Minimum 30 cases satisfying the case definition and inclusion and exclusion criteria were studied with the time duration of fifteen months. Follow up of every case was recorded regularly and at the interval of 15 days. In acute exacerbation follow up was recorded at interval of 4 to 8 days interval.
C) INTERVENTION AND SELECTION OF TOOL
1) Sampling procedure – Case presenting with symptoms such as persistent joint pain that worse on walking, with use of stairs, squatting position, morning stiffness not more than half an hour, and gelling i.e. Pain after the period of immobilization was considered for clinical diagnosis. Examination of joint for presence of crepitus, or osteophytes, restricted movements. Joint line tenderness was being carried out. The ACR criteria are used to distinguish OA from other causes of symptom. All Patients was diagnose on the based upon criteria established by ACR. WOMAC OA INDEX questionnaires were used before and after treatment to see improvement of quality of life. Body Mass Index was calculate by measuring individual‘s weight in Kg and dividing his/her height in meter square to know the relation between incidence of disease and obesity. ( Table:1)
2) Selection of remedy:-After the selection of patients according to pre-defined criteria as stated above. A specific case format was be filled by each patient with detailed case history and detailed physical examination was be done for diagnosing the disease clinically, the symptoms carefully evaluate for the arriving at prescribing totality. Repertorisation was being done after selecting the corresponding rubrics. Synthesis, Boricke, Phatks repertory was be
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Alloveda, National Conference, NIMA, Dombivli JAN-FEB 2018, VOL 4-38 Page 90 used for selection of remedy. The similinum was base on totality of symtoms. Medicine was considered on the basis of miasms, predisposing and complaints, precipitating factors, generalities, modalities, presenting complaints, constitutional features or reportorial totality. In some patients prescriptions based were based on characteristic symptoms or keynotes. Each patient was prescribed a single Homoeopathic medicine at a time. Repetition depending upon susceptibility of the patient and nature of prescribed medicine. The improvements of the patients were monitored. If patient was not shown any progress within next 2-3 days then acute acting medicine was prescribed for 2 to 3 days to control the pain intensity. During acute pain condition acute acting medicine was prescribed on basis of acute totality having no inimical relation with previously administered medicine.
3) Selection of potency and Repetition of doses: - All the medicines were prescribed in 30C 200C raising potency 1M, 10M potency and selection was as per the susceptibility of individual patient. Repetitions were done according to the present state of patient as per the principle of homoeopathic posology. The medicine was changed when patient did not shown any improvement in the complaints on two successive follow up in spite of raising the potency , following Gibson Miller Remedy Relationship chart which is given in Boericke Materia Medica. Placebo was continuing as long as improvement continued once Constitutional similinum prescribed.
4) Administration of the drug: Drug administration was done through oral route in pills and powder form.
5) Drug dispensing: Has been done in globules, powder form.
6) Storage: - Drugs has been acquired from the standard homoeopathic pharmacy and drugs have been stored as per the rules of Homoeopathic pharmacopeia of India (HPI).
7) Declaration: - It has been given that the drug used is not harmful to human beings. Given remedy was already available in homoeopathic literature, well proved on healthy human beings and is harmless, having no side effects.
8) Clinical protocol: - Ethical Committee approval has been taken. Data was collected
by proper method and was processed in standard format. Total research project has been submitted to Ethical committee and patients have been selected according to case definition. Patient was explained about the research project.
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Alloveda, National Conference, NIMA, Dombivli JAN-FEB 2018, VOL 4-38 Page 91 9) Nosological diagnosis: Diagnosis has been done by ACR criteria, patient‘s prior investigation and physical examination. Standardized case format was prepared and was maintained of individual patient. Standardized follow up sheet was prepared and maintained regularly.
D) INCLUSION CRITERIA:-
1. All patients fulfilling the case definition. Case presenting with symptoms such as persistent joint pain that worse on walking, with use of stairs, squatting position, morning stiffness not more than half an hour, and gelling i.e. Pain after the period of immobilization
2. Patient of age group above 35yrs of the both sexes. 3. Known cases of arthritis.
4. Patients presenting joint line tenderness, swelling, crepitus, or osteophytes, restricted ROM, deformity (varus, vulgus, flexion knee deformity) on clinical examination.
E) EXCLUSION CRITERIA: -
1. Patient not fulfilling the case definition (Case presenting with c/o of joint pain in OA of age group above 35yrs group of both the sex.
2. Patients more than 85 years of age.
F) PROBABLE DEFINITION AND RESOLUTION.
a) Diagnosis- Diagnosis was done by detailed history taking as per the standard case format, physical examination and investigations using ACR, WOMAC INDEX.
1. Patient was identified in correct group.
2. Utilization of data was being done for selection of the patient.
3. Treatment was follows –Homoeopathic treatment, Proper diet and regimen, Auxiliary line of treatment.
4. Quality of life was assessed by WOMAC OA INDEX before and after treatment.
G) CRITERIA OF FOLLOW UP: Standard follow up criteria was done as per the criteria. Regular follow ups of all the patients was maintained .In each follow up detail symptomatic changes were recorded and clinical examination was done and prognosis had been studied. Follow up was taken after 15 days. It has been based on homoeopathic principles. The presence or absence of radiological evidence of loss of space ,osteophyte formation, subchondral bone thickening or cyst formation was not be considered much significant for
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UGC APPROVED Sr. No 49366
Alloveda, National Conference, NIMA, Dombivli JAN-FEB 2018, VOL 4-38 Page 92 assessment. The relations between radiological changes of OA and symptoms are weak and follow up radiograph was not being taken.
H) OUTCOME ASSESSMENT: Improvement is evaluated under 3 headings.(Table:2) TABLES
Table 1 : Criteria For Assessment Of Obesity
Table 2: Outcome Assesment Table
CRITERIA SUBJECTIVE / OBJECTIVE SYMPTOMS %