A Study To Assess The Effect of Intradialytic Stretching Exercise on Muscle Cramps among Patients Undergoing Haemodialysis in A Selected Hospital, at Bangalore.

 

Manjunathan. C.

Assistant Nursing Superintendent, Apollo CBCC Cancer Care, Apollo Hospitals International Limited, Gandhinagar, Gujarat.

 

ABSTRACT:

Background of the study: Clients undergoing dialysis do not walk a pleasant road. Yet during their devastating experience of dialysis sessions, Muscle cramps may be the cause further pain. The stretching exercise can be given to the patients undergoing haemodialysis to prevent the outbreak of muscle cramps which may the result of fluid loss during the session. The effectiveness of stretching exercise is measured through modified numerical intensity scale, duration and frequency. Objectives: To assess the effect of intradialytic stretching exercise on muscle cramps among patients undergoing haemodialysis.  Design and Methods: Approach: An evaluation approach. Design: This study was only experimental design. Setting: In haemodialysis unit of Rangadore Memorial Hospital at Bangalore. Participants: 60 patients who fulfilled selection criteria were included in the study. Pre-Assessment: The tool was developed by preparation of Modified Numerical Intensity Scale, Duration, and Frequency content validity of the stool was established by giving to professional experts. Intervention: The personal data was assessed by demographic and clinical questionnaires. The stretching exercise was administered during haemodialysis on muscle cramps. Post- Assessment: Assessing the effect of stretching exercise on muscle cramps with the help of Modified Numerical Intensity Scale, Duration and Frequency. Results: 1.The study reveals that paired‘t’ values 3.19 (p<0.01) and 5.8 (p<0.001) should that there is a significant difference between the intensity scale scores during third and fourth hours in the experimental and control groups respectively. 2. The study showed that there is no significant association between any patient variable and the intensity, duration and frequency of cramps during third and fourth hours in experimental group. 3. In the control group, intensity of muscle cramps showed significant association with previous experience of muscle cramps and use of membrane stabilizing agents. Conclusions: The study concluded the findings suggest that the exercise was effective in terms of reduction in the intensity, duration and frequency of muscle cramps in the experimental group. The nurse has to be alert to spend time to assess risk factors for muscle cramps, develops nursing strategies to prevent or reduce the incidence of muscle cramps during dialysis.

 

 

 

INTRODUCTION:

The crucial areas of human life are physical well being, social activities, personal development, recreation and economic circumstances and these factors largely influence the persons relationships with environment¹.

To the greater extent, the quality led by a human being is influenced by his physical well being depends up on the accurate balance of components like fluids, solutes and even some waste materials². Different kidney pathologies challenge these functions and puts human life in danger. Two such important pathologies are acute and chronic renal failures. But in early years itself, some had the vision and courage to risk everything in search of the answer for treating renal failure and the first clinical dialysis on a uremic man was performed in mid October 1924 by George Hass in Germany². In this study the investigator is interested to elicit the effect of intradialytic stretching exercise on muscle cramps experienced, by the patients during haemodialysis³.

 

NEED FOR STUDY:

Chronic kidney disease (CKD) is an important non communicable disease epidemic the effects the world population including India. The prevalence of end stage renal disease (ESRD) is rising throughout the developed and developing countries mainly due to diabetes and hypertension³. There are currently 10,65,000 people on haemodialysis worldwide (European dialysis and transplant nurses association / European Renal care association Journal, 2005). Chronic kidney disease will kill 36 million people by the year 2015. In India 10 lakh people suffer from kidney failure and more than 4 corers are at the risk (Tamil Nadu Kidney Research Foundation)⁴. Muscle cramps are prolonged involuntary muscle contraction. To relive an established cramp on must passively stretch the contracting muscle. Prophylactic stretching of the particular muscle can also prevent attacks (Hansen, 2005)⁴. As a consequence, exercise programs are through to better incorporated into the dialysis session. But in case of stretching exercise, the patients position in during dialysis prevent self stretching⁵. The investigator has opted to provide passive calf muscle stretching exercise prophylactically during hemodialysis to relive or prevent muscle cramps.

 

OBJECTIVES:

1. To assess the effect of intradialytic stretching exercise on muscle cramps among patients undergoing haemodialysis.

2. To find out the association between the effect of intradialytic stretching exercise with demographic variables and clinical variables.

 

MATERIALS AND METHODS:

Research Design:

A post test only experimental design.

 

Setting:

This study was conducted in the hemodialysis unit of Rangadore Memorial Hospital.

 

Population:

The target population of this study was the patients undergoing hemodialysis in the hemodialysis unit of Rangadore Memorial Hospital.

 

Sample:

The sample consisted of 60 patients who satisfied the sample selection criteria with 30 patients each in the experimental and control group.

 

Sample Technique:

The technique adopted for this study was simple random sampling.

 

Data Collection Procedure:

a. Odd number sample were selected for experimental group.

b. Even number sample were selected for control group.

 

Data Analysis:

The data obtained was analyzed in terms of the objectives of the study using descriptive and inferential statistics.

 

MAJOR FINDING:

The majority of the patients were age group between 50-60 years of age in both experimental and control group and in the post test 22 patients (73.3%) of the control group experienced muscle cramps. The mean value of numerical intensity scale scores were 0.33 and 1.3 during third and fourth hour and standard deviation was 1.24 and 2.5 respectively in the experimental group. At the same, control group mean values were 2.4 and 3.6 and standard deviations were 2.77 and 3.18 respectively. Hence it is evident that there is a significant and control group groups.  The study reveals that paired ‘t’ values 3.19 (p<0.01) and 5.8 (p<0.001) should that there is a significant difference between the intensity scale scores during third and fourth hours in the experimental and control groups respectively. The study showed that there is no significant association between any patient variable and the intensity, duration and frequency of cramps during third and fourth hours in experimental group. In the control group, intensity of muscle cramps showed significant association with previous experience of muscle cramps and use of membrane stabilizing agents.

 

CONCLUSION:

The findings of the study revealed that in paired ‘t’ values 3.19 (p<0.01) and 5.8 (p<0.001) showed that there is a significant difference between the intensity scale scores during third and fourth hours in the experimental and control groups respectively. Paired ‘t’ values 2.58 (<0.05)and 5.45 (p<0.001) showed that there is a statistically significant difference between the duration of muscle cramps during third and fourth hours for the experimental and control groups. Paired ,t, values were 3.02 (p<0.01) and 6.00 (p<0.001) for experimental and control groups and showed that there is a significant difference between the frequencies of muscle cramps during the third and fourth hours in both the groups. These findings suggest that the exercise was effective in terms of reduction in the intensity, duration and frequency of muscle cramps in the experimental group. The nurse be alert to spend time to assess risk factors for muscle cramps, develop nursing strategies to prevent or reduce the muscle cramps during haemodialysis.

 

REFERENCES:

1.     Alex, M.D. Steward, C.J. Gunfield., J.P. Ponticelli C., Pitz., Christopher GW et all. (2005) Oxford text book of Clinical Nephrology(5), 34-7.

2.     Allen, RN., and Richard., N.F (2005). Clinical Dialysis (Ed-4) New York, MC. Grew Hill company. 8(5), 890-96.

3.     Kendall, P.F. Elizabath, K.M and Pratricia. G.P (1993). Muscles testing and function (Ed-4) Philandelphia: Lipincott.

4.     Driks, J. (2005) A world perspective on renal care, The challenges of prevention and treatment, EPTNA ERCA journal, 31(2), 72-4.

5.     John. T.D., Peter. G.B., and Todd.SI. (2003) Hand Book of dialysis (Ed-3) Philandelphia: Lippincott.

 

 

 

Received on 26.11.2016          Modified on13.01.2017

Accepted on 30.01.2017         © A&V Publications all right reserved