ASSESS THE IMMEDIATE EFFECTS OF EFFLEURAGE BACK MASSAGE ON SELECTED PHYSIOLOGICAL AND
PSYCHOLOGICAL RESPONSES AMONG PATIENTS WITH LOW BACK PAIN IN SELECTED HOSPITAL AT
KANYAKUMARI DISTRICT.
A DISSERTATION SUBMITTED TO THE TAMIL NADU Dr. M.G.R. MEDICAL UNIVERSITY, CHENNAI, IN
PARTIAL FULFILLMENT OF REQUIREMENT FOR THE DEGREE OF MASTER OF
SCIENCE IN NURSING
APRIL 2011
A STUDY TO ASSESS THE IMMEDIATE EFFECTS OF EFFLEURAGE BACK MASSAGE ON SELECTED PHYSIOLOGICAL AND PSYCHOLOGICAL RESPONSES AMONG PATIENTS WITH LOW BACK PAIN AT SELECTED
HOSPITAL IN KANYAKUMARI DISTRICT
.APPROVED BY THE DISSSERTATION
COMMITTEE ON : 15-09-2009
RESEARCH GUIDE : ___________________________________________
Prof. (MRS). SANTHI APPAVU, M.Sc(N), M.Phil(N).
PRINCIPAL & HEAD OF THE DEPARTMENT OF MEDICAL & SURGICAL NURSING
CHRISTIAN COLLEGE OF NURSING, NEYYOOR.
KANYA KUMARI DISTRICT.
CLINICAL GUIDE : _____________________________________________
Prof.(MRS.)S.S.SHARMILA JANSI RANI, M.Sc(N), M.A.,M.Phil.,
PROFESSOR IN MEDICAL SURGICAL NURSING, CHRISTIAN COLLEGE OF NURSING, NEYYOOR.
KANYA KUMARI DISTRICT.
MEDICAL GUIDE : ___________________________________________
DR.N.R.CHENTHIL KUMAR MBBS, MRCS Ed(Uk), CIPP-CPP(Uk),
Mch.,ortho(L.pool.Uk)
CONSULTANT ORTHOPAEDIC SURGEON J.K,HOSPITAL, KRISHNAN KOVIL
A DISSERTATION SUBMITTED TO THE TAMIL NADU Dr. M.G.R. MEDICAL UNIVERSITY, CHENNAI, IN
PARTIAL FULFILLMENT OF REQUIREMENT FOR THE DEGREE OF MASTER OF
SCIENCE IN NURSING
APRIL 2011
A STUDY TO ASSESS THE IMMEDIATE EFFECTS OF EFFLEURAGE BACK MASSAGE ON SELECTED PHYSIOLOGICAL AND PSYCHOLOGICAL RESPONSES AMONG PATIENTS WITH LOW BACK PAIN IN SELECTED
HOSPITAL AT KANYAKUMARI DISTRICT.
Submitted in partial fulfillment of the requirement for the degree of Master of Science in Nursing, The Tamil Nadu DR. M.G.R. Medical University, Chennai.
--- --- Internal Examiner External Examiner
APRIL 2011
DECLARATION
The investigator, II Year M.Sc., Nursing student of Christian College of Nursing, Neyyoor do hereby declare that this thesis, “A study to assess the immediate effects of effleurage back massage on selected physiological and psychological responses among Patients with low back pain in selected hospital at Kanyakumari District” has not been submitted by me for the award of any degree, diploma, title or recognition earlier.
………
Investigator
CERTIFICATE
Certified that the thesis “A study to assess the immediate effects of effleurage back massage on selected physiological and psychological responses among Patients with low
back pain in selected hospital at Kanyakumari District” is a bonafide work by Grace Vijaya . D, II Year M.Sc., Nursing student of Christian College of Nursing, Neyyoor
submitted in partial fulfillment of requirement for the Degree Master of Science in Nursing to the Tamil Nadu, Dr. M.G.R. Medical University, Chennai, April 2011.
Date: Signature of the Principal
ACKNOWLEDGEMENT
“Great and mighty is the lord – our God to whom all things belong, I done before lord for all wisdom, knowledge, strength and guidance which lead to the completion of this book”.
My head bows down and my heart filled with joy and immense gratitude before the almighty God who enabled me to accomplish this study.
I owe a deep sense of gratitude to all those who have contributed to the successful completion of this endeavor. It is my honor to thank Rt.Rev.G. Devakadasham, MA, BD, MTh Bishop, CSI Kanyakumari Diocese for providing me the great opportunity to undertake this course of study. I express my sincere thanks to Adv. S.Sunder singh B.Sc., LL.B., correspondent Christian college of Nursing, Neyyoor for his administrative support for the successful completion of the study.
I express my sincere gratitude from the bottom of my heart to Prof.(Mrs.) Santhi Appavu MSc(N), M.Phil(N), Principal, Christian college of Nursing,
Neyyoor for the unequivocal support, ethical guidance and constructive criticism.
This study has been undertaken and completed under the inspiration, motivation and prompt guidance from Prof.(Mrs.) S.S. Sharmila Jansi Rani M.Sc(N)., M.A., M.Phil., Professor in Medical Surgical Nursing, Christian college of nursing, Neyyoor. I am sure that no words are adequate to extent my deepest gratitude for her active involvement and contribution in this study for making it a successful one.
I owe my deepest gratitude to Dr.N.R.Chenthil Kumar MBBS, MRCS Ed(Uk), CIPP-CPP(Uk), Mch.,Ortho (L.pool.Uk) Consultant Orthopaedic Surgeon, J.K,Hospital, Krishnan Kovil for his valuable guidance and Support throughout the study.
I extent my sincere thanks to biostatistician Mr. Arumugam, M.Sc, M.Phil, Rtd. Professor in statistics Govt. Medical college, Tirunelveli for his expert guidance in statistical analysis.
I thank the librarians Mrs. Pramila M.L.I.Sc; M.Phil and Mr. Gnanadhas, C.O.T., D.O.T., for the help rendered to collect the literature.
I express my gratitude to my Husband Mr. G.k.Yesuraj, My Son Ben Franklin, for the support, Encouragement and constant prayer during the course of my study.
I extend my gratitude to all my classmates and friends who encouraged me through out the study.
I heartfully thank all the staff of Mini Internet Café, Thingal Nagar who helped me in bringing out my work into text form.
I express my thankfulness to all those who directly and indirectly contributed for this study.
I extend my deepest gratitude to all those Low back pain Patients who participated in this study.
INDEX
CHAPTER
NO TITLE PAGE
NO.
I INTRODUCTION 1-9
Need for the study 4-6
Statement of the problem 7
Objectives 7
Hypotheses 7
Operational Definitions 8-9
Assumptions 9
Limitation 9
Projected outcome 9
II REVIEW OF LITERATURE 10—16
Physiological responses among low back pain 10-12 Psychological responses among low back pain 12
Effleurage back massage on low back pain 13-14
Conceptual frame work 15-16
III METHODOLOGY 17-23
Research Approach 17
Research design 17
Setting 18
Population 18
Sampling 18
Sampling Technique 18-19
Criteria for sample selection 19
Table continues…
CHAPTER
NO TITLE PAGE
NO.
Variables 19
Data collection tools and techniques 19-20
Validity 21
Reliability 21
Scoring interpretation 21-22
Pilot study 22-23
Data Collection Procedure 23
Plan for data analysis
Ethical consideration 23
IV DATA ANALYSIS AND INTERPRETATION 24-50
V DISCUSSION 51-54
VI SUMMARY, CONCLUSION, IMPLICATION AND RECOMMENDATION
55-58
REFERENCE 59-60
APPENDICES i-
LIST OF TABLES
TABLE
NO TITLE PAGE
NO.
1. Frequency and percentage wise distribution of demographic variables of low back pain patients
26
2. Assessing the level of pain on each day before and after effleurage back massage
32
3. Assessment of anxiety beach day before and after massage. 35 4. Effect of effleurage back massage on temperature day wise. 38 5. Effect of effleurage back massage on pulse day wise 39 6. Effect of effleurage back massage on respiration day wise 40 7. Effect of effleurage back massage on diastolic blood pressure day
wise 41
8. Effect of effleurage back massage on
Systolic blood pressure day wise 42
9. Effect of effleurage massage on pain relief 43 10. Response of anxiety to the effect of effleurage back massage (day
wise) 44
11. Association between the age with pain and anxiety 45 12. Association between the sex with pain
And anxiety 46
13. Association between the religion withpain and anxiety 46 14. Association between educational level with pain and anxiety 47 15. Associations between occupation with the pain and anxiety 48 16. Association between income with pain and anxiety 48 17. Association between martial status
With pain and anxiety 49
18. Association between type of family with pain and anxiety 50
LIST OF FIGURES
FIGURE
NO FIGURES NAME PAGE
NO.
1. Conceptual Frame work based on Callista Roy’s adaptation model (1984)
16
2. Description and comparison of demographic characteristics according to their age
28
3. Description and comparison of demographic characteristics according to their sex
28
4. Description and comparison of demographic characteristics according to their religion
29
5. Description and comparison of demographic characteristics according to their educational status
29
6. Description and comparison of demographic characteristics according to their occupational status
30
7. Description and comparison of demographic characteristics according to their monthly income (rupees)
30
8. Description and comparison of demographic characteristics according to their marital status
31
9. Description and comparison of demographic characteristics according to their type of family
31
10. Assessment of pain before and after effleurage massage – day 1
33
11. Assessment of pain before and after effleurage massage – day 2
33
12. Assessment of pain before and after effleurage massage – day 3
34
13. Assessment of anxiety among low back pain patients before and after effleurage massage – day 1
36
14. Assessment of anxiety among low back pain patients before and after effleurage massage – day 2
36
15. Assessment of anxiety among low back pain patients before and after effleurage massage – day 3
37
APPENDICES
SL. NO TITLE PAGE
NO.
A Tools for data collection i-xxi
Section A : Demographic variables i-xiii Section B : State – triat anxiety scale (S – anxiety scale) xiv-xviii Section C : Bio – physiological parameters xix-xx Section D : Visual, Analog Numeric Scale xxi-xxii B Effleurage back massage procedure xxiii-xl C Letter seeking permission to conduct research study xli D Certificate regarding training of back massage xlii E Letter seeking experts opinion for the validity of tool xliii F List of experts who have validated the tool xliv G Evaluation criteria check list for tool validation xlv
H Schematic representation xlvi
I Description of the tool xlvii
J Score obtained by the respondents xlviii-l
ABSTRACT
The purpose of the study to assess the immediate effects of effleurage back massage on selected physiological and psychological responses among patients with low back pain in selected hospital at Kanyakumari District”
The objectives of the study were
1. To assess the physiological responses of patients with low back pain before and after effleurage back massage
2. To assess the psychological responses of patients with low back pain before and after effleurage back massage
3. To determine the association between selected demographic variable and physiological, psychological responses of patients with low back pain.
4. To assess the level of pain with low back pain patients before and after effleurage back massage.
The hypotheses of the study were
H1 : There will be a significant relationship between the patients
with low back pain before and after effleurage back massage at the level of 0.001 significance.
H2 : There will be a significant relationship between physiological
responses of patients with low back pain before and after effleurage back massage at the level of 0.001 significance. .
H3 : There will be a significant relationship between psychological
responses of patients with low back pain before and after effleurage back massage at the level of 0.001 significance.
.
H4 : There will be significant association between selected demographic variables such as such as age, sex, religion occupation, education, monthly income, marital Status, family structure and pain, psychological responses of patients with low back pain at the level of 0.05 significance. .
The study was based on Callista Roy’s Adaptation Model (1984). The design used for the study was quasi-experimental design. Purposive sampling technique was used for selecting the samples. The data collection tool developed for generating the necessary data was a S- anxiety scale. The content validity of the tool was established by 5 experts.
The reliability was the tool inter-tested method ( ϒ =.972) the tool was found to be reliable. Pilot study was conducted to find out the feasibility of the study. The tool was administered to the subjects and the data obtained were classified, grouped and analyzed based on the objectives and hypotheses formulated for the study.
The major findings of the study were
In day - 1 pretest, 36.7 % patients had moderate anxiety and 31.7% patients had moderate pain, 63.3% patients had very much anxiety and 68.3% had severe pain. In day – 1 posttest, 71.7% had moderate anxiety and 66.7% had moderate pain, 28.3% had very severe anxiety and 33.3% had severe pain. In day – 2 pretest, 8.3% had somewhat anxiety, 78.3% had moderate anxiety and 70% had moderate pain, 13.4% had very much anxiety and 30.0% had severe pain. In posttest, 63.3% had somewhat anxiety and 3.3%
had mild pain, 36.7% moderate anxiety and 91.7% had moderate pain, no patients had very much anxiety and 5% had severe pain. In day – 3 pretest, 75% had somewhat anxiety and 30% had mild pain, 23.3% had moderate anxiety and 70% had moderate pain, no patients had very much anxiety and severe pain. In posttest, 30.3% had somewhat anxiety and 95% had mild pain and 5% had moderate pain. From day – 1 to day – 3, mean temperature is 38.65 in pretest and 98.19 in posttest, the ‘t’ value 12.027 which was
significant at P < 0.001. from day -1 to day – 3, mean pulse in posttest 80.5 was slightly lower than pretest mean score 85.8, the ‘t’ value is 22.088 was also significant at P< 0.001.
. These findings showed that the effectiveness of effleurage back massage was effectively in reducing pain physiological and psychological responses among low back pain patients. Thus effleurage back massage played. An important role in reducing pain, physiological and psychological responses among low back pain patients.
CHAPTER I
INTRODUCTION
“Massage is the study of anatomy in Braille”.
- Jack Meagher Back pain disability is the greatest industrial health problem in the United States and is growing at staggering rates in western society as a whole. Research shows that back pain will afflict most of us, during the course of a lifetime (Susan, 2006).
Low back pain are the most common reason for health care visits.
The pain usually results from problems with the spine, including the bones of the spine(vertebrae)and the most muscles and ligaments that support it. Occasionally low back pain results from another disorder such as a stomach ulcer, pneumonia, Premenstrual syndrome, or infection of the prostate gland. Some disorders only cause low back pain (Halis, 2000).
Low back pain is one of the main reasons Americans visits their doctor. For adults over forty, it ranks 3rd as a cause for doctor visits, after heart disease and arthritis 80 % of the people will have low back pain at some point in their lives. Nearly everyone who has low back pain once will have it again and the numbers of people with chronic, debilitating low back pain is growing (Fierd, 2000).
Sachin Tendulkar a famous cricket player he is suffered with chronic back problem flared up when Pakistan toured India in 1999, with India loosing the history test at chepauk despite. A gritty century from tendulkar itself the worst was yet to come as professor Ramesh tendulkar
Tendulkar’s Father, died in the middle of the 1999 cricket world cup (Antony, 2001).
Low back pain in general practice among 50 patients aged 18-75 years of selected hospital of Canada. Among 463 Patients with new episode of low back pain 275(59%) had only a single consultation and 150(32%) had repeat consultation and only 21 % and 25% had completed recovered in terms of pain and disability. The results showed that 90% of patients with showed that 90% of patients with low back pain will have consulting with symptoms within three months and most will be experiencing low back pain and related disability one year after consultation (Peter R Croft, 2007).
Back pain anxiety is a common experience for the majority of patients with chronic dorsopathy. Anxiety is created out of fear and uncertainly for one’s own future. Back pain is a condition which robs patients of their functionally, hopes and aspirations. It is no surprise that many patients develop back pain related and general anxiety after suffering with severe pain for extended periods of time (David, 2006).
Fear and anxiety are part of life. Feeling anxious before a stressful event or while walking down a dark street are useful- these kind of responses can make you more alert or careful. Normal healthy anxiety usually ends soon after you are out of the situation that caused it. But for 40 million adults in the united states, feeling of anxiety do not go away and get worst overtime Anxiety range from Feelings of uneasiness to immobilzing bouts of terror (Allen, 2003).
Chronic back pain may be the expression of an underlying depressive disturbance; this is called a marked depression. Treatment of the depression symptoms is an important goal in the management of back pain especially the depression will prevent the patient from feeling motivated towards recovery (David, 2002).
Chatchawan (2005) had conducted a study on the immediate effects of traditional massage on stress related parameters in patients with low back pain 50 patients were randomly selected to receive a 30min session for one session. Results indicated that there was significant decrease in self reported pain intensity, anxiety and muscle tension (P<0.001) and conduced that there will be improved stress related there will be improved stress related parameters in this patient populations.
The effleurage back massage consists of stroking or glinding movements are performed with the whole hand in contact with the whole hand in contact with the client’s skin and with fingers. kept close together .the stroke is used at the beginning and at the end of series or the connect various stages. Of the undefined treatments because movements should be smooth and soothing contact with the movements performed slowly without interruption undefined means to stroke or to skin over (Hollis, 2006).
Effleurage can be firm of light stroke without dragging the skin and is performed using either the skin and is performed using either the padded parts of the finger tips or the palmer surface of the hands are works as a Mechanical pump on the body to encourage venous and lymphatic return (Halls, 2002).
Back massage is effective on all the physiological responses included blood pressure, pulse respiratory rate and psychological responses anxiety level. Oils are made up of plants essence and are used to reduce anxiety, stress or insomnia, relax r energize and simply add a pleasurable element to the massage (Stewart, 2000).
Adams (2010) had conducted a study on the effects of massage therapy on pain management in the acute care setting. Pain levels before and after massage therapy were recorded using a 0 – 10 visual analog scale. Quantitative and qualitative methods were used for analysis of this descriptive study. A sample of Hospital inpatients (n = 53) from medical, surgical, and obstetrics units participated in the current research by each receiving one or more massage therapy sessions averaging 30 minutes each. The number of sessions received depended on the length of the hospital stay. The study demonstrated not only significant reduction in pain levels, but also the interrelatedness of pain, relaxation, sleep, emotions, recovery, and finally, the healing process.
NEED FOR THE STUDY
Musculoskeletal disorders are the most common causes of severe long term pain and physical disability affecting hundreds of millions of people around the world. Joint diseases for example account for more than half of all chronic conditions in persons aged 60 years and over; and back pain is the second leading cause of sick leave despite their enormous impact worldwide they do not receive the attention they deserve and are inadequately funded (Lindgren, 2010)
Pain in the soft tissues of the back is extremely common among adults. In the United States, the National Arthritis Data Workgroup reviewed national survey data showing that each year some 15% of adults report frequent back pain or pain lasting more than two weeks [Lawrence 1998]. Back pain is widespread in many countries, and is associated with substantial financial costs and loss of quality of life. In Canada, Finland and the United States, more people are disabled from working as a result of musculoskeletal disorders (MSDs) - especially back pain - than from any other group of diseases (Riihimäki, 1995). MSDs constitute a major proportion of all registered and/or compensable work-related diseases in many countries, representing a third or more of all registered occupational diseases in North America, the Nordic countries and Japan (Laura, 2005).
Musculoskeletal conditions are a major burden on individuals, health systems, and social care systems, with indirect costs being predominant. This burden has been recognized by the United Nations and WHO, by endorsing the Bone and Joint Decade 2000-2010. This paper describes the burden of four major musculoskeletal conditions:
osteoarthritis, rheumatoid arthritis, osteoporosis, and low back pain.
Osteoarthritis, which is characterized by loss of joint cartilage that leads to pain and loss of function primarily in the knees and hips, affects 9.6%
of men and 18% of women aged >60 years. Increases in life expectancy and ageing populations are expected to make osteoarthritis the fourth leading cause of disability by the year 2020. Joint replacement surgery, where available, provides effective relief. Rheumatoid arthritis is an
inflammatory condition that usually affects multiple joints. It affects 0.3- 1.0% of the general population and is more prevalent among women and in developed countries. Persistent inflammation leads to joint destruction, but the disease can be controlled with drugs. The incidence may be on the decline, but the increase in the number of older people in some regions makes it difficult to estimate future prevalence. Osteoporosis, which is characterized by low bone mass and micro architectural deterioration, is a major risk factor for fractures of the hip, vertebrae, and distal forearm.
Hip fracture is the most detrimental fracture, being associated with 20%
mortality and 50% permanent loss in function. Low back pain is the most prevalent of musculoskeletal conditions; it affects nearly everyone at some point in time and about 4-33% of the population at any given point.
Cultural factors greatly influence the prevalence and prognosis of low back pain.
Incidence of low backpain in workage adults in rural north India Out of 11234 patients reporting to our outdoor during June 2001 to June 2002, 2594 patients (23.09%) had low back pain. 4358 roentgenograms were done in these patients, a mean of 1.68 per patient. These patients were interviewed and their psychosocial and demographic details were compared with 1000 controls who did not have back pain but attended outdoor for other reasons. In the low back pain group, 67% had psychosocial issues, 57% were in blue-collar jobs, 26% had to change/leave their profession, and 38% did not enjoy their present job.
All patients had used NSAIDS at some stage of illness and 64% were advised exercises for the back. The comparative figures in control group
were 19% with psychosocial issues, 34% in blue-collar jobs (heavy manual workers), 7% had to switch over to new job, 6% did not realize their present job. Hence, it is concluded that along with exercises and NSAIDS, sufficient consideration should be given to short centre-based intensive rehabilitation program followed by a home-based program for chronic low back pain patients.
In India, occurrence of low back pain is also alarming; nearly 60 per cent of the people in India have significant back pain at some time or the other in lives (Suryapani, 1996).
Hospitalization and disease process can place a heavy demand on an individuals Physiological and psychological status. There is a need for a non pharmacological intervention to address all these discomfort as an adjunct to the normal routine care and pharmacological interventions therefore it is necessary for the nurses to adopt some alternative holistic modalities such as yoga, meditation, therapy, effleurage back massage etc so the research have selected effleurage back massage for reducing the symptoms of anxiety and pain and maintain the normal physiological and psychological parameters of low back pain patients.
STATEMENT OF THE PROBLEM
“A study to assess the immediate effects of effleurage back massage on selected physiological and psychological responses among patiens with low back pain at selected hospitals in Kanyakumari district Tamilnadu”
OBJECTIVES
5. To assess the level of pain with low back pain patients before and after effleurage back massage
6. To assess the psychological responses of patients with low back pain before and after effleurage back massage
7. To assess the physiological responses of patients with low back pain before and after effleurage back massage
8. To determine the association between selected demographic variable such as age, sex, religion occupation, education, monthly income ,marital Status, family structure and pain, psychological responses of patients with low back pain.
HYPOTHESES
• There will be a significant relationship between the patients with low back pain before and after effleurage back massage
• There will be a significant relationship between physiological responses of patients with low back pain before and after effleurage back massage.
• There will be a significant relation between psychological responses of patients with low back pain before and after effleurage back massage.
9. There will be significant association between selected demographic variables such as such as age, sex, religion occupation, education, monthly income, marital Status, family structure and pain, psychological responses of patients with low back pain.
OPERATIONAL DEFINITION Assess
To determine the value, significant or extend of damage or to evaluate in this study it estimates the immediate effects of effleurage in reducing pain, physiological and psychological responses among low back pain patients.
Effleurage
Effleurage can be firm or light without dragging the skin and is performed using either the padded parts of the finger tips or the palmer surface of the hands, and works as a mechanical pump on the body to encourage venous and lymphatic return. In this study, effleurage massage refers to firm or light without dragging the skin and is performed using either the padded parts of the finger tips or the palmer surface of the hands.
Low back pain
Low back pain is a common musculoskeletal symptom that may be either acute or chronic. It may be caused by a variety of diseases and disorders that affect the lumbar spine. Low back pain is often accompanied by sciatica, which is pain that involves the sciatic nerve and is felt in the lower back, the buttocks, and the backs of the thighs. In this study low back pain refers to unpleasant emotional experiences and discomfort at lumbar sacral region
Immediate effects
Something will happen with immediate effect or with effect from a particular time. In this study the immediate effect refers to relief of pain, physiological parameters and psychological response.
Physiological response
Physiological response is the body’s response to intense fear. In this study physiological response which includes temperature, pulse, respiration and blood pressure.
Psychological response
Psychological response refers to everyday events which are perceived to be traumatic, difficult to manage. In this study psychological response refers to anxiety.
ASSUMPTIONS
• Sprains , strains, Lumbar muscle strain, Sciatica, Lumbago- patient will have low back pain
• Effleurage back massage relaxes the body and mind and maintains equilibrium.
LIMITATIONS
• The Sample size was limited to 60 low back pain patients
• The study conducted to low back pain patients those who are admitted in the hospital.
• The data collection period was limited to six weeks PROJECTED OUTCOME
• The finding of the study would help the nurse to understand the effects of effleurage back massage among patients with low back pain .
• Effleurage back massage will reduce the cost and duration of treatment and it has no side effect.
•
Effleurage back massage will provide physical and psychological relaxationamong patients with low back pain.
CHAPTER II
REVIEW OF LITERATURE
Researchers almost never conduct a study in intellectual vaccum.
The comparison or the result of a study with earlier finding is often a good point of departure for suggesting new research either to resolve conflicts or to external the knowledge of base (Polit, 2008).
The literature related to the study has been grouped under the following categories,
1. Physiological responses among low back pain 2. Psychological responses among low back pain 3. Effleurage back massage on low back pain Physiological responses among low back pain
Alan (2008) had conducted a study on the effect of deep-tissue massage therapy on blood pressure and heart rate. The study involved 263 volunteers (12% males and 88%
females), with an average age of 48.5. The massages were between 45 and 60 minutes in duration. Results of the present study demonstrated an average systolic pressure reduction of 10.4 mm Hg (p < 0.06), a diastolic pressure reduction of 5.3 mm Hg (p < 0.04), a mean arterial pressure reduction of 7.0 mm Hg (p < 0.47), and an average heart rate reduction of 10.8 beats per minute (p < 0.0003), respectively.
Jerrilyn (2006) had conducted a study on charges in blood pressure after various forms of therapeutic massage. Trigger point therapy and sports massage both increased the systolic and diastolic BP readings significantly increased. No other massage factors were associated with a significant change in BP. Increased in BP were noted for potentially painful Massage techniques including trigger point therapy.
Hernandaz (2000) had conducted a study on high blood pressure and associated symptoms were conducted by massage therapy. Result shows sitting diastolic blood pressure decreased after the first and last massage therapy sessions and reclining diastolic blood pressure decreased from the first to the last day of the study.
Vitsarut (2009) has conducted a study on the immediate effects of traditional thai massage on related parameters in patients with back pain associated worth myofascial trigger points. Thirty-six patients were randomly allocated to receive a 30-min session of either TTM or control (rest on bed) for one session. Results indicated that TTM was associated with significant increases in HRV (increased total power frequency (TPF) and high frequency (HF)), pressure pain threshold (PPT) and body flexibility (p< 0.05) and significant decreases in self-reported pain intensity, anxiety and muscle tension (p< 0.001).
Albert (2008) conducted a study on physiological adjustments to stress measures following massage therapy. A total of 25 studies met all inclusion criteria. A majority of studies employed a 20–30 min massage administered twice-weekly over 5 weeks with evaluations conducted pre- post an individual session (single treatment) or following a series of sessions (multiple treatments). Single treatment reductions in salivary cortisol and heart rate were consistently noted. The evidence shows that the positive effect on diastolic blood pressure has been documented.
While significant improvement has been demonstrated following massage therapy, the general research body on this topic lacks the necessary scientific rigor to provide a definitive understanding of the effect massage therapy has on many physiological variables associated with stress.
Christine (2005) conducted a study on hyper massage in hypertensive persons Hypertension one of the most pervasive disease processes in the united states. This preliminary study tested the effects of a regularly applied back massage on the BP of patients with clinically diagnosed hypertension. In this experimental, pretest-posttest study, a
10-min back massage was given to the experimental group (n = 8), three times a week for 10 sessions. The control group (n = 6) relaxed in the same environment for 10 min, three times a week for 10 sessions.
Analysis of variance determined systolic BP changed significantly, Effect size was 2.25 for systolic pressure and 1.56 for diastolic pressure (alpha of .05 and power at .80). This preliminary study suggests that regular massage may lower BP in hypertensive persons.
2. Psychological responses among low back pain
Billhult (2009) had conducted a study on light pressure massage for patients with severe anxiety. Findings showed that the patients were able to find their own capacity were during the massage period. The experiences were about being relaxed in mind and body and having unconditional attention feeling less anxious and more self confident.
Massage can be used to complement treatments when immediate relief is desirable.
Ester (2004) had conducted a study on the effect of slow stroke back massage on anxiety and shoulder pain in elderly stroke patients. An experimental quantitative design was conducted, comparing the scores for self-reported pain, anxiety, blood pressure, heart rate and pain of two groups of patients before and immediately after, and three days after the intervention. The intervention consisted of ten minutes of slow-stroke back massage (SSBM) for seven consecutive evenings. One hundred and two patients participated in the entire study. The results revealed that the massage intervention significantly reduced the patients’ levels of pain perception and anxiety. All physiological measures (systolic and diastolic blood pressures and heart rate) changed positively, indicating relaxation.
Harris (2000) had conducted a study on the physiological and psychological effects of slow stroke back massage and hand massage on relaxation in olden people The Results in All studies using slow-stroke back massage and hand massage showed statistically significant improvements on physiological or psychological indicators of relaxation.
Jason (2008) had conducted a study on the role of massage in sports performance and rehabilitation current evidence and future direction. To identify current literature
relating to sports massage and its role in effecting an athlete's psychological readiness, in enhancing sports performance, in recovery from exercise and competition, and in the treatment of sports related musculoskeletal injuries. Additional studies examining the physiological and psychological effects of sports massage are necessary in order to assist the sports physical therapist in developing and implementing clinically significant evidence based programs or treatments.
Effleurage back massage on low back pain
Budh (2004) Had conducted a study on non pharmacological pain reliving therapies in spinal card injury 123 patients with spinal cord injury were assessed in a spinal unit in Stockholm 1999 and followed up in a mailed survey 3 years later. 63% of the patients had tried non pharmacological treatments such as acupuncture, massage and transcutaneous nerve stimulation (TENS). Massage and heat were the treatments reported to result in the best pain alleviation
Devon (2000) had conducted a study on effectiveness of massage therapy for subacute low back pain a randomized controlled trial Prey107 Subjects were randomly assigned to 1 of 4 groups They received 6 treatments over a month. The comprehensive massage group had improved function and less intense pain compared with the other 3 groups. At 1 month follow up 63% of the subjects in the massage group reported no pain, compared with 23% of the soft tissue group, 14% of the remedial exercise group, and 0%
of the placebo group.
Cherkin (2009) had conducted a study on Effectiveness of focus structural massage and relatation massage for chronic low back pain. A total of 399 participants (133 in each of three arms) between the ages of 20 and 65 years of age who have low back pain lasting at least 3 months will be recruited from an integrated health care delivery system. For both primary outcome measures, this trial will have at least 85% power to detect the presence of a minimal clinically significant difference among the three treatment groups and 91% power for pair wise comparisons.
Secondary analyses will compare the proportions of participants in each group that improve by a clinically meaningful amount. Results of this trial will help clarify the value of two types of massage therapy for chronic low back pain.
Hernandez (2000) had conducted a study on chronic lower back pain is reduced and range of motion improved with massage therapy. By the end of the study, the massage therapy group as compared to the relaxation group, reported experiencing less pain, depression, anxiety and improved sleep. They also showed improved trunk and pain flexion performance, and their serotonin and dopamine levels were higher.
Uraiwon (2005) had conducted a study on effectiveness of tradiatinal thai massage versus Swedish massage among patients with myofascial trigger points. Swedish massage (SM) was selected as the treatment for the comparison group. One hundred and eighty patients were randomly allocated to receive either TTM or SM for 6 sessions during a 3–4 week period, with follow-up 1 month later. Results indicated that pain intensity, assessed using the visual analog scale (VAS), among patients in both groups was reduced by more than half after 3 weeks of treatment and for up to one month afterwards ( ) with no significant difference in VAS between the groups. We therefore suggest that massage therapy, and in particular Thai massage, be considered as an alternative primary health care treatment for this disorder.
Michele (2000) has conducted a study on effectiveness of massage therapy for subacute low back pain. Subjects with subacute low-back pain were randomlyassigned to 1 of 4 groups: comprehensive massage therapy (n= 25), soft-tissue manipulation only (n = 25), remedial exercisewith posture education only (n = 22) or a placebo of sham laser therapy (n = 26). At 1-month follow-up 63% of subjectsin the comprehensive massage therapy group reported no painas compared with 27% of the soft-tissue manipulation group,14% of the remedial exercise group and 0% of the sham lasertherapy group.
CONCLUSION
Researcher usually undertake a through literature to familiarize themselves with that knowledge based preparation of written review as a optional components of an original research study although most of the activities are similar for other types of review A literature role also play a
role at the end of the study as researchers try to make sense of their findings.
CONCEPTUAL FRAME WORK
Conceptual Framework is brief explanation of a theory or those portions of a theory to be tested in a study (Grove, 2003). The conceptual framework of this study based on the Callista Roy adaptation Model (1984) According to Roy a system is a set of units so related or connected as a form a unity or whole and characterized by inputs, outputs, control process and feedback process.
Input
A stimulus is “the degree of charge or stimulus most immediately confronting the person must make an adaptive response, that is, the factor, that precipitates behaviors” In this study inputs refers to selected demographic variables such as age, sex, religion, education, occupation, monthly income, marital status, family structure , and low back pain patients with abnormal psychological and psychological responses
Control Process
Roy views that perception of the person links the regulator with cognator.
In this study control Process refers to perception of Pain among low &
back pain adults admitted in selected hospitals Kanyakumari.
Effectors
Effectors are the way of copying that manifest regulator and cognator activity. In this study effectors refers to providing effleurage back massage to experimental group.
Output
Adaptive responses are “responses that promote integrity of the person in terms of the goals of survival growth, reproduction and mastery” In effective responses are responses that do not contribute to
adaptive goals that is survival, growth, reproduction and Mastery” In this study output refers to Pain reduced, anxiety relieved, physiological Parameters reduced.
Input Control process Effectors output
Selected Variables
• Age
• Sex
• Education
• Occupatio n
• Religion
• Monthly income
• Martial Statues
Psychologi cal Parameters
S- Anxiety Scale (State
Triat Anxiety Inventory Physiological
Parameters
• Diastolic blood pressure
• Systolic Blood pressure
• Respiratio n
• Temperat ure
Perception of pain among low back pain adults perception of anxiety low back pain adults perception of physiological parameters among low back adults
Providing Effleurag
e back massage
Physiological changes reduced Pain reduced Anxiety relived
FIG - 1 : CALLISTA ROYS ADAPTATION MODEL (1984) Feed back
CHAPTER III
RESEARCH METHODOLOGY
Research Methodology is the research designed to develop or refine methods of obtaining, organizing or analyzing data (Polit, 2008). This chapter deals with research approach, the research design, the setting, population, sample, sampling, technique, criteria for sample selection, variables, development of tools and technique description of the tools and technique, description of the tool, scoring interpretation, validity , reliability, pilot study, data collection procedure plan for data analysis consideration.
RESEARCH APPROACH
Research Approach is the whole design which includes the researcher position and assumptions, the process of enquiry and the way data is collected and analyzed. In this study to accomplish objective of the study the investigator used quantitative approach.
RESEARCH DESIGN
The overall plan for addressing a question, including specifications for enhancing the study’s integrity. The research design selected for this study was quasi experimental one group pretest post test design. The research design selected for this study was one group pre test post test design to assess the immediate effects of effleurage back massage to reduce pain, physiological and psychological responses among patients with low back pain.
Pre-test Intervention Post-test
O1 X O2
O1 = Pre test the level of pain, physiological and psychological responses.
X = effleurage massage
O2 = Post test the level of pain, physiological and psychological responses.
SETTING OF THE STUDY
Setting is physical location and condition in which data collection takes place in a study (Polit, 2008).
In this study was conducted in The J.K.Hospital, Krishnan Kovil, Kanyakumari district. Which was a 150 bedded hospital where average more than 100 patients get admitted per month. Among this 10 to 20 would be relapse patients who will be getting treatment for 30 days.
During the month of data collection there were 40 patients admitted for treatment. Of these 10 where relapse patients. The massage section was given in the ward J.K. hospital, Krishnan kovil is 18 kilometers away from Christian college of nursing Neyyoor.
POPULATION
A group of individuals are objects that meet the common criteria of research interest the target population selected for the study was the patient with low back pain who are all had severe pain, anxiety in J.K.hospital at Krishnakovil.
Population in the entire set of individual or subjects having some common characteristics (Polit, 2008). The population in the study comprised of all the low back pain patients in J.K.Hospital, Krishnancoil, SAMPLE
A subset of a population selected to participate in a study. The first face of the study consisted of 20 patients with low back pain admitted to the ward. After the screening process 10 low back pain patients were selected for the main study that fulfilled the inclusion criteria
SAMPLING TECHNIQUES
A sampling technique describes the strategies that will be used to obtain a sample for a study. In this study the Purposive sampling technique was used to select the sample. The investigator administer the S - anxiety scale Bio physiological parameters, visual analog pain scale and selected the subjects who were having severe pain and anxiety . The sample that met inclusion criteria was selected.
CRITERIA FOR SAMPLE SELECTION
The sample was collected based on the following criteria.
INCLUSION CRITERIA Patients
• Were willing to participate.
• who could speak Tamil or English
• in the age group of 25-60 years.
• who were able to turn and remain in lateral or prone position for 5 -15 Minutes.
• Who were not taken any medication.
EXCLUSION CRITERIA
• Patients who are in a confused and delirious state.
• mentally incompetent clients who were unable to answer question.
• Patients who were not willing to participate in the study
• patients on round the clock sedation and IV/IM analgesics.
VARIABLES
In this study variables are:
DEPENDENT VARIABLES : patients with Low back Pain
patients
INDEPENDENT VARIABLES : Effleurage back massage
DATA COLLECTION TOOL AND TECHNIQUE
The tools used for the study were demographic data, state triat.
Aniety Inventory (S- Anxiety Scale ), Bio-Physiological Parameters and visual analog pain scale .Anxiety scale was based on the objectives of the study and with the guidance of expects in the fields of medical surgical nursing .After getting adequate information from experts, the tools was translated into Tamil.
Selection and development of the tool
To develop is a complex and time consuming process. It consisted of defining the construct to be measured formulating the items assessing the items for content validity developing instruction for respondents pre testing, estimating the reliability and conducting the pilot study. The following methods were used for the development of the tool:
• Review of literature – Books research studies, journals, news papers, online sources.
• Discussion with colleagues
• Consultation and discussion with Nursing expects and doctors
Section A
This section deals with demographic data which included patients age, sex, religion occupation, education, monthly income, marital status and family structure.
Section B
State Trait Anxiety inventory (S- Anxiety Scale) Consisted of twenty items assessed the four areas of worry, tension, apprehension, and nervousness.
Section C
It Consisted of Physiological Parameters like systolic blood pressure, diastolic blood pressure, pulse rate, respiration rate and temperature.
Section D
Visual Analog Numeric Pain Scale Consisted of 0 - 10 Scores. It consists of 10 cm base line at 1 cm interval ranging from 0-10. The visual analog numeric pain scale was explained to the samples subjects and asked to respond to the visual analog scale after every effleurage back massage.
VALIDITY
The content validity of the tool was determined by submitting the performance of 5 experts (two experts from department of Orthopaedics and three experts from medical surgical nursing).All the tools were standardized tool. Then the tool was translated into Tamil by language experts.
RELIABILITY
The reliability of the S- anxiety scale (state trait anxiety inventory) was assessed by testing the stability and internal consistency. The interested method was used to assess the stability the value was found to be reliable (r=.972). The cron bach’s alpha method was used to assess the internal consistency (α =0.730) the values was found to be reliable.
SCORING INTERPRETATION Part I Demographic Variables
Information on demographic data was collected from the patients with low back pain patients with the use of structured questionnaire. This was not scored but used for analysis.
Part II State Trait anxiety inventory
It is an instrument that quantifies adult anxiety. This particular tool was used to simplify the separation between the feelings of anxiety and depression. The state trait anxiety inventory consisted of 40 Question this test was split into the s- Anxiety scale and the T- Anxiety scale each having 20 items the S anxiety scale were answer on the basic of 1- 4 scale including : worry, Tension, apprehension and nervousness it was used to evaluated how respondents feel right now at this movements.
This consists of 0 questions
The scoring for each item is
1 - Not at all
2 - Some what
3 - Moderately
4- - Very Much
Anxiety Scores Percentage
Not at all >20 <25 %
Some what 21- 40 25 - 50 %
Moderately 41- 60 50 – 75 %
Very much 61- 80 75 - 100%
Part III Physiological parameters
Physiological Parameters consisted of systolic blood pressure , diastolic blood pressure, pulse, respiration, and temperature. The mean values and significant of parameters were assessed every day before and after effleurage back massage.
Part IV Visual analog Numeric Pain scale
Visual analog Numeric pain scale consisted to assess the intensity of pain. It consisted of 10 cm base line at 1 cm interval ranging from 0 - 10. The visual analog scale was explained to the sample subjects and asked to response to the visual analog scale before and after every effleurage back massage.
The score allotted was ranging from 0 -10 the score was converted into percentage.
The Scoring for each item is
No pain(0) - 0 %
Mild Pain (1-3) - 10- 30 %
Moderate Pain (4-6) - 40 – 60%
Severe Pain ((7-9) - 70- 90%
Worst Pain (10) - 100%
PILOT STUDY
Pilot study is the rehearsal of the main study. It covers the entire processes of research; Preparation of a Broad Plan of the study, Construction of tools, collection of Data, Processing and Analysis of data and report writing ( Basavanthappa, 2007).
Pilot study was conducted for 6 patients with low back pain Patients with Moderate severe pain and anxiety to find out the effective of effleurage back massage for reducing anxiety, pain and maintain Normal Physiological Parameters in Sharmila Hospital Monday Market for a period of 7 Days. Written Permission was obtained from the Managing director of sharmila hospital oral consent was obtained from the subjects after explaining the purpose of the study. The study was found to be feasible to continue the main study.
DATA COLLECTION PROCEDURE
The study was conducted in J.K.Hospital, Krishna Kovil written permission was obtained from the managing director of J.K.Hospital and oral consent was obtained from the subjects after explaining the purpose
of the study. The data was collected for a period of six weeks in the month of may 1st to June 12th from 60 samples.
The Pretest with demographic variables, bio physiological parameters, S-anxiety Scale , Visual Analog Numeric pain scale was conducted before effleurage back massage and after effleurage back massage bio-physiological , anxiety scale and visual analog numeric pain scale was assessed for consecutive subsequent days for each patients soon after pretest , investigated had perform effleurage back massage for 10 minutes. Post test was conducted on every day after effleurage back massage a gap of 5 minutes to assess physiological responses and a gap of 30 minutes assess psychological responses.
PLAN FOR THE DATA ANALYSIS
This was planned according to the objectives and hypothesis of the study. The data collected were analyzed using descriptive and inferential statistics.
ETHICAL CONSIDERATION
The proposed study was conducted after the approval of the dissertation committee of Christian college of nursing, Neyyoor.
Permission was obtained from the managing Director of J.K.Hospital, Krishnan Kovil. Oral consent was obtained from each sample subject before starting the data collection. Assurance was given to the study subjects that anonymity of each individual would be maintained.
CHAPTER IV
DATA ANALYSIS AND INTERPRETATION
This chapter deals with the statistical analysis and interpretation of the data collected from 60 low back pain patients to assess the immediate effect of effleurage back massage on selected physiological and psychological responses of patients with low back pain in J.K Hospital, Kanyakumari District. The data obtained are classified, gruped and analysis based on the objectives on the hypotheses formulated for the study.
OBJECTIVES OF THE STUDY
10. To assess the level of pain of patients with low back pain before and after effleurage back massage
11. To assess the psychological responses of patients with low back pain before and after effleurage back massage
12. To assess the physiological responses of patients with low back pain before and after effleurage back massage
13. To determine the association between selected demographic variable such as age, sex, religion occupation, education, monthly income ,marital Status, family structure and pain, psychological responses of patients with low back pain.
Section A : Frequency and percentage wise distribution of demographic
variables of low back pain patients.
Section B : Assessment of pain and anxiety before and after intervention
Section C : Assessment of anxiety before and after massage.
Section D : Assessment of effectiveness of massage on physiological Response
Section E : Effect of effleurage massage on the pulse Section F : Effect of effleurage massage on respiration
Section G : Effect of effleurage massage on diastolic blood pressure Section H : effect of effleurage back massage on systolic Blood Pressure
Section I : Effect of effleurage massage on pain relief Section J : Effect of effleurage massage on anxiety relief Section K : Association between pain and anxiety level with
Demographic variables.
Section L : Association between pain and anxiety and selected Demographic variables.
SECTION – A
TABLE – 1 : FREQUENCY AND PERCENTAGE WISE DISTRIBUTION OF DEMOGRAPHIC VARIABLES OF LOW BACK PAIN PATIENTS
N= 60 Sl.No Variables Components of
variables Frequency Percentage 1. Age (years) 25-29
30-34 35-39 40-44 45-49 50-54 55-59
9 9 14
5 11 10 2
15.0 15.0 23.0 8.3 18.3 16.7 3.4
2. Sex Males
Females
32 28
53.3 46.7 3. Religion Christian
Hindu Muslim
25 25 10
41.7 41.7 16.6 4. Educational
Status
Post graduate Graduate
Higher Secondary High School Primary
20 22 9 5 4
33.3 36.7 15.0 8.3 6.7 5. Occupation
Status
Hard Workers House Wives Sedentary Teachers
9 8 23 20
15.0 13.3 38.3 33.3 6. Monthly income
(Rupees)
<5000
5000 -10,000 10,000 -15,000 15,000 – 20,000
11 14 15 14
18.3 23.3 25.0 23.3
20,0000 and above
6 10.0
7. Marital Status Married Unmarried
53 7
88.3 11.7 8. Type of family Nuclear
Joint
35 25
58.3 41.7
The table – 1 shows that the mean age between 25 -29 years9(15%) samples, 30 -34 years 9(15%), 35-39 years 14(23%) samples,40 -44 years 5(8.3 %) samples, 45-49 years 11(18.3%) 50 -54 years 10 (16.7%) Samples 55-59 years 2(3.4%) samples.
In sex males 32 (53.3 %) samples, females 28(46.7%) samples. In religion Christian 25(41.7%) samples, Hindu 25(41.7%) samples, Muslim 10(16.6 %)samples. In educational status post Graduate 20(33.3%)samples, Graduate 22(36.7%)samples, High school 5(8.3%) samples, Primary 4 (6.7%)samples. In occupational status Hard workers 9(15.0%) samples, House wives 8 (13.3%) samples, sedentary 23(38.3%)samples. In monthly income(Rupees) less that Rs 5000 11(18.3%)samples, Rs 5000 – 10,000 14(23.3%) samples, Rs 10,000 – 15,000 15(25.0%) Samples, Rs 15,000 -20,000 14(23.3%) samples.
Above 20 ,000 6 (10.0%) samples. In Martial Status Married 53(88.3%) samples, Unmarried 7 (11.7%)samples, Types of Family Nuclear 35(58.3%)samples and joint family 25(41.7%)Samples Respectively
0 5 10 15 20 25
25 - 29 years
30 - 34 years
35 - 39 years
40 - 44 years
45 - 49 years
50 - 54 years
55 - 59 years 15 15
23.3
8.3
18.3
16.7
3.4
Percentage
Patients
FIG - 2: DESCRIPTION AND COMPARISON OF DEMOGRAPHIC CHARACTERISTICS ACCORDING TO THEIR AGE
43 44 45 46 47 48 49 50 51 52 53 54
Males Females
53.3
46.7
Percenatge
Patients
FIG – 3 : DESCRIPTION AND COMPARISON OF DEMOGRAPHIC CHARACTERISTICS ACCORDING TO THEIR SEX
0 5 10 15 20 25 30 35 40 45
Christians Hindus Muslims
41.7 41.7
16.6
Percentage
Patients
FIG - 4: DESCRIPTION AND COMPARISON OF DEMOGRAPHIC CHARACTERISTICS ACCORDING TO THEIR RELIGION
0 5 10 15 20 25 30 35 40
Post graduation
Graduation Higher secondary
High school
Primary 33.3
36.7
15
8.3 6.7
Percentage
Patients
FIG – 5 : DESCRIPTION AND COMPARISON OF DEMOGRAPHIC
CHARACTERISTICS ACCORDING TO THEIR EDUCATIONAL STATUS
0 5 10 15 20 25 30 35 40
Hard work House wives Sedentary Teachers
15 13.4
38.3
33.3
Percentage
Patients
FIG – 6 : DESCRIPTION AND COMPARISON OF DEMOGRAPHIC CHARACTERISTICS ACCORDING TO THEIR
OCCUPATIONAL STATUS
0 5 10 15 20 25
< 5000 5000 - 10000
10000 - 15000
15000 - 20000
20000 and above 18.3
23.3
25
23.3
10
Percentage
Patients
FIG – 7 : DESCRIPTION AND COMPARISON OF DEMOGRAPHIC CHARACTERISTICS ACCORDING TO THEIR
MONTHLY INCOME (RUPEES)
0 10 20 30 40 50 60 70 80 90
Married Unmarried 88.3
11.7
Percentage
Axis Title
Patients
FIG – 8 : DESCRIPTION AND COMPARISON OF DEMOGRAPHIC CHARACTERISTICS ACCORDING TO THEIR
MARITAL STATUS
0 10 20 30 40 50 60
Nuclear Joint 58.3
41.7
Percentage
Patients
FIG – 9 : DESCRIPTION AND COMPARISON OF DEMOGRAPHIC CHARACTERISTICS ACCORDING TO THEIR
TYPE OF FAMILY
SECTION B
TABLE – 2 : ASSESSING THE LEVEL OF PAIN ON EACH DAY BEFORE AND AFTER EFFLEURAGE BACK MASSAGE
Day 1 Day 2 Day 3
Pre-
test Post
test Pre- test Post
test Pre-
test Post test Pain
categor y
Pain Scor
e f % f % f % f % f % f %
Mild
Pain 1-3 0 0 0 0 0 0 2 3.3 1
8 30.
0 5
7 95.0 Modera
te Pain
4-6 1 9 31.
7 4 0 66.
7 4
2 70.0 5 5 91.
7 4 2 70.
0 3 5.0 Severe
Pain 7-9 4
1 68.
3 2 0 33.
3 1
8 .30.
0 3 5.0 0 0 0 0
Worst
pain 10 0 0 0 0 0 0 0 0 0 0 0 0
the Table – 2 shows that the assessment of pain of each day before and after effleurage back massage. In day 1 Mild pain there is no pain in pretest and post test Moderate pain 19(31.7%) samples in pre test 40(66.7%) samples in post test severe pain 41 (68.3%) samples in pre test, 20(33.3%) samples in post test, Worst pain no pain in pre test and post test, In day 2 Mild pain no pain in pre test 2(3.3%) samples in posttest moderate pain 42(70.0%) samples in pre test, 55 (91.7%) samples in post test, severe pain 18(30.0%)samples in pre test 3(5.0%) samples in post test worst pain no pain in pre test and post test , In day 3 , Mild pain 18(30.0%) samples in pre test,, 57(95.0%) samples in post test, Moderate pain 42(70.0%) samples in pre test, 3(5.0%) samples in post test, sever pain no pain in pre test and post test, worst pain no pain in Pre test and post test
FIG – 10 : ASSESSMENT OF PAIN BEFORE AND AFTER EFFLEURAGE MASSAGE – DAY 1
FIG – 11 : ASSESSMENT OF PAIN BEFORE AND AFTER EFFLEURAGE MASSAGE – DAY 2
Fig – 12 : ASSESSMENT OF PAIN BEFORE AND AFTER EFFLEURAGE MASSAGE – DAY 3
SECTION C
TABLE - 3 : ASSESSMENT OF ANXIETY BEACH DAY BEFORE AND AFTER MASSAGE.
Day 1 Day 2 Day 3
Before After Before After Before After Category
of Anxiety Anxiety scale
f % f % f % f % f % f %
No Anxiety <20 0 0 0 0 0 0 0 0 0 0 0 0 Some
What 20- 40 0 0 0 0 5 8.3 38 63.3 45 75.0 23 30.3 Moderately 40-60 22 36.7 43 71.7 47 78.3 22 36.7 14 23.3 0 0 Very Much 60-80 38 63.3 17 28.3 8 13.4 0 0 0 0 0 0
The table – 3 shows that the assessment of anxiety to low back pain patients before and after effleurage back massage. In day 1, There is no anxiety in Pre test and post test, some what no anxiety in pre test and post test , Moderately 22(36.7%) in pre test, 43(71.7%) in post test, very much 38 (63.3%) in pre test, 17(28.3%) in post test . In day 2 , there is no anxiety in pretest and post test, some what 5(8.3%) in pre test, 38(63.3%) in post test ,moderately 47(78.3%) in pre test , 22(36.7%) in post test very much 8(13.4%) in pre test, no very much in post test , In day 3 No Anxiety in Pretest and post test some what 45 (75.0%) in pretest, 23 (30.3%) in post test, Moderately 14(23.3%) in pretest, no moderately Anxiety in Post- test and Very much no anxiety in pretest and post test.
FIG – 13 : ASSESSMENT OF ANXIETY AMONG LOW BACK PAIN PATIENTS BEFORE AND AFTER EFFLEURAGE
MASSAGE – DAY 1
FIG – 14 : ASSESSMENT OF ANXIETY AMONG LOW BACK PAIN PATIENTS BEFORE AND AFTER EFFLEURAGE
