INTRODUCTION :

Endotracheal intubation taking important role in the case of emergency management. But, the pulmonary complications were common in the invasive airway management like endotracheal and tracheostomy tubes intubation.

The complications may prevent or treated with chest physical therapies like spirometry, breathing exercises, postural drainage etc, (Smelterz and Susanna, 2008).

Extubation of endotracheal tube is considered when the patients can breathe spontaneously, maintain an adequate coughing up secretions, swallow, and move the jaw. Once patient can clear secretions adequately, a trail period of mouth breathing or nose breathing is conducted, (Brunner and Suddharth, 2008).

Successful weaning from the ventilator is supplemented by intensive pulmonary care. The following methods are used, oxygen therapy, arterial blood gas analysis, pulse oxymetry, bronchodilator therapy, chest physiotherapy, adequate nutrition, hydration, humidification and incentive spirometry. These patients still have borderline pulmonary function and need vigorous supportive therapy before their status returns to a level that supports activities of daily living, (Goris, Vermeeren, Wouters, et.al., 2003).

Biofeedback is a technique that trains people to improve their health by controlling certain bodily processes that normally happen involuntarily, such as heart rate, blood pressure, muscle tension, and skin temperature. Electrodes attached to your skin measure these processes and display them on a monitor. With help from a biofeedback therapist, you can learn to change your heart rate or blood pressure (Bruehl S.,2006)

Biofeedback is an effective therapy for many conditions, but it is primarily used to treat high blood pressure, tension headache, migraine headache, chronic pain, and urinary incontinence. (Abgrall-Barbry G.,2006)

Biofeedback is a mind–body technique in which individuals learns how to modify their physiology for the purpose of improving physical, mental, emotional and spiritual health. Much like physical therapy, biofeedback training requires active participation on the part of patients and often regular practice between training sessions. Clinical biofeedback may be used to manage disease symptoms as well as to improve overall health and wellness through stress management training. Research has shown that biofeedback interventions are efficacious in treating a variety of medical conditions, and many Americans are turning to biofeedback and other less traditional therapies for their routine healthcare. (Dana L Frank, 2012).

STATEMENT OF PROBLEM:

“Effectiveness of Biofeedback therapy on pulmonary function among extubated patients at Dhanvantri Critical Care Centre, Erode”

OBJECTIVES:

1) To determine the effectiveness of Biofeedback therapy on pulmonary function among extubated patients in control and experimental group.

2) To find out the association between post test scores of pulmonary function among control and experimental group of extubated patients with their demographic variables.

Operational Definition - Biofeedback therapy:

It is a process that provide feedback about their to improve pulmonary function and motivate the extubated patients towards expected outcome with the use of Easy on PC operator machine. This therapy is given to the extubated patients for the duration 30 minutes 3 times a day for 7 days.

Hypotheses:

H_2:

There is a significant effectiveness of Biofeedback therapy on pulmonary function among extubated patients in experimental group than control group.

H_3:

There is a significant association between post test scores of pulmonary function among control and experimental group of extubated patients with their demographic variables.

METHODOLOGY:

Design:

Quasi-experimental design, where Pre and Post test Non equivalent Group design.

Setting:

Dhanvantri Critical Care Centre, Erode, Tamilnadu.

Participants:

Thirty extubated patients fulfilling the inclusion criteria.

Sampling and number of samples:

Out of 30 patients, 15 patients were selected as experimental group and 15 patients were selected as control group by convenient sampling technique. Experimental group were motivated towards expected outcome with the use of Easy on PC operator machine.

Tool:

Level of pulmonary function was measured by pulmonary function observational rating scale before and after the procedure. Test Retest was used to test the reliability of the tool. The tool was found to be reliable, (r¹= 0.82).

RESULTS:

Table 1. Frequency and percentage distribution of the control group pre test and post test scores of level of pulmonary function among extubated patients. (N₁=15)

Level of pulmonary function	Control group
	Pre test scores		Post test scores
	Frequency (N₁)	%	Frequency (N₁)	(%)
Poor	7	47	0	0
Average	7	47	12	80
Good	1	06	3	20

Frequency and percentage distribution of control group pre test and post test level of pulmonary function among extubated patients depicts that, in pre test similar percentage (47% and 47%) of patients had poor and average pulmonary function and only 6% of them good pulmonary function, whereas in post test, 80% percentage of patients had average and 20% of them had good pulmonary function. It seems that without intervention also there is a mild change in the level of pulmonary function among extubated patients.

Table 2. Frequency and percentage distribution of the experimental group pre test and post test scores of level of pulmonary function among extubated patients.(N₂=15)

Level of pulmonary function	Experimental group
	Pre test scores		Post test scores
	Frequency (N₁)	%	Frequency (N₁)	(%)
Poor	6	40	0	0
Average	9	60	2	13
Good	0	0	13	87

Frequency and percentage distribution of experimental group pre test and post test level of pulmonary function among extubated patients depicts that, in pre test most percentage (60%) of patients had average pulmonary function and 40% of them had poor pulmonary function, whereas in post test, 87% percentage of patients had good and 13 % of them had average pulmonary function. It seems that biofeedback therapy was effective in improvement of pulmonary function among extubated patients,

Table 3. Frequency and percentage distribution of the control group and experimental group post test scores of level of pulmonary function among extubated patients. (N₁=15) (N₂=15)

Level of pulmonary function	Post test scores
	Control group		Experimental group
	Frequency (N₁)	%	Frequency (N₂)	%
Poor	0	0	0	0
Average	12	80	2	13
Good	3	20	13	87

Frequency and percentage distribution of control group and experimental group post test scores of level of pulmonary function among extubated patients depicts that, in control group most (80%) of patients had average and 20% of them had good pulmonary function, whereas in experimental group most (87%) of patients had good and only 13 percentage of patients had average pulmonary function. It seems that biofeedback therapy on pulmonary function among extubated patients was effective.

Table 4. Paired ‘t’ test value of pre and post test scores of level of pulmonary function in control and experimental group

Extubated patients	Paired ‘t’ value	Table value	Level of significant (P)
Control group	5.82	2.15	P < 0.05 significant
Experimental group	12.33	2.15	P < 0.05 significant

Df =14 Table value=2.15 P<0.05 significant

Paired ‘t’ test was calculated to analyze the effectiveness between pre and post test scores of control and experimental group on level of pulmonary function among extubated patients. The paired ‘t’ test value was 5.82 and 12.33 in control group and experimental group, when compared to table value (2.15) both are high. This shows that even though there was a significant effectiveness between pre and post test scores of level of pulmonary function among both control and experimental group, biofeedback therapy was more effective on pulmonary function among extubated patients.

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Table 5. Unpaired ‘t’ test value of post test scores of pulmonary function in control group and experimental group

Unpaired ‘t’ value	Table value	Level of significant (P)
4.42	2.05	P<0.05 Significant

Df=28, Table value=2.05, P<0.05 significant

Unpaired ‘t’ test was calculated to analyze the effectiveness between control and experimental groups post test scores on level of pulmonary function among extubated patients. The unpaired ‘t’ test value was 4.42, when compared to table value (2.05, p<0.05), it is high. It seems that there was a significant effectiveness of biofeedback therapy on pulmonary function among extubated. Chi-square value of association between experimental and control group post test scores with their demographic variables There was no significant association (p>0.05) found between the post test scores of experimental and control group when compared to other demographic variables such as, gender, type of intubation, duration of intubation and type of diagnosis and age. It seems that biofeedback therapy was effective to all the extubated patients irrespective of their demographic variables.

CONCLUSION:

From the findings of the study it can be concluded that, there was a significant effectiveness of biofeedback therapy on pulmonary function among extubated patients.

REFERENCES:

1. www.mayoclinic.org

2. en.wikipedia.org/wiki/Biofeedback

3. www.webmd.com

4. www.drweil.com

5. psychotherapy.com

6. www.medicalnewstoday.com

7. www.nlm.nih.gov/medlineplus/ency/.../002241.h.

8. www.bcia.org

9. www.bcia.org

10. www.zapmeta.co.in

Received on 02.08.2014 Modified on 03.09.2014

Int. J. Nur. Edu. and Research 2(4): Oct.- Dec. 2014; Page 347-349