Effectiveness of Acupressure on Pre Menstrual Syndrome among Adolescent Girls

Prof. P. Padmavathi¹, Dr. N. Kokilavani², Dr. RajaSankar³

¹Principal, Dhanvantri College of Nursing, Ganapathypuram, No -1 Ranganoor Road, Muniyappankovil, Pallakkapalyam (PO), Sankagiri West Via, Thiruchengodu (TK), Namakkal Dist – 637303.

²Principal, Adhiparasakthi College Of Nursing, Melmaruvathur

³Professor, Melmaruvathur Adhiparasakthi Institute of Medical Sciences (MAPIMS), Melmaruvathur

Corresponding Author Email: padmasekar2009@gmail.com

ABSTRACT:

Background: Premenstrual syndrome is the most common of gynecologic complaints. It affects half of all female adolescents today and represents the leading cause of periodic college/school absenteeism among that population. Objectives: To assess the effectiveness of acupressure on Premenstrual syndrome among adolescents. Design: Two group pretest and posttest True experimental design was adopted for the study. Setting: Government girls Secondary School, Erode. Participants: 40 adolescent girls with Premenstrual syndrome fulfilling the inclusion criteria were selected by simple random sampling. Methods: A pre-test was conducted by using premenstrual symptoms assessment scale. Immediately after pre-test acupressure was given once in a week for 6 weeks and again post test was conducted to assess the effectiveness of treatment. Collected data was analysed by using descriptive and inferential statistics. Results: In posttest, the mean score of the control group sample was 177.3 (SD= 2.5) and the experimental group mean score was 70.8 (SD = 10.71) with Paired‘t ‘value of 19.2 and 31.9. This showed that the acupressure was more effective in enhancing the practice of the sample regarding Premenstrual syndrome. There was a statistically no significant association found between the post test scores of the sample with their demographic variables. Conclusion: The findings imply that acupressure was effective in reducing the premenstrual syndrome among adolescent girls.

KEY WORDS: Effectiveness, Acupressure, Premenstrual syndrome, adolescents.

INTRODUCTION:

Premenstrual Syndrome (PMS) is a set of physical, emotional and behavioural symptom that start during the week preceding menstruation and are alleviated when the menstrual flow begins. The symptoms present a cyclic and recurrent character with variable in quality and intensity, (Silva CM, Gigante DP, Carret ML, Fassa AG, 2006)

Prevalence ranges from reports that suggest 5-20% have moderate to severe clinically relevant premenstrual complaints and up to 75% of all women of fertile age may experience symptoms of premenstrual syndrome (Eriksson, 2008).

This disorder is particularly common in the younger age groups and, therefore, represents a significant public health problem in young girls.

The most common physical symptoms are (headaches, breast tenderness, swelling, abdominal bloating, heaviness, low energy, tired and weak, back and muscle pain, sleep more, stay in bed increased / decreased appetite, and crave food), and emotional symptoms are (depressed mood, sad, lonely, anxious, nervous, mood swings, trouble with relationships, irritable, angry, impatient, difficulty concentrating , feel out of control, cannot cope, less productive in job or home and avoid social activity), (Mitchell, E., Woods, N., and Lentz, M.,2005)

Individual premenstrual symptoms were experienced by 65.7% of the population. The most common somatic symptom was fatigue (29.9%) and affective symptom was feeling sad/hopeless (29.6%). Prevalence of PMS was 8.75% (95%CI: 6.43-11.07). Multivariate analysis revealed the presence of: chronic physical illness (P = 0.001); dysmenorrhea (P < 0.0001), and regular menstrual cycles (P = 0.006) as correlates of PMS. Presence of PMS significantly disturbed "in school" activities, relationships and daily routines (P < 0.005) indicating a high negative influence on adolescents' daily life. Only 9.7% sought help from (western) medical practitioners for their premenstrual symptoms and a majority has not perceived it as a condition to report. Premenstrual syndrome is a common condition among adolescent schoolgirls with a high negative influence on their daily life.

Abraham S, (2006), reported many remedies for PMS have been listed such as (chiropractic, acupuncture, homoeopathy, light, yoga and meditation therapy reduce negative emotions through cognitive restructuring, enhanced problem solving skills in personal.

Lin JA, et. al., ( 2010), recommended Collateral meridian acupressure therapy that was performed once on the second day of both the first (partial treatment) and fourth (complete treatment) menstrual period. Pain was resolved immediately after partial CMAT treatment during the first menstrual period, but the pain recurred 20 minutes later. Satisfactory results were obtained during the fourth menstrual period after complete CMAT treatment, which were also carried over to the next session (fifth menstrual period). In addition, no oral analgesics were necessary after treatment. However, the symptoms of dysmenorrhea recurred 2 months after treatment (sixth menstrual period).

Kashefi F, Ziyadlou S, Khajehei M, Ashraf AR, Fadaee AR, Jafari P.(2010), conducted a study on Effect of acupressure at the Sanyinjiao point on primary dysmenorrhea: a randomized controlled trial. The acupressure caused decline in the severity of dysmenorrhea immediately after intervention in both groups during their first menstrual cycle, although, there difference was not significant (p>0.05). In addition, during the same cycle, the severity of the dysmenorrhea decreased more in study group rather than control group at 30 min, 1, 2 and 3h after intervention (p<0.05). During the second menstrual cycle, acupressure made dysmenorrhea reduced in both study and control groups; however, the decline was more salient among participants of the study group at all stages after the intervention (p<0.05). Acupressure at Sanyinjiao point can be an effective, feasible, cost-effective intervention for improving primary dysmenorrheal.

Acupressure can be easily used to reduce menstrual cramps and symptoms of PMS. Menstrual cramps are mostly related to qi stagnation, that is, when qi is not flowing freely in the body. This is most often caused by stress, worry, overwork, or sometimes people can be prone to stagnation

PROBLEM STATEMENT:

A study to assess the effectiveness of Acupressure on premenstrual syndrome among adolescent girls in selected schools at Erode, Tamilnadu.

OBJECTIVES:

1. To assess the level of premenstrual syndrome among experimental group and control group of adolescent girls before and after acupressure

2. To determine the effectiveness of acupressure on premenstrual syndrome among adolescent girls on both the groups.

3. To find out the association between post test scores of premenstrual syndrome among control and experimental group of adolescent girls with their selected demographic variables.

METHODOLOGY:

Research approach: Experimental evaluative research approach

Research design: True experimental design (pre and posttest design with control group)

Target population: Adolescent girls with premenstrual syndrome.

Accessible Population: Adolescent girls with premenstrual syndrome studying Government Higher Secondary Schools. Namakkal District

Sampling technique and sample size: Simple random samplings, 40 samples, out of 20 were experimental group and 20 were control group

Variables:

Independent Variable: Acupressure

Dependent Variable: Premenstrual syndrome among adolescent girls

Tool : There are two sections tools were used. They are;

· Section A: Demographic variables

· Section B: Premenstrual Syndrome Scale (PMSS)

Scoring Procedure:

Based on the percentage of scores the levels of premenstrual syndrome were graded in four categories. They are “No symptoms”, “Mild”, “Moderate” “Severe” and “Very severe symptoms”.

Level of symptoms	Actual Scores	Percentage of Scores
No symptoms	1- 40	< 20
Mild symptoms - only slightly apparent	41 - 80	21 -40
Moderate symptoms - aware of symptom, but it doesn’t affect daily activity at all	81 – 120	41 60
Severe - continuously bothered by symptoms	121 - 160	61 -80
very severe - symptom is overwhelming and /or interferes with daily activity	161 -200	> 80

Data collection procedure:

· Pretest was conducted by using Premenstrual Syndrome Scale to assess the level of premenstrual symptoms

· Implementing the Acupressure in experimental group and no treatment in control group for the duration of 20 minutes once in a week for 6 weeks.

(7 -10 days before the menstrual cycle acupressure for experimental group)

· Posttest was conducted with same pretest tool after 6 weeks.

Validity and Reliability:

Ø The content validity of the demographic variables and Premenstrual Syndrome Scale was validated in consultation with guide and field of experts. The tool was modified according to the suggestions and recommendations of the experts

Ø Inter-rater reliability (Cronbach's Alpha) was used to find out the reliability of the Premenstrual Syndrome Scale (r¹ = 0.97)

Plan for data analysis:

· Descriptive Statistics : Percentage, Mean and Standard Deviation

· Inferential Statistics : ‘t’ test and Chi –square test

Findings and interpretation:

Section A: Percentage distrubation of adolescent girls according to their demographic variables.

Control and experimental group – shows that,

ü Highest percentage (60% and 50%) of adolescent girls were in the age group of 15- 16 years.

ü 40% and 45% of them were 10^thand 9^th standard

ü Similar percentage (30% and 35%) of the parents were educated up to primary and seconary education

ü 65% and 80% of the parents were non professionals

ü 45% and 50% percentage of the adolescent girls were hindus.

ü Similare percentage (45% and 50%) of them were 13-16 years of age at menarche and 24 and28 days duration of menstrual cycle.

ü Highest percentage (60% and 50% ) of adolescent girls having 3-5 days menstrual flow.

ü 75% and 90% of them not having family history of PMS

ü 65% and 70% of adolsecent girls are using home remedies.

ü Similar percentage (45%and 45%) of them every cycle observing the premenstrual problems.

Section B:

The result of post test scores showed that in control group most (70%) had severe syndrome whereas in experimental group most (75%) had mild syndrome. It shows acupressure is more effective in reducing the premenstrual symptoms.

Frequency and percentage distribution of post test scores of premenstrual syndrome among adolescent girls in control and experimental group (N₁= 20) (N₂ = 20)

Level of Premenstrual syndrome	Post test score
	Control group		Experimental group
	Frequency (N₁)	Percentage (%)	Frequency (N₂)	Percentage (%)
No symptoms	-	-	-	-
Mild	-	-	15	75
Moderate	6	30	5	25
Severe	14	70	-	-
Very sever	-	-	-	-

Section C:

Area wise comparison of mean, SD, and mean percentage of control group and experimental group posttest premenstrual syndrome scores (N₁ = 20, N₂= 20)

S. No	Premenstrual symptoms	Max. scores	Post test score						Difference in Mean (%)
			Control group			Experimental group
			Mean	SD	Mean(%)	Mean	SD	Mean(%)
1.	Physiological	80	58.9	1.81	74	29.4	4.09	37	37
2.	Psychological	60	49.4	1.05	82	21.3	3.50	36	46
3.	Behavioural	60	48.9	1.82	82	21	3.36	35	47
	Total	200	177.3	2.5	89	70.8	10.71	35	54

Bar diagram shows the post test scores premnestrual symptoms among control group and experimental group of adolcesnt girls

Section D:

(a). Significance of Pre and Post test scores of experimental group I and II

Sl. No.	Premenstrual symptoms	Paired ‘t’ Value		Level of Significant
Sl. No.	Premenstrual symptoms	Control group	Experimental group	Level of Significant
1	Physiological	18.8	30.6	P< 0.05 Significant
2	Psychological	13.4	29.9	P< 0.05 Significant
3	Behaviuoral	12.2	21.9	P< 0.05 Significant
	Total	19.2	31.9	P< 0.05 Significant

df – 19 (n-1) Table Value = 2.093 (P< 0.05 Significant)

The paired ‘t’ test score for overall was 19.2 in control group whereas in experimental group score was 31.9 when compared to table value (2.093) it was high. It seems that acupressure is more effective in reducing the premenstrual syndrome among adolescents’ girls.

(b). Unpaired ‘t’ test value of post test scores of experimental group I and II.

S. No	Areas	Unpaired ‘t’ value	Level of significant
1.	Physiological	9.98	P<0.05 Significant
2.	Psychological	8.71	P<0.05 Significant
3.	Behavioural	9.26	P <0.05 Significant
	Total	12.4	P<0.05 Significant

df =38 Table Value=2.02 Significant at P<0.05

The unpaired ‘t’ test total score was 12.4, when compared to table value (2.02) it was high. It depicts that acupressure is more effective in reducing the premenstrual syndrome among adolescents’ girls.

CONCLUSION:

· From the findings it can be concluded that post test score in control group and experimental group depicts that, in control group most (70%) of them were severe symptoms whereas in experimental group most (75%) of them were mild symptoms. It seems that acupressure was highly effective on premenstrual syndrome among adolescent girls. The overall mean percentage in control group was 89% whereas in experimental group it was 35%, it revealing the difference of 54%. The paired‘t’ test value in control group was 19.2 whereas in experimental group it was 31. 9. Oleson T, Flocco W., (2012), conducted a study on Randomized controlled study of premenstrual symptoms treated with ear, hand, and foot reflexology. The study result shows that, analysis of variance for repeated measures demonstrated a significantly greater decrease in premenstrual symptoms for the women given true reflexology treatment than for the women in the placebo group. These clinical findings support the use of ear, hand, and foot reflexology for the treatment of PMS

· Highly significant association was found between posttest scores of premenstrual syndrome in experimental group.

· No significant association was found between posttest and their demographic variables of both the groups among adolescent girls.

IMPLICATIONS:

The findings of the study have implication in Nursing service, Nursing administration and Nursing research.

Nursing service

Ø Acupressure can be used by the Nursing professionals who are working in hospital and clinical settings.

Nursing Education

Ø Nurse educator should educate the students and adolescent girls regarding significance of Acupressure in premenstrual syndrome.

Ø Nurse educator should encourage the Nursing personnel to practice the Acupressure on premenstrual syndrome in their clinical and community settings.

Nursing Administration

Ø Nurse administer can support the researcher to conduct the research on various reproductive health problems faced by the adolescent girls.

Nursing Research

Ø The study may be issued for further reference.

Ø Further large scale study can be done in different settings.

RECOMMENDATION:

¨ A similar study can be undertaken with a large sample size for wider generalization

¨ A comparative study can be conducted among urban and rural adolescent girls

¨ A comparative study can be conducted among married and unmarried women

¨ A similar study can be carried out (a) among nursing personnel working in different wards.

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Received on 05.02.2015 Modified on 17.03.2015

Int. J. Nur. Edu. and Research 3(2): April-June, 2015; Page 119-123