A Comparative Study to Assess the Effectiveness of Jacobson’s Progressive Muscle Relaxation Therapy Versus Deep Breathing Exercise on the Level of Pain and Stress among Cancer patients receiving Chemotherapy admitted in SMVMCH, Puducherry
G. Sathyavathy
Associate Professor, Department of Medical Surgical Nursing, SMVNC, Puducherry – 605107.
*Corresponding Author E-mail: gsathyavathybablu@gmail.com
ABSTRACT:
According to the most recent data from the National Cancer Registry, one in eight men and one in nine women will develop some kind of cancer in India. Age, gender, ethnicity, local environmental circumstances, cuisine, and genes are only a few of the numerous factors that influence cancer types. Jacobson’s gradual muscle relaxation therapy and deep breathing techniques are successful, cancer patients undergoing chemotherapy report less stress and pain overall. The aim of the study is to evaluate the effectiveness of Jacobson’s Progressive Muscle Relaxation Therapy Versus Deep Breathing Exercise on the Level of Pain and Stress among Cancer Patients Receiving Chemotherapy. A concurrent true experimental group design was used for the investigation. 280 people were included in the sample, which was chosen using a purposive sampling method. It reveals that the Comparison of pain scores among cancer patients receiving chemotherapy between the groups before intervention shows that in Group I, In Group II, the mean pain score was 5.63±2.41, whereas the mean pain score overall was 5.53±2.49. According to the review, the mean post-test rating of 6.4% was lower than the pre-test score of 37.9 % and this score is mostly in decreasing the degree of torment in Jacobson’s dynamic muscle unwinding strategy. Hence, the Jacobson’s Progressive Muscle Relaxation Therapy is much effective in reducing the degree of level of pain and stress among cancer patients receiving chemotherapy.
KEYWORDS: Chemotherapy, Jacobson’s progressive muscle relaxation, Deep Breathing Exercise.
INTRODUCTION:
—Isaiah 41:10
WHO is the World Health Organization (WHO) defining health as an all-encompassing concept that includes not only the absence of disease or disability, but also the state of a person's Mental, social, and physical well-being. Each year 12,00,000 new instances of cancer are discovered in India. According to the most recent data from the National Cancer Registry, one in eight men and one in nine women will develop some kind of cancer in India. Age, gender, ethnicity, local environmental circumstances, cuisine, and genes are only a few of the numerous factors that influence cancer types. The most well-known malignant growths in men are in the lungs, which are then found in the mouth, throat, and bosom. In women, the most frequently analyzed conditions in India are cervical and bosom disorders.
According to research on Jacobson's gradual muscle relaxation therapy and deep breathing techniques are successful, cancer patients undergoing chemotherapy report less stress and pain overall. Jacobson's gradual relaxation of muscles technique has been shown to aid in the reduction of stress, vomiting, nausea, nervousness, and melancholy. In a trial of breast cancer patients, Jacobson's progressive relaxation of muscles technique was shown to relieve stress, nausea, vomiting, anxiety, and melancholy.
Mrs. Saraswathy. S (2021) the observe to decide whether not Jacobson's revolutionary muscle rest reduces aches in chemotherapy-dealt with most cancer sufferers. In the oncology ward of Government Rajaji Hospital in Madurai, 60 sufferers, 30 in every institution (the managed institution and 30 withinside the experimental institution), participated withinside the quasi-experimental pre-take a look at-manage institution studies design. The non-opportunity purposive sampling technique turned into used to choose the samples, and they had been assigned at random to the managed institution and the experimental institution. Demographic data, scientific variables, and a numerical ache score scale had been used to accumulate the data. The self-management technique turned into used to degree the extent of the ache. Post-take look at consequences confirmed that the experimental institution's suggest degree of ache turned into a decrease (M-2.07, S.D. 0.69), in comparison to the manage institution's (M-3,06, S.D.1) P< 0.001). It confirmed that Jacobson's revolutionary muscle rest exercising decreased chemotherapy sufferers' aches effectively.
Yongkai Lu et.al (2022) A research comparing free and deep breathing during chemotherapy for left-sided breast cancer was undertaken. The Review Manager software version 5.4 is used in this study to display standardized mean difference values and 95% confidence intervals for his. A total of 3599 patients with left-sided breast cancer were included in the meta-analysis, which comprised 41 trials. When compared to free breathing, DIBH significantly reduced cardiac capacity, left anterior descending artery (LAD) dosage (D mean, D max), ipsilateral lung dose (D mean, V20, V10, V5), and cardiac dose. Lung volume increased dramatically and made a significant effect. This increases the volume of the ipsilateral lung. Because DIBH is more successful in chemotherapy than free breathing, this study shows that DIBH may be utilized more broadly in clinical practice.
Nabeel Rashid Hasan et al (2023) Oral cancer research was carried out. This was a cross-sectional analytical investigation with a sample size of 41 cases. The study aims to know the interactions between mast cells and tumor cells in the tumor. The study is to determine the prognostic utility of mast cells and their mediators in oral squamous cell carcinoma. Mast cell assessment was done using Toluidine blue stain on tissue sections while histopathological prognostic factors were evaluated with routine stains. A result of mast cell counts in OSCC cases as a prognostic indicator in conjunction with other clinicopathological factors. Recognise that further research is needed to determine the involvement of mast cell mediators in the prognosis of oral cancer patients.
STATEMENT OF THE PROBLEM:
“A Comparative Study to Assess the Effectiveness of Jacobson’s Progressive Muscle Relaxation Therapy Versus Deep Breathing Exercise on the Level of Pain and Stress Among Cancer Patients Receiving Chemotherapy Admitted in SMVMCH, Puducherry”.
OBJECTIVES:
1. To assess the level of pain by using an analog pain scale among cancer patients receiving chemotherapy in both groups before giving the intervention.
2. To assess the level of stress by using a modified perceived stress scale among cancer patients receiving chemotherapy in both groups before giving intervention.
3. To evaluate the effectiveness of Jacobson’s progressive muscle relaxation therapy on the level of pain and stress among cancer patients receiving chemotherapy in group 1.
4. To evaluate the effectiveness of deep breathing exercises on the pain and stress levels among cancer patients receiving chemotherapy in group 2.
5. To compare the effectiveness of Jacobson’s progressive muscle relaxation therapy versus deep breathing exercises in both groups.
6. To find out the association between the level of pain among cancer patients receiving chemotherapy with their selected demography variables in both groups
7. To find out the association between the level of stress among cancer patients receiving chemotherapy with their selected demography variables in both groups.
8. To correlate the level of pain and stress among cancer patients receiving chemotherapy before and after intervention in both groups.
STUDY HYPOTHESIS:
1. To assess the level of pain by using an analog pain scale among cancer patients receiving chemotherapy in both groups before giving the intervention.
2. To assess the level of stress by using a modified perceived stress scale among cancer patients receiving chemotherapy in both groups before giving intervention.
3. To evaluate the effectiveness of Jacobson’s progressive muscle relaxation therapy on the level of pain and stress among cancer patients receiving chemotherapy in group 1
4. To evaluate the effectiveness of deep breathing exercises on the pain and stress levels among cancer patients receiving chemotherapy in group 2.
5. To compare the effectiveness of Jacobson’s progressive muscle relaxation therapy versus deep breathing exercises in both groups.
6. To find out the association between the level of pain among cancer patients receiving chemotherapy with their selected demography variables in both groups
7. To find out the association between the level of stress among cancer patients receiving chemotherapy with their selected demography variables in both groups.
8. To correlate the level of pain and stress among cancer patients receiving chemotherapy before and after intervention in both groups.
MATERIALS AND METHOD:
A comparative study to assess the effectiveness of progressive muscle relaxation technique versus deep breathing exercises on level of pain and stress among cancer patients. A concurrent true experimental group design was used for the investigation. 280 people were included in the sample, which was chosen using a purposive sampling method
Sections of data gathering tool are as follows:
Section A: Structured socio-demographic questionnaire aimed at gathering basic information on cancer patients.
Section B: The researcher was constructed a visual analogue pain scale and modified perceived stress scale in cancer patients, which was cover pain and stress.
Section C: Intervention tool:
A. Jacobson's Progressive Muscle Relaxation Therapy involves deliberately contracting their muscles to build tension, which is then progressively released. The practice is repeated until the participants are completely relaxed. This strategy employs top-down and bottom-up neural processing principles to alleviate pain and stress.
B. Deep breathing exercise might be especially useful for persons who suffer from chronic discomfort. When pain flares up, people typically hold their breath or take short, shallow breaths to relieve tension and agony. Both therapies required cancer patients to for five days, practice for twenty minutes twice every day. To explain activities, AV aids such as films and booklets were employed.
Setting of the study:
The study was conducted in Sri Manakula Vinayagar Medical College and Hospital, Puducherry. The hospital is a super speciality hospital where 280 chemotherapy-treated cancer patients were chosen to assess the efficacy of Jacobson's progressive muscle relaxation treatment and deep breathing exercises.
Inclusion criteria:
· Male and female with III and IV stages of cancer and all types of cancer patients
· Patients who are eager to participate;
· Patients who are in pain and under stress receiving chemotherapy.
· Patients who are bilingual in Tamil and English.
Exclusion criteria:
· Critically sick patients who are simultaneously undertaking alternative therapy such as yoga, meditation, and so on.
· Cancer patients in the first and second phases
· Patients with back problems, recent surgery, serious injuries, muscle spasms, or hypertension.
· Patients with mental illnesses and sensory-perceptual impairments, as well as those who refuse to engage in the study.
RESULTS:
The inquiries are intended to propose parts of a review that frequently are meriting thought; they are not intended to lay snares for distinguishing excluded and maybe superfluous subtleties. One last note is that there is expanding revenue in involving quantitative techniques to rate or score methodologic quality in individual examinations, for the reasons for doing integrative audits and meta-examinations.
The study's primary result is that many people who smoke, use smokeless tobacco, drink alcohol, use gutkha, paan, paan masala, khaini, or supari unknowingly have cancer. Cancer can be avoided if caught early enough. By detecting and correcting was, cancer pain and stress can be decreased.
It reveals that the Comparison of pain scores among cancer patients receiving chemotherapy between the groups before intervention shows that in Group I, In Group II, the mean pain score was 5.63±2.41, whereas the mean pain score overall was 5.53±2.49. The estimated student independent 't-test result was not statistically significant at the 0.05 level, which implies without a doubt that there was no discernible difference in the patient's pain scores between the groups prior to the intervention. Jacobson's gradual muscle relaxation and deep breathing techniques may help chemotherapy patients relieve pain and tension.
Table 01: Pain frequency and percentage distribution in Group I cancer patients following chemotherapy (Jacobson’s Progressive Muscle Relaxation Technique). n=14
Level of Pain |
Pre test |
Post Test |
||
Frequency |
% |
Frequency |
% |
|
None (0) |
0 |
0 |
4 |
25.0 |
Mild (1 – 3) |
2 |
12.50 |
6 |
43.75 |
Moderate (4 – 6) |
7 |
50.0 |
4 |
31.25 |
Severe (7 – 10) |
5 |
37.50 |
0 |
0 |
Table 02: Frequency and Stress level distribution as a percentage among cancer patients receiving chemotherapy in Group I (Jacobson’s Progressive Muscle Relaxation Technique). n=14
Level of Stress |
Pretest |
Post Test |
||
Frequency |
% |
Frequency |
% |
|
Low stress (0 – 13) |
2 |
12.50 |
10 |
75.0 |
Moderate stress (14 – 26) |
3 |
18.75 |
4 |
25.0 |
Severe stress (27 – 40) |
5 |
37.50 |
0 |
0 |
Extremely severe (41 – 56) |
4 |
31.25 |
0 |
0 |
Table 03: Pain level frequency as well as percentage dispersion among cancer patients receiving chemotherapy in Group 1 (Jacobson’s Progressive Muscle Relaxation Technique) and Group 2 (Deep Breathing Exercise) before giving intervention.
n=280(140+140)
Level of Pain |
Group I (JPMRT) |
Group 2 (DBE) |
Chi-Square Test |
||
Frequency |
% |
Frequency |
% |
||
None (0) |
- |
- |
- |
- |
χ2=0.166 P=0.921 N.S |
Mild (1 – 3) |
31 |
22.1 |
31 |
22.1 |
|
Moderate (4 – 6) |
56 |
40.0 |
59 |
42.2 |
|
Severe (7 – 10) |
53 |
37.9 |
50 |
35.7 |
N.S – Not Significant, p>0.05
Table 04: Frequency and Stress level distribution as a percentage among cancer patients receiving chemotherapy in Group 1 (Jacobson’s Progressive Muscle Relaxation Technique) and Group 2 (Deep Breathing Exercise) before giving intervention.
280(140+140)
Level of Stress |
Group 1 (JPMRT) |
Group 2 (DBE) |
Chi-Square Test |
||
Frequency |
% |
Frequency |
% |
||
Low stress (0 – 13) |
16 |
11.4 |
18 |
12.9 |
χ2= 0.1.484 P=0.686 N.S |
Moderate stress (14 – 26) |
30 |
21.5 |
36 |
25.7 |
|
Severe stress (27 – 40) |
51 |
36.4 |
51 |
36.4 |
|
Extremely severe (41–56) |
43 |
30.7 |
35 |
25.0 |
N.S – Not Significant, p>0.05
Table 05: The frequency and percentage distribution of stress levels among Group 1 cancer patients undergoing chemotherapy (Jacobson’s Progressive Muscle Relaxation Technique) before and after intervention. n=140
Level of Stress |
Before |
After |
Chi-Square |
||
Frequency |
% |
Frequency |
% |
||
Low stress (0–13) |
16 |
11.4 |
78 |
55.7 |
χ2=77.744 P=0.0001 S*** |
Moderate stress (14– 26) |
30 |
21.4 |
31 |
22.1 |
|
Severe stress (27–40) |
51 |
36.4 |
25 |
17.9 |
|
Extremely severe (41–56) |
43 |
30.8 |
6 |
4.3 |
***p<0001, S – Significant
Table 06: Effectiveness of Jacobson’s Progressive Muscle Relaxation Technique on the level of stress among cancer patients receiving chemotherapy in Group 1. n = 140
Stress |
Mean |
S.D |
Mean Difference and % |
Paired ‘t’ test and p-value |
Before |
30.97 |
12.72 |
14.80 (26.4%) |
t=10.369 p=0.0001, S*** |
After |
16.17 |
12.44 |
***p<0.001, S – Significant
Table 07: Pain level frequency as well as percentage dispersion among cancer patients receiving chemotherapy in Group 1 (Jacobson’s Progressive Muscle Relaxation Technique) and Group 2 (Deep Breathing Exercise) after giving intervention.
280 (140+140)
Level of Pain |
Group I (JPMRT) |
Group 2(DBE) |
Chi-Square Test |
||
Frequency |
Percentage |
Frequency |
Percentage |
||
None (0) |
16 |
11.4 |
10 |
7.1 |
χ2=23.942 P=0.0001 S*** |
Mild (1 – 3) |
63 |
45.0 |
41 |
29.3 |
|
Moderate (4 – 6) |
53 |
37.2 |
51 |
36.4 |
|
Severe (7 – 10) |
9 |
6.4 |
38 |
27.1 |
***p<0.001, S – Significant
Table 08: Association of mean reduction score of pain among cancer patients receiving chemotherapy in Group 1 (Jacobson’s Progressive Muscle Relaxation Technique) with selected demographic variables. n=40
Demographic Variables |
F |
Pretest |
Post Test |
Mean Reduction Score |
Oneway ANOVA/ ‘t’ value |
|||
Mean |
S.D |
Mean |
S.D |
Mean |
S.D |
|||
Family type |
|
|
|
|
|
|
|
F=3.104 p=0.029 S* |
Nuclear family |
71 |
5.19 |
2.51 |
3.52 |
2.23 |
2.60 |
2.65 |
|
Joint family |
26 |
6.53 |
2.17 |
3.11 |
2.28 |
4.07 |
2.09 |
|
Extended family |
40 |
5.90 |
2.18 |
2.72 |
1.63 |
3.35 |
2.38 |
|
Others |
3 |
4.33 |
3.21 |
3.00 |
1.73 |
1.00 |
3.00 |
|
Occupational status |
F=1.266 p=0.282 N.S |
|||||||
Professional |
10 |
6.20 |
2.44 |
2.80 |
1.61 |
4.20 |
3.15 |
|
Semi professional |
24 |
5.50 |
2.37 |
3.29 |
2.38 |
3.16 |
2.68 |
|
Clerical/Shop/ Farmer |
23 |
4.60 |
2.34 |
3.39 |
1.80 |
2.08 |
2.27 |
|
Skilled worker |
18 |
6.38 |
2.35 |
3.05 |
1.66 |
3.61 |
2.42 |
|
Semi-skilled worker |
39 |
5.79 |
2.59 |
3.23 |
2.01 |
3.02 |
2.69 |
|
Unskilled worker |
26 |
5.65 |
2.13 |
3.19 |
2.65 |
3.03 |
2.12 |
|
Occupational/ Professional/ Resident |
F=5.455 p=0.001 S*** |
|||||||
Noisy |
12 |
6.00 |
2.69 |
3.50 |
2.11 |
5.00 |
2.69 |
|
High radiation exposure |
56 |
5.53 |
2.34 |
3.33 |
2.16 |
3.53 |
2.34 |
|
Peaceful and harmonious |
52 |
5.50 |
2.42 |
2.88 |
2.16 |
2.50 |
2.42 |
|
Stressful / Irritate |
20 |
6.00 |
2.53 |
3.50 |
1.63 |
2.00 |
2.53 |
***p<0.001, *p<0.05, S – Significant, N.S – Not Significant
Table 09: Association of mean reduction score of stress among cancer patients receiving chemotherapy in Group 1 (Jacobson’s Progressive Muscle Relaxation Technique) with selected demographic variables n = 140
Demographic Variables |
F |
Pretest |
Post Test |
Mean Reduction Score |
Oneway ANOVA / ‘t’ value |
|||
Mean |
S.D |
Mean |
S.D |
Mean |
S.D |
|||
Age in years |
|
|
|
|
|
|
|
F=2.487 p=0.046 S* |
18 – 30 |
38 |
29.02 |
12.82 |
16.97 |
13.75 |
12.05 |
16.73 |
|
31 – 40 |
23 |
28.26 |
11.87 |
20.91 |
15.31 |
7.34 |
20.38 |
|
41 – 50 |
60 |
32.78 |
12.75 |
13.93 |
10.52 |
18.85 |
15.34 |
|
51 – 60 |
18 |
31.94 |
13.47 |
16.00 |
10.70 |
15.94 |
14.39 |
|
Above 60 years |
1 |
41.00 |
|
14.00 |
|
27.00 |
|
|
History of substance abuse |
|
|
|
|
|
|
|
F=3.147 p=0.016 S* |
Tobacco use |
9 |
34.77 |
9.05 |
12.88 |
10.99 |
21.88 |
9.40 |
|
Alcohol consumption |
28 |
30.78 |
13.32 |
11.67 |
9.37 |
19.10 |
15.34 |
|
Both of above |
52 |
28.28 |
12.36 |
19.00 |
14.88 |
9.28 |
18.24 |
|
Smoking |
38 |
34.44 |
13.24 |
15.57 |
9.66 |
18.86 |
15.41 |
|
None |
13 |
29.30 |
12.09 |
18.53 |
13.67 |
10.76 |
16.87 |
*p<0.05, S – Significant, N.S – Not Significant
CONCLUSION AND RECOMMENDATIONS:
A comparative study was carried out to compare the effectiveness of Jacobson's Progressive muscle relaxation treatment vs deep breathing exercises on the degree of pain and stress in cancer patients receiving chemotherapy. In the current review, 280 malignant growth patients getting chemotherapy were chosen to utilize the nonprobability testing strategy purposive examining technique. According to the review, the mean post-test rating of 6.4% was lower than the pre-test score of 37.9% and this score is mostly in decreasing the degree of torment in Jacobson's dynamic muscle unwinding strategy.
NURSING IMPLICATION:
The discoveries of the review have a few ramifications for Nursing Practice, Nursing Administration, Nursing Management, Nursing Education and Nursing Research.
NURSING PRACTICE:
· Malignant growth is a repulsive sickness and physiological responses and secondary effects occurring after the organization of chemotherapy add to the organized patient's misery. Moderate muscle unwinding is compelling in controlling many secondary effects like pressure and agony decrease. This can be considered by a medical caretakers and nursing understudies to decrease the symptoms of chemotherapy like agony and stress.
· Medical caretakers can oversee chemotherapy-related torment and stress in a practical and less tedious manner.
NURSING EDUCATION:
· Oncology nursing Clientss should comprehend the outcomes of chemotherapy as well as the relevance of optional therapies like moderate muscle relaxation and profound breathing practices in reducing the malignant growth discomfort and tension related to chemotherapy.
· Adding mild muscular unwinding procedures in reciprocal restorative modalities to the nursing curriculum is critical.
· The outcome of the review may be an informative representation to the understudies by their nursing instructors.
NURSING ADMINISTRATION:
For staff medical attendants, Client’s attendants, and other allied specialists, managerial nursing may also provide training in Deep Breathing Exercise and Moderate Muscle Relaxation. The accompanying designers should have a special interest in deep breathing exercises and mild muscle relaxation techniques for usage in clinical settings, community settings, and at-home healthcare.
NURSING MANAGEMENT:
NURSING RESEARCH:
· Nursing research entails broadening the scope of nursing and the variety of knowledge available. This is possible if the attendants take charge of leading additional examinations. For cancer patients receiving chemotherapy, more research into these areas might be beneficial.
· Research has to be done on different complementary and alternative therapies, including as deep breathing exercises, meditation, and targeted symbols, to alleviate pain and anxiety in cancer patients receiving chemotherapy.
· The health benefits of mild muscular relaxation can be analysed in-depth by many nursing experts.
RECOMMENDATIONS:
· The research will aid in determining the efficacy of deep breathing exercise and Jacobson’s Cancer pain and stress can be reduced by using progressive muscle relaxation treatment.
· The study will help to determine help alleviate cancer pain and stress in those with cancer.
· The study will focus on awareness creation among cancer patients with respect to prevention of cancer related disorders
· The Jacobson’s progressive muscle relaxation therapy will assist cancer patients to decrease pain and stress along these lines improve quality of life.
SUGGESTIONS FOR FURTHER STUDY:
The researcher suggested the following recommendations for the study based on the study's results.
· Randomization allows for the conduct of similar research.
· Short-term research of this kind can be carried out on a small sample size.
· Similar research can be done on alternative treatments for cancer pain and anxiety, such as yoga and meditation.
· Comparable research can be done on the effectiveness of deep breathing exercises and progressive muscle relaxation on cancer patients' fatigue and anxiety.
· Similar research can be carried out to determine the degree of stress experienced by staff nurses providing community and home health care as well as care in mental health hospitals.
· A comparable study can be carried out to assess the level of pain and tension felt by patients after surgery in general hospitals and any other types of hospitals.
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Received on 14.05.2024 Revised on 07.09.2024 Accepted on 10.11.2024 Published on 28.11.2024 Available online on December 31, 2024 A and V Pub J. of Nursing and Medical Res. 2024;3(4):125-132. DOI: 10.52711/jnmr.2024.29 ©A and V Publications All right reserved
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