SHORT COMMUINCATION RANDOMIZED CONTROL TRAIL: EFFECT OF OXYGEN COMPRESSED COLD APPLICATION ON PAIN AMONG PATIENTS WITH MUSCULOSKELETAL DISORDERS AT PUDUCHERRY

To assess the level of pain among patients with –test. To evaluate the effectiveness patients with patients with A total subjects who fulfilled the inclusion criteria were selected for the study using Randomized control trail (RCT). The study setting were selected by purposive sampling technique. Demographic variables were collected using interview schedule. Pain outcome of the patients withmusculoskeletal disorders was assessed using Numeric pain intensity scale. Pre test was done through numeric pain intensity scale. Conventional cold application using ice cap was given, Oxygen compressed cold application was given.Post test was done through numeric pain intensity scaleusing after a period of 30minutes. Results: The result shows thatmusculoskeletal painto assess the effectiveness of Oxygen compressed cold application on pain among patients with musculoskeletal disorders. Conclusion: The main aim of the study to assess the effectiveness of Oxygen compressed cold application on pain among patients with musculoskeletal disorders. Thus, it was concluded Oxygen compressed cold application effective on pain among patients with musculoskeletal disorders.

The most common chronic condition in both developed and developing countries is musculoskeletal disability, as approximately 25% of adult subjects suffer from persistent musculoskeletal pain. 5 Musculoskeletal conditions affect nearly more than 1.7 billion people worldwide and have the fourth greatest impact on the overall health of the world population, considering both death and disability. This burden has increased by 45% during the past 20 years and will continue to escalate unless action is taken.. 6 Musculoskeletal conditions impairments will increase over the next 25 years, as they are most prevalent in older segments of the population. By 2040, 1 in 5 persons in the US will be age 65 or older and approximately equal to the cohort age 18 and younger. 7 So has to reduce pain, cold treatments are delivered by means of packs, baths, vapocoolant sprays, or ice massage. Use of bags of crushed ice or cold gel packs secured to various anatomical sites with bandaging or elastic wraps is a common observation in used everywhere. 8 In this setting, cryotherapy means ice application with some degree of concomitant static compression is routinely applied immediately after an acute musculoskeletal injury (eg, ankle sprain, muscle pull) or as prophylaxis for chronic orthopedic sports problems (eg, tennis elbow). Indeed, the long held dictum among physical therapists in the management of soft tissue trauma remains protection, rest, ice, compression and elevation.. 9,10 The physiological effects of cold are generally the opposite of warm effects. The effects of cold are vasoconstriction, a slowdown in cell metabolism, local anesthesia, decrease in blood flow, reduction of the arrival of oxygen and metabolites to the area and the reduction of residuum removal. 11 Cold application is a simple and inexpensive therapy which has been accepted for decades as an effective non pharmacological intervention for oedema and as well as pain management. It reduces the oedema in acute soft tissue injuries. Cold is commonly used in the treatment of acute soft tissue injuries to relieve pain, it reduces oedema.
Cold and compression are routinely applied immediately after acute injury or following surgery to alleviate pain, reduce swelling and speed functional recovery. 12

Need for the study:
Musculoskeletal conditions were the main source of incapacity in four of the six WHO areas in 2017 (positioned second in the East Mediterranean Region and third in the African Region). While the prevalence of musculoskeletal conditions increases with old age, younger people are additionally influenced, regularly during their peak incomeearning years. 13 WHO's Study on global ageing and adult health point to the high prevalence of arthritis in low class and middle class income people, particularly among those in a lower socio economic status people. 14 Current estimates of people affected worldwide include back pain 632 million, neck pain 332 million, osteoarthritis of the knee 251 million, and other Musculoskeletal conditions 561 million. Worldwide low back pain is leading cause of disability and contributes 10.7% of all YLDs. Low back pain (83.1 million YLDs), neck pain (33.6 million YLDs), and osteoarthritis (17.1 million YLDs) are chief causes of Musculoskeletal conditions problems. 15 The Global Burden of Disease (GBD) study provides evidence of the impact of musculoskeletal conditions, highlighting the significant disability burden associated with these conditions. In the 2017 GBD study, musculoskeletal conditions were the highest contributor to global disability (accounting for 16% of all years lived with disability). 16 Although the incidence of musculoskeletal disorders varies by age and diagnosis, 20%-33% of people worldwide are suffering from a debilitating musculoskeletal disease. 17 A recent report from the United States of America suggests that one in two adult Americans live with a musculoskeletal conditionthe same number as those with cardiovascular or chronic respiratory diseases combined. 18 Arthritis is the most common cause of adult disability in the US, and a leading cause of job limitations. By 2030, it is projected that the number of adults affected by doctor-diagnosed arthritis will reach 67 million, or 25 per cent of the population. Close to 50 per cent of people age 65 and older report arthritis .19 In India the general community is burdened by musculoskeletal disorders. Cross-sectional study of 2086 National Capital Region (NCR) subjects; Total MS pain prevalence was estimated to be 25.9%. Pain among females (31.3 percent) was found to be more prevalent compared with males (20.9 percent). Our findings confirm that MS pain is a significant burden of disease among the residents of NCR. 20 The prevalence of musculoskeletal pain and joint complaints was performed at one of Puducherry Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER). Using prevalence of the musculoskeletal complaints as 26.08%, and an absolute precision of 5%, the required sample size was 296 those who are affected with musculoskeletal conditions. 21 Cold compression is used internally or systemically for medical purposes and helps to decrease the temperature of the tissue. For the treatment of knee osteoarthritis, the goal is to enhance the quality of life by minimizing discomfort, stiffness and other symptoms, preventing disease development, improving and preserving the patient's physical function. In this respect, cold application is thought to help treatment, as it has low side effects, easy application and non-invasive application. 22 It also directly addresses the swelling, inflammation and pain associated with these injuries, this modality has been extended to the post-operative management of a variety of orthopedic procedures. 23 In a study conducted by Melzack, cold application massage and TENS therapy were compared between patients with back pain and it was stated that ice massage applied to the trigger points of muscle pain, skeletal pain, soft tissue pain and joint pain offered better relief and relaxation so that it was concluded that cold application massage was an effective therapeutic process. 24 A research by Bleakley et al demonstrated regular application of cold in the early stages of recovery following ankle sprains resulted in substantially improved subjective pain management. 25 The researcher felt that the Oxygen compressed cold application which is a newly designed Oxygen compressed cold application invented by the investigator can overcome the non-availability ofConventional cold application using ice cap and can be replaced with cold water with oxygen produced through electricity.
The electrical device is designed and developed for pain reduction, to check the usability/utility and the effect of conventional cold application using ice cap. This study was chosen to compare the effectiveness of Conventional cold application VS Oxygen compressed cold application .
The result of this study will help to decide the best method to treat pain and to implement user-friendly approach in the hospital. Thus, the investigator had taken up this study with the aim of replacing Conventional cold application with Oxygen compressed cold application.
Objectives:-1. To assess the level of pain among patients with musculoskeletal disorders during pre-test and post -test. 2. To evaluate the effectiveness of oxygen compressed cold application on pain among patients with musculoskeletal disorders. 3. To associate the level of pain among patients with musculoskeletal disorders with selected demographic variables.

Hypotheses:
H1-Association exists between levels of pain among patients with musculoskeletal disorders and selected demographic variables.

Methodology:-
Quantitative research approach was adopted in this study. A total of 90 subjects who fulfilled the inclusion criteria were selected for the study using Randomized control trail (RCT). The study setting were selected by purposive sampling technique. The study setting was Male and Female ortho wards of Puducherry. Demographic variables were collected using interview schedule. Pain outcome of the patients withmusculoskeletal disorders was assessed using numeric pain intensity scale. Oxygen compressed cold application was given.Post test was done through numeric pain intensity scaleusing after a period of 30minutes.

Part 1:
It consists of interview schedule to assess the demographic data such as age, gender, educational status, occupation, monthly income, religion, residential area, duration of musculoskeletal pain, undergoing any pain relieving measures, duration of working hours per day and frequency of follow up.

Part 2:
It includes assessment of the pain intensity using numeric pain intensity scale.  The calculated paired 't' test value of t =6.459 shows statistically highly significant betweenComparison of thePretest and post-test of the level of pain ( numeric pain intensity scale) among patients with musculoskeletal disorders in oxygen compressed cold application group respectively.