INTRODUCTION:
Hypertension (HTN) or high blood pressure, sometimes arterial hypertension, is a chronic medical condition[9] in which the blood pressure[1] in the arteries[1] is elevated. This requires the heart to work harder than normal to circulate blood through the blood vessels. Hypertension is an important public health challenge in both economically developing and developed countries. Hypertension is a major risk factor[9] for stroke[10], myocardial infarction[10] (heart attacks), heart failure[9], aneurysms[9] of the arteries (e.g. aortic aneurysm[9]), peripheral arterial disease[9] and is a cause of chronic kidney disease[9]. Even moderate elevation of arterial blood pressure is associated with a shortened life expectancy[10].
The level of blood pressure can be reduced by pharmacological and non pharmacological methods. The British Hypertension Society (2009) guidelines proposed that effective blood pressure control is achieved through a combination of pharmaceutical and non pharmaceutical therapies. Non pharmacological interventions are particularly useful when (a) medications are inadequate to control blood pressure; clients are waiting for medications to take effect; (c) when side effects or client concern make the use of medications problematic. There is now considerable evidence that an array of mind-body therapies can be used as effective adjuncts to conventional medical treatment for a number of common clinical conditions.
Sheu, Barbara,[2] (2009) done a study on effects of Progressive Muscle Relaxation on Blood Pressure in Taiwan: This study examined the effect of progressive muscle relaxation (PMR) on blood pressure and psychosocial status in clients with essential hypertension. The study, which used a quasi-experimental design, recruited a convenience sample of 40 subjects from a hypertension outpatient clinic. Twenty subjects received PMR training once a week and practiced at home daily for 4 weeks. PMR training had an immediate effect, reducing pulse rate 2.35 beats/min, systolic blood pressure 5.44 mm Hg, and diastolic blood pressure 3.48 mm Hg. After 4 weeks of PMR training, further decreases in pulse rate (2.9 beats/min), systolic blood pressure (5.1 mm Hg), and diastolic blood pressure (3.1 mm Hg) occurred. PMR significantly lowered patients' perception of stress, and it enhanced their perception of health. PMR is beneficial for patients with essential hypertension, and nurses may use it to enhance their independent function as well as their quality of life.
Yung. P[6], (2007) done a study on relaxation training as complementary therapy for mild hypertension control and the implications of evidence-based medicine. The study was done to examine the effects of three relaxation therapies for the reduction of high blood pressure in nine Chinese subjects. Subjects were randomly assigned to three groups: (a) progressive muscle relaxation, (b) stretch release relaxation and (c) cognitive imagery relaxation. Systolic, diastolic blood pressure and heart rate were assessed in a baseline session, the 8th post-treatment session, and a 30-days follow-up session. Datawere analyzed using ANOVA and Paired sample t-test. One-Sample Kolmogorov-Smirnov Tests for the normal distribution were performed among the three groups. The results verified that the normality assumption for the data had not been violated. Results revealed that in the context of the study all relaxation therapies can reduce blood pressure in Chinese subjects, but stretch release relaxation and progressive muscle relaxation therapies appeared to be more effective in lowering blood pressure compared to cognitive imagery relaxation.
Hahn YB[3], (2005) In order to assess the effectiveness of the thermal biofeedback training combined with the progressive muscle relaxation therapy in the treatment of patients with essential hypertension, blood pressure decline was measured on the treatment group who had the combined thermal biofeedback and progressive muscle relaxation training (N = 11), and on the control group who had only the progressive muscle relaxation training (N = 8). Baseline blood pressure was measured four times for two weeks on both groups. For the treatment group, blood pressure was measured twice before and after each of eight sessions of thermal biofeedback training for four weeks. For the control group, blood pressure was measured every two visits to a clinic for progressive muscle relaxation self-training twice before and after the self-training. A significant decline of the systolic blood pressure by 20.6 mmHg and of the diastolic blood pressure by 14.4 mmhg was observed in the treatment group. There was a tendency for both blood pressures to increase in the control group.
OBJECTIVE OF THE STUDY:
The objectives of the study were to
· assess the pretest and post test level of blood pressure among patients with Hypertension in experimental and control group.
· assess the effectiveness of Jacobson’s progressive muscle relaxation exercise on blood pressure among patients with Hypertension in experimental group.
· associate the selected socio demographic variables with the level of blood pressure in experimental group in post test.
HYPOTHESIS:
H1; There is a significant decrease in the level of blood pressure after Jacobson’s progressive muscle relaxation exercise among patient with Hypertension in experimental group.
ASSUMPTION:
Patient will have inadequate knowledge on management of hypertension using non pharmacological measures, muscle relaxation exercises Administration of Jacobson’s progressive muscle relaxation exercise may reduce the blood pressure levels.
There may be improvement in the quality of life after performance of regular Jacobson’s progressive muscle relaxation exercise.
MATERIALS AND METHODS:
RESEARCH DESIGN:
The research design selected for the study was a Quasi-experimental pre test-post test group design to assess the effectiveness of Jacobson’s progressive muscle relaxation exercise on blood pressure among patient with hypertension in Christian Mission Hospital at Madurai.
SETTING:
The study was conducted in Christian Mission Hospital, Madurai. Christian Mission Hospital is a 500 bedded multi specialty hospital and located in heart of the Madurai city. It has medical/Surgical bed occupancy of 100. The average number of patients admitted in hospital was 50-60 per day.
POPULATION:
The target population of the study was all the patients who are getting admitted in the hospital with the history of hypertension and high blood pressure more than 140 mmHg admitted in Christian Mission Hospital.
SAMPLE:
Patients who got admitted in the hospital with the history of hypertension and high blood pressure more than 140 mmHg and taking treatment for Hypertension at Christian Medical hospital Madurai.
SAMPLE SIZE:
The sample size was estimated through the power analysis method.
The sample size estimated through power analysis method was 78 patients. Considering the time period of the study, the sample size was reduced to 60 patients.
SAMPLING TECHNIQUE:
A non probability convenience sampling was employed to choose the samples. The patients subjected to Jacobson’s progressive muscle relaxation exercise were identified from Medical and Surgical Unit of Christian Mission Hospital for the study based on the inclusion and exclusion criteria laid for the study.
CRITERIA FOR SAMPLE SELECTION:
Inclusion Criteria:
· Patients who were diagnosed as Hypertension.
· Patients from both the sex.
· Patients who were admitted in ward with the history of hypertension and high Blood pressure above 140mmHg and on regular treatment.
· Patients with age group of 35-65 years were selected.
· Patients who were hospitalized for minimum of five days.
· Patients who were available at the period of data collection.
Exclusion Criteria:
· Those patients who were physically challenged.
· Patients those who were not willing to participate in the study.
· Patients who had complications like Ischemic heart disease, stroke[10], peripheral vascular disease[9], and other cardiovascular diseases.
· Patients who had a history of injuries, back problems, or muscle spasm.
· Pilot study samples were excluded.
VARIABLES:
Independent variables:
Jacobson’s progressive muscle relaxation exercise.
Dependent Variables:
Blood pressure of the patient with hypertension.
Description of the tool:
The questionnaire consists of 2 parts:
Part 1- Demographic data
It deals with demographic data of patients which consists of age, sex, education, occupation, History of Diabetes and Hypertension, History of treatment, family history of Hypertension, History of any physical activity and Habit.
Part 2- This part consists of daily assessment sheet used to assess the vital sign parameter and Blood pressure in both the experimental and control group.
Part 3- The practice of Jacobson’s progressive muscle relaxation is assessed with the help of practice check list.
It consists of Jacobson’s progressive muscle relaxation practice checklist.
PILOT STUDY:
The pilot study was conducted during the period 17-9-12 to 25-9-2011 at Christian Mission Hospital in Madurai, after obtaining formal permission from the Institutional Review Board, scientific review board, and ethical committee of Saveetha University and medical superintendent of Christian Mission Hospital. A total of 10 samples were selected by using convenience sampling and who met the inclusion criteria was included in the study. After selecting the sample, researcher introduced himself and explained the purpose of the study to the patients. Informed consent was obtained after assuring confidentiality. A calm environment was provided to the patients by providing privacy and restriction of the visitors. For experimental group in the pre test, demographic variable was collected by using structured questionnaire and then blood pressure was assessed by using sphygmomanometer. After assessment, patient was comfortably positioned in the chair, then Jacobson’s Progressive muscle relaxation exercise involves alternately tensing and relaxing the muscles was given for 15 minutes in the morning and evening. After Progressive muscle relaxation exercise, the level of blood pressure was assessed by using sphygmomanometer. The same procedure was followed for five consecutive days. Whereas in control group the selected samples were subjected to pre test and post test assessment of blood pressure on and was under routine care. The collected data were tabulated and analyzed by using descriptive and inferential statistics. The pilot study was found to be effective and no correction was made.
DATA COLLECTION PROCEDURE- MAIN STUDY:
The permission to conduct research in Medical surgical Unit Christian Mission Hospital, Madurai obtained from concerned authorities. The ethical approval was also obtained. A total of 60 samples who met the inclusion criteria were included in the study. The eligible participants were identified and selected by using non probability convenience sampling method. The purposes of the study and their right to participate or withdraw from the study were explained to the patients and got written informed consent. Such consenting patients who fulfilled the inclusion criteria were enrolled for the study.
Demographic variables were collected by using interview technique and Privacy was provided. Ethical principles were adhered too throughout the study. Other clinical variables were collected from the patient. After selecting the sample, researcher introduced himself and explained the purpose of the study to the patients. Informed consent was obtained after assuring confidentiality. A calm environment was provided to the patients by providing privacy and restriction of the visitors. For experimental group in the pre test, demographic variable was collected by using structured questionnaire and then blood pressure was assessed by using sphygmomanometer. After assessment, patient was comfortably positioned in the chair, then Jacobson’s Progressive muscle relaxation exercise involves alternately tensing and relaxing the muscles was given for 15 minutes in the morning and evening. After Progressive muscle relaxation exercise, the level of blood pressure was assessed by using sphygmomanometer. The same procedure was followed for five consecutive days. Whereas in control group the selected samples were subjected to pre test and post test assessment of blood pressure on and was under routine care.
The practice of Jacobson’s progressive muscle relaxation exercise was assessed from first day to fifth day by means of observational check list. Blood pressure was assessed by using a stethoscope and sphygmo manometer. In this study, blood pressure was assessed in supine position by listening to korotkoff sounds.