A Quasi-Experimental Study to Evaluate the Effectiveness of Intradialytic Leg Exercise on Pain, Fatigue and Quality of life among Patients undergoing Hemodialysis in selected Hospitals at Erode

 

Ms.T. Darthi Tamilmozhi^1, Mrs. A. Valarmathi², Mrs. S. Tamilselvi³, Dr. Christy Mekala⁴

¹RN, RM M.Sc Nursing, Medical Surgical Nursing, Bishop’s College of Nursing,

C.S.I Mission Compound, Dharapuram - 638656.

²Associate Professor, Medical Surgical Nursing, Bishop’s College of Nursing,

C.S.I Mission Compound, Dharapuram - 638656.

³Professor and Head of the Department, Medical Surgical Nursing,

Bishop’s College of Nursing, C.S.I Mission Compound, Dharapuram - 638656.

⁴Principal Head of the Department, Community Health Nursing,

Bishop’s College of Nursing, C.S.I Mission Compound, Dharapuram - 638656.

 

ABSTRACT:

Renal failure is an important non – communicable disease that affects world Population including India. The prevalence of End Stage Renal Disease is rising throughout the developed and developing countries. The current study assessed the effectiveness of intradialytic leg exercise on pain, fatigue and quality of life among patients undergoing hemodialysis in selected hospitals at Erode. The study was to assess the effectiveness of intradialytic leg exercise on pain, fatigue and quality of life among patients undergoing hemodialysis in selected hospitals at Erode. An evaluative approach was used for this study. The research design used for the study was Quasi experimental non-equivalent pre-test an post-test control group design. The conceptual framework for the study has been based on the modified Wiedenbech’s helping art of clinical nursing theory (1964) purposive sampling technique was used to select 60 samples for the study, 30 in experimental group and 30 in control group. The tool used for the study was Numerical rating scale to assess the level of pain, Iowa fatigue scale to assess the level of fatigue and KDQOLT36 questionnaire to assess the level of quality of life. The intradialytic leg exercise was given to the patients undergoing hemodialysis for 25 minutes weekly thrice a day for a period of 6 weeks (42 days) in experimental group. The collected data were analysed by descriptive and inferential statistics. The paired ‘t’ value for level of pain was 6.65. which was significant at p <0.05 level of significance. The paired ‘t’ value for level of fatigue is 7.382 which was significant at P < 0.05 level of significance. The paired ‘t’ value for quality of life is 13.124 which was significant at p<0.05 level of significance. The independent ‘t’ value for level of pain 8.6278 which was significantly p<0.05 The independent ‘t ‘value for level of fatigue 6.7408 which was significantly at p<0.05. The independent ‘t’ value for quality of life 106.93 which was significant at P<0.05 level. There was no significant association between pain, fatigue and quality of life with demographic variables. The study findings revealed that practicing intradialytic leg exercise was beneficial and there was significant reduction in pain, fatigue and improvement in the quality of life among patients undergoing hemodialysis in experimental group.

 

 

 

INTRODUCTION:

Chronic kidney disease involves progressive, irreversible destruction of the nephrons in the both kidneys. The last end stage kidney failure occurs when the glomerular filteration rate is less than 15ml/minute¹. Chronic kidney disease involves progressive, irreversible loss of kidney function The kidney have remarkable functional reserve up to 80% of the glomerular filteration rate may be 1^st with few obvious changes in the functioning of the body². Chronic renal failure or kidney disease is a slow and progressive decline of kidney function. Its usually a result of a complication from another serious medical condition³. Hemodialysis defined as a help remove toxins and excess fluid from the body while the kidney heal. Hemodialysis may help to remove excess potassium from the body. During hemodialysis, a machine pumps a blood out of body through an artificial kidney (dialyser0 that filters out waste. Then blood is returned to the body⁴ The global average prevalence for hemodialysis was 215 patients per million population, although significant regional variations existed. By the year 2010, It is expected that the number of dialysis patients approach 2 million. Currently, there was over one million of dialysis patients worldwide, with as incidence of a, million new patients each year⁵. In India, the highest prevalence of CKD was observed in vishakapatnam 46% followed by Kanpur 41.7% and Delhi 41% The lowest prevalence were in Mysore 4.2% and Bangalore⁶.

 

MATERIALS AND METHODS:

Research Approach:

An Evaluative approach was used for this study.

Research Design:

The research design selected for the study was Quasi experimental nonequivalent pre-test and post-test control group design.

Setting of the study:

The study was conducted in selected hospitals at Erode.

Population:

The target population selected for the study were patients undergoing hemodialysis.

Sample:

Patients undergoing hemodialysis.

Sample Size:

Sample size for the study was 60, 30 sample were in experimental group and 30 were in control group.

Sampling Technique:

Non probability purposive sampling technique was used to select the sample for the study

 

Instrument and Scoring Procedure:

The instrument consists of 4 section.

Part I:

It consists of demographic variables such as Age, Sex, Marital status, Educational status, Occupation, Religion, Family monthly income, Type of family, Area of residence, Duration of treatment, Cycle of hemodialysis per month.

 

Part II: 

Numerical rating scale was used to assess the level of pain among patients undergoing hemodialysis.

Part III:

Iowa fatigue scale was used to assess the level of fatigue among patients undergoing hemodialysis

Part IV:

KDQOLTM³⁶questionnairewas used to assessed the quality of life among patients undergoing hemodialysis

 

Validity:

The validity of the tool was established in consultation with 3 nursing experts Medical and surgical nursing department and 2 nephrology specialist.

 

Reliability:

The reliability of the numerical rating scale was established by testing the internal consistency by using Karl Pearson correlation formula and it was found to be reliable (r = 0.7) Reliability of Iowa fatigue scale was established by testing the internal consistency by using Chronbach’s alpha formula and it was found to be reliable (r = 0.6). Reliability of KDQOL^TM-36 questionnaire was established and assessed by using Cronbachs alpha formula and found to be reliable (r=0.9).

 

PROTECTING THE HUMAN SUBJECTS:

The research proposal was approved by the dissertation committee prior to conduction of pilot study and main study. The written permission was obtained from The chief Medical officer and written consent was obtained from each participants before starting the data collection and confidentiality was maintained of Hemodialysis centre. The verbal consent was obtained from the-each hemodialysis patients after explaining the purpose of the study.

 

Data Collection Procedure:

The main study was conducted at Erode. Data collection was done for a period of 6 weeks. The investigator obtained written permission from the hospital. The written permission was obtained from each participant prior to the study. The purpose of the study was explained to the subjects. Based on the inclusion criteria 60 samples were selected by using purposive sampling technique. Out of which 30 samples were experimental group and 30 were control group. Researcher took the samples from first 3 shifts of the patients with hemodialysis. on first day 15 samples were selected. On first day, the demographic variables was collected by using interview method and selected 30 samples for the experimental group. Demographic variables were collected by interview and then the pre-test was conducted to the participants by using numerical rating scale on third day intradialytic leg exercise programme was detail explained for each patients. The leg exercise program was involved the following: Each session begin with 5 minutes warm up (extension, flexion, internal and external rotation (for the hip, knee, and ankle). Then 5 minutes cycling on the cycle ergometer. After rest for 5 minutes. Another 5 minutes cycling on cycle ergometer. Finally, the exercise ends with 5 minutes cooling down (stretching). The exercise program was performed during the first 2 hours of hemodialysis session with patients on supine position to avoid intradialytic hypotension. During exercise, the patients were monitored and connected to the cardiac monitor. Blood pressure, heart rate and respiratory rate were monitored. All patients were observed during exercise program. The patients were frequently whether they were experiencing any problem such as pain, headache, dizziness, fatigue, chest pain during exercise furthermore, the patients were told to notify and stop exercise if they felt following problem: headache, dizziness, nausea, exhaustion, palpitations or any other problems. On the other hand, the control group were receiving the routine dialysis care. For the both groups data were recollected using the same tool after 6 weeks end of the programme. The collected data were tabulated and analysed by using descriptive statistics and inferential statistics.

 

RESULT AND DISCUSSION:

In the experimental group Regarding age (10%) belongs to 35-45yrs, (54%) belongs to 46-55yrs, 11(36%) belongs to above 65yrs. In control group (13%) belongs to 35- 45yrs (60%) belongs to 46 – 55yrs, (27%) belongs to 65 and above. Regarding sex (94%) belongs to Male, (6%) belongs to Female, In control group (97%) belongs to Male, (3%) belongs to Female. Regarding marital status, (97%) belongs to Married, (3%) belongs to Unmarried. In control group (97%) belongs to Married, (6%) were Unmarried Regarding educational status (37%) were No formal education, (53%) belongs to Primary education, (3%) belongs to Higher secondary, (7%) belongs to Graduate. In control (34%) belongs to no Formal education, (50%) belongs to Primary education, (3%) belongs to Secondary education, (3%) belongs to Higher secondary education, (10%) belongs to Graduate. Regarding occupation (24%) belongs to private employee, (3%) belongs to government employee, (13%) belongs to Self-employee, (60%) belongs to Un employee. In control group, (13%) belongs to Private employee 1(3%) belongs to Government employee, (24%) belongs to Self-employee (60%) belongs to Un employee. Regarding religion (84%) belongs to Hindu, (10%) belongs to Christian, (6%) belongs to Muslim. In control group (84%) belongs to Hindu, (6%) belongs to Christian, (10%) belongs to Muslim. Regarding family monthly income (57%) below 5000, (43%) belongs to Rs.5001 to 10000. In control group (67%) belongs to below Rs.5000, (23%) belongs to Rs.5001 -10000, (10%) belongs to 10001 – 15000. Regarding type of Family, (37%) belongs to Nuclear family, (63%) belongs to joint family. In control group (67%) belongs to Nuclear family, (33%) belongs to Joint family. Regarding area of Residence 11(37%) belongs to Rural, (63%) belongs to Urban. In control group (54%) belongs to Rural, (46%) belongs to city. Regarding, duration of treatment (17%) belongs to 1-6 months, (33%) belongs to 7 - 12 months, (30%) belongs to 4- 6 years, (20%) 6 years and above. In control group (17%) belongs to 1-6 months, (20%) belongs to 7-12 months, (33%) belongs to 4-6 years, (30%) belongs to 6 yr and above. Regarding cycle of hemodialysis per month (67%) belongs to 8-10 cycle, (33%) belongs to 11-13 cycle, In control group (50%) belongs to 8-10 cycle, (50%) belongs to 11-13 cycle.

 

TABLE 1: Comparison of mean, standard deviation and paired ‘t’ test value of pre-test and post-test level of pain among patient undergoing hemodialysis in experimental group.   n₁=30

df=29                                                                       p<0.05

 

Table 1: showed that the mean pre-test scores of level of pain in experimental group 4.5 (SD±1.48) and post-test mean score is 2.6 (SD±1.37) and mean difference is 2.03. The paired ‘t’ value was 6.65. which was significant at p<0.05 level, which showed that the intradialytic leg exercise is effective in reducing the level of pain.

 

Table 2: showed that the pre-test score of level of fatigue in experimental group is 33.3 (SD ±21.97) and post-test mean score is 28.4 (SD±10.16) and mean difference is 6.83. The paired ‘t’ value was 7.758 which was significant at P< 0.05 level, which showed that the intradialytic leg exercise was effective in reducing the level of fatigue.

 

 

Table 2: Comparison of mean and standard deviation and paired ‘t’ value of pre test and post test level of fatigue among patients undergoing hemodialysis.   n=30

df=29  p<0.05

 

 

 

 

Table 3: Comparison of mean and standard deviation and paired ‘t’ test and post-test level of quality of life patients undergoing hemodialysis in experimental group.                n=30

df=29  p<0.05

 

Table 4: Comparison of mean, standard deviation and independent ‘t’ value of post-test level of pain among patients undergoing hemodialysis between experimental group and control group.                  n₁=30, n₂=30

df=58  p<0.05

 

Table 5: Comparison of mean, standard deviation and independent ‘t’ value of post-test level of fatigue among patients undergoing hemodialysis between experimental group and control group.                                                                                            n₁=30, n₂=30

df=58   p<0.05

 

Table 6: Comparison of mean, standard deviation and independent ‘t’ value of post-test level of quality of life among patients undergoing hemodialysis between experimental group and control group.    n₁=30, n₂=30

df=58   p<0.05

 

Table 3: Table showed that the mean pre-test score of level of quality of life in experimental group was 103.93 (SD±7.68) and post-test mean scores 117.53(SD ±13.14) and mean difference was 20.06 The post-test mean score was higher than the pre-test mean score 103.93. The paired ‘t’ value was 13.38 which was significantly at p<0.05 level, which showed that the intradialytic leg exercise intervention was effective in improving the quality of life.

 

Table 4: showed that the mean post test score of level of pain in experimental group was 2.6(SD±1.37) and mean difference was 2.6. significantly lower than the mean post test score of control group 5.10(SD±1.47). The independent ‘t’ value was 8.628 which was significantly at p<0.05. Which showed that intradialytic leg exercise is effective in reducing the level of pain in experimental group than the control group.

 

Table 5: Showed that the mean post test score of level of fatigue in experimental group 28.5(SD±10.16) was significantly lower than the mean post test score of control group 34.06 (SD ±17.50) and mean difference was 6.6. The independent ‘t’ value was 6.7408 which was significantly at p<0.05.Which showed that intradialytic leg exercise was effective in reducing the level of fatigue in experimental group than the control group.

 

Table 6: Showed that that the mean post-test level of quality of life scores in experimental group 117.53(SD ±13.14) was significantly higher than the mean pre-test level of quality of life scores in control group 98.73(SD ±8.961) and mean difference is 25.66 The independent ‘t’ value was 9.813 which was significant at P<0.05 level Which showed that intradialytic leg exercise was effective in improving the level of quality of life in experimental group than the control group.

 

CONCLUSION:

The present study was conducted to assess the effectiveness of intradialytic leg exercise on pain, fatigue and quality of life among patients undergoing hemodialysis in selected hospitals at Erode. The independent ‘t’ value for level of pain was 8.62 which was significant at p<0.05 level. The independent ‘t’ value for level of fatigue was 6.74 which was significant at p<0.05 level. The independent ‘t’ value was 106.93 which was significant at P<0.05 level. The result of the study concluded that intradialytic leg exercise programme was effective in reducing the pain, fatigue and improving the quality of life with patients undergoing hemodialysis.

 

IMPLICATIONS:

The findings of the study have certain important for nursing service, nursing education, nursing administration, and nursing research.

 

Nursing Service:

·       The nurse can organise in – service education about the nonpharmacological measures used in treating patients undergoing hemodialysis.

·       Nurse as the change agent, can introduce the various measures for the reduction of pain, fatigue and improving quality of life among patients undergoing hemodialysis who were admitted in the hospitals.

·       Nursing service department must arrange health education for the hemodialysis patients regarding intradialytic leg exercise programme to reduce the muscle pain, fatigue, muscle cramps.

 

Nursing Education:

·       Nurse educator can train and encourage the student nurses to utilize intradialytic leg exercise as an alternative complimentary therapy to reduce of pain and fatigue and improving the quality of life.

·       Nurse educators can motivate student nurses to explore new strategies for effective reduction of pain and fatigue.

·       Nurse educators should motivate the students to do mini projects on techniques to reduce the pain, fatigue and improving the quality of life.

·       This research report can be kept in library for reference of nursing personels. And other health care professionals.

·       Intradialytic leg exercise intervention can be integrated with nursing curriculum.

·       The nurse educators must to conduct in service education program / seminars to update knowledge of the students and to promote practicing alternative therapies among patients undergoing hemodialysis.

 

Nursing Administration

·       Nursing administrator can prepare the protocol regarding intradialytic stretching exercise.

·       Intradialytic leg exercise is one of the best nursing intervention in reducing pain, fatigue, and improving quality of life among patients undergoing hemodialysis.

·       The nurse administrator should encourage the student and staff members to actively participate in seminars, workshop and conferences regarding intradialytic leg exercise in reducing pain, fatigue and quality of life.

·       Intradialytic leg exercise can be recommended in the hospital along with routine management of pain and fatigue.

·       Nurse administrator can recognize intradialytic leg exercise as cheap, low cost-effective method in the management of pain and fatigue.

·       Nursing administrator can instruct and encourage their subordinate to utilize this as a intervention in their clinical setting.

 

Nursing Research:

·       The study findings can be a baseline for further studies to build upon for improving the body of knowledge in nursing.

·       The study findings should be effectively utilised by the emerging researchers to conduct further studies.

 

RECOMMENDATIONS:

Based on the findings the following recommendations are stated,

·       A similar study can be replicated in a larger-samples there by findings can be generalized to a large population.

·       Comparative study the between intradialytic leg exercise and other nonpharmacological methods in reducing the pain, fatigue and improving quality of life.

·       Longitudinal study can be done between the effectiveness of intradialytic leg exercise programme among patients undergoing hemodialysis.

·       A study can be done by maximizing the time and duration of programme among patients undergoing hemodialysis.

 

LIMITATIONS:

The intervention would be more effective if it is extended for a period of 8 weeks.

 

REFERENCES:

1.     Lewis, et al., Assessment and management of clinical problems 6^th edition., (2007); Pp:1217.

2.     Black M Joyce., clinical management for positive outcome Medical surgical Nursing 7^th edition volume 1. Pp: 949

3.     Subish Jose., et al. Effectiveness of intradialytic leg exercise on Fatigue and activities of daily living among patients subjected to hemodialysis Journal of science (2014); 4(1)

4.     Mrs. Seham Fahad AL, Rashedi, et.al. Effectiveness of intradialytic leg exercise on dialysis efficacy among patients undergoing hemodialysis International Journal of Advanced Research and Innovative ideas in Education (2017)., 4(1)

5.     Yuanmay Chang., et.al. The Effectiveness of intradialytic leg ergometry exercise for improving sedentary life style and fatigue among patients with chronic kidney disease: A randomised clinical trial International journal of Nursing Studies 47 (2010); Pp:1383-1388

6.     Wioletta Dziubek., et. al. The Effects of aquatic exercises on physical fitness and muscle function in dialysis patients Bio Med Research International (2015)

 

 

 

 

Received on 04.12.2020          Modified on 18.01.2021

Accepted on 10.02.2021       ©A&V Publications All right reserved