Effectiveness of Structured Teaching Programme on self care of Plaster of paris casted limb among patients with Lower Limb Fracture

 

Rupa Upadhyaya¹*, Hiramoni Barman²

 

ABSTRACT:

The patients with casted limb suffer with complications due to inadequate knowledge which lends them in great physical, social, psychological and economic loss. Structured teaching programme becomes an integral part to empower the patients with knowledge and skill in caring himself, prevent complication and improve bone healing. The current study aimed to evaluate the effectiveness of structured teaching programme on self care of Plaster of Paris casted limb among patients with lower limb fracture. The study adopted a pre experimental, one group pre test post test design. 50 patients with Plaster of Paris casted lower limb fracture were selected by using non-probability convenient sampling technique and data were collected by using socio demographic proforma and structured knowledge questionnaire. Descriptive and inferential statistics were used to analysis the data. There was a significant increase in the level of knowledge of patients between the pre test and post test. The mean pre test score is 12.14 and the mean post test score on self care of POP is 17.46 (p<0.01) at 0.05 level of significance. A significant association of the pre test levels of knowledge was found with age, educational status, occupation, previous history of fracture, previous information of fracture and Plaster of Paris cast. The result shows that structured teaching programme improved the knowledge regarding self care of Plaster of Paris casted limb.

 

 

 

INTRODUCTION:

The skeletal system is collectively the largest organ system in the body. The skeleton acts as a scaffold by providing support and protection for the soft tissues that make up rest of the body. If any injury like accidents, falls, blows etc occurs then the functions will be disturbed. Injuries include fractures, sprains and strains and dislocations. Among them fractures are the most common injuries¹. Lower limb fractures account for approximately one third of all fractures. They can occur isolated or in combination with other serious injuries, including cranial, spinal and upper body injuries².

 

 

The Global Burden of Disease (GBD) study, 2016 highlighted that musculoskeletal conditions were the second highest contributor to global disability. While the prevalence of musculoskeletal conditions varies by age and diagnosis, between 20%–33% of people across the globe live with a painful musculoskeletal condition³. Related to musculoskeletal system, bone fractures are considered as a major public health problem throughout the world, which causes a severe and long term disability⁴.

 

Worldwide, osteoporosis causes more than 8.9 million fractures annually⁵. In every 3 seconds 1 case is diagnosed as fracture. In India, According to WHO report (2010) the incidence of fractures is 14 cases /10,000 each year, lower limb fractures accounts for 26%, arm fractures accounts for 14% and other fractures for 5%. As compared to other fractures, lower limb fractures are more common than any other fractures⁶. J. Bharathi et al (2016)⁷ also evaluated that Osteoarthritis is another musculoskeletal condition most frequent in the lower extremity.

 

India has highest incidence of road traffic accidents (RTA). Tintu Annie Mathew (2014)⁸ stated that everyday as many as one lakh forty thousand people are injured on the worlds road and more than fifteen thousand are disabled for lifetime. The highest number of victims of RTA (29.4%) was between the age group of 20-29 years. 64.9% of the victim were between 15-44 yrs of age group. Among the fractures, lower limbs (46.3%) were the commonest site for fracture, followed by fracture of upper limbs (24.7%) and skull (13.2%)⁹. Singh S. et al (2012)¹⁰ also stated that various studies conducted by various authors noted that patients fractured were of young active age group and in their study average age of the patients were 40 years.

 

Road traffic accident is an emerging public health problem in Assam also. Various study conducted in Assam reported that accident rate is very high and it results high morbidity and mortality rate. Head and neck, upper limb and lower limb were commonly involved¹¹. Basim Mohammed D et al (2017)¹² stated that road traffic accident still remains commonest cause of injury and fracture are common presentation.

 

Immobilization of the fractured part is achieved by application of Plaster cast. It has been used for centuries as a stiffening agent to treat fractures and other musculoskeletal conditions that requires rest, immobilization or correction of a deformity. Though there are advantages of plaster cast, there are short term complications also like impaired blood flow, nerve injury, tissue necrosis, infection, compartment Syndrome, fat embolism, deep vein thrombosis, and cast syndrome¹³. Again, Bhavani. A, Sara. B (2017)¹⁴ evaluated that prolonged bedrest and immobilization inevitably lead to complications such as deep vein thrombosis, contracture, pulmonary embolism, pneumonia, pressure ulcer, calculi, osteoporosis, constipation, urinary tract infection, muscle atrophy, depression and psychosis. It can also create circulatory disturbances, inflammation, and bone disease resulting in osteoporosis, chronic oedema, soft tissue atrophy, joint stiffness and loss of function. Good physiotherapy will help to avoid these problems¹⁵.

 

There is a need of care after application of Plaster cast. It helps in early recovery and prevention of complications. The care includes checking peripheral pulse and nerve function to assess the neurovascular status of the distal part, changing of position, maintenance of nutritional status, maintenance of health hygiene, medications to relieve pain. Singh S, Thakur A.K, KK Singh, et al (2012)¹⁶ concluded in their study that there is an urgent need to conduct continuous medical education all concerened on the rational use of drugs. Patient’s role is also involved in taking care of their casted limb to prevent swelling, necrosis and compartment syndrome. Patients knowledge in skin care, active and passive exercise, proper nutrition, frequent position change are much useful for early recovery¹⁷. M. P. Santhosh Kumar, Devishree (2018)¹⁸ concluded that Bone morphogenic protein 3 plays a role in fracture healing and provides a novel therapeutic intervention for the treatment of diseases from osteopenia to fracture nonunion. K. Srinivassan (2014)¹⁹ conducted a study among arthritis patients knowledge, attitude and practice. A patient education programme was considered to be effective and brought about 15-30% betterment. It was successful at increasing knowledge, changing behavior, and improving physical and psychological health status.

 

Nurses play a major role in preventing further complication by educating the patient regarding self care for preventing further complication. This will empower the patient with knowledge and skill in caring themselves, prevent complication and improve bone healing. The study conducted by Harpreet Kaur (2014)²⁰ to evaluate the effectiveness of structured teaching programme regarding self care management has lead to the conclusion that the structured teaching programme was effective in improving the knowledge regarding self care management.

 

The present study has been undertaken to assess the effectiveness of structured teaching programme on self care of POP casted limb among the patients with lower limb fracture.

 

MATERIALS AND METHOD:

A pre experimental one group, pre-test post test research design has been adopted. The study was carried out among both male and female patients with lower limb fracture who have POP cast admitted in Orthopaedic wards of Gauhati Medical College and Hospital, Guwahati, Assam with a sample size of 50. Non-probability convenient sampling technique was used as sampling technique.

 

A pre validated demographic data sheet was used to collect socio demographic information. To assess knowledge on self care of POP casted lower limb, a pre validated questionnaire was used. It contains 25 multiple choice questions. The reliability of the tool was assessed using split half method (r = 0.8). Each multiple choice question contains 4 options. Each correct answer carries 1 mark and incorrect was scored 0. The score range was 0 -25.

The data have been collected from 4^th February to 2^nd March 2019. After getting clearance from IEC and permission from hospital authority, samples were selected for the study using convenient sampling technique. Written informed consent was taken from the participants. Data were collected using interview technique. The pre test was conducted by administering the structured questionnaire on day 1 followed by structured teaching programme on self care of Plaster of Paris casted limb. On the 8^th day post test was conducted by using the same tool. To complete structured questionnaire each subject took 10-15 minutes. Pre validated structured teaching programme was administered to the patients using lecture cum discussion method using a suitable audio visual aids. Structured teaching programme was carried out for 20-25 minutes for each patients. The score was interpreted as higher the score, higher is the knowledge on self care management of Plaster of Paris casted limb. The knowledge level was interpreted on the basis of value of mean and standard deviation.

 

The statistical package for social science (SPSS) 20 versions was used for the statistical analysis. Descriptive statistics were done for socio demographic data and Chi square/ Fishers exact, Paired t test were used for inferential analysis.

 

RESULT:

Socio demographic profile shown in table 1 shows that majority of the respondents (38%) were from the mean age group of 40 years, (64%) of them were male, (32%) were female, Hindu (64%) in religion, (48%) of the participants studied upto primary school, (78%) of them were married, (70%) did not have previous history of fracture, 62% of them did not had previous information regarding fracture and 76% of the participants did not have previous information regarding Plaster of Paris cast.

 

Frequency and percentage distribution of pre test and post test knowledge score range (table 2) revealed that maximum number of samples 31(62%) scored in the range of 11-15 in pre test and in the post test maximum number of samples 41(82%) scored in the range of 16-20.

 

Table 3 shows that 32% of patients had inadequate knowledge, 48% had average knowledge and 20% had adequate knowledge in pretest whrease in post test 06% had average knowledge and 94% had adequate knowledge on self care of Plaster of Paris casted lower limb.

 

Table 4 indicates that the mean post test score (17.46) was higher than the mean pre test score (12.14). The median post test knowledge score (17.5) also showed higher than the median pre test knowledge score (12) and the post test score (SD= 1.84) seemed to be less dispersed than the pre test score (SD= 2.61).

 

Table 1: Distribution of participants according to socio demographic characteristics.                                 N=50

Variables		Frequency	Percentage %
Age in years	18-24	2	4
	25-34	14	28
	35-44	19	38
	45-54	13	26
	55 and above	2	4
Gender	Male	32	64
	Female	18	36
Religion	Hindu	32	64
	Christian	3	6
	Muslim	15	30
Educational status	Primary	24	48
	Middle school	14	28
	High school	5	10
	Higher secondary	7	14
Marietal status	Married	39	78
	Unmarried	11	22
Occupation	Unemployed	15	30
	Self employed	23	46
	Private	9	18
	Government service	3	6
Previous history of fracture	Yes	15	30
	No	35	70
Experience of being caregiver of POP casted limb	Yes	1	2
	No	49	98
Previous information regarding fracture	Yes	19	38
	No	31	62
Previous information regarding POP	Yes	12	24
	No	38	76

 

Table 2: Frequency and Percentage Distribution of Pre test and Post test Knowledge Score Range.                          N=50

Score range	Pre test		Post test
	Frequency	Percentage	Frequency	Percentage
1 - 5	0	0%	0	0%
6 - 10	16	32%	0	0%
11 - 15	31	62%	7	14%
16 - 20	3	6%	41	82%
21 - 25	0	0%	2	4%

 

 

Table 3: Frequency and Percentage Distribution of Pre test and Post test Level of Knowledge.                                                 N=50

Level of knowledge	Score	Knowledge
		Pre test		Post test
		Frequency	Percentage	Frequency	Percentage
Inadequate	0-10	16	32%	0	0%
Average	11-14	24	48%	3	06%
Adequate	15-25	10	20%	47	94%

Table 4: Comparison Between Score range, Mean, Median and Standard deviation of Pre-test and Posttest Level of Knowledge of Subjects Regarding Self Care of Plaster of Paris Casted Lower Limb.                                                                                               N=50

 

 

 

Table 5: Comparison (Paired t- test) Between Pre test and Post test Level of Knowledge of Subjects Regarding Self care of Plaster of Paris Casted Limb.                                                                                                                                                                                N=50

 

 

Table 6: Association of Pre test Levels of Knowledge Score with Selected Socio- Demographic variables.                                   N=50

Sl no	Demographic Variables	Knowledge Scores				(c2) / Fishers exact test			df	P-value (2tailed)		Significance
		Inadequate (0-10)	Average (11-14)	Adequate (15-25)
1	Age					0.079			8	0.020		S*
	18- 24 years	0	2	0
	25-34 years	4	6	4
	35-44 years	3	13	3
	45-54 years	7	3	3
	55 years and above	2	0	0
2	Gender					0.050			2	0.09		NS
	Male	7	16	9
	Female	9	8	1
3	Educational status					0.002			8	0.00		S*
	Primary	15	9	0
	Middle school	6	7	1
	High school	0	1	4
	Higher secondary	1	3	3
4	Occupation					0.05			6	0.01		S*
	Unemployed	10	5	0
	Self employed	4	15	4
	Private service holder	2	4	3
	Government service holder	0	0	3
5	Type of family							0.928		2	0.154		NS
	Joint family		5		10		3
	Nuclear family		10		14		7
6	Previous history of fracture							0.002		2	0.001		S*
	Yes		1		7		7
	No		15		17		3
7	Previous experience as a caregiver of Plaster of Paris casted patient							1		2	0.48		NS
	Yes		0		1		0
	No		16		23		10
8	Previous information regarding fracture							0.01		2	0.00		S*
	Yes		2		7		10
	No		14		17		0
9	Previous information regarding Plaster of Paris cast							0.01		2	0.00		S*
	Yes		0		4		8
	No		16		20		2

S* = Significance at 0.05 level of significance,                                                                             NS= Not significant

 

 

The paired ‘t’ test (table 5) was carried out to examine the effectiveness of the structured teaching programme. It shows that there is significant difference between pretest and post test knowledge score. So it reflects that the structured teaching program was found effective.

 

Table 6 revealed the significant association obtained between pre test levels of knowledge score with age, educational status, occupation, previous history of fracture, previous information regarding fracture and previous information regarding Plaster of Paris cast at 0.05 level of significance (p<0.05).

 

DISCUSSION:

The statistical findings of the present study is based on knowledge regarding self care of Plaster of Paris casted limb through pre-test knowledge score among patients with lower limb fracture.

 

In the present study, mean pre test score was 12.14 and SD + 2.61. The findings of the study revealed that 32% of the participants had inadequate knowledge. This finding contradicts the study conducted by Mary RL (2015) which revealed 100% inadequate knowledge on self care management of Plaster of Paris cast before the structure teaching programme.

 

In the present study, the mean post test score 17.46 was higher than the mean pre test score 12.14 (table 4). The median post test knowledge score 17 also showed higher than the median pre test knowledge score 12 and the post test score of SD +1.84 seemed to be less dispersed than the pre test score of SD +2.61. Present study findings are consistent with the study conducted by Nagaraju B, Shampalatha S, Pavani GV (2012)²².

 

The obtained ‘t’ value in present study was found significant (P < 0.01) reflecting that the structured teaching program was effective. This study findings supports the study conducted by Mary RL (2015)²¹ where significant increase in level of knowledge of patients between the pretest and posttest was noted. Another study by Preksha, Kumar A (2019)²³, Hadapad C (2005) also reported similar findings.

 

In the present study, association of the pretest knowledge score with occupation, age, educational status and previous knowledge on fracture and Plaster of Paris cast of the respondents. This findings is supported by the study conducted by Hadapad C which revealed a significant association between pre test knowledge score with age and educational status²⁴. But the study revealed no significant association with occupation and previous knowledge on fracture and Plaster of Paris cast. Again another study conducted by Mathew T.A (2014)⁸ reported significant relationship between the level of knowledge and educational status. The study by Damor B, Chavda A and Menaria K(2019)²⁵ also revealed significant association between pre-test knowledge score with age, education.

 

CONCLUSION:

The findings of the study are consistent with the literatures and have a strong support from some of the studies of the world and India. The study is limited to the component of structured teaching program on knowledge regarding self care of Plaster of Paris casted limb. The tool was structured with application of Multiple choice question and hence responses were limited.

 

Based on the finding of the present study it is concluded that lower limb fracture is one of the most common problems that may result in short and long term complications due to level of knowledge. Structured teaching programme is very effective in improving the knowledge of patients with Plaster of Paris cast regarding self care of casted limb and there is a need for conducting such programme frequently. Nurses can help the patients to educate them in this regard.

 

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Received on 04.04.2020         Modified on 14.05.2020

Accepted on 13.06.2020      ©A&V Publications All right reserved