Sathyabama-Spondylitis Dissertation

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CHAPTER – I
INTRODUCTION
“Look After Your Body And Your Body Will Look After You”
-Paul Boxer
BACKGROUND OF THE STUDY
The spine runs from the base of the skull to the pelvis. It serves as a pillar to
support the body’s weight and to protect the spinal cord. The spine is made up of a
serious of bones that are stacked like blocks on top of each other with cushions called
discs. The spine is divided into three regions like cervical spine, thoracic spine and
lumbar spine. (Department of Neuroscience., 2016)
Inflammatory disease of the joints such as arthritis, including osteoarthritis
and rheumatoid arthritis as well as Spondylitis, an inflammation of the vertebrae, can
also cause low back pain. Spondylitis is also called spondyloarthritis or
spondyloarthropathy. (Mchado., 2015 )
Spondylitis is one of the most common causes of back and neck pain, and
results from inflammation of the vertebral joints. The condition is often not detected
until it has fully developed and is causing pain. Low back pain is a common
musculoskeletal disorder affecting 80 percent of people at some point in their lives. It
is an extremely common human phenomenon which occurs because of trauma,
degeneration or any pathology related to back. It can be acute, sub-acute or chronic in
duration.(Christian Nordqvist., 2015).
The causes of Spondylitis is unknown, it is believed to involve a combination
of generic and environmental factors. Spondylitis is a type of seronegative
spondyloarthropathy, meaning that tests show no presence of rheumatoid factor

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antibodies. It is also within a broader category known as axial spondyloarthritis.
(Bernard. 2015).
Mostly 0.1% and 1.8% of people are affected by Spondylitis. The onset is
typically in young adults. Males are more often affected than females. The signs and
symptoms of Spondylitis often appear gradually, with peak onset being between 0 and
30 years of age. Spondylitis can occur in any part of the spine (or) the entire spine,
often with pain referred to one (or) the other back of the thigh from the sacroiliac
joint. Treatments may improve symptoms and prevent worsening. This may include
medication, exercise, and surgery. (Matteson.2014).
Low back pain contributes substantially to the workload of general practices.
The origin of low back pain is not clearly known and has never been fully described.
The causes of low back pain namely lumbar - sacral ligament and the weak muscles,
spinal stenosis, obesity and occasionally. Low back pain results from herniation of the
nucleus pulposus in the intervertebral disc. It also occurs due to degeneration of the
vertebrae, or disc injury from Hyper reflexes, herniation or Injury, Spinal root
compression,which leads to subsequent motor and sensory manifestation.(J Guzman.
2014).
Men and women are equally affected by low back pain, which can range in
intensity from a dull, constant ache to a sudden, sharp sensation that leaves the person
incapacitated. Sedentary lifestyles also can set the stage for low back pain, especially
when a weekday routine of getting too little exercise is punctuated by strenuous
weekend workout. Low back pain can be caused by number of reasons that is due to
excessive standing or sitting, exercises, lifting heavy objects and bad posture, etc.(Jab
Hayden., 2015).
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The vast majority of low back pain is mechanical in nature. Some examples of
mechanical causes of low back pain are sciatica, Spondylolisthesis and skeletal
irregularities. Sciatica is a form of radiculopathy caused by compression of the sciatic
nerve, this compression causes shock-like or burning low back pain. Spondylolisthesis
is a condition in which a vertebra of the lower spine slips out of place, pinching the
nerves exiting the spinal column. Spinal stenosis is a narrowing of the spinal column
that puts pressure on the spinal cord and nerves that can cause pain or numbness with
walking and over time leads to leg weakness and sensory loss. (William. 2015).
The first attack of low back pain typically occurs between the ages of 30 and
50,and back pain becomes more common with advancing age. As people grow
older,loss of bone strength from osteoporosis can lead to fractures, and at the same
time,muscle elasticity and tone decrease. Being overweight, obese or quickly gaining
significant amounts of weight can put stress on the back and lead to low back pain.
Some causes of back pain, such as Ankylosing Spondylitis, a form of arthritis that
involves fusion of the spinal joints leading to some immobility of the spine, have a
genetic component. Having a job that requires heavy lifting, pushing or pulling,
particularly when it involves twisting or vibrating the spine,c an lead to injury and
back pain.(Nadine Foster., 2014).
Low back pain is treated by pharmacological treatment, non- pharmacological
treatment, injection therapies and surgical treatment. Pharmacological treatment
includes NSAIDs, acetaminophen, opioids, muscle relaxants and corticosteroids. Non
pharmacological treatments include exercise such as lumbar stabilizing exercise. Low
back pain, long term relief, can only be obtained through nursing interventions, like
monitoring vital parameters, providing comfortable position, hot and cold application
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and health education regarding maintaining body mechanism, exercises, dietary
management and self-activities.(Jan Hartvigsen., 2013).
Mckenzie exercise, it is a philosophy of active patient involvement and
education for back, neck and extremity issues. Mckenzie exercise is a type of
Mechanical Diagnosis and Therapy [MDT].The choice of exercises in the Mckenzie
exercises is based upon flexion, extension or lateral shift of the spine to reduce low
back pain disability. (Robin., 2013).
NEED OF THE STUDY
The world wide statistics of 55% of people, mostly suffer incapacitating low
back pain at some stages in their because of low back pain. Approximately 1.5 million
new cases of low back pain are been growing concern about the low back disability in
western society.(American chiropractic association., 2018).
The worldwide lifetime prevalence of low back pain and functional disability
varies from 50% to 80%. Studies in developed countries have shown that the low
back pain and functional disability prevalence was 6.8% in North America ,13/7% in
Denmark,12% in Sweden,14% in the United Kingdom. Similarly, (International
survey of Low back Pain 2017).
In world level data from multiple countries, the age and sex – adjusted
incidence of Spondylitis is 0.4 – 14 per 1, 00,000 person in the year. Spondylitis
occurs more frequently in men then in women (2:1). Approximately 80% of patients
with Spondylitis experience symptoms at <30 years of age, while only 5% will
present with symptoms at > 45 years of age. (Johns Hopkins Arthritis centre.,
2016).
In United Kingdom, low back pain was identified as the most common cause
of disability in young adults, which more than 100 million workdays lost per year. A
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systemic review of prevalence studies reported estimates for point prevalence of low
back pain ranging from 1 % to 33%, the one - year prevalence ranging from 20% to
55 % and the lifetime prevalence ranging from 11% to 84%. [Global burden of
disease andstudy.,2015).
As per census 2011,in India the occurrence of low back pain nearly 60% of
people are suffered, and the low back pain prevalence has been found to range from
62% to 92% with increase of prevalence with age and female preponderance.(Indian
journal of pain., 2014).
The prevalence of Spondylitis in the rural and urban area is estimated in
Tamilnadu population is revealed that, significantly higher prevalence of Spondylitis
in the rural area 17% in adult and 54.1% in elderly , compared with the urban 5.6% in
adult and 16.4% in elderly. The prevalence of Spondylitis high among older people in
both rural and urban areas. (Indian Council of Medical Research. 2013)
In Thirunelveli, about 1 in 5 patients over the age of 50 has some form of
Spondylitis and 1 in 20 patients most severely affected by lower back pain. The
people falling in the age group of 35 – 65 years are mainly affected by Spondylitis.
(Dr.Nisha Elizabeth., 2014)
Mckenzie exercise is used to strengthen muscles, increase soft tissue stability,
restore range of movement and improve cardiovascular conditioning. (Mckenzie.,
2013).
The Mckenzie approach can help “centralize” the patient’s pain by moving it
away from the extremities (leg or arm) to the back. Back pain is usually better
tolerated than leg pain or arm pain, and the theory centralizing the pain allows the
source of the pain to be treated rather than the symptoms.(Vet Mooney, 2012)
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Edward. D. Rich (2013), conducted the randomized trial on effect of
Mckenzie exercise to improve functional ability and reduce back pain among
Spondylitis. A group of elderly subjects 50 to 70 years of age randomized into a
training group (N=18) that performed one set of 3 to 5 Mckenzie exercise, to reduce
low back pain and improve functional ability 3 times per week, and a control group
(N=6). Before and after study period, subjects were assessed for Quebec scale. The
result shows a significant improvement in Mckenzie exercise, while the control group
showed no change.
By reviewing the prevalence and incidence of level of low back pain and
functional disability in Spondylitis, and also the investigator personally found that
Mckenzie exercise, is a successful method to treat low back pain and functional
disability in Spondylitis patients. It helps to improve the patient’s ability to move
normally without back pain and to do their activities of daily living independently.
Which influence the investigator to select the Mckenzie exercise to reduce the low
back pain and functional disability and improve their quality of life of Spondylitis
patients.
STATEMENT OF THE PROBLEM
A study to assess the effectiveness of Mckenzie exercise on low back pain and
functional disability among Spondylitis Patients in selected hospitals Thirunelveli
District.
OBJECTIVES
 To assess the Pre - test and Post - test level of low back pain and functional
disability among spondylitis patients in experimental group and control group.
 To find out the effectiveness of Mckenzie exercise on low back pain and
functional disability among spondylitis patients in experimental group.

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 To compare the Pre - test and Post - test level of low back pain and functional
 To correlate the post-test level of low back pain and functional disability
among Spondylitis patients in experimental group.
 To associate the post - test level of low back pain and functional disability
among spondylitis patients in experimental and control group with their
selected demographic variables such as Age, Sex, Marital status, Education,
Occupation, Dietary pattern, Body mass index, History of previous
orthopaedic surgery, Duration of illness and Duration of treatment.
HYPOTHESES
RH1: The Mean Post - test level of low back pain and functional disability
among spondylitis patients in experimental group will be significantly lower than the
Mean Post - test level of low back pain and functional disability in control group.
RH2: The Mean Post - test level of low back pain and functional disability
among Spondylitis patients in experimental group will be significantly lower than
their Mean Pre - test level of low back pain and functional disability.
RH3: The Mean Post-test level of low back pain and functional disability
among Spondylitis patients in control group will be significantly higher than their
Mean Pre-test level of low back pain and functional disability.
RH4: There is a positive correlation between the post-test level of low back
pain and functional disability in the experimental group.
RH5: There is a significant association between the Post- test level of Low
back pain and functional disability in experimental group with their selected
demographic variables.
OPERATIONAL DEFINITION
Assess
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In this study, It refers to a process of systematically and continuously
collecting, validating and communicating the data regarding, level low back pain and
functional disability of Spondylitis patients on before and after administration of
Mckenzie exercise.
Effectiveness
In this study, it refers to find the degree to which extend the desired outcome
of Mckenzie exercise on reducing low back pain, was measured by Standardised
Numerical Intensity Pain Rating Scale and functional disability was measured by
Modified Self-Administered Rolland Morris Functional disability scale among
spondylitis patients.
Mckenzie exercise
Mckenzie exercise is a type of exercise, which is designed to reposition the
displaced intervertebral discs. To facilitate the disc movement, and maintain relax
while patient taking breathe by the time of this exercise.
In this study, Mckenzie exercises refers to performing a serious of five
progressive exercises continuously with a minute of relaxation by taking breath, such
as Press ups, Forward bend, Cat-cow stretch, Lower back Twist, Lower back massage
and stretch. It was given 20 minutes per session for 2 times a day and consequently
for 2 weeks from Monday to Sunday.
Low back pain
In this study, it refers to unpleasant experience perceived by the spondylitis on
the back side with mild, moderate and severe pain at the lumbar region and it was
measured by Standardised Numerical Intensity Pain Rating Scale.
Functional Disability
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In this study, it refers to limitation of activities of Spondylitis patients with
mild and moderate functional disability, which was measured by Modified Self
Administered Rolland Morris Functional Disability Scale.
Spondylitis Patients
In this study, spondylitis patients refers to the Patients who are diagnosed as
spondylitis by Orthopaedician, between the age group of 35 – 65 years, with mild,
moderate and severe low back pain, and mild and moderate functional disability and
including both males and females those who are fulfilled the inclusive and exclusive
criterias.
ASSUMPTION
 Mckenzie exercises was reduce the low back pain and functional disability
disability, and improve the health status of Spondylitis patients.
 Most of the Patients between 35- 65 years age group may have limited
movements and functional disability due to the low back pain.
DELIMITATION
 Study is limited to 74 samples.
 Study period is limited to 4 weeks period.
PROJECTED OUTCOME
 The study findings will help the Spondylitis patients to reduce the low back
pain and reduce the functional disability.
 The findings of the study will help the nurse to administer Mckenzie exercise
among Spondylitis Patients.

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CONCEPTUAL FRAMEWORK
The conceptual framework for research study presents the measure on which
the purpose of study is based.
Faye G. Abdellah, (1960) proposed helping art of clinical nursing theory,
which focused patient centered approach as the basis for her typology of 21 nursing
problem, it directed action towards the explicit goal, this theory has 3 sections.
 Health care need
 Problem solving approach
 Health care need management
Health care need
Health care need defined as such a need is one related to the treatment, control
and prevention of a disease, illness, injury or disability and the care or aftercare of a
person with these needs.
In this study, the low back pain disability was faced by the spondylitis patients
aged 35 – 65 years, pre assessment level of low back pain was assessed by
Standardised Numerical Intensity Pain Rating scale and functional disability was
assessed by Self Administered Rolland Morris Functional Disability scale for both
experimental and control group.
Problem solving approach

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The analyzer identifies overt and covert problem and interpret, analyze, and
selects as appropriate course of action to solve the best professional nursing care. A
nurse must be able to solve the problem and render the best professional nursing
carrier.
In this study, Mckenzie exercises refers to performing a serious of five
progressive exercises continuously with a minute of relaxation by taking breath, such
as Press ups, Forward bend, Cat-cow stretch, Lower back Twist, Lower back massage
and stretch. It was given 20 minutes per session for 2 times a day and consequently
for 2 weeks from Monday to Sunday to the experimental group and no intervention
was given to control group.
Health care need management
It helps to meet the client need, increase or restores self-help ability or
alleviates impairement.
In this study, Mckenzie exercise was used to reduce the low back pain and
reduce the functional disability of Spondylitis patients.

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Health care need Problem solving approach

Health care need management
DEMOGRAPHIC
VARIABLES Mild low back pain and
CONTROL GROUP
PRE-TEST (n=38) POST -TEST functional disability
1.Age
Spondylitis
2.Sex Low back patients with Mckenzie Low back pain was
pain was Mild, moderate assessed by Moderate low back pain
exercise not
3.Marital status assessed by and severe low Standardised and functional disability
administered
Standardised back pain and Numerical Intensity
4.Education
Numerical mild, moderate Pain rating scale
5.Occupation intensity pain functional and functional Severe low back pain and
rating scale disability disability was functional disability
6.Body mass index and functional assessed by Self
7.Dietary pattern disability was EXPERIMENTAL Administration administered
assessed by GROUP (n=36) of Mckenzie Rolland Morris Nolow back pain and functional
8.History of previous Self Spondylitis functional disability
orthopedic surgery.
exercise for 20
administered patients with disability scale. On
minutes per
9.Duration of illness Rolland Mild, moderate day 7 and 14
session for 2 Mild low back pain and
Morris
and severe low times a day functional disability
10. Duration of treatment functional
disability
back pain and consequently for
scale. mild , moderate 2 weeks. Moderate low back pain and
functional functional disability
disability
REASSESSMENT
Not Included in study
FIGURE 1 : The Conceptual Framework based on Faye. G. Abdellah theory

Application
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CHAPTER-II
REVIEW OF LITERATURE
Review of literature is a key step in Research process. Nursing research may
be considered as a continuing process in which knowledge gained from earlier studies
is an integral part of Research. The literature review is an extensive, systematic, and
critical review of the most important published scholarly literature on aparticular
topic.
In the present study the review of literature is organized and presented as follows.
 Section A- Studies related to Incidence and prevalence of Low back pain in
Spondylitis .
 Section B - Studies related to Incidence and Prevalence of Functional
Disability in Spondylitis.
 Section C - Studies related to Risk factors of Low back pain and functional
disability in spondylitis.
 Section D - Studies related to effect of Mckenzie exercise on Low back pain
and functional disability.
Section A - Studies related to Incidence and Prevalence of Low back
pain in spondylitis:
Theise et al., (2014) conducted a cross sectional analysis in U.S," to evaluate
differences in lifetime prevalence", in 1- month period prevalence, and point
prevalence of low back pain in spondylitis from 28 different employment settings. All
workers completed Computerized Questionnaires and Structured Interviews regarding
low back pain. The low back pain prevalence is measured by Pain Rating Scale. The
investigator concluded that the higher pain rating thresholds yield lower prevalence
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measures and may impact assessments of risk factors and the differences in pain
ratings may allow for focused surveillance with in an occupational cohort.
Mathew et al., (2014) analyzed a cross-sectional study ," to estimate the
prevalence of low back pain in spondylitis and its association with Height, Fat
distribution, Reproduction History and Socioeconomic influence" in Southern India.
A representative sample of 401 men and 403 women aged 20 years and above were
selected and structured questionnaire was used. The investigators concluded, that the
findings were confirms the higher burden of low back pain in spondylitis on the
socially disadvantaged, but cannot yet be explained by known risk factors.
Azize - Karah., (2014) conducted a prospective study on, "workers
experience more low back pain in spondylitis than many other groups" in Norway.
The incidence varies in work activities involving Bending, Twisting; Frequent heavy
lifting, Static Posture and Psychological Stress and these are regarded as causal
factors for many low back injuries and disabilities in spondylitis group.
Hoy D.Bain Williams et al., (2013) Reviewed that “A systemic review of the
global prevalence of low back pain in spondylitis at Bangalore”. A total of 165 studies
from 54 countries were identified. The study concluded that low back pain in
spondylitis was shown to be a major problem throughout the world, with the highest
prevalence among female individuals and those aged 40 – 80 years. After adjusting
the methodology variation, the mean +_ point prevalence was estimated to be
11.9+_20% and the one month prevalence were estimated to be 23.2+_2.9.
Knavery (2012) conducted a population based perspective study to determine
the prevalence of chronic low back pain among spondylitis elderly population at
Pune. Chronic low back pain prevalence in older adults was significantly higher than
the 21 – 45 years age group (12.3% vs. 6.5%). Older adults were more disabled, have
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longer symptom duration, and were less depressed. Chronic low back care seeked by
older adults was significantly lower than the 45- 65 years age group (80% vs. 88%).
Older adults were less likely to receive bed rest, spinal manipulation, heat /cold
treatments, electrical stimulation, and massage therapy.
Bardot (2011) conducted prospective cohort study to estimate the prevalence,
incidence and recurrence of low back pain in spondylitis among safflowers in
Rotterdam. The objective of the study was to describe the natural history of low back
pain in spondylitis by its prevalence, incidence and recurrence. The results of the
study were that at baseline 60% of the study population had an episode of low back
pain in spondylitis in the past 12 months of which 22% was of chronic nature and
during follow up the yearly incidence of low back pain in spondylitis varied between
20%-30% while yearly recurrence rates were 65% - 77%.
Deyo RA Mirza (2010) reported the result of the study to examine the
prevalence of low back pain in spondylitis in the United States. The results of the
study were that in the 2010 NHIS. There were 31,404 adult respondents included the
low back pain lasting at least a whole day in the past 3 months. The survey was
reported by 26.5% of respondents, prevalence generally declined with greater levels
of education and increasing income and about one fourth of U.S. adults report low
back pain in spondylitis in the past 3 months.
Chong EY, khan (2010), carried out a study to determine the prevalence of
low back pain in spondylitis and the associated risk factors among health care workers
in Italy. Through this study concluded that the prevalence of low back pain was
40.4%. Health care workers with poor mental health and had higher risk of
developing low back pain.

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Section B -Studies related to Incidence and Prevalence of Functional
Disability in spondylitis:
David Cassidy et al.,(2015) conducted a prospective cohort study on, "to
estimate incidence and course of severity-graded functional disability episodes in
spondylitis adults" in California. Totally 318 subjects free of functional disability and
course of 792 prevalent cases were formed respondents to a mailed survey. Incidence,
recurrent, persistent defined by the chronic pain Questionnaire. The researcher
concluded that functional disability episodes are more recurrent and persistent in older
adults.
K.R.Sowmiya (2015) carried out a cross sectional study on" prevalence and
correlates of functional disability in spondylitis among elderly in western countries."
Totally 509 elderly people participated. The functional status of the study population
–vision, hearing, arm function, leg function, cognition and activities of daily living
were assessed. The prevalence of functional disability in spondylitis among the
elderly aged 60 years and above was found to be 46.84%. Visual impairment was the
most commonly observed functional defect with 34% of female and 21% of male
elderly were affected. 27.3% of female elders were dependently for doing their
activities of daily living. Hearing impairment was also common with 16. 4% and
28.7% of male and female elders were affected respectively. The prevalence of
functional disability in spondylitis was very high with advancing age, presence of co
morbidities, illiteracy and economical dependence.
Kath D Watson et al., (2013) has done a population based cross sectional
study to estimate the prevalence of Functional disabilities in spondylitis in India.
Totally 1200 adolescent girls with aged between 21 – 29 years were participated by
using a self complete modified Hanover Questionnaire, to assess low back pain
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prevalence, symptom characteristics, associated disabilities and health seeking
behaviour. The one month period prevalence of low back pain was increased, they
experienced some functional disability and that affect limitation of activities. The
conclusion is increased incidence level of functional disability in spondylitis
occurring among the adolescent girls.
Susan JS, (2013), conducted a cross sectional study in a rural hospital in
South India “to determine the prevalence of functional disability in spondylitis among
the staff nurses in the year 2011”. Totally 80 staff nurses were participated,
questionnaire administered to staff sought information on social and demographic
characteristics, job history, smoking status, frequency and severity of functional
disability and factors predisposing to functional disability. The prevalence of
functional disability in spondylitis among staff was 46%. The highest prevalence of
functional disability (69%) was recorded among staff nurses due to workload and
lower back pain.
Mark Andro (2012) has done a questionnaire survey among 200 students in
Spain, revealed that the prevalence of musculo skeletal symptoms at anybody site
ranged from 69% - 75%. Muscular skeletal symptoms were most probably reported at
the lower back pain (45%), neck pain (25.5%), and limitation of activity (35%).
Al Mazora et al., (2012) conducted a cross sectional study on prevalence of
functional disability in spondylitis related to low back pain in young adults in India.
The 2020 Global Burden of Disease Study estimated that low back pain among the
top 10 disease and injuries that account for the highest number of DALYs worldwide.
The lifetime prevalence of non – specific low back pain is estimated at 65% to 75% in
industrialised countries.
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Aggarwal P et al (2012) analyzed a relationship between level of functional
disability in spondylitis and intensity of low back pain among computer professionals
in Iran. Totally 70 computer professionals were involved in the age group of 30 to
55 , all the subjects were assessed for the intensity of pain and level of functional
disability by Visual analogue scale and low back pain disability index. The result
showed a statistically positive correlation between level of pain and level of
functional disability in spondylitis.
Hoy, D.G (2011) conducted a study to assess the prevalence of low back pain
related Functional disability in spondylitis among the patients admitted in
Orthopaedic hospital in Delhi. Totally 100 patients of chronic low back pain related
functional disability in spondylitis between the age group of 20 to 65 years of both
male and female. In 50 cases of functional disability studies were 23% of heavy work,
57% of prolonged sitting and study work, 20% of laptop users .The study concluded
that more females are affected with functional disability compare to male.
Section C - Studies related to Risk factors of Low back pain and
Functional disability in spondylitis:
Furtado et al., (2014) conducted a study to evaluate" potential risk factors
related to Low back pain and disability in spondylitis in the daily routines of two sets
of youths" in Nigeria. A univariate analysis showed statistically significant
association (p<0.05), between low back pain disability and the following variables
such as Body mass index, Health self-assessment, Physical functioning, Body pain,
General health and social functioning. There was a positive pain by Visual Analogue
Scale, presence of diffuse pain and number of tender points. The Investigators
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concluded that some variables related to chronic pain and lower quality of life might
be associated in young adults.
Anna Ozgular et al., (2013) conducted a cross sectional study on,
"prevalence and risk factors of low back pain and functional disability in spondylitis
among 725 old age workers from occupational sectors. Self-Administered Nordic
Questionnaire, and questions about Intensity of Pain and individual and occupational
factors were used and reported the prevalence of Low back pain varied from 8% to
45%, according to occupation such as bending or carrying loads were often
associated to low back pain disability, where as other factors were related to some
specific dimensions of the disorder.
Hannover et al., (2013) carried a cohort study at Colombia university in UK,
“systematically evaluate the available evidence on the association between physical
activity” (i.e. Occupational load and non-occupational physical activities) and Low
back pain. A systematic approach was used to explore the literature between 1999 and
2009.The investigators concluded that, the occurrence of Low back pain in spondylitis
was related to the nature and intensity of the physical activities undertaken.
Patrick VN et al., (2012) did a cross sectional study on risk factors of low
back pain and functional disability in spondylitis among 3,000 school teachers in
Pune. Data was collected over a period of 1 month using self-administered
questionnaire. The study conducted that a total of 1,500 teachers returned completed
questionnaires yielding a response rate of 57%.Among them 67% of them reporting
minimal disability. The results revealed that female gender [OR: 1.50, 95% CI:1.14 –
2.00] and previous back injury [OR:9.67,90% CI:4.80 – 17.84] were positively
corrected to low back pain.

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Valeant Edward (2011) performed a Meta-analysis to evaluate and correlate
the various biological risk indicators of non-specific low back pain and functional
disability in spondylitis in Delhi. Totally 100 older people were purposively selected,
among them 50 male and 50 female, aged 50 -60 years with non- specific low back
pain and 100 matched controls, 50 males and 50 females, asymptomatic with no
history of low back pain and functional disability taken. The investigator concluded
that indicated statistically significant differences (p<0.005) in abdominal muscle
endurance between males and controls and in weight biceps skin fold, height, triceps
skin fold, sub scapular skin fold and in present lean body mass between non- specific
Low back pain and functional disability females and controls..
Shajith S.A (2010) conducted a cross sectional study to find out the risk
factors of low back pain and functional disability in spondylitis in Calcutta city. The
data was collected from 500 subjects between 30 to 55 years via structured mailed
questionnaire which included individual variables and work related variables. Results
showed that out of 500, 330 subjects reported low back pain related functional
disability. Risk factors of low back pain and functional disability was found to be
40%. The study shows the low back pain is influenced by individual variables and
work related variables.
Section D- Studies related to effect of MCKENZIE exercise on Low
back pain and Functional disability:
Luciana AC Machado., (2018) performed a randomized controlled trial in
India, to assess effect of Mckenzie method for acute low back pain, with a 3 month
follow up was conducted between September 2005 and June 2008.Eligible
participants were assigned to receive a treatment based on Mckenzie exercise and first
line care (Advice, Reassurance and Time-Contingent Acetaminophen)or first –line

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care alone, for 3 weeks. Treatment effects were estimated using linear mixed models.
However, the Mckenzie method to reduce low back pain.
Cho Kim Kam H et al., (2017) carryout the experimental study about ``effect
of Mckenzie exercise program me on low pain and functional disabilities in elderly
people at old age home in Spain``. The experimental group performed the exercise
program for 30 minutes per day 3 times week for 4 weeks. While control group did
not, and visual analogue scale was used. The study concluded that experimental
group showed significantly decreased visual analog scale when compared to the
control group. Thus the investigator concluded that Mckenzie exercise programme
can be used to manage pain and functional disability with low back pain.
Peter O et a., (2017) conducted a randomized control study on the
effectiveness of Mckenzie exercise on functional disability with non- acute non
specific low back pain at Switzerland. Totally 23 trials met the inclusion criteria and
the structured Questionnaire was used, the results of the study showed a statistically
significant effect in favor of exercise on functional disability in the long term (odds
ratio= 0.66, 95% confidence interval 0.48 – 0.92).The results conclude that Mckenzie
exercise have a significant effect on functional disability in patients with non- acute
and non- specific low back pain in the long term.
Hannu Claire (2017) carried out a prospective study to assess the
effectiveness of Mckenzie exercise in improvement of low back movement control,
decreased pain and disability at Sweden. Totally 38 patients suffering from non-
specific low back pain and movement control impairment were treated. Treatment
effects were evaluated using a set of six movement control tests (MCT), patients-
specific functional pain scores (PSFS) and a Rolland and Morris disability
questionnaire (RMQ). The results of the study indicated that movement control
22
showed a 50% improvement from 3.3 to 1.3 positive tests (d=1/3, p<0.001),
complaints decreased 41% from 5.9 points to 3.5 (d= 1.3.p<0.001) and disability
decreased 43% from 8.9 to 5.1 points (d= 1.0,p<0.001). These results showed that
movements control improved along with reduction in patient specific functional
complaints and disability.
Schult C Duralle (2015) performed a clinical trial to evaluate the role of
Mckenzie exercise in treating low back pain and functional disability related
spondylitis pain. A search of MEDLINE April 2005 and CINAHL 2002 data base
were performed and key words utilized for searches included, lumbar stability and
treatment of low back pain and functional disability. The study concluded that the
clinical trials analyzed varied considerably in the type of Mckenzie exercise
evaluated. However, it has been demonstrated that Mckenzie exercise can be
beneficial in reducing pain improving function in patients presenting with instability
related spondylitis pain.
Burnett C (2015) shouted a report, that McKenzie exercise can be used for
the primary, secondary and tertiary prevention of low back pain and functional
disability in the work place in Thailand. It was a comprehensive literature search of
controlled trials published between 2010-2015 and a total of 15 studies were
subsequently reviewed and analyzed. The literature concluded that there was strong
evidence that McKenzie exercise was effective in reducing the severity of low back
pain and reduces the functional disability.
Baerga L et al (2015) conducted a experimental study in USA, to assess the
effectiveness of Mckenzie exercise to reduce low back pain and functional disability
among 70 spondylitis patients. The activities are performed only by experimental

23
group are press up. Forward bend pelvic tilt and lower back massage to reduce the
low back pain and reduce functional disability. This activity was carried over for 20 to
30 sec and repeated 5 times per a day for a period of 3 weeks. Quebec scale was used.
There was a significant reduction in low back pain and reduction in functional
disability after the intervention in experimental group at p<0.05. The study suggests
that allowing Mckenzie exercise to reduce low back pain and functional disability
among the spondylitis patients.
Goldbyee VJ et al., (2014) performed a comparative study in Australia to find
the efficacy of Mckenzie exercise on low back pain and spinal rehabilitation among
300 older adults between 30 – 60 years with chronic low back pain and functional
disability. Mckenzie exercise administered to experimental group and spinal
rehabilitation to control group for twice a day for 3 weeks. It was measured by low
back pain functional scale, Oswestry Disability Questionnaire. Significant
improvement was noted in all outcome measures in both groups. The study concluded
that, the three weeks Mckenzie exercise was an effective method to reduce low back
pain and functional disability.
Skikic AM et al., (2013) reviewed on the effect of Mckenzie exercise for
patients with low back pain and functional disability in 34 patients with spondylitis in
Brazil. Patients attended exercise programme daily under supervision of physician
and do it also at home, 5 times a day in series of 5 to 10 repetitions each time. All the
patients were assessed before and after the treatment with visual analog scale,
localization of pain and Schober’s test. The researcher concluded that pain was
reduced on VAS, spinal movement was improved and functional disability was
reduced and low back pain was reduced.
Machado La et al., (2012), conducted a Meta-analysis of randomized
controlled trials to “compare the effectiveness of the Mckenzie exercise and passive
24
therapy on acute Low back pain and functional disability" in Sweden. Mckenzie
reduced pain and functional disability at 1 week follow-up when compared with
passive therapy for acute low back pain. There is some evidence that the Mckenzie
exercise is more effective than passive therapy for in acute Low back pain and
functional disability.
AN Garcia (2012) conducted a randomized controlled trial in the London to
evaluate the effect of Mckenzie exercise and conventional physiotherapy for patients
with low back pain and functional disability. Totally 80 patients were included and
divided into two groups, conventional physiotherapy consisting general active
exercise and Mckenzie exercise consisting of 5 steps of exercise, Quebec pain scale
was used and the results shown that Mckenzie exercise reduced pain intensity and
functional disability compared to conventional physiotherapy.
Scott Buxton (2011) performed a experimental study to assess the
effectiveness of Mckenzie exercise to reduce low back pain and functional disability
among60 elderly in Bangalore. In this study, the activities are performed [lower back
twist, cat cow stretch] in morning and evening at 30 sec and repeated 3 times per day
for a period of one month, and the pain was assessed by numerical pain rating scale.
There was a significant reduction in low back pain and functional disability after
given the intervention in experimental group. The study suggests that allowing elderly
people to take more rest to reduce the severity of low back pain and functional
disability.
Malgarota Wazak et al., (2011), conducted a randomized study on the
impacts of Mckenzie exercise enriched on subjective and objective parameters to
lumbar function at spondylitis in Norway. Totally 60 patients with mean age of 44
years with chronic low back pain and functional disability, subjects were randomly
assigned into 3 groups one group for performing Mckenzie exercise, one group for
25
spinal manipulation exercise and another one for acupuncture therapy. 10 daily
sessions were performed during 5 consecutive weekdays the outcome was measured
by Visual Analog scale. Outcome were evaluated and concluded that Mckenzie
exercise was more effective in individuals with chronic low back pain and functional
26
RESEARCH APPROACH
Quantitative research approach
RESEARCH APPROACH
SAMPLING
Quantitative research approach
TECHNIQUE
DEMOGRAPHIC *Convenient
VARIABLES sampling technique
was used to select
*Age RESRARCH DESIGN
settings.
Quasi experimental pre- test and post- test control group design
*Sex *Non probability
purposive sampling
*Marital status technique to select
POPULATION samples.
*Education Spondylitis patients who have low back pain and functional
disability and age between 35 – 65 years
*Occupation
*Family monthly ACCESSIBLE POPULATION

Spondylitis patients who have mild, moderate and severe low back
income
pain and mild,moderate functional disability in selected hospital.
*Dietary pattern
*Body mass index SAMPLE

Spondylitis patients who have mild, moderate and severe low back
*History of previous
pain and mild,moderate functional disability in selected hospitals
orthopedic surgery fulfilled the inclusion and exclusion criterias.
*History of previous drug

SAMPLE SIZE
intake Totally 74 samples. Experimental group 38 from Devi Orthopedic Data collection
hospital and Parvathi Orthopedic hospital and Control group procedure by using
*Duration of illness
Thiraviyam Orthopedic hospital , C.S.I hospital frok Tirunelveli. Standardised
*Duration of treatment Numerical intensity
pain rating scale
PRE- TEST and Modofied Self
Low back pain assessed by Standardised Numerical Pain Intensity administered
scale and functional disability assessed by Self Administered Modified Rolland morris
Rolland Morris Functional Disability scale. functional disability
scale.
Experimental group(n=38) Control group(n=36)
Mckenzie exercise No intervention
POST – TEST
Low back pain assessed by Standardised Numerical Pain Intensity scale
and functional disability assessed by Modified Self Administered
Modified Rolland Morris Functional Disability scale.
FINDINGS
Mckenzie exercise was effective in reducing the low back pain and
improve the functional ability among Spondylitis patients.
REPORT
27
CHAPTER –III
RESEARCH METHODOLOGY
Research methodology refer to the techniques used to structure a study and
together and analyse information in a systematic fashion (Polit and hunger 2008).
This chapter consists of research design, variables, setting of the study, population,
sample, sample size, sampling technique, criteria for selection of sample,
development and description of tool, content validity, reliability, intervention, pilot
study, data collection procedure, plan for data analysis and protection of human
rights.
RESEARCH APPROACH
Quantitative research approach was used for this study.
RESEARCH DESIGN
Quasi experimental Pre-test, Post-test control group design was adopted for
this study. It is diagrammatically represented as
GROUP PRETEST INTERVENTION POST TEST
Experimental group O1 X O2,O3
Control group O4 - O5,O6
Figure 2: Schematic Representation of Research Design
KEY:
O1&O4 - Pre-test level of Low back pain and functional disability in
experimental and control groups
X - Administration of Mckenzie exercise to experimental group.

28
O2&O3 - Post-test level of Low back pain and Functional disability in
experimental group on 7th and 14th day of intervention.
(-) - Mckenzie exercise not administered to control group.
O5& O6 - Post-test level of low back pain and Functional disability in
control group on 7th and 14th day of study.
RESEARCH VARIABLES
Independent variables
Mckenzie exercise.
Dependent variables
Low back pain and functional disability
DEMOGRAPHIC VARIABLES
Demographic variables such as Age, Sex, Marital status, Education,
Occupation, Body mass index, Dietary pattern, History of previous orthopaedic
surgery, Duration of illness and Duration of treatment.
SETTING OF THE STUDY
The setting of the study refers to the area where the study was conducted,
Devi Orthopaedic Hospital and Elaiyaraja Orthopaedic Hospitals-Tirunelveli was
selected for Experimental group .C.S.I. Jeyaraj Annapakkium Hospital and
Thiraviyam Orthopaedic Hospital from Thirunelveli was selected for the Control
group.
SETTING – I
Devi Orthopaedic Hospital, it is a 50 bedded hospital, the daily census of
Orthopaedic patients are approximately 70 with the different diagnosis of fracture,
osteoporosis and osteomyelitis among them 5-7 patients per day were diagnosed as
Spondylitis. The hospital is facilitated with post-operative ward, emergency

29
department and all labs. The distance between the Devi Orthopaedic Hospital from
Sri.K.Ramachandran Naidu College of Nursing is 55 Km.
SETTING – II
Elaiyaraja Orthopaedic Hospital, it is a 50 bedded Hospital. The approximate
census of Spondylitis cases are 5-10 patients per week .The hospital is facilitated with
post-operative ward, Physiotherapy unit and all labs. The distance between the
Elaiyaraja Orthopaedic Hospital from Sri.K.Ramachandran Naidu College of Nursing
is 58 km.
SETTING – III
C.S.I. Jeyaraj Annapakkiam Hospital, it is a 150 bedded Hospital situated at
Palayamkottai, Thirunelveli. It is 57 kms away from Sri.K.Ramachandran Naidu
College of Nursing. The hospital is facilitated with, emergency department and
Physiotherapy unit. In this hospital 55 orthopaedic cases were identified ,among
them,10 of them were diagnosed as spondylitis and remaining cases are fracture ,
knee pain , joint pain and osteoporosis.
SETTING – IV
Thiraviyam Orthopaedic Hospital, the daily census of Orthopaedic patients are
approximately 70 with the different diagnosis of fracture, osteoporosis and
osteomyelitis among them 5-7 patients per day were diagnosed as Spondylitis. The
hospital is facilitated with General wards, and emergency department. The distance
between the Devi Orthopaedic Hospital from Sri.K.Ramachandran Naidu College of
Nursing is 55 Km.
POPULATION
30
In this study Population comprises of Spondylitis patients aged between 35-
65years,who had diagnosed as Spondylitis by Orthopaedic Physician.
ACCESSIBLE POPULATION
In this study Accessible Population comprises of Spondylitis patients with
mild, moderate and severe low back pain and mild and moderate functional disability.
TARGET POPULATION
In this study Target Population comprises of Spondylitis patients includes both
male and female with mild, moderate and severe low back pain and mild and
moderate functional disability aged between 35 – 65 years and who fulfilled in the
exclusive and inclusive criterias.
SAMPLE
Sample consists of 35 – 65 years old both male and females with mild,
moderate and severe low back pain and mild and moderate functional disability and
who fulfilled with inclusive and exclusive criterias.
SAMPLE SIZE
Sample size of the study was comprised of 74 patients with Spondylitis.
Among them 38 samples were experimental group and 36 samples were in control
group.
SAMPLING TECHNIQUE
Non probability purposive sampling technique was used for the study.
Step 1: The investigator selected the Devi Orthopaedic Hospital and Elaiyaraja
Hospital at Thirunelveli for experimental group.

31
In Devi Orthopaedic Hospital 200- 250 orthopaedic patients were diagnosed
as different orthopaedic problems among them 65 – 75 patient were diagnosed as
Spondylitis .During the data collection period 145 Orthopaedic cases were diagnosed
among them 27 were diagnosed as spondylitis were between the age group of 35 – 65
years of age. Followed with collection of demographical variables, Pre – test was
conducted to select mild, moderate and severe low back pain by using Standardized
Numerical Intensity Pain Rating Scale and mild and moderate functional disability by
using Modified Self-Administered Rolland Morris Functional Disability Scale.
Among them investigator identified6 patients with mild low back pain, 19 patients
with moderate low back pain ,1 patient with severe low back pain and 1patient with
worst low back pain8 patients with mild functional disability , 12 patients with
moderate functional disability 4 patients with severe functional disability and 3 were
not had any functional disability. Out of 6 mild low back pain patients, 1 had fracture
in femur, 1 patient was not willing to participate in the study. Whereas among 19
moderate low back pain 1 patient had osteoporosis and 2 patients are not willing to
participate in the study. In this hospital based on inclusive and exclusive criterias 20
samples were selected by using non probability purposive sampling technique, rest of
the samples were excluded from the study.
In Elaiyaraja Orthopaedic Hospital 140 – 155 orthopaedic patients were
diagnosed as different orthopaedic problems per month. Among them 30 – 45 patient
were diagnosed as lumbar spondylitis. During the data collection period 145
Orthopaedic cases were diagnosed among them 23 spondylitis cases were identified in
the age group of 35 – 65 years of age. Followed with collection of demographical
variables, Pre – test was conducted to select mild, moderate and severe low back pain
and mild and moderate functional disability Among them investigator selected, 5
32
patients with mild low back pain, 12 patients with moderate low back pain , 1
patient with severe low back pain and 5 patient with worst low back pain 8 mild
functional disability and 15 moderate functional disability no patients had severe
functional disability .Out of 5 mild low back pain patients, 1 of them had fracture in
wrist, 1 patient was not willing to participate in the study Whereas
among 18 moderate pain 1 patient had osteoporosis and 2 patient not willing to
participate in the study In this hospital based on inclusive and exclusive criterias18
samples were selected by using non probability purposive sampling technique , rest of
Step 2: The investigator selected the C.S.I Jeyaraj Annapakkium Hospital and
Thiravium Orthopaedic Hospital at Thirunelveli for Control group.
In C.S.I Jeyaraj Annapakkium Hospital patients 330 - 450 orthopaedic
patients were diagnosed as different orthopaedic problems among them 30 – 55
patients were diagnosed as Spondylitis. During the data collection period 150
Orthopaedic cases were diagnosed among 23 spondylitis patients were identified.
Among them 15 females and 8 males in the age group of 35 – 65 years of age.
Followed with collection of demographical variables, Pre – test was conducted to
select mild, moderate and severe low back pain and mild and moderate functional
disability by Among them investigator identified 1 patients with mild low back pain,
16 patients with moderate low back pain , 3 patient with severe low back pain and 3
patient with worst low back pain,11 mild functional disability and 12 moderate
functional disability and no patients had severe functional disability. Among 16
moderate pain 1 patient not willing to participate and 1 patient had severe functional
disability in the study In this hospital based on inclusive and exclusive criterias18
33
In Thiraviyam Orthopaedic Hospital, 100 – 120 orthopaedic patients were
diagnosed as different orthopaedic problems per month. Among them 40 – 45 patients
were diagnosed as Spondylitis. During the data collection period, among 90
Orthopaedic cases, 22 spondylitis patients were identified in the age group of 35 – 65
conducted to select mild, moderate and severe low back pain by using Standardized
Numerical Intensity Pain Rating Scale and mild and moderate functional disability by
using Modified Self Administered Rolland Morris Functional Disability Scale.
Among them investigator identified 2 patients with mild low back pain, 17 patients
with moderate low back pain , 3 patient with severe low back pain and no patient
had worst low back pain,9 had mild functional disability and 9 patients had moderate
functional disability. 3 were had severe functional disability and 1 patient does not
had functional disability Among 17 moderate pain,4 patients were not willing to
participate From this hospital based on inclusive and exclusive criterias 18 samples
were selected by using non probability purposive sampling technique , rest of the
samples were excluded from the study.
CRITERIA FOR SAMPLE SELECTION
The samples were selected based on the following inclusive and exclusive
criterias.
INCLUSIVE CRITERIA
 Both male and female patients between 35-65 years.
 Patients with mild, moderate and severe low back pain.
 Patients who are willing to participate in the study.

34
 Patients with mild and moderate functional disability.
 Patients who are suffering with spondylitis for less than 3 years.
EXCLUSIVE CRITERIA
 Patients who are not co-operative
 Patients who are having no and worst Low back pain.
 Patients who are having no and severe Functional disability.
 Female patients who have menstruation during the time of data collection and
post natal mothers.
 Patients who had fracture, equina syndrome, lumbar spinal stenosis and
Spondylilisthesis, cardiac disease, severe hypertension and asthma
DEVELOPMENT AND DESCRIPTION TOOL:
The tool comprises of three section
Section A- It deals with demographic data.
Section B – It deals with Standardised Numerical Intensity Pain Rating Scale
used to assess the level of low back pain among Spondylitis patients.
Section C – It deals with Modified Self-Administered Rolland Morris
Functional Disability on position, walking, climbing upstairs and weight lifting
among Spondylitis patients.
SECTION: A – Demographic variables
It consists of demographic variables such as Age, Sex, Marital status,
Education, Occupation, Body mass index, Dietary pattern, History of Previous
Orthopaedic Surgery, Duration of illness and Duration of treatment.
SECTION: B – Standardised Numerical Intensity Pain Rating Scale
Standardised Numerical Intensity Pain Rating Scale used to find the level of
low back pain among Spondylitis patients. Total score is 10.

35
SCORING PROCEDURE:
When the patients reports No Pain, the pain score is 0, 1-2 indicates Mild
Pain, it S.NO RATE SCORE DESCRIPTION denotes
the 1. 0 0 No Pain score 1.
the 3, 4, 2. 1-2 1 Mild Pain 5

3. 3-5 2 Moderate Pain
4. 6-8 3 Severe Pain
5. 9-10 4 Worst Pain
indicates Moderate pain, it denotes the score 2. The 6, 7, 8 indicates Severe pain it
denotes the score 3. And 9, 10indicates Worst Pain, it denotes the score is 4.The score
will be interpreted as,
SECTION: C- Modified Self Administered Rolland Morris Functional Disability
Scale.
Modified Self Administered Rolland Morris Functional disability scale to
assess the level of functional disability on position, walking, climbing upstairs and
weight lifting. The total score is 75.

36
SCORING PROCEDURE
It consists of 25 items, each items has four responses, such as, Never, Often,
Very often, Always. When the patient response is Never the score 0, for Often the
score 1, for Very often the score 2, and Always the score 3 was given. The score has
been interpreted as follows,
SCORING INTERPRETATION:
S.NO SCORE LEVEL OF DISABILITY
1 0 No disability
2 01 – 25 Mild disability
3 26 – 50 Moderate disability
4 51 – 75 Severe disability
DEVELOPMENT OF INTERVENTION
Mckenzie exercise is designed to reposition any displaced intervertebral discs.
This is initially done by using gravity to draw the discs back into the spine and then
actively to consolidate the effect of gravity.
STEPS
1. PRESS UPS (2 minutes)
 Ask the participants to lie on the stomach on a soft mat spread on the floor.
 Instruct the participants to keep hands to be at the sides. If required, one can
put a soft pillow below the abdomen.
 Explain the participants to place the arms in such a way that the hands are
placed flat in front of the body while the elbow is under the shoulders.
37
 Using the arm strength, the torso should be pushed upwards. It should be held
it for 1 minute and then returned back to the original position.
 This step for should be repeated 3-5 times, twice a day and taking relaxation
for 1 minute.
2. FORWARD BEND(2 minutes)
A. It was done in sitting position
 Ask the participant to sit on with the flat feet on the ground. The knees should
be at right angles.
 Instruct the participants to lean forward as much as possible till reaches the
ground.
 Advice the participant to hold the stretch for 1 minute and then return back to
the sitting position.
 This step for should be repeated 3 times and relax for 1 minute.
It was in standing position (2minutes)
 Ask the participants to stand with feet with apart and hands at the sides.
 Instruct the participants to lean forward and lower the hands down the legs to
the feet.
 Advised to maintain this position for 1 minute and then return back to the
standing position and relax for 1 minute.
Cat-cow Stretch (Pelvic Tilts) (5 minutes)
 Ask the participants to in kneeling position, with hands on the floor under the
shoulder,
 Advised to move the chin towards the chest and when one breaths out while
the back is raised towards the ceiling.

38
 Subsequently, the stretch should be reversed. The stomach should be pulled to
the floor and the neck should be stretched backed with chin towards the
ceiling. This should be repeated slowly for about 4 minutes and relax for 1
minute.
LOWER BACK TWIST (4 minutes)
 Advised the participant to lie on the back, with arms outstretched and feet flat
on the floor.
 Instruct to turn the head and neck to one side while the knees should be turned
to the opposite side.
 Participants instructed to keep the shoulders on the ground.
 Participants should be in this same position for 1 minute, and then it is to be
repeated on other side for 1 minute and relax for 1 minute.
LOWER BACKMASSAGE AND STRETCH (5 minutes)
 Participants are advised to lie on the back, bring both the knees to the chest
and hold the knees with the hands.
 Instruct the participants should rock them slightly backwards and forwards
doing a gentle massage to the lower back.
 This should be repeated s for 5 minutes.
Mckenzie exercise was given for 20 minutes per session for 2 times a day and
consequently for 2 weeks period.
CONTENT VALIDITY
The content of the tool was established on the basic opinion of One Medical
Expert and Five Nursing Experts in field of Medical Surgical Nursing.
RELIABILITY
39
Reliability of tool was tested by “test- retest’’ method by using Karl Pearson's
correlation coefficient of the reliability method. The reliability score was r = 0.9.
Hence, tool was considered as highly reliable for conducting the study.
PILOT STUDY
Pilot study is a rehearsal for main study. Investigator got prior permission
from the Principal, Head of the department of Medical surgical Nursing and Ethical
Research Committee of Sri.K.Ramachandran Naidu college of Nursing. Formal
Permission was obtained from the Medical Director of the selected Hospitals.
Rapport was established and brief introduction and outline of the study was given to
all samples. Oral consent was obtained from the patient and reassurance was given
that the collected data will be kept it confidential.
Pilot Study was conducted in two hospitals such as Shifa Multi Speciality
Hospital (experimental group)and C.S.I. Jeyaraj Annapakkium Hospital (control
group) at Thirunelveli. Study was conducted for the period from 01.02.2020 to
08.02.2020. The total sample size was 10. From them 5 for experimental and 5 for
control group were selected by using non- probability purposive sampling technique.
In Shifa Multi Speciality hospital 75- 100 patients were diagnosed as different
orthopaedic problems among them 24 patient were diagnosed as Spondylitis. During
the data collection period 60 Orthopaedic cases were diagnosed among them 20 were
diagnosed as spondylitis in the age group of 35 – 65 years. Followed with collection
of demographic variables, Pre – test was conducted to select mild, moderate and
severe low back pain by using Standardized Numerical Intensity Pain Rating Scale
and mild and moderate functional disability by using Modified Self- Administered
Rolland Morris Functional Disability Scale. Among them investigator identified 3
patients with mild low back low back pain, 12 patients with moderate low back pain
40
and 2 of them had severe low back pain, 3 patients with worst low back pain. 3
patient had mild functional disability and 14 patient had moderate functional
disability and 3 of patients with severe functional disability. Out of 3 mild low back
pain patients, 1 patient had recent fracture in pelvis, 2 patients were not willing to
participate in the study. Whereas among 14 moderate low back pain 3 patients had
osteoporosis and 3 patients are not willing to participate in the study and 3 of them
had severe functional disability. Based on inclusive and exclusive criterias,5 samples
were selected for experimental group, by using non probability purposive sampling
technique, rest of the samples were excluded from the study.
In C.S.I Jeyaraj Annapakkium Hospital 120 patients were diagnosed as
different orthopaedic problems among them 25 patient were diagnosed as Spondylitis.
During the data collection period 90 Orthopaedic cases were diagnosed among 18 of
them were diagnosed as spondylitis in the age group of 35 – 65 years of age.
Followed with collection of demographic variables, Pre – test was conducted to select
mild, moderate and severe low back pain by using Standardized Numerical Intensity
Pain Rating Scale and mild and moderate functional disability by using Modified
Self-Administered Rolland Morris Functional Disability Scale. Among them
investigator identified 2 patient with mild low back pain, 10 patients with moderate
low back pain and3 of them had severe low back pain, 3 patients with worst low
back pain.6 patient had mild functional disability and 9 patient had moderate
functional disability and 3 of patients with severe functional disability. Out of 2 mild
low back pain patients, 1patients were not willing to participate in the study. Whereas
among 10 moderate low back pain 6 patients were not willing to participate in the
study. Based on inclusive and exclusive criterias 5 samples were selected for control
41
group, by using non probability purposive sampling technique, rest of the samples
were excluded from the study.
Followed with pre- test, Mckenzie exercise was administered 20 minutes per
session for 2 times per day and consequently for 2 weeks period from Monday to
Sunday only for the experimental group .No intervention was given to the control
group. Post- test level of low back pain and functional disability was assessed by
using the same scale on 7th and 14th day of study for both experimental and control
groups. Both descriptive and inferential statistics were used to analyze and interpret
the result findings.
DATA COLLECTION PROCEDURE
The researcher got Prior permission from the Principal and research ethical
committee of Sri.K.Ramachandran Naidu College of Nursing, and department of
Medical Surgical Nursing. A formal permission was obtained from the Medical
Director of the Four Hospitals. In that Devi Orthopaedic Hospital and Elaiyaraja
Orthopaedic Hospital was selected for experimental group and C.S.I. Jeyaraj
Annapakkim Hospital, Thiravium Orthopaedic Hospital was selected for control
group. The investigator was introduced herself to the participants and explain the
purpose of the study. Oral consent was obtained from the patient and reassurance was
given that the collected data was kept it confidential. The study was conducted for the
period of four weeks and data collection was done from 10.02.2020 to 14.03.2020.
PHASE I:
Step 1- In Devi Orthopaedic Hospital 200- 250 orthopaedic patients were
diagnosed as different orthopaedic problems among them 65 – 75 patient were
diagnosed as Spondylitis .During the data collection period 145 Orthopaedic cases
were diagnosed among them 27 were diagnosed as spondylitis were between the age
42
group of 35 – 65 years of age. Followed with collection of demographical variables,
Pre – test was conducted to select mild, moderate and severe low back pain by using
Standardized Numerical Intensity Pain Rating Scale and mild and moderate functional
disability by using Modified Self Administered Rolland Morris Functional Disability
Scale. Among them investigator identified 6 patients with mild low back pain, 19
patients with moderate low back pain, 1 patient with severe low back pain and
1patient with worst low back pain 8 patients with mild functional disability , 12
patients with moderate functional disability 4 patients with severe functional disability
and 3 were not had any functional disability. Out of 6 mild low back pain
patients, 1 had fracture in femur, 1 patient was not willing to participate in the study.
Whereas among 19 moderate pain 1 patient had osteoporosis and 2 patients are not
willing to participate in the study. In this hospital based on inclusive and exclusive
criterias 20 samples were selected by using non probability purposive sampling
technique , rest of the samples were excluded from the study.
In Elaiyaraja Orthopaedic Hospital 140 – 155 orthopaedic patients were
diagnosed as different orthopaedic problems per month. Among them 30 – 45 patient
were diagnosed as lumbar spondylitis .During the data collection period 145
Orthopaedic cases were diagnosed among them 23 spondylitis cases were identified
in the age group of 35 – 65 years of age. Followed with collection of demographical
variables, Pre – test was conducted to select mild, moderate and severe low back pain
by using Standardized Numerical Intensity Pain Rating Scale and mild and moderate
functional disability by using Modified Self-Administered Rolland Morris Functional
Disability Scale. Among them investigator selected, 5 patients with mild low back
pain, 12 patients with moderate low back pain , 1 patient with severe low back pain
and 5 patient with worst low back pain 8 mild functional disability and 15 moderate
43
functional disability no patients had severe functional disability .Out of 5 mild low
back pain patients, 1 of them had fracture in wrist, 1 patient was not willing to
participate in the study Whereas among 18 moderate pain 1 patient had osteoporosis
and 2 patient not willing to participate in the study In this hospital based on inclusive
and exclusive criterias 18 samples were selected by using non probability purposive
sampling technique , rest of the samples were excluded from the study.
Step 2: The investigator selected the C.S.I Jeyaraj Annapakkium Hospital and
Thiravium Orthopaedic Hospital at Thirunelveli for Control group.
In C.S.I Jeyaraj Annapakkium Hospital patients 330 - 450 orthopaedic
patients were diagnosed as different orthopaedic problems among them 30 – 55
patient were diagnosed as Spondylitis. During the data collection period 150
Orthopaedic cases were diagnosed among 23 spondylitis patients were identified.
Among them 15 females and 8 males in the age group of 35 – 65 years of age.
Followed with collection of demographical variables, Pre – test was conducted to
select mild, moderate and severe low back pain and mild and moderate functional
disability. Among them investigator identified 1 patients with mild low back pain, 16
patients with moderate low back pain , 3 patient with severe low back pain and 3
patient with worst low back pain,11 mild functional disability and 12 moderate
functional disability and no patients had severe functional disability. Among 16
moderate pain 1 patient not willing to participate and 1 patient had severe functional
disability in the study In this hospital based on inclusive and exclusive criterias 18
In Thiraviyam Orthopaedic Hospital, 100 – 120 orthopaedic patients were
diagnosed as different orthopaedic problems per month. Among them 40 – 45 patients

44
were diagnosed as Spondylitis. During the data collection period, among 90
Orthopaedic cases, 22 spondylitis patients were identified in the age group of 35 – 65
conducted to select mild, moderate and severe low back pain and mild and moderate
functional disability Among them investigator identified 2 patients with mild low
back pain, 17 patients with moderate low back pain , 3 patient with severe low back
pain and no patient had worst low back pain,9 had mild functional disability and 9
patients had moderate functional disability. 3 were had severe functional disability
and 1 patient does not. had functional disability Among 17 moderate pain, 4 patients
were not willing to participate From this hospital based on inclusive and exclusive
criterias 18 samples were selected by using non probability purposive sampling
technique , rest of the samples were excluded from the study.
PHASE II
Data collection details of Experimental and Control groups:
Groups Date Assessment No. of Total Intervention

Samples Sample
10.02.2020 Pre – test 4 MCKENZIE
16.02.2020 Post – test 1(day 7) 4 EXERCISE
23.02.2020 Post – test 2(day 14) 4 4 -20 minute per
EXPERIMENTAL session
GROUP -2 times a day
(morning and
45
evening)
-consequently for
2 weeks period.
18.02.2020 Post – test 1(day 7) 3 3 EXERCISE
25.02.2020 Post – test 2(day 14) 3 -20 minutes per
session
-2 times a day
(morning and
evening)
- consequently for
2 weeks period
session
-2 times a day
(morning and
evening)
- consequently for
2 weeks period
session
-2 times a day
(morning and
evening)
- consequently for
2 weeks period
session
-2 times a day
(morning and
evening)
- consequently for
2 weeks period
session
-2 times a day
(morning and
evening)
46
- consequently for
2 weeks period
session
-2 times a day
(morning and
evening)
- consequently for
2 weeks period
session
-2 times a day
(morning and
evening)
- consequently for
2 weeks period
session
--2 times a day
(morning and
evening)
- consequently for
2 weeks period

session
-2 times a day
(morning and
evening)
- consequently for
2 weeks period
session
-2 times a day
(morning and
evening)
47
- consequently for
2 weeks period
11.02.2020 Pre – test 4
CONTROL 17.02.2020 Post – test 1(day 7) 4 4 Intervention was
GROUP 22.02.2020 Post – test 2(day 14) 4 not administered
13.02.2020 Pre – test 4 Intervention was
19.02.2020 Post – test 1(day 7) 4 4 not administered
24.02.2020 Post – test 2(day 14) 4
28.02.2020 Post – test 2(day 14) 4
01.03.2020 Post – test 2(day 14) 4
03.03.2020 Post – test 2(day 14) 4
05.03.2020 Post – test 2(day 14) 4
07.03.2020 Post – test 2(day 14) 4
09.02.2020 Post – test 2(day 14) 4
11.03.2020 Post – test 2(day 14) 4
Duration of data collection:
Number of samples : Total number of samples = 74

Experimental group =38
Control group = 36
Name of the tool used: Standardised Numerical Intensity Pain Rating scale to assess
the level of low back pain and Modified Self- Administered Rolland Morris
Functional Disability scale used to assess the Functional disabilities on position,
walking, climbing upstairs and weight lifting.
PLAN FOR THE DATA ANALYSIS

48
After data collection the collected data was organized and analysed according
to the objectives of the study by using both descriptive and inferential statistics.
Descriptive statistics:
 Frequency & percentage analysis was used to describe the demographic
characteristics of low back pain and functional disability.
 Frequency & percentage analysis was used to describe the Physiological
Parameters and Psychological wellbeing level of experimental and control
groups
 Mean, standard deviation was used to assess the Pre-test and Post-test level of
low back pain and functional disability experimental and control groups
Inferential statistics:
 Unpaired ‘t’ test was used to find out the Post-test level of low back pain and
functional disability among Spondylitis Patients in experimental group and
control group.
 Paired ‘t’ test was used to compare the Pre and post- test level of low back
pain and functional disability among Spondylitis Patients in experimental
group.
 Correlation coefficient test was used to analyze the relationship between the
post -test level of low back pain and functional disability in experimental
group.
 Chi- square test was used to associate the post test level of low back pain and
functional disability among spondylitis patients in experimental and control
groups.
PROTECTION OF HUMAN RIGHTS
Research proposal was approved by the research and ethical committee of
Sri.K.Ramachandran Naidu College of Nursing, prior to the pilot study and the main
49
study formal permission was obtained from the Principal and the Head of the
department of Medical Surgical Nursing of Sri.K.Ramachandran Naidu college of
Nursing and Medical Director from selected hospitals .Informed oral consent was
obtained and assurance was given to each participant, confidentiality will be
maintained and no harm will be done.
CHAPTER IV
DATA ANALYSIS AND INTERPRETATION
50
This chapter deals with the analysis and interpretation of the data collected
from the samples to assess the effectiveness of Mckenzie Exercise on low back pain
and Functional disability among Spondylitis patients.
The analysis and interpretation of data is based on data collection, the result
are compared by using descriptive (mean, Frequency, percentage distribution and
standard deviation) and inferential (‘t’ – test and chi square test) statistics. The data
has been tabulated and organized as follows.
ORGANIZATION OF DATA
SECTION A: ASSESSMENT OF DEMOGRAPHIC VARIABLES OF LOW
BACK PAIN AND FUNCTIONAL DISABILITY AMONG SPONDYLITIS
PATIENTS.
 Frequency and percentage distribution of samples based on demographic variables
such as Age, Sex, Marital status, Education, Occupation, Body mass index,
Dietary pattern, History of previous orthopedic surgery, Duration of illness and
Duration of treatment.
SECTION B: ASSESSMENT OF FREQUENCY AND PERCENTAGE OF
LOW BACK PAIN AND FUNCTIONAL DISABILITY AMONG
SPONDYLITIS PATIENTS IN EXPERIMENTAL AND CONTROL GROUPS.
 Assessment of frequency and percentage distribution of pre – test and post- test
level of low back pain on day 7 among spondylitis patients in experimental and
control groups.
 Assessment of frequency and percentage distribution of pre-test and post-test
level of low back pain on day 14 among spondylitis patients in experimental and
control groups.
51
 Assessment of frequency and percentage distribution of pre – test and post- test
level of Functional disability on day 7 among spondylitis patients in
experimental and control groups.
 Assessment of frequency and percentage distribution of pre-test and post – test
level of Functional disability on day 14 among spondylitis patients in
SECTION C: COMPARISON OF POST-TEST LEVEL OF LOW BACK PAIN
AND FUNCTIONAL DISABILITY AMONG SPONDYLITIS PATIENTS IN
EXPERIMENTAL AND CONTROL GROUPS.
 Comparison of mean post-test level of low back pain on 7 th and 14th day among
spondylitis patients in experimental and control groups.
 Comparison of mean post-test level of functional disability on day 14 th among

spondylitis patients in experimental and control groups.
 Comparison of mean post-test level of low back pain and functional disability
on day 14th among spondylitis patients in experimental and control groups.
SECTION D: COMPARISON OF MEAN PRE-TEST AND POST-TEST

LEVEL OF LOW BACK PAIN AND FUNCTIONAL DISABILITY AMONG
 Comparison of mean pre-test and mean of 7th day post-test level of low back
pain among spondylitis patients in experimental and control groups.
 Comparison of mean pre-test and mean of 7 th day post-test level of functional
disability among spondylitis patients in experimental and control groups.
 Comparison of mean pre-test and mean of 14 th day post-test level of low back
pain among spondylitis patients in experimental and control groups.
 Comparison of mean pre-test and mean of 14 th day post-test level of functional
disability among spondylitis patients in experimental and control groups.
52
SECTION E: CO-RELATION BETWEEN THE LEVEL OF LOW BACK

PAIN AND FUNCTIONAL DISABILITY AMONG SPONDYLITIS PATIENTS
IN EXPERIMENTAL GROUP.
 Co- relation between the post-test level of low back pain and functional
disability among spondylitis patients in experimental group.
SECTION F: ASSOCIATION OF POST-TEST OF LEVEL OF LOW BACK
PAIN AND FUNCTIONALDISABILITY AMONG SPONDYLITIS PATIENTS
IN EXPERIMENTAL AND CONTROL GROUPS.
 Association of post-test of level of low back pain among spondylitis patients
in experimental group with their selected demographic variables.
 Association of post-test of level of low back pain among spondylitis patients
in control group with their selected demographic variables.
 Association of post-test of level of functional disability among spondylitis
patients in experimental group with their selected demographic variables
 Association of post-test of level of functional disability among spondylitis
patients in control group with their selected demographic variables.
PRESENTATION OF DATA
SECTION I: DESCRIPTION OF DEMOGRAPHIC VARIABLES AMONG

SPONDYLITIS PATIENTS.
53
TABLE I: Frequency and percentage distribution of samples based on

demographic variables.
(N=74)
DEMOGRAPHIC EXPERIMENTAL GROUP CONTROL GROUP

S.NO VARIABLES (n = 38) (n = 36)
F % F %
1. Age
a) 35 – 40 years 07 18.4 08 22.4
b) 41 – 50 years 13 34.2 15 41.6
c) 51 – 60 years 10 26.3 07 19.4
d) 61 – 65 years 08 21.0 06 16.6
2. Sex
a) Male 22 57.8 24 66.6
b) Female 16 42.2 12 33.4
3. Marital status
a) Married 26 68.4 25 69.4
b) Unmarried 04 10.5 08 22.4
c) Widow 05 13.1 02 5.5
d) Divorced 03 7.8 01 2.7
4. Education
a) Illiterate 15 39.4 18 50.0
b) Primary 05 13.3 02 5.6
education
c) Secondary 10 26.3 12 33.3
education
d) Degree holder. 08 21.0 04 11.1
5. Occupation
a) Unemployed 10 26.3 15 41.6
b) Coolie 18 47.3 10 27.7
c) Business 05 13.2 08 22.4
d) Professional 05 13.2 03 8.3
work.
6. Body mass index
a) Under weight 18 47.4 14 38.8
b) Normal weight 10 26.3 14 38.8
c) Over weight 10 26.3 8 24.2
7. Dietary pattern
a) Vegetarian 10 26.4 15 41.6
b) Non vegetarian 28 73.6 21 58.4
54
8. History of Previous
Orthopedic surgery
( If any ……….)
a) Yes
1. Knee 03 7.89 2 5.5
arthoplasty 02 5.2 2 5.5
2. Ankle repair 01 2.6 1 2.7
3. Joint fusion 32 84.3 26 72.3
b) No
9. Duration of illness
a) months – 1 years 18 47.4 15 41.6
b) More than 1 10 26.3 10 27.7
years – 2 years
c) More than 2 10 26.3 01 2.7
years – 3 years
10. Duration of treatment
a) months – 1 years 18 47.4 15 41.6
b) Morethan 1 10 26.3 10 27.7
years – 2 years
c) Morethan 2 10 26.3 01 2.7
years – 3 years
Table I denotes the frequency percentage and distribution of the samples based on
demographic variables .
 While considering the age, in the experimental group out of 38 samples, 10
(12.8%) of them were51 – 60 years Whereas in control group out of 36 samples,
15(19.2%) of them were 41 – 50 years.
 With respect to sex, in the experimental group, out of 38 samples , 22(28.2%) of
the samples were males Whereas in control group out of 36 samples, 24 (66.6%)
of them were males.
 In relation with occupation, in the experimental out of 38 samples, 18(23.8%) of
them were coolie. Whereas in control group out of 36 samples, 15(41.6%) of them
were unemployed.
55
 With regard to body mass index, in the experimental group out of 38 samples
18(23%) of them were underweight. Whereas in control group out of 36
samples, 14(38.8%) of them were underweight, 14(38.8%) of them were normal
weight.
 Regarding history of previous orthopedic surgery, in the experimental group out
of 38 32(41.02%) of them not undergone for previous orthopedic surgery. Where
as in control group out of 36 samples, 26(72.2%) of them not undergone for
previous orthopedic surgery.
 In relation with duration of illness, in the experimental group out of 38 samples
18(47.36%) of them were 6 months - 1 year of illness .Whereas in control group
out of 36 samples, 15(41.6%) of them were 6 months - 1 years of illness.
 Regarding duration of treatment, in the experimental group among 38 samples ,
18(47.36%) of them were on treatment for 6 months - 1 year. Whereas in control
group out of 36 samples, 15(41.6%) of them were for 6 months - 1 years of
treatment.
56
Experimental group
25% Control group
20% 18.40%
19.20%
18.40%
16.60%
15.70%
PERCENTAGE
15%
12.80%
Figure 4: Percentage
10.20% distribution of demographic variable of 10.20%
age in years in
10%

5%
0%
35 – 40 years 41 – 50 years 51 – 60 years 61 – 65 years
AGE IN YEARS
Experimental group
70% 66.60%
Control group
60%
PERCENTAGE
50%
40%
33.30%
30% 28.20%
20.50%
20%
10%
0%
Male Female
SEX
Figure 5: Percentage distribution of demographic variable of sex in experimental
and control groups.
Experimental group
41.60% Control group
45%
40%
35% 27.70%
PERCENTAGE
30% 23.80% 22.20%

25%
20%
13.80%
15%
6.41% 6.41% 3.84%
10%
5%
0%
Unemployed Coolie Business Professional
work.
OCCUPATION
57
Figure 6: Percentage distribution of demographic variable of occupation in
45%
40% 38.80% 38.80% Experimental
group
35%
Control group
P 30%
E
R 25% 23.00% 22.20%
C
E 20%
N
T 15% 12.80% 12.80%
A
G 10%
E
5%
0%
UNDER NORMAL OVER
WEIGHT WEIGHT WEIGHT
BODY MASS INDEX
Figure 8: Percentage distribution of demographic variable of Body mass index in

58
80.00%
72.20%
70.00% Experimental group
60.00%
P
Control group
E 50.00%
R 41.20%
C 40.00%
E
N 30.00%
T
A
G 20.00% 15.70%
E 12.80%
10.00%
0.00%
Yes No
HISTORY OF PREVIOUS ORTHOPEDIC SURGERY
Figure 9: Percentage distribution of demographic variable of family monthly
income in experimental and control groups.
50% 47.36% Experimental group

45% 41.60%
40% Control group
35%
PERCENTAGE
30% 26.31% 26.31%

25%
20%
15% 12.80%
10%
5% 2.70%
0%
6 months – 1 years Morethan 1 years – 2 Morethan 2 years – 3
years years
DURATION OF ILLNESS
Figure 10: Percentage distribution of demographic variable of duration of illness
in experimental and control groups.

59
Experimental group
47.36%
Control group
50% 41.60%
40%
26.31% 26.31%
PERCENTAGE
30%
12.80%
20%
2.70%
10%
0%
6 months – 1 years Morethan 1 years Morethan 2 years
– 2 years – 3 years
DURATION OF TREATMENT
Figure 11: Percentage distribution of demographic variable of duration of
treatment in experimental and control groups.

60
SECTION B : ASSESSMENT OF FREQUENCY AND PERCENTAGE ON
TABLE 2(A): Assessment of frequency and percentage distribution of pre – test
and post- test level of low back pain on day 7.
(N=74)
Experimental group Control group
(n=38) (n=36)
Level of low
S.no Post test on Post test on
back pain Pre test Pre test
day 7 day 7
f % f % f % f %
1. No pain - - 05 13.1 - - 00 00
2. Mild pain 07 18.2 12 31.5 03 8.33 03 8.33
3. Moderate pain 25 65.7 20 52.6 29 76.6 30 83.3
4. Severe pain 06 16.6 01 2.6 04 10.56 01 2.7
5. Worst pain - - 00 00 - - - -
Table 2 (A) denotes that, pre- test and 7th day post test level low back pain in
experimental and control groups. It is evidence from above table that, Out of 38
samples in experimental group 25(65.78%) were had moderate low back pain and in
7th day post- test 5(13.1%) were had no pain, 12 (31.5%), 20 (52.6%) and 1(2.6%)
were had severe low back pain and no one had worst low back pain. Whereas in
control group 3(8.33%) were had mild low back pain, 29 ( 76.6%), 4( 10.6%) were
had moderate low back pain and 4(10.56%) were had severe low back pain and no
one had worst low back pain and in 7 th day post- test 3(8.33%), 30 (83.3%),1 (2.7%)
were had severe low back pain and no one had worst low back pain.
61
7000% 65.78%
Experimental group
6000%
5000%
Control group
P
E 4000%
R
C
E 3000%
N
T 2000% 18.4%
A 16.6%
G
E 1000%
10.22%
00.00% 8.33% 76.60% 00.00%
0%
No pain Mild pain Moderate Severe pain Worst pain
pain
PRE- TEST LEVEL OF LOW BACK PAIN
Figure 12 :.Frequency and percentage distribution of pre- test level of low back
pain in experimental and control group.
90.00%
83.30%
80.00%
Experimental
70.00% group
P
E 60.00% 52.60% Control group
R
C 50.00%
E 40.00%
N 31.50%
T 30.00%
A 20.00%
G 13.10%
E 10.00% 8.33%
2.60% 2.20%
0.00% 0.00%
0.00%
0.00%
No pain Mild pain Moderate Severe pain Worst pain
pain
Post- Test Level Of Low Back Pain On Day 7
Figure 13: Frequency and percentage distribution of post- test level of low back
pain in experimental and control group on day 7.

62
TABLE 2(B): Assessment of frequency and percentage distribution of pre-test

and post – test level of low back pain on day 14 in experimental and control
groups.
(N=74)

(n=38) (n=36)
Level of low
S.no Pre test Post test on Pre test Post test on
back pain
day 14 day 14
f % f % f % f %
1. No pain - - 06 18.42 - - 00 00
2. Mild pain 07 18.2 15 39.4 03 8.33 07 19.44
3. Moderate pain 25 65.7 16 42.1 29 76.6 27 77.77
4. Severe pain 06 16.6 01 2.6 04 10.56 02 8.3
5. Worst pain - - 00 00 - - 00 00
Table 2(B) reveals the frequency and percentage distribution of pre -test and
14th day post- test level of low back pain in experimental group Out of 38 samples in
pre- test ,25(65.78%) were had moderate low back pain In 14 th day post test
16(42.1%) were had moderate low back pain,1(2.6%) were had severe low back pain
.and none of them had worst low back pain. Whereas in control group Out of 36
samples in pre- test ,29(76.6%) were had low back moderate pain In 14 th day post
test, 27(77.77%) were had moderate low back pain.

63
90.00%
80.00% 77.70%
70.00% Experimental group

P
60.00%
E
R Control group
50.00% 42.40%
C 39.40%
E 40.00%
N 30.00%
T 19.40%
A 20.00% 18.40%
G 10.00% 8.30%
E 2.60%
0.00% 0.00%0.00%
0.00%
No pain Mild pain Moderate Severe Worst
pain pain pain
Post - Test Level Of Low Back Pain On Day 14.
Figure 14: Frequency and percentage distribution of post- test level of low
backpain in experimental and control group on day 14 .
64
Table 2(C): Assessment of frequency and percentage distribution of pre – test
and post- test level of Functional disability on day 7 in experimental and control
groups.
(N=74)
(n=38) (n=36)
Functional Post- test Posttest on
S.no Pre-test Pre-test
Disability on day 7 day 7
f % f % f % f %
1. No disability - - 02 5.2 - - 00 00
2. Mild disability 16 44.4 16 42.1 16 44.44 20 55.55
3. Moderate 22 61.1 20 57.8 20 55.55 15 44.44
disability
4. Severe disability - - 00 00 - - 01 2.7
Table 2(C) reveals the frequency and percentage distribution of pre-test and
7th day post- test level of functional disability in experimental group and control
group. It is evident from the above table that, in pre- test level of functional disability
among experimental group out of 38 samples, 22(61.1%) were had moderate
functional disability. In 7th day post -test level, 20(57.8%) were had moderate
functional disability
65
90% 83.30%
80%
70% 61.40% Experimental group
60%
P 50% 44.40% Control group
E 40%
R
C 30%
E 20% 16.60%
N
T 10%
0.00%
0.00% 0.00%
0.00%
A 0%
G
E
y
y
y
lit
lit
lit
lit
bi
bi
bi
bi
sa
sa
sa
sa
di
di
di
di
re
ild
o
at
N
ve
M
er
Se
od
M
Pre- Test Level of Functional Disability
Figure 15: Frequency and percentage distribution of pre- test level of functional
disability in experimental and control groups.
70%
60% 58%
55.50% Experimental
P 50%
group
E 42%
44.40%
R Control group
40%
C
E 30%
N
T 20%
A
G 10% 5%
E 2.70%
0.00% 0%
0%
No disability Mild disability Moderate Severe
disability disability
Post- test level of functional disability on day 7.
Figure 16: Frequency and percentage distribution of post- test level of
functional disability in experimental and control group on 7th day.

66
Table 2(D): Assessment of frequency and percentage distribution of pre-test and
post – test level of Functional disability on day 14 in experimental and control
groups.
S.no Functional Experimental group Control group

Disability (n=38) (n=36)
Pre test Post test on Pre test Post test on
day 14 day 14
f % f % f % f %
1. No disability - - 05 13.1 - - 00 00
2. Mild disability 16 44.4 14 36.8 16 44.44 22 61.1
3. Moderate 22 61.1 19 50.1 20 55.55 11 30.5
disability
4. Severe disability - - 00 00 - - 03 8.4
Table 2(D) reveals the frequency and percentage distribution of pre- test and
14th day post test level of functional disability in experimental group out of 38
samples in pre- test 16(44.4%) were had mild functional disability, and 22(61.1%)
were had moderate functional disability and 14 th day post test level of functional
disability 5(13.1%) were had no functional disability, 14(36.8%) were had mild
functional disability, 19(50%) were had moderate functional disability and no one
had severe functional disability.
Where as in the post test level of functional disability among the control group
out of 36 samples 16(16.6%) were had mild functional disability and 20(83.3%) of
them had moderate functional disability and 14 th day , none of the patients had no
functional disability, 22(61.1%) of them had mild functional disability , 11(30.5%) of

67
them had moderate functional disability and 3(8.4%) of them had severe functional
disability.
70.00%
61.10%
60.00%
50.10%
50.00% Experimental
P group
E 40.00% 36.80%
R 30.50%
30.00% Control group
C
E 20.00%
13.10%
N 10.00% 8.40%
T 0.00% 0.00%
A 0.00%
G
y
y
y
lit
lit
lit
lit
E
bi
bi
bi
bi
sa
sa
isa
sa
di
di
di
d
No
re
ild
e
at
ve
M
er
Se
od
M
Post- Test Level of Functional Disability on 14th Day
Figure 17: Frequency and percentage distribution of post- test level of
functional disability in experimental and control groups on 14th day.

68
SECTION C: COMPARISON OF POST – TEST LEVEL OF LOW BACK
IN EXPERIMENTAL AND CONTROL GROUPS.
Table 3(A): Comparison of mean post – test level of low back pain on 7 th and 14th day
in experimental and control group.
(N=74)
Post-Test on Post- Test on
day 7 day 14 Mean ‘t’ test
S. No Group
Standard Standard Difference value
Mean Mean
deviation deviation
Experimental 0.488
1. 03 0.16 1.5 0.14 1.5
group S*
Control 12.9
2. 20 3.4 22 3.7 02
group NS
Table 3(A): The above table reveals the comparison of mean post- test level
of low back pain on 7th day and 14th day in experimental group and control group. It is
evident from the above table that, 7 th day post- test level of low back pain in
experimental group the mean value was 3 and SD 0.16 and 14 th day mean value was
1.5 and SD was0.14 and their mean difference was 1.5 and the ‘t’ test value is
0.488. Whereas in control group 7 th day mean value was 20, and SD was 3.4 and
14thday mean value was 22 and SD was 3.7 and their difference value was 02 and the
‘t’ value is 12.9.

69
25
22
20 Experimental
20 group
M Control group
E 15
A
N
10
V
A
L
U 5
E 3
1.5
0
POST TEST POST TEST
ON DAY 7 ON DAY 14
Comparison of Mean Post Test Level of Low Back Pain On 7th Day
and 14thday
Figure18: Comparison of Mean Post Test Level of Low Back Pain On 7 th Day
And 14thday
70
Table 3(B): Comparison of mean post- test level of functional disability on 7 th and
14th day n experimental and control groups.
(N=74)
Post-Test on Post- Test on
day 7 day 14 Mean ‘t’ test
S. No Group
Standard Standard Difference value
Mean Mean
deviation deviation
Experimental 1.8
1. 25 9.07 21 11.3 2
group S*
Control 0.65
2. 35 10.9 44 5.5 15.8
group S*
Table 3(B) The above table reveals the comparison of mean post- test level of
functional disability on 7th day and 14th day in experimental group and control group.
It is evident from the above table that, 7 th day post- test level of functional disability in
experimental group the mean value was 25 and SD 9.07 and 14 th day mean value was
21 and SD was 11.3 and their mean difference was 2 and the ‘t’ test value is 1.8
Whereas in control group 7th day mean value was 35, and SD was 10.9 and 14 thday
mean value was 44 and SD was 5.5 and their difference value was 15.8 and the ‘t’
value was 0.65.

71
2 1.9
1.8 Experimental group
1.6 1.5 Control group
M 1.4
E
1.2
A
N 1 0.74000000000000
1 0.78
0.8
V 0.6
A
L 0.4
U 0.2
E 0
Post- test Post test 14th
14th day day SD
mean
Comparision of Mean Post - Test Level Functional Disability in Exper -
imental and Control Group On Day 14
Figure 24: Comparison of mean post- test level of functional disability on day
14th among spondylitis patients in experimental and control group.
72
TABLE 3(C): Comparison of mean post- test level of low back pain and functional
disability on day 14th.in experimental and control groups
N=74
S.no Group Experimental Control group Mean “t” test
group n-=38 n=36 difference value
Post- test on Post- test on
day 14 day 14
Mean SD Mean SD
Low back
1. 1.5 0.14 22 3 1.36 0.563 S
pain
Functional
2. 21 3.7 44 5.5 17.3 1.768NS
disability
Table 3(C) Comparison of mean post- test level of low back pain and
functional disability on day 14th among spondylitis patients. It is evident from the
above table, experimental group , the 14th day low back pain mean value was 1.5 and
SD was 0.14 and functional disability mean value was 21 and SD was 19.5. Their
mean difference was 19.5 and “t” value was 0.724.
Whereas in control group on14th day low back pain mean value was 22 and SD
was 3.7 and functional disability mean value was 44 and SD was 5.5. Their mean
difference was 22 and “t” value was 1.75.Hencehypothese RH 1 was accepted.

73
25
21
20
M
E
A 15
N
V
A 10 LOW BACK PAIN
L FUNCTIONAL DISABILITY
U
E 5 3.7
1.5
0.14
0
MEAN SD
Mean And Standared Deviation Of Lowback Pain And Functional Disability On Day
14
Figure 25 Mean And Standard Deviation Of Low back Pain and Functional
Disability On Day 14
74
50
45 44
40
M 35
E
A 30
N
25 22
V
A 20 LOWBACK PAIN
L FUNCTIONAL DISABILITY
U 15
E 10
5.5
5 3
0
MEAN SD
Mean And Standared Devation Of Low Back Pain And Functional Disability On Day
14
Figure 26 Mean and Standard Devotion of Low Back Pain and Functional
Disability On Day 14
SECTION D: COMPARISON OF MEAN PRE -TEST AND POST-TEST LEVEL

OF LOW BACK PAIN AND FUNCTIONAL DISABILITY AMONG
Table 4 (A): Comparison of mean pre – test and mean 7th day post- test level of low
back pain in experimental and control groups.
(N=74)
Pre-test Post- test
On day 7 Mean ‘t’ test
S.n Group Mea Standard Mea Standard differenc value
o n deviation n deviation e
1. Experimental 5.1 0.29 03 1.16 3.39 0.41

group S*
2. Control 5.2 1.6 20 3.4 14.8 0.050
group S*
p>0.05
Table 4(A) reveals the comparison of mean pre- test and 7 th day post test level
of low backpain in experimental group and control group. It is evident from the
75
above table that, the experimental group pre-test mean value was 5.1 and SD was
0.29. Post- test on day 7th mean value was 03 and SD was 1.16 and their mean
difference was 3.39. The calculated ‘t’ value was 0.41. Hence the research hypothesis
RH2 was accepted. Whereas in control group pre-test mean value was 5.2 and SD
was 1.64. Post test on day 7th mean value was 3.4 and SD was 3.4 and their mean
difference was 14.8. The mean post-test score on 7 th day level of low back pain among
spondylitis patients in experimental group will be lower than their mean post- test
score level of low back pain in control group. Hence the research hypothesis RH 3.was
accepted.
Experimental group
Control group
25
20
20
15
MEAN VALUE
10
5.1 5.2
5 3
0
Pre-test Post-test on day-7
76
Figure 20: Comparison of mean pre – test and mean 7th day post- test level of low
back pain in experimental and control groups.
Table 4 (B): Comparison of mean pre -test and mean of 7 th day post- test level of
functional disability in experimental and control groups.
(N=74)
Pre-test Post- test
S.n Group Mean Standard Mean Standard difference value
o deviation deviation
1. Experimental 27.2 11.4 25 9.07 02 1.8
group S*
2. Control group 33.2 9.46 35 10.9 1.8 2.74
NS
77
Table 4 (B) reveal the comparison of mean pre test and 7th day post test level
of functional disability among spondylitis patients in experimental group and control
group. It is evident from the above table that, experimental group the pre- test mean
value was 27.2 and SD was 11.4 and 7th day post -test mean value was 25 and SD
was 9.07 and their mean difference was 02 and the ‘t’ test value. Hence research
hypotheses RH2 was accepted.
Experimental group
45 Control group
40 39
35
35 33.2
30 27.2
25
MEAN VALUE
20
15
10
5
0
Pre-test Post-test on day 7
Comparison Of Mean Pre-test and 7th Day Post- Test Level Of Func-
tional Disability.
78
Figure 21: Comparison of mean pre test and 7th day post -test level of functional
disability in experimental and control groups.
Table 4(C): Comparison of mean pre test and mean of 14 th day post test level of low back
pain in experimental and control groups.
(N=74)
Pre-test Post- test

On day 14 Mean ‘t’
S.n Group Mean Standard Mean Standard differenc test
o deviation deviation e value
Experimental 0.86
1. 5.1 0.29 1.5 0.14 3.6
group S*
Control 0.425
2. 5.2 1.64 22 3.7 16.8
group S*
Table 4(C) reveals the comparison of mean pre test and 14th day post test level
of low back pain among spondylitis patients in experimental group and control
79
group. It is evident from the above table that, experimental group pre- test mean value
was 5.1, SD was 0.29 and 14 th day post- test mean value was 1.5 and SD was 0.14 and
their mean difference value is 3.6 and ‘t’ value was 0.86. Whereas in control group
pre- test mean value was 5.2, SD was 1.64 and 14 th day mean value was 22, SD was
3.7 and their mean difference value is 16.8, and the ‘t’ value is 0.425. The mean post-
test score on 7th day level of low back pain among spondylitis patients in experimental
group will be lower than their mean post- test score level of low back pain in control
group. Hence the research hypothesis RH3 was accepted.
6
5.2 Experimental group
5.1
5 Control group
4
3
MEAN VALUE
1.9
2 1.5
1
0
Comparison Of Mean Pre-test and 14th Day Post-test Level Of Low

Back Pain.
80
Figure 22 : Comparison of mean pre test and 14 th day post test level of low back
pain in experimental and control groups.
Table 4 (D): Comparison of mean pre test and mean of 14th day post test level of
functional disability experimental and control groups.
(N=74)
Pre-test Post- test

S.n Group Mean Standar Mean Standar difference value
o d d
Experimental deviation deviation 0.655
1. 27.2 11.4 21 11.3 15.8
group S*
4.43
2. Control group 33.2 9.46 44 5.5 10.8
NS
p<0.05
81
Table 4 (D) reveals the comparison of mean pre test and 14 th day post test
level of functional disability among spondylitis patients in experimental group and
control group. It is evident from the above table that, experimental group the pre- test
mean value was 27.2 and SD was 11.4and 14 th day post- test mean value was 21 and
SD was 11.3 and their mean difference value was 15.8 and the ‘t’ test value is 0.655.
Whereas in control group pre- test mean value was 33.2 and SD was 9.46 and, 14 th
day mean value was 44 and SD was 5.5 and their mean difference value was 10.8
and the ‘t’ value is 4.43,which shows that there was a significance difference in the
mean pre- test and mean post – test level of functional disability among control
group at p<0.05 level. Hence the research hypothesis RH3 was accepted.
Experimental group
Control group
44
43
45
40 33.2
35 27.2
30
MEAN VALUE
25
20
15
10
5
0
82
Figure 23: Comparison of mean pre test and 14 th day post test level of functional
disability among spondylitis patients in experimental group and control group
SECTION E: CORRELATION BETWEEN THE POST TEST LEVEL OF
SPONDYLITIS PATIENTS IN THE EXPERIMENTAL GROUP.
Table 5 : Correlation between the 14th day post test level of low back pain and
functional disability among spondylitis patients in the experimental group.
(N=74)
7th Day 14th Day
S.no Group Mean Standar Mean Standar

‘r’
d d
value
1. Low back pain 03 1.6
deviation 1.5 0.74
deviation 0.96
2. Functional 39 9.07 43 11.3 0.61

83
disability
Table 5 reveals that the correlation between the post- test level of low back
pain and functional disability in the experimental group, shows that a strongly
positive correlation between the 14th day post-test level of low back pain and
functional disability among spondylitis patients in experimental group with r = 0.91 at
p<0.05. Hence research hypotheses RH4 was accepted.
Low back pain

Functional disability
50
45 43
39
40
35
30
MEAN VALUE
25
20
15
10
5 3 1.5
0
7 th Day 14 th Day
Correlation between the post test level of low back pain and functional
84
Figure 24: Correlation between the post test level of low back pain and
functional disability in the experimental group.
SECTION F: ASSOCIATION OF POST – TSET LEVEL OF LOW BACK

IN EXPERIMENTAL AND CONTROL GROUPS WITH THEIR SELECTED
DEMOGRAPHICVARIABLES.
Table 6(A): Association of post test level of low back pain among spondylitis patients
in experimental group with their selected demographic variables. (n=38)
S. Low back pain

χ2
No Demographic No pain Mild Moderate Severe Worst
variables Value
pain pain pain pain
f % f % f % f % f %
1. Age
a) 35 – 40 3 7.8 1 2.6 8 21.05 4 10.5 0 0 0.52
b) 41 – 50 3 7.8 3 7.8 10 26.31 2 5.2 0 0 d(f)=6
c) 51 – 60 0 0 2 5.2 5 13.1 0 0 0 0 S*
d) 61 – 65 0 0 1 2.6 2 5.2 0 0 0 0
2. Sex 0.75
a) Male 4 10.5 4 10.5 13 34.21 2 5.2 0 0 d(f)=9
b) Female 2 5.2 3 7.8 12 31.57 4 10.5 0 0 S*
85
3. Marital status
a) Married 2 7.8 5 13.1 14 36.8 4 10.5 0 0 0.58
b) Unmarried 2 7.8 1 2.6 4 10.5 2 5.2 0 0 d(f)=3
c) Widow 2 7.8 1 2.6 4 10.5 0 0 0 0 S*
d) Divorced 0 0 0 0 3 7.8 0 0 0 0
4. Occupation
a) Unemployed 3 7.8 3 7.8 5 13.1 2 5.2 0 0 0.61
b) Coolie 3 7.8 1 2.6 12 31.5 2 5.2 0 0 d(f)=9
c) Business 0 0 2 5.2 3 7.8 1 2.6 0 0 S*
d) Professional 0 0 1 2.6 5 7.8 1 2.6 0 0
work.
5. Body mass index
a) Under weight 3 7.8 2 5.2 15 39.4 2 5.2 0 0 0.52
b) Normal 2 7.8 3 7.8 5 13.1 2 5.2 0 0 d(f)=6
weight 1 2.6 2 5.2 5 13.1 3 0 0 0 S*
c) Over weight
6. History of
Previous
Orthopedic
surgery
a) Yes
1. knee 3 5.5 2 5.2 3 7.8 2 5.2 0 0 0.52
arthoplasty 3 5.5 1 2.7 2 5.2 1 2.7 0 0 d(f)=6
2. Ankle repair S*
3. joint fusion 0 0 1 2.7 1 2.7 1 2.7 0 0
b) No 0 10.5 5.2 0 0
0 4 20 52.63 2
7. Duration of
illness
a) 6 months –
1 years 3 7.8 3 7.8 9 23.6 3 7.8 0 0 0.75
b) More than 1 d(f)=9
years – 2 3 7.8 3 7.8 6 15.7 3 7.8 0 0 S*
years
c) More than 2 0 0 1 2.6 10 26.3 0 0 0 0
years – 3
years
8. Duration of
treatment
a) 6 months –
1 years 3 7.8 3 7.8 9 23.6 3 7.8 0 0 0.75
b) More than d(f)=9
1 years – 2 3 7.8 3 7.8 6 15.7 3 7.8 0 0 S*
years
c) More than 0 0 1 2.6 10 26.3 0 0 0 0
2 years – 3
years
NS= Non Significant S*= Significant P<0.05
86
Table 6(A) reveals that the association between the post- test level of low
back pain with their selected demographic variables. While analyzing the statistical
significance at (p<0.05) level it shows that there is a significance association of the
post- test level of low back pain with all demographic variables of spondylitis
patients in experimental group except dietary pattern, education. Hence the
hypotheses RH5was accepted.
Table 6(B): Association of post test level of low back pain among spondylitis
patients in control group with their selected demographic variables.
(n=36)
S. Demographic variables Level of Low Back Pain χ2
No No Mild Moderate Severe Worst Value

pain pain pain pain pain
f % f % f % f % f %
1. Age
a) 35 – 40 0 0 1 2.7 9 25 1 2.7 1 2.7 0.52
b) 41 – 50 0 0 1 2.7 9 25 1 2.7 1 2.7 d(f)=3
c) 51 – 60 0 0 1 2.7 3 8.3 2 5.5 0 0 S*
d) 61 – 65 0 0 0 0 8 22.2 0 0 0 0
2. Sex 0.75
a) Male 0 0 1 2.7 19 52.7 2 5.5 1 2.7 d(f)=9
b) Female 0 0 2 5.5 10 27.7 2 5.5 1 2.7 S*
87
3. Occupation
a) Unemployed 0 0 1 2.7 12 33.3 1 2.7 1 2.7 0.61
b) Coolie 0 0 1 2.7 8 22.2 1 2.7 1 2.7 d(f)=9
c) Business 0 0 1 2.7 7 19.4 0 0 0 0 S*
d) Professional work. 0 0 0 0 2 5.5 1 2.7 0 0
4. Body mass index
a) Under weight 0 0 1 2.7 13 36.1 1 2.7 1 2.7 0.52
b) Normal weight 0 0 2 5.5 15 41.6 1 2.7 1 2.7 d(f)=9
c) Over weight 0 0 0 0 4 11.1 1 2.7 0 0 S*
5. Dietary pattern 0.58
a) Vegetarian 0 0 1 2.7 10 27.7 1 2.7 1 2.7 d(f)=6
b) Non vegetarian 0 0 2 5.5 19 52.7 3 8.3 1 2.7 S*
Orthopedic surgery
a) Yes
1. knee arthoplasty 3 5.5 0 0 0 0 0 0 1 2.7 0.52
2. Ankel repair 3 5.5 0 0 0 0 0 0 1 2.7 d(f)=3
3. joint fusion 0 0 0 0 0 0 0 0 0 0 S*
b) No 0 0 1 2.7 20 55.5 2 5.5 0 0
a) 6 months – 1 years 0 0 1 2.7 17 47.2 2 5.5 0 0
b) More than 1 years – 0.75
2 years 0 0 1 2.7 5 41.6 1 2.7 2 5.5 d(f)=9
c) More than 2 years – S*
3 years 0 0 1 2.7 7 19.4 1 2.7 0 0
a) 6 months – 1 years 0 0 1 2.7 17 47.2 2 5.5 0 0 0.75
b) More than 1 years – d(f)=9
2 years 0 0 1 2.7 5 41.6 1 2.7 2 5.5 S*
c) More than 2 years –
3 years 0 0 1 2.7 7 19.4 1 2.7 0 0
Table 6(B) reveals that the association between 14 th post- test level of low
back pain with their selected demographic variables. While analyzing the statistical
significance at (p<0.05) level it shows that there is a significance association of the

88
post- test level of low back pain with all demographic variables of spondylitis
patients in control group except marital status and education. Hence the hypotheses
RH5was accepted.
Table 6(C) : Association of post- test level of functional disability among

spondylitis patients in experimental group with their selected demographic
variables.
(n=38)
S. Demographic Functional Disability χ2

no Variables No Mild Moderate Severe Value
disability disability disability disability
f % f % f % f %
1. Age
a) 35 – 40 2 5.2 9 23.6 14 36.8 0 0 0.61
b) 41 – 50 1 2.7 7 18.4 4 10.5 0 0 d(f)=9
c) 51 – 60 3 7.4 0 0 2 5.2 0 0 S*
d) 61 – 65 0 0 0 0 2 5.2 0 0
2. Sex
a) Male 2 5.2 9 23.6 12 31.5 0 0 0.58
b) Female 3 7.4 7 18.4 20 52.6 0 0 d(f)=3
S*
3. Occupation
a) Unemployed 2 5.2 9 23.6 10 26.3 0 0 0.75
b) Coolie 3 7.4 5 13.1 8 21.5 0 0 d(f)=9
c) Business 0 0 2 5.2 4 10.5 0 0 S*
d) Professional 0 0 0 0 0 0 0 0
work.
89
4. Family monthly
income per month
a) Up to Rs. 4000 2 5.2 1 15 39.5 0 0
2.6
b) Rs.4001 – 0.75
Rs. 5000 3 7.4 3 5 13.1 0 0 d(f)=9
7.89
c) Rs. 5001 – S*
Rs.6000 0 0 0 0 1 0 0 0
d) Above
Rs. 6000 0 0 0 0 1 20 0 0
5. Body mass index

a) Under weight 1 2.7 8 21.5 8 21.5 0 0 0.75
b) Normal d(f)=9
weight 3 7.4 6 15.7 11 28.9 0 0 S*
c) Over weight 1 2.7 2 5.2 4 10.5 0 0
6. Dietary pattern
a) Vegetarian 2 5.2 9 23.6 18 47.3 0 0 0.58
b) Non vegetarian 3 7.4 7 18.4 4 10.5 0 0 d(f)=3
S*
Orthopedic
surgery(if any
specify….)
0.75
a)Yes 2 5.2 5 23.6 5 23.6 0 0
1.Knee arthoplasty d(f)=9
4 10.5 2 5.2 0 0
2.Ankel repair 2 5.2 S*
1 2.7 3 7.4 0 0
3. joint fusion 1 2.7
7 18.4 12 31.5 0 0
b) No 0 0
a) 6 months – 1
8
years 2 5.2 21.0 13 34.2 0 0
b) More than 1 0.52
8
years – 2 years 3 7.4 21.0 5 13.1 0 0 d(f)=6
c) More than 2 S*
0
years – 3 years 0 0 0 4 10.5 0 0
9. Duration of
treatment 0.52
a) 6 months – 1 d(f)=6
years 2 5.2 8 21.0 13 34.2 0 0 S*
b) More than 1
years – 2 years
c) More than 2 3 7.4 8 21.0 5 13.1 0 0
years – 3 years
90
0 0 0 0 4 10.5 0 0
Table 6(C) reveals that the association between the post- test level of
functional disability with their selected demographic variables. While analyzing the
statistical significance at (p<0.05) level it shows that there is a significance
association of the post- test level of functional disability with all demographic
variables of spondylitis patients in experimental group except marital status,
education. Hence the hypotheses RH5was accepted.
Table 6(D) : Association of post test level of functional disability among

spondylitis patients in control group with their selected demographic variables.
(n=36)
S.No Demographic Functional Disability χ2
Variables No Mild Moderate Severe
disability disability disability disability Value
f % f % f % f %
1. Age
a) 35 – 40 0 0 11 30.5 0 0 1 2.7 0.61
b) 41 – 50 0 0 5 13.8 7 19.4 1 2.7 d(f)=9
c) 51 – 60 0 0 0 0 11 30.5 1 2.7 S*
d) 61 – 65 0 0 0 0 02 5.5 0 0
2. Sex 0.58
a) Male 0 0 9 25 8 22.2 2 45.5 d(f)=3
b) Female 0 0 7 19.4 12 33.3 1 2.7 S*
3. Marital status
a) Married 0 0 7 19.4 8 22.2 1 2.7
b) Unmarried 0 0 3 8.3 7 19.4 1 2.7 0.75
c) Widow 0 0 3 8.3 5 13.8 1 2.7 d(f)=9
d) Divorced 0 0 3 8.3 0 0 0 0 S*
4. Occupation 2 45.5 9 25
a) Unemployed 0 0 8 22.2 4 11.1 1 2.7 0.75
b) Coolie 0 0 3 8.3 5 13.8 1 2.7 d(f)=9
c) Business 0 0 3 8.3 2 45.5 1 2.7 S*
d) Professional 0 0 0 0
91
work.
Body mass index
0
5. a) Under weight 0 8 22.2 8 22.2 1 2.7 0.75
0
b) Normal weight 0 3 7.6 5 13.8 1 2.7 d(f)=9
0
c) Over weight 0 5 13.8 7 19.4 1 2.7 S*
6. Dietary pattern 0.58

a) Vegetarian 0 0 9 25 8 22.2 3 7.4 d(f)=3
b) Non vegetarian 0 0 7 19.4 12 33.3 0 0 S*
Orthopedic surgery(if
any specify….)
a)Yes 0.75
0 0 8 22.2 10 27.7 0 0 d(f)=9
1.Knee arthoplasty
0 0 2 45.5 0 0 0 0 S*
2.Ankel repair
0 0 1 2.7 0 0 0 0
3. joint fusion
0 0 8 22.2 10 27.7 0 0
b) No
a) 6 months – 1 0 0 13 36.1 10 27.7 0 0
years 0.52
d) More than 1 0 0 2 5.2 10 27.7 2 45.5 d(f)=
years – 2 years 6
e) More than 2 0 0 1 2.7 0 0 1 2.7 S*
years – 3 years
a) 6 months – 1 0 0 13 36.1 10 27.7 0 0
years
0.52
b) More than 1
d(f)=
years – 2 years 0 0 2 5. 10 27.7 2 45.5
6
c) More than 2
S*
years – 3 years 0 0 1 2.7 0 0 1 2.7
Table 6 (D) reveals that the association between the post- test level of
functional disability with their selected demographic variables. While analyzing the

92
variables of spondylitis patients in control group except education. Hence the
hypotheses RH5was accepted.
CHAPTER V
DISCUSSION
This chapter deals with the discussion of the result of the data analysis to
assess the effectiveness of Mckenzie exercise on low back pain and functional
disability among Spondylitis patients in selected hospitals at Thirunelveli District.
The discussion is based on the objectives of the study and the hypotheses
specified in the study.
MAJOR FINDINGS OF THE STUDY WERE
 While considering the age, in the experimental group out of 38 samples, 10
(12.8%) of them were 51 – 60 years and in control group 15(19.2%) of them were
41 – 50 years.
93
 With respect to sex, in the experimental group, out of 38 samples , 22(28.2%) of
the samples were males Whereas in control group out of 36 samples, 24 (66.6%)
of them were males
 In relation with occupation, in the experimental out of 38 samples, 18(23.8%) of
them were coolie. Whereas in control group out of 36 samples, 15(41.6%) of them
were unemployed.
 In relation with family monthly income, in the experimental group out of 38
samples 26(23.3%) of them up to Rs. 4000
 With regard to body mass index, in the experimental group out of 38 samples
18(23%) of them were underweight..
 Regarding history of previous orthopedic surgery, in the experimental group out
of 38 32(41.02%) of them not undergone for previous orthopedic surgery.
 In relation with duration of illness, in the experimental group out of 38 samples
18(47.36%) of them were 6 months - 1 year of illness .
 Regarding duration of treatment, in the experimental group among 38 samples ,
18(47.36%) of them were on treatment for 6 months - 1 year.
1. First objective was to assess the pre- test and post test level of low back pain
and Functional disability among Spondylitis in experimental and control
groups.
 During pre- test, the level of low back pain in experimental group out of 38
samples 25(65.78%) were had moderate low back pain, Whereas in control group
out of 36 samples 29(76.6%) were had moderate low back pain,
 During the 14th day post- test, the level of low back pain in experimental group out
of 38 samples ,27(71.05%) were had moderate low back pain, Whereas in control
group Out of 36 samples, 28(77.77%) were had moderate pain,

94
 During the pre -test level of functional disability in experimental group out of 38
samples, , 22(61.1%) were had moderate functional disability. Where as in
control group out of 36 samples, 20(83.3%) were had moderate functional
disability,
 During the 14th day post- test level of functional disability in experimental group
out of 38 samples, 20(52.63%) were had mild functional disability, Where as in
control group out of 36 samples 26(72.22%) were had mild functional disability.
2. Second objective was to find out the effectiveness of Mckenzie exercise on low
back pain and functional disability among experimental group.
 The comparison of mean and standard deviation of pre- test and post – test on day
14th level of low back pain in experimental group, mean pre test level low back
pain value was 5.1 and SD was 0.25 and Mean post – test on day 14 th value was
1.5 and SD was 0.74. Their mean difference was 3.6. The calculated “t’’ value
was 0.86.
14th level of functional disability in experimental group, mean pre test level of
functional disability value was 27.2 and SD was 11.4 and Mean post – test on day
14th value was 43 and SD was 11.3. Their mean difference was 15.8. The
calculated “t’’ value was 0.655.
 During the comparison of mean post - test level of low back pain on the day 14 in
experimental group the , experimental group the mean value is 1.5 and SD was
0.14. Whereas in the control group mean value is 22 and SD was 3.7. Their mean
difference was 20.5. The calculated ‘t’ value was 0.425.
 During the comparison of mean post - test level of functional disability on day 14
in experimental group the mean value was 21 and SD was 11.3. Whereas in
95
control group mean value was 44 and SD was 5.5. Their mean difference was 23.
The calculated ‘t’ value was 4.43. Hence the research hypothesis RH1.
The study was supported by Machado La et al., (2012),conducted a Meta
analysis of randomized controlled trials to “compare the effectiveness of the
Mckenzie exercise and passive therapy on acute Low back pain and functional
disability". Structure questionnaire was used,11 trials of mostly high quality were
included. Mckenzie reduced pain (weighted mean difference[WMD] on a 0 - to 100
point scale, - 4.16 points;95%confidence interval,-7.12 to -1.20)and functional
disability (WMD on a 0- to 100- point scale,-5.22 points; 95% confidence interval,-
8.28 to -2.16) at 1 week follow-up when compared with passive therapy for acute low
back pain. There is some evidence that the Mckenzie exercise is more effective than
passive therapy for in acute low back pain and functional disability.
3. To compare the pre and post-test level of low back pain and functional
disability among the Spondylitis in experimental and control groups.
7 level of low back pain in experimental group, mean value was 5.1 and SD was
0.25 and Mean post – test on day 7 value was 0.3 and SD was 0.16. Hence
research hypothesis RH2 was accepted. Whereas in control group mean pre-test
value was 5.2 and SD was 1.64 and Mean post – test on day 7 value was 20 and
SD was 3.4. Their mean difference was 14.8. Hence the research hypothesis RH 3
was accepted.
 The comparison of mean and standard deviation of pre- test and post - test on day
14th level of low back pain in experimental group, mean pre test level low back
96
pain value was 5.1 and SD was 0.25 and Mean post - test on day 14 th value was
1.5 and SD was 0.14. Hence research hypotheses RH2 was accepted. Whereas in
control group mean pre- test value was 5.2 and SD was 1.64 and mean test on
day14th value was 0.2 and SD was 0.10. Their mean difference was 3.3. The
calculated “t’’ value was 0.425.. Hence the research hypothesis RH3 was accepted.
7th level of functional disability in experimental group, mean pre test level of
functional disability score value was 27.2 and SD was 11.4 and Mean post - test
on day 7th value was 25 and SD was 9.07. Hence research hypotheses RH2 was
accepted. Whereas in control group, mean pre test level of functional disability
score value was 33.2 and SD was 9.46 and Mean post - test on day 7 th value was
35 and SD was 10. 5. Their mean difference was 1.8 The calculated “t’’ value was
2.74 Hence the research hypotheses RH3 was accepted.
14th level of functional disability score in experimental group, mean value was
27.2 and SD was 11.4 and Mean post - test on day 14 th value was 20 and SD was
8.5.Whereas in control group, mean pre testvalue was 33.2 and SD was 9.46 and
Mean post - test on day 14th value was 40 and SD was 11.5. Their mean difference
was 10.8. The calculated “t’’ value was 4.43 Hence the research hypothesis RH 3
was accepted.
Edward. D.Risch (2011), conducted the randomized trial on effect of
Mckenzie exercise to improve functional ability and reduce back pain .A group of
elderly subjects 50 to 70 years of age randomized into a training group (n=18) that
performed one set of 3 to 5 Mckenzie exercise to reduce low back pain and improve
functional ability 3 times per week and a control group (N=6). Before and after study
period, subjects were assessed for Quebec scale. The result shows a significant
improvement in Mckenzie exercise, while the control group showed no change. It was
97
concluded that Mckenzie exercise are effective in reducing low back pain and
improve functional ability.
4. Fourth objectives was to correlate the post-test level of low back pain and
functional disability among Spondylitis patients in experimental group.
 During that the correlation between the post- test level of low back pain and
functional disability in the experimental group, shows that a strongly positive
correlation between the 14th day post-test level of low back pain and functional
disability among spondylitis patients in experimental group with r = 0.91 at
p<0.05. Hence research hypotheses RH4 was accepted.
5. Fifth objective was to associate the post test level of low back pain and
functional disability among spondylitis patients with their selected demographic
variables in experimental and control groups.
 Chi- square test to associate post- test level of low back pain with their selected
demographic variables in experimental group. While analyzing the statistical
significance at (p<0.05) level it shows that there is a significance association of
the post- test level of low back pain with all demographic variables of spondylitis
patients in experimental group except dietary pattern. Hence the hypotheses RH5
was accepted.
 Chi- square test to associate the post- test level of functional disability with their
selected demographic variables in experimental group. While analyzing the
variables of spondylitis patients in experimental group except marital status,
education, family monthly income. Hence the hypotheses RH5 was accepted.
98
CHAPTER VI
SUMMARY, CONCLUSION, IMPLICATIONS,
RECOMMENDATIONS AND LIMITATIONS
This chapter deals with summary of the study findings, conclusion drawn,
implications, recommendations and limitations of the study.
SUMMARY
99
This study was undertaken to assess the effectiveness of Mckenzie exercise on
low back pain and functional disability among Spondylitis patients in selected
hospitals at Thirunelveli District.
Low back pain is a common musculoskeletal disorder affecting 80 percent of
people at some point in their lives. The causes of Spondylitis is unknown, it is
believed to involve a combination of generic and environmental factors. (Bernard.,
2015).
THE OBJECTIVES OF THE STUDY WERE
 To assess the Pre - test and Post - test level of low back pain and functional
 To findout the effectiveness of Mckenzie exercise on low back pain and
functional disability among spondylitis patients in experimental group.
 To compare the Pre - test and Post - test level of low back pain and functional
 To correlate the post-test level of low back pain and functional disability
among Spondylitis patients in experimental group.
 To associate the post - test level of low back pain and functional disability
among spondylitis patients in experimental and control group with their
selected demographic variables .
HYPOTHESES
RH1 : The Mean Post - test level of low back pain and functional disability among
spondylitis patients in experimental group will be significantly lower than their
Mean Post - test level of low back pain and functional disability in control group.
RH2: The Mean Post - test level of low back pain and functional disability among
Spondylitis patients in experimental group will be significantly lower than their
Mean Pre - test level of low back pain and functional disability.
100
RH3: The Mean Post-test level of low back pain and functional disability among
Spondylitis patients in control group will be higher than their Mean Pre-test level of
low back pain and functional disability.
RH4 : There is a positive correlation between the post test level of low back pain
and functional disability in the experimental group.
RH5: There is a significant association between the Post- test level of Low back
pain and functional disability in experimental group with their selected demographic
variables .
THE ASSUMPTIONS WERE
 Mckenzie exercises will reduce the low back pain and functional disability,
and improve the health status of Spondylitis patients.
 Most of the Patients between 35- 65 years age group may have limited
movements and functional disability due to the low back pain.
THE REVIEW OF LITERATURE COLLECTED FOR THE
STUDY PROVIDED A STRONG BASIS FOR THE STUDY
A Review of literature refers to the process in which the investigator
examines the strength and weakness of the appropriate scholarly publications.
Review of literature of the present study is arranged in the following headings.
SECTION A- Studies related to Incidence and prevalence of Low back pain in
spondtlitis
SECTION B -Studies related to Incidence and Prevalence of Functional Disability in
spondylitis.
SECTION C - Studies related to Risk factors of Low back pain and functional
SECTION D - Studies related to effect of MCKENZIE exercise on Low back pain
and functional disability.

101
Researcher adopted Faye G. Abdellah’ theory, helping art of clinical nursing
theory, which focused patient centered approach as the basis for her typology of 21
nursing problems, it directed action towards the explicit goal, this theory has 3
sections, Health care need Problem solving approach and Health care need
management
The research design selected for this study was quasi experimental pre -test,
post - test control group design. The study was conducted in selected hospitals Devi
Orthopedic hospital and Elaiyaraja Orthopedic Hospital (Experimental group) and
C.S.I Jeyaraj Annapakkium Hospital, Thiraviyam Hospital (Control group) at
Thirunelveli District by using non probability purposive sampling technique. The tool
used for data collection consisting of demographic variables, the Standardised
Numerical Intensity Pain Rating Scale was used to assess the level of low back pain
and Modified Self Administered Rolland Morris Functional disability scale was used
to assess the level of functional disability on position, walking, climbing upstairs, and
weight lifting.
The tool was validated by four nursing experts and one medical experts and
the reliability of the tool was confirmed by test retest method. The value of the
reliability was r= 0.9, and hence the tool was highly reliable. The pilot study was
conducted and the findings revealed that the tool was feasible and practicable to
conduct the main study.
FINDINGS
The data was collected and analyzed by using descriptive and inferential
statistics. The findings revealed that the calculated ‘t’ test value was 0.7 and 0.39
which shows that there was a high statistical significant difference in the post- test
level of low back pain and functional disability between the experimental group and
control group of the samples at p< 0.05 level. Hence the result hypotheses stated that,
102
the Mean Post - test level of low back pain and functional disability among
spondylitis patients in experimental group will be significantly lower than the Mean
Post - test level of low back pain and functional disability in control group was
retained at p<0.05 level.
Data findings revealed that there was statistically significant association of the
level of low back pain and functional disability related with the selected demographic
variables such as Age, Sex, Marital status, Education, Occupation, Dietary pattern,
Body mass index, History of previous orthopedic surgery, Duration of illness and
Duration of treatment in Spondylitis patients in experimental and control groups with
their selected demographic variables at p<0.05 level.
CONCLUSION
From the result of the study, it was concluded that administration of Mckenzie
exercise to reduce low back pain and functional disability was effective in reducing
the low back pain and functional disability. Therefore the investigator felt that more
important should be given to Mckenzie exercise to reduce low back pain and
IMPLICATIONS
The researcher has derived the following implications from the study results
which are of vital concern to the nursing service, nursing administration, nursing
education and nursing research.
IMPLICATIONS FOR NURSING PRACTICE:
1. Nursing personnel should develop sound knowledge about the low back pain
and functional disability among Spondylitis patients.
2. Nurses should promote and encourage Mckenzie exercise to reduce low back
pain and functional disability

103
IMPLICATIONS FOR NURSING EDUCATION:
1. The Nurse educators need to be equipped with adequate knowledge regarding
Mckenzie exercise to reduce low back pain and functional disability.
2. Nursing students should receive adequate training regarding the principles of
Mckenzie exercise to reduce low back pain and functional disability.
3. Conduct workshops or conferences for students regarding the use of Mckenzie
exercise to reduce low back pain and functional disability.
4. Strengthen the curriculum for nurses to excel them in knowledge and skill in
areas of Mckenzie exercise to reduce low back pain and functional disability.
IMPLICATIONS FOR NURSING ADMINISTRATION:
1. Nurses should assist in implementing public health awareness Campaigns
aimed at promoting Mckenzie exercises to reduce low back pain and
2. Nurses should provide knowledge, resources and leadership for establishing
public health policies that focus on Mckenzie exercises to reduce low back
pain and functional disability.
3. Nurses should conduct continuing nursing education regarding the effects of
Mckenzie exercises to reduce low back pain and functional disability.
IMPLICATIONS FOR NURSING RESEARCH:
As a nurse researcher,
1. Nurses should conduct research to further clarify the beneficial effects of
Mckenzie exercises to reduce low back pain and functional disability.

104
2. Encourage further research to be conducted for reducing the low back pain and
functional disability by giving Mckenzie exercise.
3. Disseminate the findings of the research through conferences, seminars and
publishing in nursing journals.
LIMITATIONS
1. Since there were very few studies done on the effectiveness of Mckenzie
exercise to reduce low back pain and functional disability, the investigator
had a lot of difficulties collecting the study materials for the review.
2. Mckenzie exercise over 2 weeks time samples may not cooperate well, hence
motivation is needed.
RECOMMENDATIONS
The following studies can be undertaken to strengthen the studies regarding
effectiveness of Mckenzie exercise to reduce low back pain and functional disability.
1. A Longitudinal study to assess the effectiveness of Mckenzie exercise to
reduce low back pain and functional disability.
2. A study to assess the knowledge regarding effectiveness of Mckenzie exercise
to reduce low back pain and functional disability among staff nurses working
in orthopedic ward.
3. A Comparative study to assess the effectiveness of Mckenzie exercise and
yoga on reduction of low back pain and functional disability among the
computer workers.

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1

BACKGROUND OF THE STUDY

lumbar spine. (Department of Neuroscience., 2016)

Inflammatory disease of the joints such as arthritis, including osteoarthritis

and rheumatoid arthritis as well as Spondylitis, an inflammation of the vertebrae, can

also cause low back pain. Spondylitis is also called spondyloarthritis or

spondyloarthropathy. (Mchado., 2015 )

musculoskeletal disorder affecting 80 percent of people at some point in their lives. It

is an extremely common human phenomenon which occurs because of trauma,

degeneration or any pathology related to back. It can be acute, sub-acute or chronic in

duration.(Christian Nordqvist., 2015).

The causes of Spondylitis is unknown, it is believed to involve a combination

of generic and environmental factors. Spondylitis is a type of seronegative

spondyloarthropathy, meaning that tests show no presence of rheumatoid factor

antibodies. It is also within a broader category known as axial spondyloarthritis.

medication, exercise, and surgery. (Matteson.2014).

Low back pain contributes substantially to the workload of general practices.

compression,which leads to subsequent motor and sensory manifestation.(J Guzman.

when a weekday routine of getting too little exercise is punctuated by strenuous

irregularities. Sciatica is a form of radiculopathy caused by compression of the sciatic

back pain.(Nadine Foster., 2014).

Low back pain is treated by pharmacological treatment, non- pharmacological

treatment, injection therapies and surgical treatment. Pharmacological treatment

includes NSAIDs, acetaminophen, opioids, muscle relaxants and corticosteroids. Non

pharmacological treatments include exercise such as lumbar stabilizing exercise. Low

and health education regarding maintaining body mechanism, exercises, dietary

management and self-activities.(Jan Hartvigsen., 2013).

Mckenzie exercise, it is a philosophy of active patient involvement and

Mechanical Diagnosis and Therapy [MDT].The choice of exercises in the Mckenzie

back pain disability. (Robin., 2013).

NEED OF THE STUDY

western society.(American chiropractic association., 2018).

Denmark,12% in Sweden,14% in the United Kingdom. Similarly, (International

survey of Low back Pain 2017).

incidence of Spondylitis is 0.4 – 14 per 1, 00,000 person in the year. Spondylitis

journal of pain., 2014).

The prevalence of Spondylitis in the rural and urban area is estimated in

Tamilnadu population is revealed that, significantly higher prevalence of Spondylitis

In Thirunelveli, about 1 in 5 patients over the age of 50 has some form of

(Dr.Nisha Elizabeth., 2014)

Mckenzie exercise is used to strengthen muscles, increase soft tissue stability,

restore range of movement and improve cardiovascular conditioning. (Mckenzie.,

Edward. D. Rich (2013), conducted the randomized trial on effect of

Spondylitis. A group of elderly subjects 50 to 70 years of age randomized into a

disability in Spondylitis patients. It helps to improve the patient’s ability to move

STATEMENT OF THE PROBLEM

functional disability among Spondylitis Patients in selected hospitals Thirunelveli

disability among spondylitis patients in experimental group and control group.

functional disability among spondylitis patients in experimental group.

disability among spondylitis patients in experimental group and control group.

among Spondylitis patients in experimental group.

among spondylitis patients in experimental and control group with their

selected demographic variables such as Age, Sex, Marital status, Education,

Occupation, Dietary pattern, Body mass index, History of previous

orthopaedic surgery, Duration of illness and Duration of treatment.

among Spondylitis patients in experimental group will be significantly lower than

Mean Pre-test level of low back pain and functional disability.

pain and functional disability in the experimental group.

In this study, It refers to a process of systematically and continuously