling technique is adopted for
selecting the sample.
Tools for data collection 17
Section A: The structured interview schedule to assess the demographic data of
lower limb fracture clients.
Section B: Self administered questions will be used to assess the knowledge of
the clients.
Methods of data collection:
Phase 1: After obtaining the permission from the significant authorities demographic
data will be assessed for 15 minutes, followed by which structured questionnaire will
be administered for 45 minutes to assess the knowledge of life style practices of lower
limb fracture clients admitted in medical and surgical ward of selected hospital.
Phase 2: Self administered structured questions will be used to assess the knowledge
and skill regarding life style practices of lower limb fracture clients.
Phase 3: Investigator may distribute the pamphlets at the end of the study based on the
results obtained.
Duration of the study: 4 week.
Plan for data analysis: Data collected will be analyzed by means of descriptive and
inferential statistics.
Descriptive statistics: Mean, percentage, Distribution and Standard Deviation will be used.
Inferential statistics: Correlation-co-efficient for correlating knowledge and skill of lower
limb fracture clients in life style practices.
And chi-square for association of the knowledge and skill with selected demographic
variable will be used.
Projected outcome: 18
After the study the researcher will know the level of knowledge and skill of lower limb
fracture clients regarding life style practices. Based on the study results researcher may
distribute pamphlets to lower limb fracture clients regarding life style practices.
7.3 Does the study requires any investigation or intervention to be
conducted onthe patients or other human beings or animals. If so please
describe briefly
Yes, in the form of structured teaching programme.The study will be conducted on
lower limb fracture clients in in-patient ward at selected hospital of Bangalore.
7.4 Has ethical clearance been obtained from your institution in case of the
above?
Yes, Ethical clearance has will be obtained from the institutions ethical committee.
8. LIST OF REFERENCES
1. Court-Brown CM, Rimmer S, Prakash U, McQueen MM. The epidemiology of open
long bone fractures. Injury.1998 Sep ; 29(7):529-34.
2. Howard M, Court-Brown CM. Epidemiology and management of open fractures of the
lower limb. Br J Hosp Med.1997 Jun 4-17 ; 57(11):582-87.
3. Parrett BM, Matros E, Pribaz JJ, et al. Lower extremity trautrends in the management
of soft-tissue reconstruction of open tibia-fibula fractures: Plast Reconstr Surg
2006;117: 1315–22 discussion 23-4.
19
4. Greebspan L. Mclellan BA, Grieg H. Abbreviated injury severity and injury severity
score L Ascoring Chart. J Trauma 1985: 25 (1): 60-64.
5. Gopal S, Majumder S, Batchelor AG, et al. Fix and flap: the radical orthopaedic and
plastic treatment of severe open fractures the tibia. J Bone Joint Surgery
Br 2000; 82:,959–66.
6. P Saija Karinkanta, Maarit Piirtola, Harri Sievänen, Kirsti Uusi-Rasi& Pekka
Kannus. Nature Reviews Endocrinology6, 2010 July:340
7. Bhandari M, Guyat GH, swiontkowsi MF, schemitsch EH. Treatment of open fractures
of the tibia.The journal of bone joint surgery 2001: 83-B:,62-68.
8. Gershuni DH, Pinsker R. Bone grafting for nonuation of fractures of the tibia: a
critical review. The journal of bone and joint surgery (American). 2005:87:1415-22.
9. Jennie Phd, Bridget MSCP. Journal of trauma, injury, infection and critical care.
vol. 64, issue 4, 2008 Apr ,pages 1001-09.
10. J.Kaye and H.Jick.Epidemiology of lower limb fractures in general practice in the
United Kingdom,Dec.2004;10[6]:368-74.
11. S.Ghali, N.Bowman. Department of plastic and reconstructive surgery, charing cross
hospital volume 58 ,issue 2005dec 3 ,1086-89
12. Fowlar. J. Macintyre : The importance of surgical sequence in the treatment of lower
extremity injuries with concomitant vascular injury 2009: Jan:40 (1) 72-6.
13. C.T.Davis , A.J.Sargiant. Physiological responses to exercise in patients following fracture
of the lower limb 1998, 128-33.
14. Dawson, Hughes. Calcium and protein in bone health, November 2003:62:505-09
20
15.Michelle D.Miller, MNutrDiet, Lynne A.Daniels Phd. Department of rehabitation and age
gap Austrialia 1989 mar,volume 240.
16. F.J.Clay, S.V.Newstead, A.D.Ella. First return to work following injury:2010 Nov
1 :67:730-36.
17. Jeffrey O.Anglen,MD.Department of orthopaedics,Indiana University,clinical chemistry
53;2007, 131-34.
18. K.J.O. Dwver, RD.Charkravarthy , intra medullary nailing technique and its effect on
union rates of tibial fracture injury ,volume 25, issue 7, 1994 Sep, 461-64
19. Abha,Saudi Arabia,postbox ,34.
20. Allan.C.Gaszioo.P,DelMarc,Bed rest a potentially harmful treatment needing more careful
evaluation,lancet,1999,354:1229-33
21.Jha N .Srinivasan , DK,Roy , G,Jagdish .S. Injury pattern among road traffic accident
cases:A study from South India. Indian journal of community Medicine 2003; 28(2):85-90.
9. Signature of Candidate :
10. Remarks of the Guide :
11. Name & Designation :
11.1 Guide :
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11.2 Signature :
11.3 Co-Guide (if any) :
11.4 Signature :
11.5 Head of Department :
11.6 Signature :
12.
12.1 Remarks of the Principal :
12.2 Signature :
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