RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE.

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION.

|01. |NAME OF THE CANDIDATE AND ADDRESS: |Mr. BHANWARLAL DOTASRA. |

| | |M. Sc. [NURSING] Ist YEAR. |

| | |MEDICAL SURGICAL NURSING, |

| | |SHRI. B.V.V. SANGHA’S, |

| | |SAJJALASHREE INSTITUTE OF NURSING SCIENCES, BAGALKOT. KARNATAKA.|

| | | |

|02. |NAME OF THE INSTITUTION: |SHRI. B.V.V. SANGHA’S, |

| | |SAJJALASHREE INSTITUTE OF NURSING SCIENCES, NAVANAGAR, |

| | |BAGALKOT. KARNATAKA. |

|03. |COURSE OF STUDY AND SUBJECT: |M. Sc. [NURSING] Ist YEAR. |

| | |MEDICAL SURGICAL NURSING, |

|04. |DATE OF ADMISSION TO COURSE: |30th May 2009. |

|05. |TITLE OF THE TOPIC: |

| | |

| |“A STUDY TO ASSESS THE KNOWLEDGE REGARDING MANAGEMENT OF LUMBAR DISC PROLAPSE AMONG THE STAFF NURSES WORKING AT |

| |SELECTED ORHTOPEDIC HOSPITAL IN BAGALKOT. WITH A VIEW TO PREPARE AN INFORMATION GUIDE SHEET ON MANAGEMENT OF LUMBAR |

| |DISC PROLAPSE” |

| | |

|6. |BRIEF RESUME OF THE INTENDED WORK. |

| |NEED FOR THE STUDY: |

| |Now a days degenerative change in intervertebral discs begin from the late teens after the completion of physical growth |

| |and development, during which posterior herniation of the nucleus pulposus can cause sciatica because of nerve root |

| |compression. Therefore, it is known that over half of lumbar disc herniations occur in active individuals aged between 20|

| |and 40 years.1 |

| |Approximate 2% of the general population present with low back pain as a presenting complaint. It is estimated that upto |

| |70% of the population will experience back pain sometime in their life. Dilliance reported that in 79% of men and 89% of |

| |women the specific cause was known. They also noted that 40% of those reporting of low back pain also reported sciatica. |

| |However, clinically significant sciatica due to lumbar disc prolapse occurs in 4-6% of the population. The people |

| |affected are most commonly below 40 years who are in economically productive age group. Hence, low back pain affects the |

| |socio-economic status of a region significantly. The lumbar disc prolapse occurs after degeneration of intervertebral |

| |disc and it is more common at L4-5 and L5-S1 levels. L3-4 and L2-3 levels accounts for the majority remaining |

| |herniations. Swenson and Anderson noted psychological variables associated with low back pain to be dissatisfaction with |

| |work environment and a higher degree of worry and fatigue at the end of the workday.2 |

| |Degeneration of the intervertebral disc from a combination of factors can result in herniation, particularly at the L4-5 |

| |and L5-S1 levels. The presence of pain, radiculopathy and other symptoms depends on the site and degree of herniation. A |

| |detailed history and careful physical examination, supplemented if necessary by magnetic resonance imaging, can |

| |differentiate a herniated lumbar disc from low back strain and other possible causes of similar symptoms. Most patients |

| |recover within four weeks of symptom onset. Many treatment modalities have been suggested for lumbar disc herniation, but|

| |studies often provide conflicting results. Initial screening for serious pathology and monitoring for the development of |

| |significant complications (such as neurologic defects, cauda equina syndrome or refractory pain) are essential in the |

| |management of lumbar disc herniation.3 |

| |The intervertebral disc is responsible for the attachment of vertebral bodies to each other, providing flexibility and |

| |absorbing and distributing the loads applied to the spinal column. With aging, the disc undergoes significant changes in |

| |volume and shape as well as in biochemical composition and biomechanical properties. Lumbar disc herniations are believed|

| |to result from anular degeneration that leads to a weakening of the anulus fibrosus, leaving the disc susceptible to |

| |anular fissuring and tearing.4 |

| |Several factors, including genetic factors and changes in hydration and collagen, are believed to play a role in the |

| |development of degenerative disc disease. It is widely accepted that the water-binding capability of the nucleus plays an|

| |integral role in the physical properties of the disc. In the healthy disc, the nucleus distributes the applied forces |

| |equally throughout the anulus. Decreased hydration of the disc can reduce the cushioning effect, thus transmitting a |

| |greater portion of the applied loads to the anulus in an asymmetric distribution, Increases in the collagen content of |

| |the nucleus and in its crystallinity have been reported to be partially responsible for disc degeneration.8 |

| |The possibility of genetic effects has been investigated in other spinal disorders, such as scoliosis, spondylolisthesis |

| |and ankylosing spondylitis, but few studies have searched for genetic factors in degenerative disc disease. One study5 |

| |reported a strong familial predisposition to discogenic low back pain and suggested that the etiology of degenerative |

| |disc disease includes both genetic and environmental factors.10 |

| |Low back pain is reported to occur at some time in 25-50% of the adult population.1-2 Lumbar disc prolapses are estimated|

| |to account for approximately 1% of cases of back pain. The management of prolapsed lumbar intervertebral discs (PIDs) has|

| |changed over time with developments in diagnostic technology (computerized tomographic scans and magnetic resonance |

| |imaging), newer minimally invasive surgical approaches and the continued use of complementary therapy. Despite the range |

| |of new technologies, no systematic review of the evidence of the effectiveness and appropriateness of different forms of |

| |management for PIDs exists in the literature, although a review of spinal disorders in general, published in 1987, does |

| |exist/ Such an overview is essential to enable practitioners to keep up with current evidence for effective practice.12 |

| |This review was undertaken as a part of a project comparing current practice in the management of prolapsed lumbar |

| |intervertebral discs with the published evidence for effective and appropriate management of this condition. The aim was |

| |to a establish a knowledge base, providing a starting point for the development of clinical guidelines. An assessment of |

| |current clinical practice has been carried out separately. |

| | |

| | |

| |6.2 REVIEW OF LITERATURE: |

| |A study was conducted on management of lumbar prolapse, among 100 patients with lumbar disc protrusions were studied. 36 |

| |control patients were admitted in the same time period with low back pain and sciatica but with subsequently normal |

| |myelograms and no surgery. The objective of the study was to relate history and clinical signs to the myelograms and |

| |surgical findings. Ninety nine per cent of our patients presented with sciatica (controls 94%). The most frequently found|

| |sign in patients with a disc protrusion was reduction of ipsilateral straight leg raising (98%). However, 55% of controls|

| |also showed this sign. There were three signs that, when present, particularly indicated a disc protrusion; "crossed |

| |straight leg raising" (pain on contralateral straight leg raising), measured calf wasting and impaired ankle reflex: the |

| |latter being especially indicative of an L5-S1 disc protrusion. There were two further important signs, weakness of |

| |dorsiflexion of the foot and scoliosis of the lumbar spine. However, such signs occurred in about half the patients and |

| |so clinical diagnosis in the remaining half depended on obtaining a good history of sciatica, and paying due regard to |

| |severity of the pain, the mobility of the patient, the ability and desire to work and the overall personality. |

| |Satisfactory results of surgery simply depend on finding and removing a definite disc protrusion. Using these methods of |

| |selection, 98% have returned to their original employment, 86% within 3 months of the operation. For a patient with no |

| |abnormal signs and a normal myelogram, surgical treatment should not be advised.19 |

| |A prospective study was conducted on knowledge of lumbar disc prolapse management and outcome analysis of 96 surgically |

| |treated patients. Objectives of the study were to evaluate the presentation, diagnosis and management outcome of |

| |surgically treated patients of lumbar disc prolapse. Patients were selected using following neuroimagings like plain |

| |radiographs, myelograms, CT myelograms and MRI Scan of lumbosacral spine. The operative procedure applied was |

| |hemilaminectomy and removal of herniated disc material. Postoperatively patients were analyzed for outcome by standard |

| |subjective analysis (Mac nab criteria), objective examinations and radiographic studies. Results of the study were there |

| |were 96 patients, 70 males and 26 females. Predominant mode of presentation was low back pain with radiation to leg |

| |(46.9%), neurogenic claudication in 18 patients (18.7%). Eighty Six percent of the disc prolapses were found at L4 L5 and|

| |L5 SI levels. Complication rate was 14.6% with infections being commonest. Excellent to good outcome was found in 85.4% |

| |of the cases. Mean follow up period was 18 months. Study concluded that surgery for cauda equina syndrome and motor |

| |deficits has a good outcome with hemilaminectomy and is the best surgical option for large disc prolapses.5 |

| |A study was conducted on surgical management of lumbar disc prolapse. Objective of the study was to assess the effects of|

| |surgical interventions for the treatment of lumbar disc prolapse. Randomized trials (RCT) and quasi-randomized trials |

| |(QRCT) of the surgical management of lumbar disc prolapse. Result shows that 39 RCTs and two QRCTs were identified, |

| |including 16 new trials since the first edition of this review in 1999. Many of the early trials were of some form of |

| |chemonucleolysis, whereas the majority of the later studies either compared different techniques of discectomy or the use|

| |of some form of membrane to reduce epidural scarring. Despite the critical importance of knowing whether surgery is |

| |beneficial for disc prolapse, only three trials have directly compared discectomy with conservative management and these |

| |give suggestive rather than conclusive results. There is insufficient evidence on other percutaneous discectomy |

| |techniques to draw firm conclusions. Three small RCTs of laser discectomy do not provide conclusive evidence on its |

| |efficacy; there are no published RCTs of coblation therapy or trans-foraminal endoscopic discectomy. Study concluded that|

| |surgical discectomy for carefully selected patients with sciatica due to lumbar disc prolapse provides faster relief from|

| |the acute attack than conservative management, although any positive or negative effects on the lifetime natural history |

| |of the underlying disc disease are still unclear. The evidence on other minimally invasive techniques remains unclear |

| |(with the exception of chemonucleolysis using chymopapain, which is no longer widely available).6 |

| |A study was conducted on surgery for lumbar disc prolapse. An objective of the study was to relieve nerve root irritation|

| |or compression due to herniated disc material. Claims of the merits of alternative surgical procedures are made without |

| |clear evidence about clinical outcomes. Randomised and quasi-randomised trials of the surgical management of lumbar disc |

| |prolapse. Result shows that 27 trials have now been found. There were methodological weaknesses in many of the trials. |

| |Sixteen of the 27 trials were of some form of chemonucleolysis. Eleven trials compared different surgical techniques, |

| |although only one of these compared surgical discectomy with conservative management. Surgical discectomy produced better|

| |clinical outcomes than chemonucleolysis with chymopapain, and chemonucleolysis produced better clinical outcomes than |

| |placebo. Three trials showed no difference in clinical outcomes between microdiscectomy and standard discectomy. A recent|

| |trial suggests that an inter-position gel covering the spinal dura after discectomy may reduce scar formation, although |

| |both this trial and two others failed to show any definite improvement in clinical outcomes. Three trials of percutaneous|

| |discectomy provided moderate evidence that it produces poorer clinical outcomes than standard discectomy or chymopapain. |

| |We found no published randomised trials of laser discectomy. Study concluded that surgical discectomy for carefully |

| |selected patients with sciatica due to lumbar disc prolapse provides faster relief from the acute attack than |

| |conservative management, although any positive or negative effects on the lifetime natural history of the underlying disc|

| |disease are unclear.11 |

| |A study was conducted on interventions for lumbar disc prolapsed objective of the study was to assess the effects of |

| |surgical interventions for the treatment of lumbar disc prolapse. Use of standard Cochrane review methods to analyze all |

| |randomized controlled trials published up to January 1, 2007. Result shows that 40 randomized controlled trials (RCTs) |

| |and 2 quasi-RCTs were identified. Many of the early trials were of some form of chemonucleolysis, whereas the majority of|

| |the later studies either compared different techniques of discectomy or the use of some form of membrane to reduce |

| |epidural scarring. Four trials directly compared discectomy with conservative management, and these give suggestive |

| |rather than conclusive results. However, other trials show that discectomy produces better clinical outcomes than |

| |chemonucleolysis, and that in turn is better than placebo. Microdiscectomy gives broadly comparable results to standard |

| |discectomy. Recent trials of an interposition gel covering the dura (5 trials) and of fat (4 trials) show that they can |

| |reduce scar formation, although there is limited evidence about the effect on clinical outcomes. There is insufficient |

| |evidence on other percutaneous discectomy techniques to draw firm conclusions. Three small RCTs of laser discectomy do |

| |not provide conclusive evidence on its efficacy. There are no published RCTs of coblation therapy or transforaminal |

| |endoscopic discectomy. Study concluded that surgical discectomy for carefully selected patients with sciatica due to |

| |lumbar disc prolapse provides faster relief from the acute attack than conservative management, although any positive or |

| |negative effects on the lifetime natural history of the underlying disc disease are still unclear. The evidence for other|

| |minimally invasive techniques remains unclear except for chemonucleolysis using chymopapain, which is no longer widely |

| |available.13 |

| |A case-control study of 4180 subjects was carried. Objective of the study was to explore the risk factors of lumbar disc |

| |herniation in China. In this situation, it is important to know whether the risk factors of lumbar disc herniation have |

| |changed or not. This case-control study, including the possible social and psychological factors based on the literature,|

| |attempted to search the new risk factor, therefore provide better prevention measures for lumbar disc herniation. A total|

| |of 2010 hospitalized patients, diagnosed with lumbar disc protrusion by CT and/or MRI were selected as cases. A total of |

| |2070 people from communities and hospitals, without history of low back pain and sciatica, were selected as controls. |

| |Result shows that family history (OR = 3.6) was the most important risk factor for lumbar disc protrusion in this study, |

| |followed by lumbar load (OR = 2.1), hard-working (OR = 1.8), and time urgency (OR = 1.1). Additionally, physical |

| |exercises (OR = 0.5) and bed characteristics (OR = 0.4) appeared to be the protective factors for lumbar disc protrusion.|

| |After stratified by age, family history (OR = 14.5), occupational character (OR = 5.2), and physical exercises (OR = 0.2)|

| |stronger association with lumbar disc protrusion was seen in subjects younger than 30 years. In subjects from 30 to 55 |

| |years, family history (OR = 5.1), lumbar load (OR = 1.91), hard-working (1.9), physical exercises (OR = 0.5), time |

| |urgency (OR = 1. 3), bed characteristics (OR = 0.4) were significantly important. In subjects older than 55 years, lumbar|

| |load (OR = 2.9) and bed characteristics (OR = 0.4) were closely related to lumbar disc protrusion. Study concluded that |

| |family history, lumbar load, hard-working, and time urgency are the major risk factors for lumbar disc herniation, and |

| |physical exercises and sleeping on the hard bed might be the protective factors.14 |

| |A study was conducted on the contribution of RCTs to quality management and their feasibility in practice. The randomized|

| |controlled trial (RCT) is generally accepted as the most reliable method of conducting clinical research. To obtain an |

| |unbiased evaluation of the effectiveness of spine surgery, patients should be randomly assigned to either new or standard|

| |treatment. The aim of the present article is to provide a short overview of the advantages and challenges of RCTs and to |

| |present a summary of the conclusions of the Cochrane Reviews in spine surgery and later published trials in order to |

| |evaluate their contribution to quality management and feasibility in practice. From the searches, 130 RCTs were included,|

| |95 from Cochrane Reviews and systematic reviews, and 35 from additional search. No study comparing surgery with sham |

| |surgery was identified. The first RCT in spine surgery was published in 1974 and compared debridement and ambulatory |

| |treatment in tuberculosis of the spine. The contribution of RCTs in spinal surgery has markedly increased over the last |

| |10 years, which indicates that RCTs are feasible in this field. The results demonstrate missing quality specifications. |

| |Despite the number of published trials there is conflicting or limited evidence to support various techniques of |

| |instrumentation. The only intervention that receives strong evidence is discectomy for faster relief in carefully |

| |selected patients due to lumbar disc prolapse with sciatica. For future trials, authors, referees, and editors are |

| |recommended to follow the consort statement. RCTs provide evidence to support clinical opinions before implementation of |

| |new techniques, but the individual clinical experience is still important for the doctor who has to face the patient.16 |

| |An experimental study was conducted on lumbar disc prolapse: management and outcome analysis of 96 surgically treated |

| |patients. Objective of the study was to evaluate the presentation, diagnosis and management outcome of surgically treated|

| |patients of lumbar disc prolapse. Patients were selected using following neuroimagings like plain radiographs, |

| |myelograms, CT myelograms and MRI Scan of lumbosacral spine. The operative procedure applied was hemilaminectomy and |

| |removal of herniated disc material. Postoperatively patients were analyzed for outcome by standard subjective analysis |

| |(Mac nab criteria), objective examinations and radiographic studies. Result shows that there were 96 patients, 70 males |

| |and 26 females. Predominant mode of presentation was low back pain with radiation to leg (46.9%), neurogenic claudication|

| |in 18 patients (18.7%). Eighty Six percent of the disc prolapses were found at L4 L5 and L5 SI levels. Complication rate |

| |was 14.6% with infections being commonest. Excellent to good outcome was found in 85.4% of the cases. Mean follow up |

| |period was 18 months. Study concluded that surgery for cauda equina syndrome and motor deficits has a good outcome with |

| |hemilaminectomy and is the best surgical option for large disc prolapses.15 |

| |Retrospective surveys clinical study was conducted on assess the knowledge of lumbar disc prolapse. Objective of the |

| |study was to estimate the recurrence rate of lumbar disc prolapse after open discectomy in active young men using |

| |survival analysis and assess the knowledge of lumbar disc prolapse. Medical records were retrospectively reviewed and |

| |phone call surveys were undertaken for 241 patients aged from 20 to 39 who had undergone open discectomies over a period |

| |of 14 years. A diagnosis of recurrence was based on the development of new symptoms and magnetic resonance imaging |

| |showing compatible lesions in the same segment as the initial diagnosis. Results shows that the overall recurrence rate |

| |was 7.1% (17 patients) at a mean follow-up of 8.55 years, and the cumulative survival rate was 91.5% at a follow-up of 14|

| |years. Survival analysis estimated a higher rate of recurrence at longer follow-up, although there was no recurrence |

| |after ninth year from the primary surgery. The recurrence rate was significantly higher for protruded discs compared with|

| |other types. Study concluded that analysis provides a more accurate estimation of true recurrence rate. Protruded discs |

| |are more likely to show recurrence than other types.18 |

| |A prospective and controlled study of training after surgery for lumbar disc herniation (LDH). The objective was to |

| |determine the effect of early neuromuscular customized training after LDH surgery and to determine the effect of early |

| |neuromuscular customized training after lumbar disc surgery. The inclusion criteria for this study specified patients |

| |aged 15–50 years, scheduled to undergo surgery for a symptomatic, MRI-verified disc prolapse at L4–L5 or L5–S1. Patients |

| |with a previous spine operation or any other spinal, rheumatological, or neurological disease or lower extremity |

| |dysfunction emanating from musculoskeletal disorder, other than the current LDH, were excluded. All patients received |

| |verbal and written information about the study and gave informed consent. The patients were allocated to an early |

| |training group (ETG) and a control group (CG), based on geographic habitat. Altogether, 69 patients with MRI-documented |

| |LDH managed surgically by open or microscopic technique during a 3-year period were included in the study. All patients |

| |had previously undergone non-operative therapy without pain-relieving effect. The patients were examined the day before |

| |surgery and at out-patient visits to the orthopedic department 6 weeks, 4 months, and 12 months after surgery. Follow-up |

| |was conducted according to the Swedish National Register of Lumbar Spine Surgery. The study was approved by the local |

| |ethics committee. Several studies on training models after disc surgery have been presented over the years. The content |

| |and results have varied. Many have demonstrated good short-term effect but few have proven long-lasting results as in the|

| |present study. Current data about the biomechanics of the lumbar spine support postoperative muscle rehabilitation after |

| |LDH surgery. No study with a pronounced focus on early neuromuscular customized training for stabilization in neutral |

| |position and closed kinetic chain exists to our knowledge.17 |

| | |

| |STATEMENT OF THE PROBLEM: |

| | |

| |“A STUDY TO ASSESS THE KNOWLEDGE REGARDING MANAGEMENT OF LUMBAR DISC PROLAPSE AMONG THE STAFF NURSES WORKING AT SELECTED |

| |ORHTOPEDIC HOSPITAL IN BAGALKOT. WITH A VIEW TO PREPARE AN INFORMATION GUIDE SHEET ON MANAGEMENT OF LUMBAR DISC PROLAPSE”|

| | |

| | |

| | |

| | |

| |6.3 OBJECTIVES OF THE STUDY: |

| |To assess the knowledge regarding management of lumbar disc prolapse among staff nurses. |

| |To find out the association between knowledge regarding management of lumbar disc prolapse with selected socio |

| |demographic variables. |

| |To develop an information guide sheet on management of lumbar disc prolapse. |

| |6.4 OPERATIONAL DEFINITIONS OF TERMS : |

| |ASSESS: In this study assess refers to statistical measurement of knowledge of the staff nurse regarding management of |

| |lumber disc prolapsed. |

| |KNOWLEDGE: In this study knowledge refers to correct responses of the staff nurses to the knowledge items in the close |

| |ended questionnaire regarding management of lumbar disc prolapsed. |

| |THE STAFF NURSE: In this study staff nurse refers to nurses who have undergone Diploma or B Sc nursing course and who is |

| |registered nurse and who are working in selected orthopedic hospitals in Bagalkot. |

| |MANAGEMENT OF LUMBER DISC PROLAPSE: In this study management of lumbar disc prolapsed refers to the care given to the |

| |lumbar disc prolapse patient. |

| |ORHTOPEDIC HOSPITAL: In this study orthopedic hospital refers to the place where the orthopedic patients will receive the|

| |care, in H S K Hospital, Soragavi Hospital, Bagalkot Orthopedic Center and Kerudi Hospital. |

| |INFORMATION GUIDE SHEET: In this study information guide sheet refers to printed learning materials prepared by the |

| |researcher with an aim to improve the knowledge on lumbar disc prolapsed. |

| | |

| |6.5 ASSUMPTIONS: |

| |The study assumes that: - |

| |The staff nurses are having some knowledge regarding management of lumber disc prolapsed. |

| |The staff nurses are willing to participate in study regarding management of lumber disc prolapsed. |

| |6.6 HYPOTHESIS: |

| |There will be significant difference between knowledge regarding management of lumber disc prolapsed & significant |

| |association between knowledge score and the demographic variable. |

| |6.7 DELIMITATIONS: |

| |Prescribed data collection period is only 4-6 weeks |

| |Sample size is limited to 100 staff nurses. |

| |Study design is limited to descriptive design. |

| |6.8 PROJECTED OUT COME: |

| |The findings of the study will help staff nurses to manage the lumbar disc prolapse. |

| |7. MATERIAL AND METHODS |

| |7.1 SOURCE OF DATA : |

| |RESEARCH DESIGN: A descriptive survey design. |

| |RESEARCH SETTING: The study will be conducted in staff nurses working in selected hospitals, Bagalkot, Karnataka. |

| |POPULATION: The population selected for the study will be the staff nurses working in selected hospitals, Bagalkot |

| |SAMPLING TECHNIQUE: Simple Random sampling technique. |

| |SAMPLE SIZE: 100. |

| |DURATION OF STUDY: 4 weeks |

| |RESEARCH VARIABLES: |

| |Dependent variable: The staff nurses knowledge who is working in selected orthopedic hospitals, Bagalkot. |

| |Demographic variable: Age, Sex, Professional education, Experience, In-service Education, Religion, Income, Marital |

| |status. |

| | |

| |INCLUSION CRITERIA: |

| |Irrespective of gender |

| |Who are willing to participate in the study. |

| |Present during the period of data collection. |

| |Who are not attending workshop on management of lumbar disc prolapse. |

| |EXCLUSION CRITERIA: |

| |Who are: |

| |Not willing to participate in the study. |

| |Who are attending workshop on management of lumbar disc prolapse. |

| |Who are not willing to participate in the study. |

| |7.2 METHOD OF COLLECTION OF DATA: - |

| |Step 1: Formal permission from |

| |Principal of Sajjalashree institute of nursing sciences Bagalkot. |

| |Permission from selected Hospitals in Bagalkot. |

| |Step 2: Investigator introduces himself to the subject. |

| |Step 3: Administration of structured questionnaire to assess the knowledge regarding management of lumbar disc prolapse. |

| |DATA COLLECTION TOOLS : |

| |Instruments: |

| |Structured questionnaire to collect the socio demographic data of staff nurses. |

| |Structured questionnaire to assess the knowledge regarding management of lumbar disc prolapse. |

| | |

| |DATA ANALYSIS PLAN: |

| |Descriptive & inferential statistics will be used. |

| | |

| |Frequency and percentage will be used to summarize the sample characteristics by item wise analysis. |

| |Mean, standarad deviation and paired‘t’ test will be used to calculate the effectiveness of planned teaching programme. |

| | |

| | |

| |7.3 Does the study require any investigation or inferential interventions to be |

| |Conducted on participants. |

| |No |

| | |

| |7.4 Whether the ethical clearance has been obtained from the concerned hospital in case of 7.3. |

| |Yes |

| | |

| | |

|8. |LIST OF REFERENCES : |

| |Abramovitz ZN, Neff S. Lumbar Disc Surgery: Results of prospective lumbar discectomy study of joint section on disorders |

| |of spine of peripheral nerves of American Association of Neurological surgeons and Congress of neurological surgeons. |

| |Neurosurgery 29: 301 – 308, 1991. |

| |Finesson BE. Lumbar disc excision – Schidesk H.K., Sweet W.H. (eds). Operative Neurosurgical Technique, 3rd Ed., 1905 – |

| |1924, 1995. |

| |Rothman RH, Simeone FA. The Spine, 2nd ed. Philadelphia: Saunders, 1982. |

| |Dan M. Spengler, M D, Results with limited disc excision: Spine 7:604- 607, 1982 |

| |Michael H. Newman M D, Out patient conventional laminotomy and disc excision. Spine 1995 Vol 20, no 3, pp 353-355 |

| |Smith M, Gallagher J, Memanus F. Surgery in lumbar disc protrusion. A long term follows up. In Med J 76:25-26, 1983. |

| |Spangfort EV. The Lumbar disc herniation – a computer aided analysis of 2504 |

| |operation. Acta Orthop. Scand suppl 142:3-95, 1972. |

| |Tycho Tullberg, MD, Johan Isacson, Does Microscopic Removal of Lumbar Disc |

| |Herniation Lead To Better Results Than The Standard Procedure, Spine, Vol 18, number 1, 1993. |

| |Mouw LJ, Hitchan PW. Pathogenesis and natural history of degenerative disc disease and spinal disease. Trindal GI, Cooper|

| |PR, Barrow DL. (eds). In The Practice of Neurosurgery, 2357-2366, 1966. |

| |Toshihico Maruta, MD, Sherwin Goldman, MD. Waddell’s nonorganic signs and Minnesota Multiphasic Personality Inventory |

| |Profiles in patients with chronic low back pain. Spine, Vol 22, Number 1, 1997, page72-76. |

| |Sharma S, Sarkar B. A clinical profile of prolapse intervertebral disc and its management. Indian Journal of |

| |Orthopaedics. 14, 7: 1980. |

| |Barr JS and Mixter WJ. Posterior protrusion of lumbar intervertibral disc. Jounal of Bone joint Surgery, 23: 444, 1941. |

| |Weber H. Lumber disc herniation: a prospective study of prognostic factors including a controlled trial. J Oslocity Hosp,|

| |28: 33 – 64, 89-103, 1978. |

| |Tania Larequi-Labuer, MD John-Paul Vader, MD, MPH. Appropriate indications for surgery of lumbar disc hernia and spinal |

| |stenosis. Spine vol, 22, nov-1997, page-203-209. |

| |Williams RW. Microlumbar discectomy – A conservative surgical approach to virgin herniated lumbar disc. Spine. 3: |

| |175-183, 1978. |

| |Conley Fk, Dicision making and conservative management of lumbar disc surgery.Tindall GI. In The Practice of |

| |Neurosurgery., 2473 – 2482, 1983. 28. |

| |Deyo RA. Conservative therapy for low back pain; Distinguishing useful from useless theraphy. JAMA, 250: 1057 – 1062, |

| |1983. |

|9. |SIGNATURE OF THE CANDIDATE | |

| | | |

|10. |REMARKS OF THE GUIDE |This study is feasible and I forward it for acceptance. |

|11. |NAME AND DESIGNATION OF |Prof. Maruti. S .Chalawadi |

| | |Prof & H O D |

| |11.1. GUIDE. |Dept of Medical Surgical Nursing |

| | |Shri. B.V.V. Sangha’s Sajjalashree Institute of Nursing |

| | |Sciences, |

| | |Navanagar, Bagalkot, Karnataka |

| |11.2. SIGNATURE | |

| |11.3. CO – GUIDE |Mrs. Jayashri, G. Itti, |

| | |Professor & HOD |

| | |Dept. of Community Health Nursing. |

| | |Shri. B.V.V. Sangha’s Sajjalashree Institute of Nursing |

| | |Sciences, |

| | |Navanagar, Bagalkot, Karnataka |

| |11.4. SIGNATURE | |

| |11.5. HEAD OF THE DEPT. |Prof. Maruti. S .Chalawadi |

| | |Prof & H O D |

| | |Dept of Medical Surgical Nursing |

| |11.6. SIGNATURE | |

|12. |REMARKS OF THE CHAIRMAN & PRINCIPAL |The topic is discussed with the members of the research |

| | |committee and is finalized. He is permitted to conduct the |

| | |study. |

| |12.1 SIGNATURE | |

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