2. STATEMENT OF PROBLEM
A STUDY TO ASSESS THE EFFECTIVENESS OF TOUCH THERAPY IN
REDUCING PAIN AMONG PATIENT ADMITTED IN ORTHOPAEDIC
SURGERY WARD IN SELECTED HOSPITAL AT BHIWANI.
3. OBJECTIVES OF THE STUDY
1. TO ASSESS THE PRETEST AND POSTTEST LEVEL OF PAIN AMONG PATIENTS UNDERGONE
ORTHOPAEDIC SURGERY IN THE CONTROL AND EXPERIMENTAL GROUP
2. TO EVALUATE THE EFFECTIVENESS OF TOUCH THERAPY ON THE LEVEL OF PAIN AMONG
PATIENTS UNDERGONE ORTHOPAEDIC SURGERY IN EXPERIMENTAL GROUP.
3. TO FIND OUT THE CORRELATION BETWEEN POSTTEST LEVEL OF PAIN AMONG PATIENTS
UNDERGONE ORTHOPAEDIC SURGERY IN EXPERIMENTAL GROUP AND CONTROL GROUP
4. TO FIND OUT THE ASSOCIATION BETWEEN POSTTEST TEST LEVEL OF PAIN AMONG
PATIENTS UNDERGONE ORTHOPAEDIC SURGERY AND WITH THEIR SELECTED
DEMOGRAPHIC VARIABLES IN CONTROL AND EXPERIMENTAL GROUP.
4. INTRODUCTION
"THE FIRST EMOTIONAL COMFORT, TOUCHING AND BEING TOUCHED BY OUR MOTHER, REMAINS THE
ULTIMATE MEMORY OF SELFLESS LOVE, WHICH STAYS WITH US LIFE LONG.“ -DIANE ACKERMAN
THE SKELETAL SYSTEM SERVES AS A FRAMEWORK FOR TISSUES AND ORGANS TO ATTACH
THEMSELVES TO. THIS SYSTEM ACTS AS A PROTECTIVE STRUCTURE FOR VITAL ORGANS. BONES AND
OTHER SKELETAL MATERIALS MUST BE RESISTANT TO SUCH STRESSES, OR THEY MAY BREAK OR DISTORT.
ORTHOPAEDIC SURGERY ADDRESSES AND ATTEMPTS TO CORRECT PROBLEMS THAT ARISE IN THE
SKELETON AND ITS ATTACHMENTS, THE LIGAMENTS AND TENDONS. IT MAY ALSO INCLUDE SOME
PROBLEMS OF THE NERVOUS SYSTEM, SUCH AS THOSE THAT ARISE FROM INJURY OF THE SPINE. THESE
PROBLEMS CAN OCCUR AT BIRTH, THROUGH INJURY, OR AS THE RESULT OF AGING. THEY MAY BE ACUTE,
AS IN AN ACCIDENT OR INJURY, OR CHRONIC, AS IN MANY PROBLEMS RELATED TO AGING.
IN THIS STUDY, THE LINK BETWEEN INTENTION, PHYSICAL TOUCH, AND THEIR HEALING
CAPACITIES WAS OF PRIMARY INTEREST. RESEARCHER FOCUSES ON PAIN IN ORTHOPAEDIC SURGERY
PATIENTS BECAUSE IT CAN BE PROBLEMATIC TO ADDRESS IN EVERYDAY NURSING ROUTINES. IN A FIRST
STEP, THE INTERVENTION WAS DEVELOPED, WHICH WE NAMED INTENTIONAL TOUCH (IN TOUCH). UNLIKE
THERAPEUTIC TOUCH OR MASSAGE, IN TOUCH DOES NOT REFER TO A SPECIFIC METHOD, TECHNIQUE, OR
CONCEPT, BUT SHOULD REFER SIMPLY TO A SOFT PHYSICAL TOUCH WITH A POSITIVE INTENTION TO EASE
COMPLAINTS AND ENHANCE WELL-BEING. IN THE QUALITATIVE PART OF THE STUDY, THE SUBJECTIVE
EXPERIENCE OF NURSES AND PATIENTS WITH CHRONIC PAIN RELATIVE TO IN TOUCH WAS EXAMINED.
5. NEED FOR STUDY
THE INTERNATIONAL ASSOCIATION FOR THE STUDY OF PAIN DEFINES PAIN AS “AN UNPLEASANT
SENSORY AND EMOTIONAL EXPERIENCE ASSOCIATED WITH ACTUAL OR POTENTIAL TISSUE DAMAGE”. THERE
ARE VARIATIONS IN EACH PATIENT’S EXPERIENCE WITH PAIN AND THE ABILITY TO COPE OR DEAL WITH THE
‘’UNPLEASANT SENSORY’’ PERCEPTION THAT THE PAIN ENTAILS. PAIN IS SUBJECTIVE, ELICITING DIFFERENT
RESPONSES; HOWEVER THERE IS NO SET GOLD STANDARD OF CARE FOR TREATING PAIN IN PATIENTS.
NURSES ARE THE HEALTH CARE PROFESSIONALS WHO SPENT MOST OF TIME WITH THE PATIENTS AND
THEIR ROLE IN PAIN MANAGEMENT IS ESSENTIAL. IN ADDITION; TO ENSURE AN EFFECTIVE PAIN MANAGEMENT,
THERE SHOULD BE AN EFFECTIVE PAIN ASSESSMENT.
THE APPROPRIATE USE OF TOUCH THERAPY BY NURSES HAS THE POTENTIAL TO SIGNIFICANTLY
IMPROVE THE FUNCTIONAL INDEPENDENCE FOR THE ORTHOPAEDIC SURGERY PATIENTS. SO THAT THE STUDY IS
AIMED AT EVALUATING THE EFFECTIVENESS OF TOUCH THERAPY IN ORDER TO RELIVE PAIN IN ORTHOPAEDIC
SURGERY PATIENTS.
6. RESEARCH HYPOTHESIS:
• H1-THE MEAN POST TEST LEVEL OF PAIN WILL BE SIGNIFICANTLY LOWER THAN THE
MEAN PRE TEST LEVEL OF PAIN AMONG PATIENTS UNDERGONE ORTHOPAEDIC SURGERY
IN THE EXPERIMENTAL GROUP.
• H2-THE MEAN POST TEST LEVEL OF PAIN IN EXPERIMENTAL GROUP WILL BE
SIGNIFICANTLY LOWER THAN THE MEAN POST TEST LEVEL OF PAIN IN CONTROL GROUP
AMONG PATIENTS UNDERGONE ORTHOPAEDIC SURGERY.
• H3-THERE WILL BE A SIGNIFICANT ASSOCIATION BETWEEN THE POST TEST LEVEL OF
PAIN AMONG PATIENTS UNDERGONE ORTHOPAEDIC SURGERY AND THEIR
DEMOGRAPHIC VARIABLES IN CONTROL AND EXPERIMENTAL GROUP.
7. ASSUMPTION
TOUCH THERAPY IS AN EASY AND EXECUTABLE METHOD FOR TREATING PAIN IN
ALL MEDICAL CARE CENTERS AND EVEN AT PATIENT’S HOME.
TOUCH THERAPY IS CONSIDERED AS A SAFE AND EFFECTIVE INTERVENTION FOR
REDUCING ORTHOPAEDIC SURGICAL PAIN.
TOUCH THERAPY RELAX THE BODY TISSUES AND MIND THERE BY REDUCING
ORTHOPAEDIC SURGICAL PAIN.
8. INPUT THROUGHPUT OUTPUT
DEMOGRAPHIC
VARIABLES
•Age,
•Education
•Occupation of
women
•Family income
•Husband’s
occupation
PRE-ASSESSMENT
ASSESSMENT OF
PAIN –
Numerical pain rating
scale is used for pain
assessment
POST-ASSESSMENT
INTERVENTION
TOUCH THERAPY
The practice of placing
hands lightly on or just
above the person’s body,
palms down, on pain site
(total 15-20 minutes) and
two times a day for the
first, second and third post-
operative days.
ASSESSMENT OF
PAIN –
Numerical pain rating
scale is used for pain
assessment
MILD PAIN
MODERATE
PAIN
FIGURE 1: CONCEPTUAL FRAMEWORK BASED ON MODIFIED ROY’S ADAPTATION MODEL
9. REVIEW OF LITERATURE
• THE LITERATURE REVIEW RELATED TO THIS STUDY WAS DISCUSSED UNDER THE
FOLLOWING HEADING;
LITERATURE RELATED TO PAIN SEVERITY ON ORTHOPAEDIC SURGERY
LITERATURE RELATED TO EFFECTIVENESS OF DIFFERENT THERAPIES IN
REDUCING POSTOPERATIVE PAIN
LITERATURE RELATED TO EFFECTIVENESS OF TOUCH THERAPY IN REDUCING
POSTOPERATIVE PAIN
10. RESEARCH METHODOLOGY
• EVALUATIVE RESEARCH APPROACH IS USED IN THIS STUDY.
• QUASI EXPERIMENTAL DESIGN WAS USED.
• STUDY SETTING- KADAM MULTISPECIALITY HOSPITAL AND CHUGH MULTISPECIALITY HOSPITAL,
BHIWANI, HARAYANA
• TARGET POPULATION- POST-OPERATIVE ORTHOPAEDIC PATIENTS ADMITTED IN KADAM
MULTISPECIALITY HOSPITAL AND CHUGH MULTISPECIALITY HOSPITAL, BHIWANI
• SAMPLING TECHNIQUE: NON PROBABILITY PURPOSIVE SAMPLING TECHNIQUE.
• SAMPLE SIZE: : 60 POST-OPERATIVE ORTHOPEDIC PATIENTS (30=EXPERIMENTAL AND 30= CONTROL
GROUP)
• TOOL IS FORMULATED NUMERICAL PAIN RATING SCALE
• INTERVENTION- TOUCH THERAPY
• ANALYSIS WAS USE AS INFERENTIAL STATISTICS.
• FINDINGS, SUMMARY, CONCLUSION, AND RECOMMENDATIONS
• COMMUNICATION AND FINDINGS
11. PILOT STUDY
BEFORE CONDUCTING THE PILOT STUDY FORMAL CONSENT WAS OBTAINED FROM THE MEDICAL
OFFICER OF KADAM MULTISPECIALITY HOSPITAL AND CHUGH MULTISPECIALITY HOSPITAL AT BHIWANI,
DURING 20-4-2022 TO 27-4-2022.
IN ORDER TO TEST THE FEASIBILITY, RELEVANCE AND PRACTICABILITY OF THE STUDY, A PILOT
STUDY WAS CONDUCTED AMONG SIX SUBJECTS WHO HAD ORTHOPAEDIC SURGERY (3= EXPERIMENTAL GROUP,
3= CONTROL GROUP). FIRST THREE DAY EXPERIMENTAL GROUP PARTICIPANTS WERE SELECTED AND
FOLLOWED BY CONTROL GROUP THREE DAYS. INITIALLY, THE SUBJECTS WERE INTERVIEWED IN ORDER TO
COLLECT THE DEMOGRAPHIC DATA AND RESEARCHER EXPLAINED THE PROCEDURE. THE PRE-TEST LEVEL OF
PAIN WAS ASSESSED BY NUMERICAL PAIN SCALE FOLLOWED BY TOUCH THERAPY FOR 10-15 MINUTES. POST-
TEST WAS DONE IMMEDIATELY AFTER MUSIC THERAPY. NEXT THREE DAYS CONTROL GROUP PARTICIPANTS
WERE SELECTED. SAME PROCEDURE WAS FOLLOWED TO THE CONTROL GROUP WITHOUT INTERVENTION
(MUSIC THERAPY). THE WHOLE PROCEDURE WAS REPEATED IN 2ND, 3RDAND 4TH POST OPERATIVE DAYS. DATA
WERE ANALYZED TO FIND OUT THE SUITABILITY OF THE STATISTICAL METHOD. IT REVEALED THAT THE STUDY
WAS FEASIBLE. THE SUBJECTS INCLUDED IN THE PILOT STUDY WERE EXCLUDED IN THE MAIN STUDY.
12. METHOD OF DATAANALYSIS
• FREQUENCY, PERCENTAGE AND MEAN WERE USED FOR ANALYSIS
DATA WERE ORGANIZED IN MASTER SHEET.
THE FREQUENCIES AND PERCENTAGE WAS USED FOR THE ANALYSIS OF SOCIO
DEMOGRAPHIC VARIABLES.
MEAN, MEAN SCORE PERCENTAGE AND STANDARD DEVIATION WAS USED TO
ASSESS THE PRE-TEST AND POST-TEST SCORES.
PAIRED ‘T’ TEST WAS USED TO DETERMINE THE DIFFERENCE BETWEEN PRETEST
AND POST-TEST LEVEL OF PAIN AMONG EXPERIMENTAL GROUP.
CHI-SQUARE WAS USED TO DETERMINE THE ASSOCIATION BETWEEN POST-TEST
LEVEL OF PAIN AND SELECTED VARIABLES.
13. ORGANIZATI ON OF FINDINGS
• SECTION – I: DISTRIBUTION OF SAMPLES BASED ON THE SELECTED DEMOGRAPHIC
VARIABLES AMONG EXPERIMENTAL AND CONTROL GROUPS.
• SECTION – II: DISTRIBUTION OF SAMPLES BASED ON THE LEVEL OF PAIN AMONG
EXPERIMENTAL AND CONTROL GROUPS.
• SECTION – III: DISTRIBUTION OF MEAN AND STANDARD DEVIATION IN THE EFFECTIVENESS
OF TOUCH THERAPY ON PAIN REDUCTION AMONG EXPERIMENTAL GROUP.
• SECTION – IV: COMPARISON OF THE POST TEST LEVEL OF PAIN IN EXPERIMENTAL GROUP
AND CONTROL GROUP.
• SECTION – V: ASSOCIATION BETWEEN THE POST TEST LEVEL OF PAIN IN EXPERIMENTAL AND
CONTROL GROUP AND THEIR SELECTED DEMOGRAPHIC VARIABLES.
14. SECTION-A DEMOGRAPHIC VARIABLE PROFILE
DEMOGRAPHIC VARIABLE EXPERIMENTAL GROUP
N=30
CONTROL GROUP
N=30
F % F %
1. Age (in years)
21-40 11 36.67% 13 43.33%
41-60 14 46.67% 11 36.67%
61-80 5 16.66% 6 20%
Above 80 0 0% 0 0%
2. Gender
Male 16 53.33% 20 66.67%
Female 14 46.67% 10 33.33%
3. Educational status
Illiterate 0 0% 0 0%
Primary school 7 23.33% 6 20%
High school 14 46.67% 13 43.33%
Higher secondary & above 9 30% 11 36.67%
15. 4. Work pattern
Sedentary 13 43.33% 19 63.33%
Moderate 11 36.67% 7 23.33%
Heavy 6 20% 4 13.34%
5. Area of living
Urban 9 30% 12 40%
Semi-urban 7 23.33% 6 20%
Rural 14 46.67% 12 40%
6. Types of ortho surgery
Upper extremity 13 43.33% 19 63.33%
Lower extremity 17 56.67% 11 36.67%
7. Types of anesthesia
Spinal 12 40% 8 26.67%
General 18 60% 22 73.33%
16. SECTION – II
DISTRIBUTION OF SAMPLES BASED ON THE LEVEL OF PAIN AMONG EXPERIMENTALAND
CONTROL GROUPS
N=3
0% 0% 0% 0% 0% 0%
0% 0% 0%
23% 23%
63%
27%
70%
80%
77% 77%
37%
73%
30%
20%
0% 0% 0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
2nd day Pre-test 2nd day post test 3rd pre test 3rd post test 4th day pre test 4th day post test
LEVEL OF PAIN IN EXPERIMENTAL GROUP
No pain
Mild pain
Moderate pain
Severe pain
Fig-9 Percentage distribution of pre test and post test level of pain among patients in experimental group
17. N=30
0% 0% 0% 0% 0% 0%
0% 0% 0% 0% 0% 0%
0% 0% 0% 3% 0% 3%
100% 100% 100% 97% 100% 97%
0%
20%
40%
60%
80%
100%
120%
2nd day Pre-test 2nd day post test 3rd pre test 3rd post test 4th day pre test 4th day post test
LEVEL OF PAIN IN CONTROL GROUP
No pain
Mild pain
Moderate pain
Severe pain
Fig-10 Percentage distribution of pre test and post test level of pain among patients in control group
18. SECTION – III
DISTRIBUTION OF MEAN AND STANDARD DEVIATION IN THE EFFECTIVENESS OF TOUCH
THERAPY ON PAIN REDUCTION AMONG EXPERIMENTAL GROUP
Level of pain post
operative day
Experimental
group pre test
Experimental group
post test
Mean
difference
t-value
mean SD Mean SD
2nd day 6.77 0.57 5.83 0.53 0.94 20.14**
3rd day 5.46 0.51 4.56 0.50 0.9 16.15**
4th day 4.16 0.46 3.2 0.41 0.96 29**
H1-The mean post test level of pain will be significantly lower than the mean pre test level of pain among patients undergone
orthopaedic surgery in the experimental group.
This table reveals in pre-test, 2nd day mean scores and SD of pain was 6.77 and 0.57, in post test 2nd day mean scores and
SD of pain was 5.83 and 0.53. The mean difference of pre test and post test was 0.94, the calculated t- value was 20.14 which was
significant at p<0.05. In pre-test, 3rd day mean scores and SD of pain was 5.46 and 0.51, in post test 3rd day mean scores and SD
of pain was 4.56 and 0.50. The mean difference of pre test and post test was 0.9, the calculated t- value was 16.15 which was
significant at p<0.05. In pre-test, 4th day mean scores and SD of pain was 4.16 and 0.46, in post test 4th day mean scores and SD
of pain was 3.2 and 0.41. The mean difference of pre test and post test was 0.96, the calculated t- value was 29 which was
significant at p<0.05.
Hence hypothesis H1 was accepted.
19. SECTION – IV
COMPARISON OF THE POST TEST LEVEL OF PAIN AMONG POST OPERATIVE ORTHOPAEDIC
SURGERY PATIENTS IN EXPERIMENTAL GROUPAND CONTROL GROUP
Level of pain post operative
day
Experimental group
post test
Control group post test Mean
difference
t-value
Mean SD Mean SD
2nd day 5.83 0.53 8.06 0.53 2.77 17.97
3rd day 4.56 0.50 7.33 0.54 2.77 20.38
4th day 3.2 0.41 7.33 0.53 4.13 33.32
H2-The mean post test level of pain in experimental group will be significantly lower than the mean post test level of pain in
control group among patients undergone orthopaedic surgery.
This table reveals that post test score of mean and SD of experimental group and control group. In experimental group 2nd
day post test mean scores and SD of pain was 5.83 and 0.53, in control group 2nd day post test mean scores and SD of pain was
8.06 and 0.53. The mean difference of control and experimental group was 2.77, the calculated t- value was 17.97 at p<0.05. In
experimental group 3rd day post test mean scores and SD of pain was 4.56 and 0.50, in control group 3rd day post test mean
scores and SD of pain was 7.33 and 0.54. In the mean difference of control and experimental group was 2.77, the calculated t-
value was 20.38 at p<0.05 so it is significant. . In experimental group 4th day post test mean scores and SD of pain was 3.2 and
0.42, in control group 3rd day post test mean scores and SD of pain was 7.33 and 0.53. In the mean difference of control and
experimental group was 4.13, the calculated t- value was 33.32 at p<0.05 so it is significant.
Hence hypothesis H2 was accepted.
20. SECTION – V
ASSOCIATION BETWEEN THE POST TEST LEVEL OF PAIN IN EXPERIMENTALAND CONTROL
GROUPAND THEIR SELECTED DEMOGRAPHIC VARIABLES
H3-there will be a significant association between the post test level of pain among patients undergone
orthopaedic surgery and their demographic variables in control and experimental group.
The table showed in experimental group association of post test level of pain with selected
demographical variables. The variables such as educational status, work pattern, type of orthopaedic surgery
and type of anesthesia shows no association with posttest level of pain. There was a significant association of
selected demographic variables such as duration of diabetes age, gender and area of living with posttest level
of pain.
Hence the hypothesis H3 was accepted.
21. DISCUSSION
This chapter deals with the discussion of the findings of present study in accordance with the objectives of the
research problem.
The post test score of mean and sd of experimental group and control group. In experimental group 2nd day post
test mean scores and SD of pain was 5.83 and 0.53, in control group 2nd day post test mean scores and SD of pain was 8.06
and 0.53. The mean difference of control and experimental group was 2.77, the calculated t- value was 17.97 at p<0.05. In
experimental group 3rd day post test mean scores and SD of pain was 4.56 and 0.50, in control group 3rd day post test mean
scores and SD of pain was 7.33 and 0.54. In the mean difference of control and experimental group was 2.77, the calculated
t- value was 20.38 at p<0.05 so it is significant. . In experimental group 4th day post test mean scores and sd of pain was 3.2
and 0.42, in control group 3rd day post test mean scores and SD of pain was 7.33 and 0.53. In the mean difference of control
and experimental group was 4.13, the calculated t- value was 33.32 at p<0.05 so it is significant.
22. CONCLUSION
In the present study in pre-test, 2nd day mean scores and SD of pain was 6.77 and 0.57, in
post test 2nd day mean scores and SD of pain was 5.83 and 0.53. The mean difference of pre test
and post test was 0.94, the calculated t- value was 20.14 which was significant at p<0.05. In pre-
test, 3rd day mean scores and SD of pain was 5.46 and 0.51, in post test 3rd day mean scores and
SD of pain was 4.56 and 0.50. The mean difference of pre test and post test was 0.9, the calculated
t- value was 16.15 which was significant at p<0.05. In pre-test, 4th day mean scores and SD of pain
was 4.16 and 0.46, in post test 4th day mean scores and SD of pain was 3.2 and 0.41. The mean
difference of pre test and post test was 0.96, the calculated t- value was 29 which was significant at
p<0.05.Hence the touch therapy was effective in reducing post operative pain
23. SUMMARY
The study design consisted of an evaluative approach with one group pre test and post test control group
design. The study population consisted of 60 post-operative orthopaedic patients in Kadam multi-speciality hospital and
Chugh multi-speciality hospital Bhiwani, purposive sampling technique was adopted. The tool developed and used for
data collection was demographic variables and numerical pain rating scale.
In experimental group 2nd day post test mean scores and sd of pain was 5.83 and 0.53, in control group 2nd
day post test mean scores and SD of pain was 8.06 and 0.53. The mean difference of control and experimental group
was 2.77, the calculated t- value was 17.97 at p<0.05. In experimental group 3rd day post test mean scores and SD of
pain was 4.56 and 0.50, in control group 3rd day post test mean scores and SD of pain was 7.33 and 0.54. In the mean
difference of control and experimental group was 2.77, the calculated t- value was 20.38 at p<0.05 so it is significant. .
In experimental group 4th day post test mean scores and sd of pain was 3.2 and 0.42, in control group 3rd day post test
mean scores and SD of pain was 7.33 and 0.53. In the mean difference of control and experimental group was 4.13, the
calculated t- value was 33.32 at p<0.05 so it is significant. Hence hypothesis H2 was accepted.
In experimental group association of post test level of pain with selected demographical variables. The
variables such as educational status, work pattern, type of orthopaedic surgery and type of anesthesia shows no
association with posttest level of pain. There was a significant association of selected demographic variables such as
duration of diabetes age, gender and area of living with posttest level of pain. Hence the hypothesis H3 was accepted.
24. RECOMMENDATION
A similar study can be conducted for all types of surgical patients.
The same study can be conducted in larger groups in different settings.
Comparison study can be done by various distraction therapies.
This can be done as a true experimental study
A similar study can be conducted in various age groups.
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