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Determinants of traditional bone setter preference and its association with delayed orthopaedic presentation and functional disability among rural trauma patients at a tertiary care For this topic for k TV abstract give inclusion and exclusion criteria icmr sts

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ICMR STS abstract inclusion exclusion criteria traditional bone setter rural trauma patients orthopaedic

Here is a fully structured ICMR STS abstract with proper Inclusion and Exclusion Criteria for your topic:

ICMR STS Abstract

Title

"Determinants of Traditional Bone Setter Preference and Its Association with Delayed Orthopaedic Presentation and Functional Disability among Rural Trauma Patients at a Tertiary Care Centre"

Background

Traditional bone setters (TBS) remain a primary source of musculoskeletal injury care in rural India due to cultural beliefs, affordability, accessibility, and distrust of formal healthcare. Despite widespread use, TBS practice is associated with significant complications including malunion, compartment syndrome, osteomyelitis, and limb loss. Delayed orthopaedic presentation following TBS management worsens patient outcomes and increases functional disability. Literature from India and sub-Saharan Africa consistently reports TBS utilization rates of 40-60% among rural trauma patients. Systematic data on determinants of TBS preference and its impact on functional outcomes at tertiary care level in the Indian context remains scarce.

Aim

To identify the determinants of TBS preference and to assess the association between prior TBS consultation, delayed orthopaedic presentation, and functional disability among rural trauma patients attending a tertiary care hospital.

Objectives

  1. To assess the prevalence of prior TBS consultation among rural trauma patients.
  2. To identify socio-demographic, economic, and cultural determinants of TBS preference.
  3. To determine the proportion of patients with delayed presentation (>72 hours after injury) attributable to prior TBS consultation.
  4. To assess functional disability using a validated tool (DASH / LEFS / WHODAS 2.0) among TBS-exposed vs. non-TBS-exposed patients.
  5. To identify complications arising from TBS management.

Study Design

Hospital-based cross-sectional observational study.

Study Setting

Department of Orthopaedics, [Name of Tertiary Care Hospital], [Place] - a rural/semi-urban referral centre.

Study Duration

6 months (within the ICMR STS project period).

Sample Size

Using the reported prevalence of TBS utilization of 55% (Frontiers, 2025), with 10% allowable error, 95% confidence interval: n = Z²PQ/d² = (1.96)² × 0.55 × 0.45 / (0.1×0.55)² ≈ 315 patients (adjust per institutional case load and guide's advice).

INCLUSION CRITERIA

  1. Age: Patients aged 18 years and above presenting to the orthopaedic OPD/casualty with acute or subacute musculoskeletal trauma (fractures, dislocations, ligament injuries, soft tissue injuries).
  2. Residence: Patients from rural or semi-urban areas (as defined by Census of India - residing in villages or towns with population <20,000 or non-municipal areas).
  3. Injury mechanism: Patients with traumatic musculoskeletal injuries sustained within the past 6 weeks (acute and subacute trauma).
  4. Prior healthcare contact: Patients who did AND patients who did not consult a traditional bone setter prior to presenting to the tertiary centre (both groups included for comparison).
  5. Consent: Patients willing to give written informed consent to participate.
  6. Language: Patients who can communicate in the local language(s) used by the interviewer.

EXCLUSION CRITERIA

  1. Pathological fractures: Patients with fractures secondary to underlying bone pathology (metastasis, osteoporosis-related vertebral fractures, bone tumours, Paget's disease).
  2. Polytrauma with life-threatening injuries: Patients with severe polytrauma (ISS >15) requiring immediate resuscitation where interview is not feasible.
  3. Non-traumatic orthopaedic conditions: Patients presenting with congenital deformities, degenerative joint disease, inflammatory arthritis, or elective orthopaedic complaints not related to trauma.
  4. Urban residents: Patients who are permanent residents of urban municipal areas (as they have better access to formal healthcare and TBS dynamics differ).
  5. Paediatric patients: Patients below 18 years of age (different consent process and different TBS practice patterns; a separate study may be warranted).
  6. Re-presentations: Patients presenting for follow-up visits for the same injury episode already enrolled in the study (to avoid duplication).
  7. Unable to communicate: Patients with altered sensorium, severe cognitive impairment, or hearing/speech impairment that precludes reliable interview.
  8. Refused consent: Patients not willing to participate.
  9. Referred-in with complete hospital records: Patients referred from another formal hospital with documented in-hospital orthopaedic management (as the exposure variable - TBS contact - would be absent or non-applicable).
  10. Spinal cord injury with complete neurological deficit - functional disability assessment tools are not applicable in this subgroup and would confound WHODAS/DASH scoring.

Study Tool / Outcome Measures

VariableMeasurement Tool
TBS preference determinantsStructured interviewer-administered questionnaire (sociodemographic + Likert-scale attitude items)
Delay in presentationHours/days from injury to first orthopaedic contact (>72 hours = delayed)
Functional disabilityDASH (upper limb) / LEFS (lower limb) / WHODAS 2.0 (global)
Complications from TBSClinical examination + imaging (malunion, wound infection, gangrene, neurovascular deficit)
Socioeconomic statusModified Kuppuswamy Scale (updated 2024 figures)

Key Determinants to be Studied (Independent Variables)

  • Age, sex, education level, occupation
  • Distance from tertiary hospital (in km)
  • Socioeconomic status (Kuppuswamy/BG Prasad scale)
  • Cost perception of formal vs. TBS care
  • Cultural beliefs and family/community pressure
  • Prior personal or family experience with TBS
  • Availability of transport
  • Type and severity of injury

Ethical Considerations

  • IEC/IRB approval to be obtained before data collection.
  • Written informed consent in local language.
  • No patient identifiers in the data sheet.
  • Participation is voluntary; refusal does not affect treatment.

Expected Outcomes / Significance

This study will generate evidence on modifiable determinants of TBS preference at the community level, quantify the delay attributable to TBS contact, and measure its functional impact - data directly relevant to public health policy, rural health worker training, and orthopaedic awareness campaigns. The findings will be directly applicable to ICMR's priority areas of rural health equity and musculoskeletal disability burden.
Tips for ICMR STS submission:
  • Word limit for abstract is typically 250-500 words - use only the background, objectives, methods (with I/E criteria), and expected outcomes.
  • Mention your guide's name, institution, and MCI/NMC registration.
  • The I/E criteria above are comprehensive - you can trim to 5-6 points each for the abstract box, and keep the full version for the detailed protocol.
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