1. INTRODUCTION:

Stroke is a term used to describe neurologic changes caused by an interception in the blood supply to a part of the brain. Stroke is a leading cause of adult disability and a leading primary diagnosis in long-term cure. Thrombolytic therapies can prevent or limit the extent of damage to brain tissue caused by acute stroke. The effect of stroke can be prevented by using physical therapies. Physical therapists work with client to build strength, passive ROM and tone in non-involved muscles. Signs and symptoms of stroke may also be associated with a severe headache, inability to move or feel on one side of body, problem in understanding or speaking, feeling like the world is spinning or loss of vision to one side. Prevention includes decreasing risk factors.¹

In India approximately 1.5 million people affected with stroke annually. From that more than half of affected people can changed into permanently or temporarily disabled. In a study conducted at Mangalore, the mean percentage of the burden score among caregivers of CVA patients was 53.8%.² Long term physiotherapy is required for a simple progress also. In this situation a novel approach as came, that is influence of chair exercise. Mainly after discharge from hospitals patient is on wheelchair. They are in hemiplegic and paraplegic condition. In this time many studies done regarding influence of chair exercise in hemiplegic patients. As a result of some research studies, they proved that better improvement in physical mobility of such patients. Chair exercise also helps to attain normal coordination, muscle strengthens, it also helps to maintain the balance and improve circulation towards affected extremities.^3,14

The stroke may result muscle and fat imbalances in all extremities. It is seen that fat deposition is more prominent in post-stroke patients. But regularly performed physical activity may help to reduce muscle atrophy.⁴

The concept of assistive movement stroke therapy is new but widely known. The goal is to develop an assistive device for the individual movement of fingers of stroke patient.⁵ Because of this exercise we can able to reduce the degree of disability that can be caused by ischemic attack. It is also done as in home setting also. Continuation of proper exercise will improve the quality of life and increase the mobility of hemiplegic patients.⁶

A Pretest-posttest study was conducted to find the effects of treadmill-based locomotor training with leg weights in 20 individuals with chronic stroke. Participants underwent 30-minute treadmill-based locomotor training sessions three times per week for four weeks. Improvements were more significant in cadence than other gait parameters such as step length and stride length. In mEFAP, 5.98% improvement was seen showing enhanced the functional ambulatory capacity of participants. In Chedokemcmaster Stroke Assessment Activity Inventory, 4.27% improvement was seen. The result shows that treadmill-based locomotor training combined with leg weights can make improvement in the physical ability of stroke patients.⁷

A study was conducted to investigate the effect of intensive rehabilitation on physical and arterial function among 44 community-dwelling stroke survivors. The experimental group (n = 22) received primarily intensive strengthening exercise and the control group (n = 22) received standard physical therapy consisting mainly of stretching and gait training. Both groups underwent the rehabilitation program for 12 weeks. Physical function was evaluated using 10-m gait velocity, the 30-s chair stand test, Timed Up and Go test, and grip strength. Arterial function of the affected and unaffected sides was evaluated using the cardio-ankle vascular index (CAVI) as an index of arterial stiffness and the ankle-brachial pressure index (ABI) as an index of arterial occlusion. After the 12-week rehabilitation period, improvement in physical function did not differ between the 2 groups; whereas with regard to arterial function, a significant improvement in the CAVI for the affected side was observed in the experimental group (P < .001). Also, the ABI for the unaffected side in the experimental group was significantly improved after intervention (P < .001). No significant differences were found for the unaffected-side CAVI and affected-side ABI between the 2 groups. These findings suggested that intensive rehabilitation for stroke patients during the chronic stage preserved physical function and improved arterial function.⁸

It is seen that immediate reduction in the risk of stroke and length of physical inabilities after the onset of stroke both depend on the level of knowledge of stroke in the general population. Several studies points the need to educate the patients with stroke and vulnerable about stroke and its management.⁹

A comparative cross-sectional survey was conducted on adult stroke survivors (n=201) and patients of cardiovascular disorders who are at high risk (n=201) in neurology and cardiology wards and outpatient clinics. More than half of the patients in both groups had <50% of knowledge. Study stated that majority of the patients were having poor knowledge regarding stroke and its management. Hence, there is an intense need to educate the population at risk for stroke regarding its management.¹⁰

A descriptive study was conducted to assess the knowledge and attitude of 60 caregivers regarding home care management of stroke patients. Data collected using structured interview schedule. Result showed that majority 25(41.65%) care givers have average knowledge, 23(38.3%) have good knowledge and 12(20%) care givers have poor knowledge. Majority 40(66.6%) care givers have unfavourable attitude and 20 (33.3%) have favourable attitude. Study concluded that more provision need to increase the awareness of caregivers of stroke patients.¹¹

Improving quality of life of stroke patient is an ongoing challenge for health care providers and the government. In India the prevalence mortality rate and healthcare cost of stroke have dramatically increased. It seems that comprehensive nursing rehabilitation programme was highly effective on improving quality of life among post acute ischemic stroke patients.¹²

A pre experimental one group pre test post test was used to find out effectiveness of STP on CPR among nursing students. Pre-test median score was 12.4 whereas post-test median score was 27.2. The difference between the knowledge score of post-test and pre-test of IIIyear B.Sc. Nursing students were analyzed using paired ‘t’. The result was found to be very highly significant (t= 27.44, p ≤ 0.001). The study concluded that the structured teaching programme was very effective to improve knowledge.^13.

2. PROBLEM STATEMENT:

A study to assess the effect of structured teaching programme on knowledge and practice regarding chair exercises for hemiplegic patients among second year B.Sc nursing students in a selected nursing college at Thiruvalla.

3. OBJECTIVES:

To assess the pre - test level of knowledge and practice on chair exercises among nursing students.

To develop and administer structured teaching programme on chair exercises for hemiplegic patients among nursing students.

To assess the effect of structured teaching programme on chair exercises in terms of post –test knowledge and practice scores.

4. RESEARCH METHODOLOGY:

4.1 Research approach: In this study, quantitative research approach was used to assess the effectiveness of structured teaching programme on knowledge and practice regarding the chair exercise for hemiplegic patients among nursing students.

4.2 Research design: Pre experimental one group pre-test post-test design

4.3 Variables:

Independent variable: In this study the dependent variable is structured teaching programme on chair exercise for hemiplegic patients among selected nursing students.

Dependent variable:

In this study the dependent variable is the knowledge and practice of nursing students about chair exercise for hemiplegic patients

Extraneous variable:

In this study the extraneous variable were educational qualification, and source of information, religion, age, sex, family history of stroke.

4.4 Research setting:

Selected nursing college at Thiruvalla

4.5 Sample: In

the present study samples are selected nursing students.

4.6 Sampling technique:

Simple randomsampling technique is used in present study to draw 40 samples.

4.7 Sample size:

It consists of 40 selected nursing students

4.8 Duration of the study:

weeks, from 13th February 2017.

4.9 Data collection instruments:

The instrument used for this study was structured knowledge questionnaire on chair exercises for patients with hemiplegia to assess knowledge of samples and observational checklist for assessing practice level. The structured knowledge questionnaire and observational checklist were developed after review of the literature topics, discussion with experts and guide.

TOOL: 1, Structured questionnaire was used to collect data has 2sections:

Section A: Demographic data

Section B: Knowledge questionnaire consisting of 22 questions on chair exercise.

TOOL: 2, Practice checklist- consist of 20 steps/items

4.10 scoring procedure:

For scoring questionnaire on knowledge on chair exercise, multiple choice questionnaire was used and one mark was given for correct response and zero for incorrect response. Total score is out of 22. Based on the evaluation, knowledge level was categorized using the following scoring:

0-6: poor

7-11: Average

12-17: Good

18-22: Excellent

For scoring practice level on chair exercise, practice checklist was used and one mark was given for correct step and zero for incorrect. Total score is out of 20.

Based on the evaluation, practice level can be categorized using the following scoring:

0-5: poor

5-10: Average

10-15: Good

15-20: Excellent

4.11 Reliability and validity:

The content validity of the tool was obtained by presentation and submission of tool to the expert and modification were made as suggested by experts. Reliability of tool was completed by Karl person coefficient (r=0.7).

4.12 Data collection procedure:

The formal written permission was obtained from TMM College of nursing. Data collection procedure extended from 21st February 2017. The simple random sampling technique was used to select 40 samples. The purpose of the study was explained to the students and consent was obtained from the subjects involved in the study. The existing knowledge and practice were assessed by pre-test using structured knowledge questionnaire and practice checklist on chair exercise. The average time taken for pre-test was 10 minutes to 15 minutes respectively. After pre-test, structured teaching programme and practice was conducted. Post test was conducted after 7 days (28-02-2017) of implementation of structured teaching programme using the same structured knowledge questionnaire and practice checklist. The average time taken for post-test was 25 minutes.

5. FINDINGS:

The data collected from 40 samples were tabulated, analyzed and interpreted.

The findings of the study were presented under the following headings:

SECTION A: Description of demographic data.

SECTION B: Description of pretest and post knowledge and practice score

SECTION C: Effectiveness of structured teaching programme

Description of demographic data with regard to the distribution of subject according to selected demographic variables such as age, previous experience of care to CVA patient, family h/o CVA, knowledge about chair exercise for hemiplegic patient.

From the pie diagram it was observed that majority of participant belonged to the age group of 19 yrs (60%) further age group 20yrs (20%),18yrs (20%).

The above Cylindrical bar diagram depicts that majority of participant had previous experience of providing care to hemiplegic patients.

The above bar diagram depicts majority of samples (97.5%) have no family history of cerebrovascular accident.

Above diagram depicts majority of the samples (98%) have no previous knowledge regarding chair exercises.

Section B: Description of Pre-Test and Post-Test Knowledge and Practice Score

Frequency and percentage of pre test knowledge

Mark obtained	Frequency	%	Mean	SD
Excellent (17-22)	0	0%	5.9	2.04
Good (11-17)	0	0%
Average (6-11)	3	7.50%
Poor (0-6)	37	92.50%

The above table shows that most (92.5%) of samples have poor knowledge regarding chair exercises for stoke patients.

Frequency and percentage of pre test practice

Mark obtained	Frequency	%	Mean	SD
Excellent (15-20)	0	0%	1.75	1.74
Good (10-15)	0	0%
Average (5-10)	0	0%
Poor (0-5)	40	100%

The above table shows that all (100%) of samples have poor practice score regarding chair exercises for stoke patients.

Frequency and percentage of post test knowledge

Mark obtained	Frequency	%	Mean	S:D
Excellent (17-22)	38	95%	18.67	1.59
Good (11-17)	2	5%
Average (6-11)	0	0%
Poor (0-6)	0	0%

This table shows that most of the samples (95 %) achieved excellent knowledge regarding chair exercises for stoke patients.

Frequency and percentage of post test practice

Mark obtained	Frequency	%	Mean	S:D
Excellent (15-20)	40	100%	16.52	0.78
Good (10-15)	0	0%
Average (5-10)	0	0%
Poor (0-5)	0	0%

This table shows that all samples (100%) achieved excellent practice score regarding chair exercises for stoke patients.

SECTION C: Effectiveness of structured teaching programme

Effect of structured teaching programme on chair exercises

Knowledge Level of Subjects	Pre Test			Post Test
	Mean	Mean %	SD	Mean	Mean %	SD
	5.9	14.75 %	2.04	18.67	46.68 %	1.59
Practice Level of Subjects	1.75	4.375 %	1.74	16.52	41.3 %	0.78

SD= Standard Deviation

The table shows that in post test about 95% had very good score and 5% had good score and average and poor was 0%. In post practice score was 100% very good score.

6. DISCUSSIONS:

The present study was aimed to assessing the effectiveness of structured teaching programme on knowledge and practice regarding chair exercise for hemiplegic patients among 2nd year BSc Nursing students .Base line of the pretest knowledge and practice of the 2nd year BSc Nursing students of TMM College of Nursing regarding regarding chair exercise for hemiplegic patients revealed that majority of the samples had poor (97.5%) knowledge and practice (100%) which increased to 100% (excellent) in both knowledge and practice in the post test. The standard deviation shows that there was statistical significant difference in pretest and post test score of knowledge after administration of structured teaching programme.

Most of the second year B.Sc Nursing students from selected samples are the age of 19 yrs (60%). Majority of the nursing students (70%) of samples have the previous experience of caring of CVA patients. Majority of the nursing students (97.5%) have no family history of CVA.Majority of the nursing students(97.5%) have no knowledge regarding chair exercise. The pre test score ranges from 7.5 % have average score and 92.5% have poor score. In pre practice 100% have poor practice knowledge. In post test about 95% have very good score and 5% have good score and in post practice score 100% have very good score.

7. NURSING IMPLICATIONS:

Nursing service:

Nursing personnel’s can plan teaching programme and provide adequate information to people regarding chair exercise for hemiplegic patients. Nurses especially community health nurse can perform a major role in organizing mass education programme.

Nursing administration:

need to plan educational session for staff nurses regarding effect of chair exercise for hemiplegic patients and thus motivates the staff nurse to teach the hemiplegic patients and their family regarding chair exercise as home care management during the lack of physiotherapist.

Nursing education:

Nurses have an important role in promoting knowledge regarding effect of chair exercises for hemiplegic patients. Nursing students after learning about the topic on effect of chair exercise for hemiplegic patients should be encouraged to conduct teaching session and health education in hospital as well as community

8. RECOMMENDATIONS:

The study can be conducted on a large number of samples. The study can be conducted among nursing staffs.

A study can be conducted by using various methods of teaching, to determine the most effective method of teaching

9. REFERENCES:

1. American Association of Neurological Surgeons (2017).Cerebrovascular Disease. Retrieved from https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Cerebrovascular-Disease

2. Barboza, H. R (2015). A Correlative Study to Assess the Burden and Coping Strategies among Caregivers of Cerebrovascular Accident (CVA) Patients who are Visiting the Rehabilitation Departments of Selected Hospitals of Mangalore Taluk with a View to Provide an Information Booklet. Asian J. Nursing Edu. and Research 5(2): April- June 2015

3. World Health Organization (2017).Global Burden of Stroke. The Atlas of Heart Disease and Stroke. MacKay J, Mensah GA. Retrieved from https://www.who.int/publications/10-year-review/ncd/en/index3.html

4. Jee H (2017). Comparisons of the body Composition and the effects of Physical activity on the Upper and Lower Limbs of the Female Post-Stroke Patients. Research J. Pharm. and Tech. 10(9): September 2017

5. Sindu D, Bethanney J J, Umashankar G, Leena N V (2017). Rehabilitative Finger Mount to assist Finger Movement in Chronic Stroke Patients. Research J. Pharm. and Tech. 10(4): April 2017

6. Lee HS,Kim JU:The effect of self directed exercise using a task board on pain and function in the upper extrimities of stroke patients.J Phys ther sci,2013,25:963-967

7. Kalirathinam, D, Jerome.A , Bhagyashri B , Raj N , Rao M (2017).Treadmill-Based Locomotor Training with Leg Weights in People with Chronic Stroke. Research J. Pharm. and Tech. 10(5): May 2017

8. Takatori K1, Matsumoto D, Okada Y, Nakamura J, Shomoto K. (2012). Effect of intensive rehabilitation on physical function and arterial function in community-dwelling chronic stroke survivors. Top Stroke Rehabil. 2012 Sep-Oct;19(5):377-83. doi: 10.1310/tsr1905-377.

9. Koushal D , Nirmala S (2016).Knowledge Among Stroke and High Risk Patients Regarding Risk Factors, Warning Signs and Immediate Treatment of Stroke. International Journal of Advances in Nursing Management 4(4): October-December 2016.

10. Sapna , Rohit B, Gautam S, Gopichandran, L (2016). A Comparative Study to Assess the Knowledge on Risk Factors, Warning Signs and Immediate Treatment of Stroke among Stroke Survivors and Patients of Cardiovascular Disorders who are at risk of Stroke. Asian J. Nursing Edu. and Research 6(3): July- Sept. 2016

11. Bhavya S V, Vidya. M (2017). Knowledge and Attitude of Care Givers regarding Home Care Management of Stroke Patients International Journal of Nursing Education and Research 5(3): July- September 2017

12. Balaguru T (2016). Effectiveness of Comprehensive Nursing Rehabilitation Programme on Quality of Life among Patient with Post - Acute Stroke – Pilot Study. International Journal of Nursing Education and Research 4(4): October -December 2016.

13. Najrana, Asif K, Nazneen S (2018). Effectiveness of STP on CPR among Nursing Students. International Journal of Nursing Education and Research. 6(1): January- March, 2018

14. Je J, ByeongSeon M, SeungIn O, KIM, Kyung T. (2017). Effects of Self-Stretching, Transcutaneous Electrical Nerve Stimulation, and Functional Massage on Muscle Strength for Muscle Fatigue Caused by Isotonic Exercise Research J. Pharm. and Tech. 10(9): September 2017

Received on 11.11.2019 Modified on 26.12.2019

Asian J. Nursing Education and Research. 2020; 10(2):201-206.

DOI: 10.5958/2349-2996.2020.00043.9