\documentclass[twocolumn,twoside]{article}
\makeatletter\if@twocolumn\PassOptionsToPackage{switch}{lineno}\else\fi\makeatother

\usepackage{amsfonts,amssymb,amsbsy,latexsym,amsmath,tabulary,graphicx,times,xcolor}

%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
% Following additional macros are required to function some 
% functions which are not available in the class used.
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
\usepackage{url,multirow,morefloats,floatflt,cancel,tfrupee}
\makeatletter


\AtBeginDocument{\@ifpackageloaded{textcomp}{}{\usepackage{textcomp}}}
\makeatother
\usepackage{colortbl}
\usepackage{xcolor}
\usepackage{pifont}
\usepackage[nointegrals]{wasysym}
\urlstyle{rm}
\makeatletter

%%%For Table column width calculation.
\def\mcWidth#1{\csname TY@F#1\endcsname+\tabcolsep}

%%Hacking center and right align for table
\def\cAlignHack{\rightskip\@flushglue\leftskip\@flushglue\parindent\z@\parfillskip\z@skip}
\def\rAlignHack{\rightskip\z@skip\leftskip\@flushglue \parindent\z@\parfillskip\z@skip}

%Etal definition in references
\@ifundefined{etal}{\def\etal{\textit{et~al}}}{}


%\if@twocolumn\usepackage{dblfloatfix}\fi
\usepackage{ifxetex}
\ifxetex\else\if@twocolumn\@ifpackageloaded{stfloats}{}{\usepackage{dblfloatfix}}\fi\fi

\AtBeginDocument{
\expandafter\ifx\csname eqalign\endcsname\relax
\def\eqalign#1{\null\vcenter{\def\\{\cr}\openup\jot\m@th
  \ialign{\strut$\displaystyle{##}$\hfil&$\displaystyle{{}##}$\hfil
      \crcr#1\crcr}}\,}
\fi
}

%For fixing hardfail when unicode letters appear inside table with endfloat
\AtBeginDocument{%
  \@ifpackageloaded{endfloat}%
   {\renewcommand\efloat@iwrite[1]{\immediate\expandafter\protected@write\csname efloat@post#1\endcsname{}}}{\newif\ifefloat@tables}%
}%

\def\BreakURLText#1{\@tfor\brk@tempa:=#1\do{\brk@tempa\hskip0pt}}
\let\lt=<
\let\gt=>
\def\processVert{\ifmmode|\else\textbar\fi}
\let\processvert\processVert

\@ifundefined{subparagraph}{
\def\subparagraph{\@startsection{paragraph}{5}{2\parindent}{0ex plus 0.1ex minus 0.1ex}%
{0ex}{\normalfont\small\itshape}}%
}{}

% These are now gobbled, so won't appear in the PDF.
\newcommand\role[1]{\unskip}
\newcommand\aucollab[1]{\unskip}
  
\@ifundefined{tsGraphicsScaleX}{\gdef\tsGraphicsScaleX{1}}{}
\@ifundefined{tsGraphicsScaleY}{\gdef\tsGraphicsScaleY{.9}}{}
% To automatically resize figures to fit inside the text area
\def\checkGraphicsWidth{\ifdim\Gin@nat@width>\linewidth
	\tsGraphicsScaleX\linewidth\else\Gin@nat@width\fi}

\def\checkGraphicsHeight{\ifdim\Gin@nat@height>.9\textheight
	\tsGraphicsScaleY\textheight\else\Gin@nat@height\fi}

\def\fixFloatSize#1{}%\@ifundefined{processdelayedfloats}{\setbox0=\hbox{\includegraphics{#1}}\ifnum\wd0<\columnwidth\relax\renewenvironment{figure*}{\begin{figure}}{\end{figure}}\fi}{}}
\let\ts@includegraphics\includegraphics

\def\inlinegraphic[#1]#2{{\edef\@tempa{#1}\edef\baseline@shift{\ifx\@tempa\@empty0\else#1\fi}\edef\tempZ{\the\numexpr(\numexpr(\baseline@shift*\f@size/100))}\protect\raisebox{\tempZ pt}{\ts@includegraphics{#2}}}}

%\renewcommand{\includegraphics}[1]{\ts@includegraphics[width=\checkGraphicsWidth]{#1}}
\AtBeginDocument{\def\includegraphics{\@ifnextchar[{\ts@includegraphics}{\ts@includegraphics[width=\checkGraphicsWidth,height=\checkGraphicsHeight,keepaspectratio]}}}

\DeclareMathAlphabet{\mathpzc}{OT1}{pzc}{m}{it}

\def\URL#1#2{\@ifundefined{href}{#2}{\href{#1}{#2}}}

%%For url break
\def\UrlOrds{\do\*\do\-\do\~\do\'\do\"\do\-}%
\g@addto@macro{\UrlBreaks}{\UrlOrds}



\edef\fntEncoding{\f@encoding}
\def\EUoneEnc{EU1}
\makeatother
\def\floatpagefraction{0.8} 
\def\dblfloatpagefraction{0.8}
\def\style#1#2{#2}
\def\xxxguillemotleft{\fontencoding{T1}\selectfont\guillemotleft}
\def\xxxguillemotright{\fontencoding{T1}\selectfont\guillemotright}

\newif\ifmultipleabstract\multipleabstractfalse%
\newenvironment{typesetAbstractGroup}{}{}%

%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

\usepackage[authoryear]{natbib}



\newif\ifnokeywords\nokeywordsfalse

\makeatletter\input{size10-pointfive.clo}\makeatother%
\definecolor{kwdboxcolor}{RGB}{242,242,242}
\usepackage[hidelinks,colorlinks=true,allcolors=blue]{hyperref}
\linespread{1}                 
\def\floatpagefraction{0.8}

\usepackage[paperheight=11.69in,paperwidth=8.26in,top=1in,bottom=1in,left=1in,right=.75in,headsep=24pt]{geometry}

\usepackage{multirow-custom}

\makeatletter

\def\hlinewd#1{%
  \noalign{\ifnum0=`}\fi\hrule \@height #1%
  \futurelet\reserved@a\@xhline}
\def\tbltoprule{\hlinewd{1pt}\\[-14pt]}
\def\tblbottomrule{\noalign{\vspace*{6pt}}\hline\noalign{\vspace*{2pt}}}
\def\tblmidrule{\hline\noalign{\vspace*{2pt}}}



\let\@articleType\@empty
\let\@journalDoi\@empty
\let\@journalVolume\@empty
\let\@journalIssue\@empty
\let\@crossMarkLink\@empty
\let\@receivedDate\@empty
\let\@acceptedDate\@empty
\let\@revisedDate\@empty
\let\@publishedDate\@empty
\let\@copyrightYear\@empty
\let\@firstPage\@empty
\def\articleType#1{\gdef\@articleType{#1}}
\def\journalDoi#1{\gdef\@journalDoi{#1}}
\def\crossMarkLink#1{\gdef\@crossMarkLink{#1}}
\def\receivedDate#1{\gdef\@receivedDate{#1}}
\def\acceptedDate#1{\gdef\@acceptedDate{#1}}
\def\revisedDate#1{\gdef\@revisedDate{#1}}
\def\publishedDate#1{\gdef\@publishedDate{#1}}
\def\copyrightYear#1{\gdef\@copyrightYear{#1}}
\def\journalVolume#1{\gdef\@journalVolume{#1}}
\def\journalIssue#1{\gdef\@journalIssue{#1}}
\def\firstPage#1{\gdef\@firstPage{#1}}
\let\@issuelogo\@empty%
\let\@issuelogoex\@empty%
\def\issuelogo#1{\gdef\@issuelogo{#1}}
\def\issuelogoex#1{\gdef\@issuelogoex{#1}}


\def\author#1{%
  \gdef\@author{%
    \hskip-\dimexpr(\tabcolsep)\hskip5pt%
    \parbox{\dimexpr\textwidth-1pt}%
    {\fontsize{11}{13}\selectfont\raggedright #1}%
  }%
}


\usepackage{pharmascope-abs}
\usepackage{caption}
\usepackage{lastpage}
\usepackage{fancyhdr}
\usepackage[noindentafter,explicit]{titlesec}
\usepackage{fontspec}

\setmainfont[%
BoldFont=cambriab.ttf,%
ItalicFont=CAMBRIAI.TTF,%
BoldItalicFont=CAMBRIAZ.TTF]{Cambria.ttf}
\lefthyphenmin = 3

\def\title#1{%
  \gdef\@title{%
      \vspace*{-40pt}%
       \ifx\@articleType\@empty\else{\fontsize{10}{12}\scshape\selectfont\hspace{8pt}\@articleType\hfill\mbox{}\par\vspace{2pt}}\fi%
       \minipage{\linewidth}
         \hrulefill\\[-0.7pt]%%{\includegraphics[width=75pt,height=50pt]{ijrps_logo.png}}\hfill
         \mbox{~}\hspace{5pt}\parbox{.1\linewidth}{\IfFileExists{images/\@issuelogo.\@issuelogoex}{\includegraphics[width=79pt,height=61pt]{images/\@issuelogo.\@issuelogoex}}{\includegraphics[width=75pt,height=50pt]{ijrps_logo.png}}}\hfill
         \fcolorbox{kwdboxcolor}{kwdboxcolor}{\parbox{.792\linewidth}{%
          \begin{center}\fontsize{17}{17}\selectfont\scshape\vskip-7pt International Journal of Research in Pharmaceutical Sciences\hfill\end{center}%
          \vspace*{-10pt}\hspace*{4pt}{\fontsize{8}{9}\selectfont Published by JK Welfare \& Pharmascope Foundation\hfill  Journal Home Page: \href{https://ijrps.com}{\color{blue}\underline{\smash{https://ijrps.com}}}}\hspace*{4pt}\mbox{}}}%
       \par\vspace*{-1pt}\rule{\linewidth}{1.3pt}%
       \endminipage%
    \par\vspace*{9.2pt}\parbox{.98\linewidth}{\linespread{.9}\raggedright\fontsize{14}{17}\selectfont #1}%
    \vspace*{-8pt}%
  }
}


\setlength{\parindent}{0pt}
\setlength{\parskip}{0.4pc plus 1pt minus 1pt}

\def\abbrvJournalTitle{Int. J. Res. Pharm. Sci.}

\fancypagestyle{headings}{%
  \renewcommand{\headrulewidth}{0pt}%
  \renewcommand{\footrulewidth}{0.3pt}
  \fancyhf{}%
  \fancyhead[R]{%
    \fontsize{9.12}{11}\selectfont\RunningAuthor,\ \abbrvJournalTitle,\ \ifx\@journalVolume\@empty X\else\@journalVolume\fi%
    \ifx\@journalIssue\@empty\else(\@journalIssue)\fi%
    ,\ \ifx\@firstPage\@empty 1\else\@firstPage\fi-\pageref*{LastPage}%
  }%
  \fancyfoot[LO,RE]{\fontsize{9.12}{11}\selectfont\textcopyright\ International Journal of Research in Pharmaceutical Sciences}%
  \fancyfoot[RO,LE]{\fontsize{9.12}{11}\selectfont\thepage}
}\pagestyle{headings}

                                                         
\fancypagestyle{plain}{%
  \renewcommand{\headrulewidth}{0pt}%
  \renewcommand{\footrulewidth}{0.3pt}%
  \fancyhf{}%
  \fancyhead[R]{%
    \fontsize{9.12}{11}\selectfont\RunningAuthor,\ \abbrvJournalTitle,\ \ifx\@journalVolume\@empty X\else\@journalVolume\fi%
    \ifx\@journalIssue\@empty\else(\@journalIssue)\fi%
    ,\ \ifx\@firstPage\@empty 1\else\@firstPage\fi-\pageref*{LastPage}%
  }%
  \fancyfoot[LO,RE]{\fontsize{9.12}{11}\selectfont\textcopyright\ International Journal of Research in Pharmaceutical Sciences}%
  \fancyfoot[RO,LE]{\fontsize{9.12}{11}\selectfont\thepage}
  \ifx\@firstPage\@empty\else\setcounter{page}{\@firstPage}\fi
}


\def\NormalBaseline{\def\baselinestretch{1.1}}
\usepackage{textcase}
\setcounter{secnumdepth}{0}

\titleformat{\section}[block]{\bfseries\boldmath\NormalBaseline\filright\fontsize{10.5}{13}\selectfont}
{\thesection}
{6pt}
{\MakeTextUppercase{#1}}
[]
\titleformat{\subsection}[block]{\bfseries\boldmath\NormalBaseline\filright\fontsize{10.5}{12}\selectfont}
{\thesubsection}
{6pt}
{#1}
[]
\titleformat{\subsubsection}[block]{\NormalBaseline\filright\fontsize{10.5}{12}\selectfont}
{\thesubsubsection}
{6pt}
{#1}
[]
\titleformat{\paragraph}[block]{\NormalBaseline\filright\fontsize{10.5}{10}\selectfont}
{\theparagraph}
{6pt}
{#1}
[]
\titleformat{\subparagraph}[block]{\NormalBaseline\filright\fontsize{10.5}{12}\selectfont}
{\thesubparagraph}
{6pt}
{#1}
[]

\titlespacing{\section}{0pt}{.5\baselineskip}{.5\baselineskip}  
\titlespacing{\subsection}{0pt}{.5\baselineskip}{.5\baselineskip}  
\titlespacing{\subsubsection}{0pt}{.5\baselineskip}{.5\baselineskip}  
\titlespacing{\paragraph}{0pt}{.5\baselineskip}{.5\baselineskip}  
\titlespacing{\subparagraph}{0pt}{.5\baselineskip}{.5\baselineskip}

\captionsetup[figure]{skip=1.4pt,font=bf,labelsep=colon,justification=raggedright,singlelinecheck=false}
\captionsetup[table]{skip=1.4pt,font=bf,labelsep=colon,justification=raggedright,singlelinecheck=false}

\def\bibyear#1{#1}
%\def\bibjtitle#1{#1}   %%Publisher request
\def\bibauand{}
\setlength\bibsep{3pt}
\setlength\bibhang{8pt}

\makeatother
\date{}


\usepackage{float}

\begin{document}


\def\RunningAuthor{Bhuvaneshwari G et al.}
\firstPage{2711}
\articleType{Original Article}
\receivedDate{10.03.2019}
\acceptedDate{19.06.2019}
\revisedDate{15.06.2019}
\journalVolume{10}
\journalIssue{4}
\journalDoi{ijrps.v10i4.1534}
\copyrightYear{2019}
\def\authorCount{5}
\def\affCount{1}

\def\journalTitle{International Journal of Research in Pharmaceutical Sciences}

\title{A study to assess the quality of life among the women with osteoarthritis\textbf{\space }}
\author{Bhuvaneshwari~G\textsuperscript{*},  
            Thephilah~Cathrine~R,  
            Rinson~Kunjachan,  
            Soundarya, 
            Yamuna~\\[5pt]{Department of Community Health Nursing\unskip, Saveetha College of Nursing, SIMATS, Chennai, Tamil Nadu, India}}

\begin{abstract}
Osteoarthritis (OA) is the most habitual type of arthritis in both developing and developed countries. It is a long-term, dynamic musculoskeletal disorder characterized by abrupt loss of cartilage in joints which results in bones rubbing together and make stiffness, impaired movement and pain. Osteoarthritis primarily affects the elderly population. It's a significant cause of disability in elderly peoples worldwide. So the present study is done to assess the quality of life among the women with osteoarthritis, residing at Thirumazhisai. A descriptive research design was done in an urban area of Thirumazhisai. 100 women with osteoarthritis are included in our study. Purposive sampling techniques method was used in selecting the samples. Modified Knee Injury and Osteoarthritis Outcome Score(KOOS)checklist were used to collect data on quality of life among the women with osteoarthritis. The woman aged above 40 years has the percentage of mild pain (26\%), moderate pain (72\%), and severe pain (2\%). In conclusion, women aged above 40 years were found to be experiencing moderate osteoarthritis pain and quality of life of women aged above 40 years experiencing a reasonable quality of life.
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}quality of life,\newline women,\newline osteoarthritis
\end{keywords}
\twocolumn[ \maketitle {\printKwdAbsBox}]
\makeatletter{\raggedright\textsuperscript{*}Corresponding Author\par Name:\ Bhuvaneshwari~G~\\ Phone:\ 9043872624~\\  Email:\ bhuvana.prabha1981@gmail.com
        \par}\vspace*{-11pt}\hrulefill\par{\fontsize{12}{14}\selectfont ISSN: 0975-7538}\par% 
        \textsc{DOI:}\ \href{https://doi.org/10.26452/\@journalDoi}{\textcolor{blue}{\underline{\smash{https://doi.org/10.26452/\@journalDoi}}}}\par%
        \vspace*{-11pt}\hrulefill\\{\fontsize{9.12}{10.12}\selectfont Production and Hosted by}\par{IJRPS |~\href{https://ijrps.com}{https://ijrps.com}}\par%
        \vspace*{-2pt}{\fontsize{9.12}{10.12}\selectfont\textcopyright\ \@copyrightYear\ $|$ All rights reserved.}\par%
        \vspace*{-11pt}\rule{\linewidth}{1.2pt}
        \makeatother
        
    
\section{Introduction}
Osteoarthritis (OA) is the most habitual type of arthritis in both developing and developed countries. It is a long-term, dynamic musculoskeletal disorder characterized by abrupt loss of cartilage in joints which result in bones rubbing together and make stiffness, impaired movement and pain. The disease most usually affects the joints in the hands, hips, knees, spine and feet. The disease is associated with non-modifiable and modifiable risk factors such as lack of exercise, genetic predisposition, obesity, bone density, trauma, occupational injury and gender \unskip~\citep{555922:12752112}.

Osteoarthritis primarily affects the elderly population. It's a significant cause of disability in elderly adults worldwide. According to the World Health Organization (WHO), 18.0\% of women and 9.6\% of men aged over 60 years have symptomatic osteoarthritis worldwide. 80\% of those with osteoarthritis have restrictions in movement, and 25\% cannot perform their major daily activities of life \unskip~\citep{555922:12752113}.

Osteoarthritis can be classified into two groups primary and secondary. Primary osteoarthritis is a long-term degenerative disease and related to aging. The water content of the cartilages lessens on increasing age, thus making them more susceptible to degradation. While secondary arthritis usually affects the joints prior in life due to specific causes such as an injury during a job requiring frequent squatting or kneeling for a long duration, diabetes and obesity\unskip~\citep{555922:12752114}.

Osteoarthritis is the second most habitual rheumatologic problem, and it is the most prevalent joint disease with a prevalence of 22\% to 39\% in India. OA is more frequent in women than in men. Nearly, 45\% of women over the age of 65 years have symptoms while 70\% of those extending 65 years show radiological evidence of OA \unskip~\citep{555922:12752115}.

The prevalence of OA is rising due to population ageing and an increase in related factors such as sedentary lifestyle, obesity. The physical disability arising from loss of functional capacity and pain reduces the quality of life and increases the risk of further morbidity. As highly effective medicinal management is not available, emphasis should be given to the preventive aspect of lifestyle measures in the form of a healthy diet and exercise \unskip~\citep{555922:12752115}.

Osteoarthritis is a long-term degenerative disorder of multifactorial etiology characterized by the depletion of articular cartilage hypertrophy at the bone of the margins, subchondral sclerosis, and range of biochemical \& morphological alterations at the joint capsule \& synovial membrane. Persistent changes in the late stage of OA include ulceration, softening, and focal disintegration at the articular cartilage \unskip~\citep{555922:12752116}.

Osteoarthritis is a slowly continuing inflammatory disorder of the diarthroidal joints. Prevalence of the knee osteoarthritis is reported to increase in females during premenopausal age and remains high throughout menopause \unskip~\citep{555922:12752120}. The reason for this is revealed in many studies that loss of estrogen at the time of menopause multiplicate women's risk of getting osteoarthrirtiswa \unskip~\citep{555922:12752116}. 
    
\section{Materials and Methods}
A sample of 100 women aged above 40 years. Samples are selected purposive sampling techniques. The descriptive study was conducted during a one-week period. Data collection was conducted in Thirumizhisai, after getting permission from the head of the Thirumizhisai.


\bgroup
\fixFloatSize{images/66d42894-2b31-4c42-83fc-7b577983be3c-upicture1.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/66d42894-2b31-4c42-83fc-7b577983be3c-upicture1.png}{\includegraphics{images/66d42894-2b31-4c42-83fc-7b577983be3c-upicture1.png}}{}
\makeatother 
\caption{\boldmath {Shows the demographic variables among quality of life among the women with osteoarthritis}}
\label{f-c838c6775c9d}
\end{figure}
\egroup

\begin{table*}[!htbp]
\caption{\boldmath {Frequency and distribution of the variable demographic quality of life among the women with osteoarthritis} }
\label{tw-66e84c3d66fb}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.1478\linewidth-2\tabcolsep}p{\dimexpr.3297\linewidth-2\tabcolsep}p{\dimexpr.2188\linewidth-2\tabcolsep}p{\dimexpr.30370000000000005\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}S.No & Demographic Variables & Frequency & Percentage\\
\tblmidrule 
\multicolumn{2}{p{\dimexpr(.4775\linewidth-2\tabcolsep)}}{1. Age in years} &
   &
  \\
 &
   &
   &
  \\
 &
  a)40-49 \mbox{}\protect\newline  b)50-59 \mbox{}\protect\newline  c)60-69 \mbox{}\protect\newline  d)70-79 &
  27 \mbox{}\protect\newline 38 \mbox{}\protect\newline 28 \mbox{}\protect\newline 7 &
  27\% \mbox{}\protect\newline 38\% \mbox{}\protect\newline 28\% \mbox{}\protect\newline 7\%\\
\multicolumn{2}{p{\dimexpr(.4775\linewidth-2\tabcolsep)}}{2. Religion} &
   &
  \\
 &
   &
   &
  \\
 &
  a)Hindu \mbox{}\protect\newline b)Christian \mbox{}\protect\newline  c) Muslim &
  69 \mbox{}\protect\newline 20 \mbox{}\protect\newline 11 &
  69\% \mbox{}\protect\newline 20\% \mbox{}\protect\newline 11\%\\
 &
   &
   &
  \\
\multicolumn{2}{p{\dimexpr(.4775\linewidth-2\tabcolsep)}}{3. Type of Family} &
   &
  \\
 &
   &
   &
  \\
 &
  a)Nuclear \mbox{}\protect\newline  b)Joint &
  55 \mbox{}\protect\newline 45 &
  55\% \mbox{}\protect\newline 45\%\\
 &
   &
   &
  \\
\multicolumn{2}{p{\dimexpr(.4775\linewidth-2\tabcolsep)}}{4. Educational Qualification} &
   &
  \\
 &
   &
   &
  \\
 &
  a)primary school \mbox{}\protect\newline b)higher school \mbox{}\protect\newline  c)degree \mbox{}\protect\newline  d)none  &
  33 \mbox{}\protect\newline 12 \mbox{}\protect\newline 2 \mbox{}\protect\newline 53 &
  33\% \mbox{}\protect\newline 12\% \mbox{}\protect\newline 2\% \mbox{}\protect\newline 53\%\\
\multicolumn{2}{p{\dimexpr(.4775\linewidth-2\tabcolsep)}}{5. Occupation} &
   &
  \\
 &
   &
   &
  \\
 &
  a)housewife \mbox{}\protect\newline b)employees \mbox{}\protect\newline  c) self-employed \mbox{}\protect\newline  d)cooli &
  45 \mbox{}\protect\newline 14 \mbox{}\protect\newline 15 \mbox{}\protect\newline 26 &
  45\% \mbox{}\protect\newline 14\% \mbox{}\protect\newline 15\% \mbox{}\protect\newline 26\%\\
 &
   &
   &
  \\
\multicolumn{2}{p{\dimexpr(.4775\linewidth-2\tabcolsep)}}{6. Socio-Economic Status} &
   &
  \\
 &
   &
   &
  \\
 &
  a)upper class \mbox{}\protect\newline b)middle class \mbox{}\protect\newline  c)lower class &
  13 \mbox{}\protect\newline 64 \mbox{}\protect\newline 23 &
  13\% \mbox{}\protect\newline 64\% \mbox{}\protect\newline 23\%\\
\multicolumn{2}{p{\dimexpr(.4775\linewidth-2\tabcolsep)}}{7. Marital Status} &
   &
  \\
 &
   &
   &
  \\
 &
   a) married \mbox{}\protect\newline  b) unmarried &
  82 \mbox{}\protect\newline 20 &
  82\% \mbox{}\protect\newline 20\%\\
 &
   &
   &
  \\
\multicolumn{2}{p{\dimexpr(.4775\linewidth-2\tabcolsep)}}{8. Health Problems} &
   &
  \\
 &
   &
   &
  \\
 &
  a) diabetes milletus \mbox{}\protect\newline  b) renal diseases \mbox{}\protect\newline  c) cardiac diseases \mbox{}\protect\newline  d) none &
  31 \mbox{}\protect\newline 2 \mbox{}\protect\newline 6 \mbox{}\protect\newline 61 &
  31\% \mbox{}\protect\newline 2\% \mbox{}\protect\newline 6\% \mbox{}\protect\newline 61\%\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Frequency and percentage distribution of the quality of life among the women with osteoarthritis} }
\label{tw-101a80b42cf6}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.31100000000000005\linewidth-2\tabcolsep}p{\dimexpr.3576\linewidth-2\tabcolsep}p{\dimexpr.3314\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor} & Frequency & Percentage\\
\tblmidrule 
Mild &
  26 &
  26\%\\
Moderate &
  72  &
  72\%\\
 Severe &
  2 &
  2\%\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Graphical presentation of the mean score and standard deviation score of women aged above 40 years for mild, moderate and severe} }
\label{tw-73b44ca99392}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.2781\linewidth-2\tabcolsep}p{\dimexpr.3386\linewidth-2\tabcolsep}p{\dimexpr.3833\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor} & Mean Deviation & Standard Deviation\\
\tblmidrule 
Mild &
  7.42 &
  12.98\\
Moderate &
  35.31 &
  18.05\\
Severe &
  1.42 &
  10.00\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}
\textbf{Tool for data collection}

 Modified Knee Injury and Osteoarthritis Outcome Score(KOOS)checklist were used to collect data on quality of life among the women with osteoarthritis. A demographic variable consists of age, religion, type of family, education, occupation, socio-economic status, marital status, Any other health information. The study investigators explained to the women's about the study's objectives, and requirement of consent to participate in the study. The investigators then provided instructions for filling the questionnaire, and then guided the women \unskip~\citep{555922:12752120}. Understanding of each question was checked by asking the women to repeat the meaning. During the filling of questionnaires, the investigators helped the women throughout and helped to simplify the purpose of each question, clarifying doubts and checking for completeness of filling up the questionnaire. Chi-square test was used to test the association between categorical variables. P \textless\ 0.05 was taken as statistically significant.

\textbf{Tool reliability}

The test-retest reliability measured using a two-way random-effects model of interclass correlation coefficient with 95\% confidence interval (95\% CI). An ICC equal or more than 0.70 is considered acceptable for test-retest reliability

\textbf{Ethical consideration}

The ethics committee has approved the project of the institution. Informed consent was obtained from participants before initiating the study.
    
\section{Results and Discussion}
Out of 100 samples 27(27\%) samples were come under type age group of 40-49 years ,38(38\%) were under the age group of 50-59 years ,28(28\%)samples were under the age group of 60-69years.7(7\%)samples were under the age group of 70-79years Figure~\ref{f-c838c6775c9d}. Regarding occupation out of 100 samples 45(45\%) samples were housewives, 14(14\%) samples were employees, 15(15\%) samples were self-employees, 26(26\%)samples were daily wagers. Regarding Socioeconomic status out of 100 samples, 13(13\%)samples were upper class, 64(64\%) were middle class, 23(23\%)samples were lower level. Regarding marital status, out of 100 samples, 82(82\%) samples were married, 20(20\%) samples were unmarried. Regarding health information out of 100 samples, 31(31\%) samples have diabetes mellitus, 2(2\%) samples have renal disease, 6(6\%) samples have cardiac disease, 61(61\%)samples have no health problems Table~\ref{tw-66e84c3d66fb}.

There was an association between a demographic variable with knee joint osteoarthritis among the women aged above 40 years. There was statistically significant found in any other health problems on clients to assess the quality of life among the women with osteoarthritis. Quality of being among the women with osteoarthritis aged above 40 years has the percentage of mild (26\%), moderate (72\%), and severe (2)Table~\ref{tw-101a80b42cf6}.

Table~\ref{tw-73b44ca99392} shows the mean score for women aged above 40years for mild (7.42), moderate (35.31) and severe (1.42) and standard deviation score for mild (12.98), moderate (18.05) and severe (10.00).

The present study assesses the relationship between the quality of life among women with osteoarthritis aged above 40 years. The result indicates that approximately women aged above 40 years have a percentage of mild (26\%), moderate (72\%), and severe (2)\textbf{. }Which is similar to findings reported by study conducted by \unskip~\citep{555922:12752117} from Delhi which showed that out of 123 women with osteoarthritis only 53 (43\%) were currently on treatment, out of which 40 (78.4\%)are receiving treatment from government facility whereas remaining participants were seeking treatment from private practitioners, chemist and traditional healers. More than half of women (57\%) who were suffering from osteoarthritis did not seek any treatment \unskip~\citep{555922:12752117}.

In another study conducted by \unskip~\citep{555922:12752118}. We also found there was a significant association between prevalence of knee osteoarthritis and BMI of study participants (p-0.04) and also there was a significant association between osteoarthritis and activities of daily living (Chi-38.7, df- 1, p{\textless}0.001) \unskip~\citep{555922:12752118}.

\unskip~\citep{555922:12752119}  conducted a similar study. The prevalence of OA is accessible for the USA and European populations, but there are scare studies done in other regions. In 1990, it was the 10\ensuremath{^{th}} leading cause of nonfatal diseases contributed 2.8\% years of disability. The estimated prevalence of symptomatic OA is 18\% in females and 9.6\% in men. In the global burden of diseases, in 2000, it was the 4\ensuremath{^{th}} leading cause of years lived with disability (YLD) leads to 3\% YLD \unskip~\citep{555922:12752119}.
    
\section{Conclusion}
The study urban had a higher prevalence (21.5\%) of knee osteoarthritis as compared to rural women (17.5\%); the difference was not significant. Our findings support the previous studies done in UT. A significant difference between the prevalence of KOA in rural (32.6\%) and urban (60.3\%) areas. The low prevalence among rural area could be due to more physical work, higher tolerance, less obesity, diet and lifestyle. Knee OA was significantly more common in the country compared to urban and suburban populations in Athens, Greece

\textbf{ACKNOWLEDGEMENT}

The authors are thankful to Prof. Dr.S.Kalabarathi, principal of Saveetha College of Nursing, SIMATS. The authors also wish cordial thanks to Dr.G.Bhuvaneshwari,asso. Professor, Dr Tamilselvi assistant professor of saveetha college of nursing, SIMATS, for their encouragement, valuable suggestions, support and advice given throughout the study.
    

\bibliographystyle{pharmascope_apa-custom}

\bibliography{\jobname}
\end{document}
