Effectiveness of Progressive Muscle Relaxation therapy (PMR) on Health Status among Cancer Patients Receiving Chemotherapy Treatment

 

Mrs. J. Annalakshmi, Dr. T. Sivabalan*

Pravara Institute of Medical Sciences (DU), College of Nursing, Loni (Bk), Tal. Rahata,

Dist. Ahmednagar, MS – 413736

 

ABSTRACT:

Introduction: Cancer is known to be a multi facet, chronic and difficult disease affects individual and their families both physically and emotionally. With advance cancer treatment strategies it is still considered dangerous disease with enormous pain, suffering and even death. There are several distinct categories of interventions have been employed for cancer patients such as education, support, psychotherapy and complementary therapies. The psychosocial interventions provide positive effect on cancer symptoms and quality of life. Thus the present communication was carried out to assess the effectiveness of Progressive Muscle Relaxation therapy (PMR) on health status among cancer patients receiving chemotherapy.Materials and Methods: It’s a quasi experimental study, where pre test post test design was used among 30 purposively selected cancer patients receiving initial course of chemotherapy, and admitted at Pravara Rural Hospital. Cancer patients above 18 years of age, able to follow PMR therapy and willing to participate were enrolled in the study. Structured interview schedule was used to assess the study variables. The data were analyzed with descriptive and inferential statistics wherever required.Results: The results revealed that the overall post intervention physical health status mean score (12.43±9.89) which is lower than the pre test score, and found statistically significant (t=5.96) at p<0.05 level. Similarly the overall post test psychological health status mean score (67.50±15.86) which is significantly (t=14.7) lower than the pre test score. These findings highlights that the PMR therapy had significant effect in minimizing physical and psychological health problems of cancer patients. A significant association was found between nausea and vomiting with gender; and emotional instability with age at p<0.05 level.Conclusion: The PMR therapy was found to be effective to improve the physical and psychological health status of cancer patients receiving initial course of chemotherapy. It should be emphasized that training and use of PMR by cancer patients improve their awareness and practice of PMR therapy which leads to reduction in the severity of side effects, and improvement of quality of life

 

 

 

INTRODUCTION:

Cancer – is a group of more than 200 diseases characterized by uncontrolled and unregulated growth of cells, and it’s a major health problem that occurs in people of all ethnicities. World Health Organization reported that most new cancer cases (56%) and deaths (63%) occurs in less developed regions of the world like Asia; further the most common cancers worldwide are lung (1.61 million – 12.7% of the total), breast (1.38 million – 10.9%), and colorectal (1.23 million – 9.7%). The common causes of cancer death are lung (1.38 million – 18.2% of the total), stomach (0.74 million – 9.7%), and liver (0.69 million – 9.2%) of cancers.¹

 

There are three main modalities of cancer management i.e. Surgery, Radiotherapy and chemotherapy. Majority of patient needs to be treated with a combination of these approaches. However, it’s often results in debilitating effects which lead to variety of physical, psychological and social problems.² Progressive Muscle Relaxation therapy enable the patients to recognize muscle tension in various areas and to diminish it gradually and progressively, beginning at the head and slowly progressing through large muscle groups up to foot muscles.³It is very effective in lowering heart rate and blood pressure, decreasing muscle tension, improving well being, and reducing symptom distress in persons experiencing a variety of situation (side effects of cancer treatment).⁴ Evidence highlights that the PMR therapy is considerably effective in reducing the severity and frequency of nausea and vomiting, pain and fatigue level in comparison with control patients. ^{5, 6} Alongside, it was evident that it has impact on anxiety, insomnia and mood disturbance of patients undergoing cancer treatment.⁷ Thus the present communication was carried out to determine the effect of PMR therapy on health status among cancer patients receiving initial course of chemotherapy.

 

MATERIALS AND METHODS:    

It’s a quasi experimental study; where pre test post test design was used assess the effect of PMR therapy. The study was conducted at oncology wards of Pravara Rural Hospital, Loni (Bk) Maharashtra among 30 purposively selected cancer patients receiving the initial course of chemotherapy treatment. Study was approved by the institutional ethics/research committee of PIMS (DU), and protocol of study was explained to the participants and written informed consent was obtained before the enrollment. Cancer patients above 18 years of age, able to follow PMR therapy, understand Marathi language and willing to participate were included in the study. The cancer patients who are critically ill and unable to respond to tool and having medical and psychiatric co morbidity were excluded from the study. The pre tested structured interview schedule was used to assess the study variables.

The interview schedule was comprised of a) questionnaire for assessing the physical health status such as Check list on nausea and vomiting, Pain scale, Modified Brief Fatigue Inventory and b) tools for assessing the psychological health status such as Modified Zung self rating Anxiety Scale, Modified Beck depression rating scale, Emotional instability rating scale and Stress scale. Based on obtained scores the physical and psychological health status was categorized as ‘no, mild, moderate, severe and very severe’. After pre test, the intervention such as a self prepared and pre tested PMR therapy (in local language) was implemented with the help of VCD player for 3 times a day (8.30 am, 11.30 am and 3.30 pm) throughout the course of hospitalization to the cancer patients by the researcher. The total duration of PMR therapy was 30 minutes. The evaluation i.e. post test was carried out on the day of discharge with help of same structured interview schedule. The collected data were complied, tabulated and analyzed based on objectives/hypotheses with help of descriptive (mean, SD and mean %) and inferential (t test, chi square test) statistical methods wherever required.

 

RESULTS:

Socio demographic profile of cancer patients:

nearly one third (31%) of cancer patients were above 51 years of age, majority (67%) were male, one third (34%) were educated up to primary education and significant percent (33%) had secondary school education. Half (50%) of the patients were daily wagers, among the female patients (31%) were housewife, most (90%) were married, and majority (80%) were resides in rural area. In relation to complementary therapies only (13%) of patients knows and practice yoga.

 

Clinical profile of cancer patients: majority (83%) of them had carcinoma, (27%) had oral cancer followed by significant percent (17%) had cancer cervix, most (97%) of them had duration of illness less than 6 months. A mere percent (9%) had family history of cancer, and majority (93%) had chemotherapy as primary cancer treatment and remaining (7%) had combined therapy. 

 

 

 

Table No: 1 Effectiveness of PMR therapy on physical health status

df – 29 ; *Significant                p<0.05

 

 

Above table depicts that during pre test the cancer patients receiving chemotherapy had ‘moderate level’ of pain (2.73±1.71) whereas after the intervention it was reduced to ‘mild level’ (1.09±0.84) shows the effectiveness of PMR therapy. Alongside the fatigue was reduced from ‘mild fatigue’ (20.3±9.37) to ‘no fatigue’ (10.1±6.95). It interprets that the PMR therapy significantly reduces the health problems (t=4.43 and t=6.69) at p<0.05 level.  The nausea and vomiting had significant association with socio demographic variable such as gender (x2=4.37) at p<0.05 level.

 

Table No. 2 Effectiveness of PMR therapy on psychological health status

Area	Pre test			Post test			‘t’ value
	Mean	SD	Mean %	Mean	SD	Mean %
Anxiety	20.57	6.21	34.28	14.27	4.52	23.67	4.39*
Depression	36.06	9.16	48.08	26.40	5.67	35.22	6.47*
Emotional instability	33.21	10.75	83.00	10.13	4.12	25.33	8.94*
Stress	25.77	9.59	42.95	17.70	6.51	27.83	3.31
Overall	98.93	22.97	42.09	67.50	15.86	27.82	14.78*

df – 29; *Significant p<0.05

 

Above table depicts that during post test the mean score of anxiety, depression and emotional instability was lower than the pre test scores indicates PMR therapy was effective in reducing the severity of psychological symptoms. It was found to be statistically significant at p<0.05 level. The emotional instability had significant association with socio demographic variable such as age (x2=3.91) at p<0.05 level.

 

DISCUSSION:

The study results revealed that majority of patients under study were belonging to carcinoma category and only mere percent of patients had sarcoma. It was consistent with the study of Tebeu P M that maximum cancer patients affected with carcinomas.⁸ Higher percent of patients under study had oral cancer followed by cancer cervix. These facts were in congruence with the World Health Organization fact sheet on cancer statistics.

 

Most of patients had duration of cancer less than 6 months period. It was consistent with the study done by Verkooijen H, Ooi L and Koh W revealed that 74% of the cancer patients were diagnosed < 1 year.⁹ Majority of patients were received chemotherapy treatment, while only mere number of patients had combined therapy. It was well supported by the findings of Karabulu N, Erci B, Ozer NandOzdemir S that majority (72%) of cancer patients were received chemotherapy treatment.¹⁰

 

Progressive Muscle Relaxation is a systematic technique for achieving a deep state of relaxation, and developed by Dr. Edmund Jacobson >50 years ago. He discovered that a muscle could be relaxed by first tensing it for a few seconds and then releasing its. PMR is capable of relieving a variety of condition, from high blood pressure to ulcerative colitis.¹¹ The results of study highlights that in relation to physical health status after PMR therapy there was a significant reduction in the level of pain and fatigue. These findings were well documented by Kwekkeboom KL, Wanta Band and Bumpus M; and Chan W, Chang A, Leung S and Mak S also noticed that the pain and fatigue level was minimized after the PMR intervention.^{12, 13}

 

In our study the psychological health status such as anxiety, depression and emotional instability was significantly improved after the practice of PMR therapy. These results were uphold by Cheung Y L, Molassiotis A and Chaung A M; and Luebbert K, Dahme B and Hasenbring M also observed that PMRT significantly decreases the anxiety with comparison to control group, and effective in the improving the emotional status (anxiety, depression, hostility, tension, overall mood) of cancer patients under chemotherapy treatment.^{14, 15}

 

As emphasized through study findings that practicing PMR therapy improve their health status and reduces the severity of side effects of cancer patients undergoing chemotherapy treatment. It is important to make awareness on PMR therapy through education and training to enhance the patient’s knowledge and compliance of PMR therapy.

 

CONCLUSION: 

The findings demonstrated that the cancer patients undergoing chemotherapy treatment suffer with variety of health problems (i.e. physical and psychological) of cancer and treatment effects. Results of the study highlight that the practice of PMR therapy was found to be effective in improving the physical (i.e. pain, fatigue) and psychological (i.e. anxiety, depression and emotional instability) health status of cancer patients receiving initial course of chemotherapy. It should be emphasized that training and continuous practice of PMR by cancer patients improve their awareness and practice of PMR therapy which will incrementally minimize the severity of treatment side effects and improves the quality of life. Utilization of complementary therapies in side effects management is paramount important, and needs to be practiced wisely with adequate compliance.

ACKNOWLEDGEMENT

The authors expresses sincere thanks to Pravara Institute of Medical Sciences (Deemed University), Institutional Ethics/Research Committee, Medical Superintendent, Head of Department of Department of Oncology and Radiation therapy of Pravara Rural Hospital, Loni (Bk) and the cancer patients for their kind cooperation and support.

 

REFERENCE:

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12.     Kwekkeboom KL, Wanta B and Bumpus M. Individual difference variables and the effects of progressive muscle relaxation and analgesic imagery interventions on cancer pain. J Pain Symptom Manage. 2009;36(6): 604 – 15

13.     Chan W, Chang A, Leung S and Mak S. Reducing breathlessness, fatigue, and anxiety in Chinese patients undergoing lung cancer radiotherapy in Hong Kong. Hong Kong Med J 2010;13(2): 4 – 7

14.     Chan C, Cheng K, Lam M, Li CK, Chik KW and Cheung J. Effects of psycho educational interventions in managing chemotherapy associated nausea and vomiting (CANV) in pediatric oncology patients: a pilot study. Health and Health Services Research Fund. 2008

15.     Luebbert K, Dahme B and Hasenbring M. The effectiveness of relaxation training in reducing treatment related symptoms and improving emotional adjustment in acute non surgical cancer treatment; a meta analytic review. Psycho oncology 2009; 10: 490 – 502

 

 

 

 

Received on 30.08.2016          Modified on 25.09.2016

Accepted on 21.12.2016         © A&V Publications all right reserved