الفهرس 
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Abstract
Osteoarthritis (OA) is considered a major public health problem globally, affecting the cartilage of joint and contributing to reduced function that affects the quality of life. Although pain is the main and most common disabling symptom for osteoarthritis patients; however, joint stiffness, edema, disfigurement and decreased functional ability such as walking, are widespread associated health issues of those patients. Since there is no cure for OA, the aim of therapy is generally to reduce pain, manage symptoms, improve joint function, and minimize disability. Reflexology is a therapeutic method of applying appropriate compression technique to pressure points to specified areas on the feet, as a means of inducing relaxation and relieving stress. Reflexology promotes healing by stimulating the reflexes located on the surface of the skin, which causes the release of endorphins by brain cells, which help to reduce pain and control muscle and joint tension as well as enhancing of mood and emotions. Aim of the study: The aim of the this study was to evaluate the effect of foot reflexology with pharmacological treatment on pain and quality of life among elderly suffering from osteoarthritis in Tanta city. Materials & methods Study design: Experimental research design was used in this study. Setting: This study was conducted in outpatient clinic in Physical, Rheumatology and Rehabilitation Department at Tanta University Hospital. Subjects: The total sample was 175 elderly suffering from osteoarthritis. Subjects were be classified into two groups. - group A was managed by foot reflexology with pharmacological treatment. This group included 105 and was classified into three equal subgroups. The sample size of each subgroup was 35 elderly. These groups were as follows:- • group A.1 with mild degree of osteoarthritis. • GroupA.2 with moderate degree of osteoarthritis. • group A.3 with severe degree of osteoarthritis - group B was managed by pharmacological treatment only. It included 70 elderly. Tools of the study: Four tools were used by the researcher in order to obtain the necessary data. Tool I: Structured Interview Schedule: This tool included three parts: Part (1): Socio-demographic characteristics: such as age, sex, marital status, level of education, occupation, residence and monthly income. Part (2): Medical history: which included items related to onset, duration of the disease, family history, signs and symptoms, type of management (pharmacological & non-pharmacological treatment), drugs used (type, duration, availability, common side effects and their compliance) and degree of the disease. Part (3): Anthropometric physical parameters: This part included measuring of height (cm), weight (kg) and thigh circumference. - The body mass index (BMI) was calculated with weight divided by the height squared ((kg)/ (m2) according to Guidelines for Taiwan, (2011) (129). It categorized into four levels: - Underweight (BMI < 18.5). - Ideal weight (BMI ≤ 18.5 - < 24.9). - Overweight (BMI ≤ 25 - < 29.9). - Obese (BMI ≥ 30.0). - Measuring Thigh Circumference: Measurement of thigh circumference was performed 15 cm proximal to the superior pole of the patella. The thigh circumference was categorized into 9 percentile categories (2.5th, 5th, 10th, 25th, 50th, 75th, 90th, 95th and 97.5th percentiles) (130). Tool II: Western Ontario and Mcmaster (WOMAC) Osteoarthritis Index: It comprises 24 questions in three subscales which include (WOMAC pain, stiffness and physical function disability. Tool III: Quality of Life Questionnaire This tool composed of 36 items measuring physical and mental health status in relation to eight health domains: physical functioning (10 items), role limitations due to physical health (4 items), role limitations due to emotional health (3items), vitality (energy/fatigue) (4items), emotional well-being (5 items), social functioning (2 items), pain (2 items) and general health (5 items). A final item was answered by the client but wasn’t included in the scoring process. Tool IV: Knowledge of the studied elderly regarding pharmacological treatment of OA: Appendix (II) It consisted of 43 choice questions that aimed to assess the elderly knowledge about pharmacological treatment of OA. It covered the following items: drug used, drug side effects, contraindications, instructions of use and compliance of these drugs. The results of the current study can be summarized as follows: • The age of the study group ranged from 60- 86 years, with a mean of 69.50 6.829 years and less than two thirds (61.9%) of them were females, while the age of the control group ranged from 60- 85 years, with a mean of 68.63 6.61years and about three quarters (72.9%) of them were females. • About 41.9% of the study group were married and 30.5% were widow. On the other hand, 38.6%, 34.3% of the control group were married and widow respectively. • About 25.7% of the study group and 31.4% of the control group were illiterates compared with 29.6% % and 31.5% of the study and control groups respectively were university and postgraduates. • About 36.2% and 35.7% of the study and control group respectively were housewives. • Nearly 55.2% and 62.9% of the study and control groups respectively had adequate income. • Nearly 57.1% and 60.0% of the study and control groups respectively came from rural area. • More than half (62.8%, 62.9% ) of the study and control group respectively had osteoarthritis from < 5 years. • The majority of both the study and control groups (88.6% and 95.7% respectively) had knee joint osteoarthritis. • About 74.8%, 74.8 % and 72.4% of the study group complained of joint stiffness, increase pain during physical activities and limited physical movement respectively. This was followed by crackling sound by 64.8% and finally swelling by 51.4%. As regard the control group, 80% and 74.3% of them reported limited physical movement and increased pain respectively, followed by joint stiffness by 68.6% and finally swelling by 44.3%. • One third (33.3%, 33.3%, 33.3%) of the study group had mild, moderate and severe degrees of the osteoarthritis. This is compared with 32.9%, 35.7% and 31.4% of the control group had mild, moderate and severe degree respectively. • About three quarters (76.2%, 75.7%) of both the study and control groups respectively had BMI ≥ 30 m\kg2. • More than half (53.3% and 57.1%) of the study and control groups respectively had thigh circumference ≥ 95th percentile. • The total mean WOMAC of the study group was of 60.65±18.02 pre intervention and 43.45±13.6 and 45.64±16.31 immediately post and three months after the implementation of the intervention, with a statistically significant difference (p=0.000). • Regarding the total mean WOMAC score, the great improvement was seen in mild degree of osteoarthritis with the mean of 34.58±2.16 pre intervention, 14.58±1.84 immediately post and 17.33±1.23 three months after the implementation of the intervention with statistically significant difference with in the whole study period (p=0.000). • The total mean WOMAC for elderly with moderate degree of osteoarthritis changed from 57.10±2.27 to 46±2.02 three months posttest with statistically significant difference from pre intervention to three months after implementation of the intervention (p=0.000). • The total mean WOMAC score for elderly with severe degree of osteoarthritis was 79.92±2.11 as the initial assessment and changed to 70.84±1.46 three months after implementation of the intervention with a statistically significant difference (p=0.000) and this difference wasn’t statistically significant (p=0.109). • The majority (89.5%) and about three quarters (74.3%) of both the study and control groups respectively had poor level of quality of life pre intervention. • Half (51.4%) and 11.4% of the study group had fair and good level of the total quality of life score respectively immediately post the implementation of the intervention compared to about one quarter (24.3%) had fair level and no elderly had good level of the quality of life of the control group. • After three months of implementation of the intervention, about half (49.5%) of the study group and 16.2% had fair and good level of the total quality of life score respectively compared to one quarter (25.7%) and no one respectively of the control group. • For elderly with mild degree of osteoarthritis, the total mean quality increased from 40.87±1.51 pre intervention to be 63.04±2.56 and 65.77±2.89 immediately post and three months after the implementation of the intervention with a statistically significant difference (p=0.000). • For elderly with moderate degree of osteoarthritis, the total mean score of quality of life increased from 36.78± 3.68 pre intervention to be 55.06±2.18, 57.51±1.71 immediately post and three months after the implementation of the intervention respectively with a statistically significant difference (p=0.000). • For elderly with severe degree of osteoarthritis, there was a statistically significant difference of the total mean quality of life from pre intervention to three months after the implementation of the intervention (p=0.000). • All the study and control groups had poor knowledge pre educational program, after the implementation of the educational program, 56.2% and 45.7% of both the study and control groups respectively had fair level of knowledge. • There was a statistically significant relation between total mean quality of life and age of the elderly of the study group (p=0.043, 035) immediately post and three months after the implementation of the intervention with high total mean quality of life for elderly whose age ranged from 60-70 years. • There was a statistically significant relation between total mean WOMAC and age of the elderly of the study group immediately post intervention and three months after the implementation of the intervention (p= 0.042 & 0.046) respectively with high total mean WOMAC index for elderly whose age was 80 years and more. • There was a statistically significant relation between total mean WOMAC score and BMI of the study group (p=0.042,0.039& 0.039) pre intervention, immediately post and three months after the implementation of the intervention with high total mean WOMAC index for elderly whose BMI greater than 30 Kg|M2. • For the study group, there was a statistically significant negative correlation between total quality of life score and total WOMAC score pre, immediately post and three months after implementation of the intervention ( r=--0.673, p=0.000, r=-0.685, p=0.000 and r=-0.692, p=0.000) respectively. also, there was a statistically significant negative correlation between total knowledge score and total WOMAC score pre and immediately post after implementation of the intervention (r=-0.346, p=0.001 and r=-0. 383, p=0.001). Based on the findings of the study the following recommendations are suggested that:- 1- Foot reflexology technique should be recommended in hospital protocols beside pharmacological treatment for management of osteoarthritis. 2- Incorporate the foot reflexology in gerontological nursing curriculum of undergraduate students. Nurse educator should have training regarding reflexology technique. 3- Application of continuous health education program about pharmacological treatment of osteoarthritis should be applied to elderly in the different community settings to improve their knowledge that affect their quality of life. 4- Continuous evaluation of elderly’s knowledge for enhancing compliance with pharmacological treatment of osteoarthritis is urgent need.