Naveen Jebakumar M. et al. / Journal of Science / Vol 4 / Issue 1 / 2014 / 23-26.

e ISSN 2277 - 3290

Print ISSN 2277 - 3282

Journal of Science

Nursing

www.journalofscience.net

EFFECTIVENESS OF PROGRESSIVE MUSCLE RELAXATION ON

PSYCHO-PHYSIOLOGICAL PARAMETERS AMONG PATIENTS
WITH COPD AT UNIVERSITY TEACHING HOSPITAL
*

Naveen Jebakumar M, 1Porkodi A, 2Akila P

M.Sc. II year, Faculty of Nursing, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India.
Reader (Ph.D), Faculty of Nursing, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India.
2
Lecturer (MSN), Faculty of Nursing, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India.
1

ABSTRACT
Anxiety is common among COPD patients and considerably alters breathing pattern. The aim of this study was to
assess the effectiveness of progressive muscle relaxation on psycho-physiological parameters among patients with COPD. A
sample of 40 COPD patients were randomly assigned to study and control groups and PMR was given. Results showed that
PMR significantly reduced anxiety and thereby peak expiratory flow rate (PEFR), blood pressure and heart rate.
Keywords: Progressive Muscle Relaxation, COPD, Anxiety, Physiological Parameters.
INTRODUCTION
The prevalence of chronic disease is showing an
uphill trend in most of the countries and about one-third
of the population is affected with chronic diseases.
Among the chronic diseases, COPD is a serious
contemporary health issue. Psychological comorbidities
such as anxiety and depression are very common among
COPD patients. Dyspnea is a common symptom of many
lung disorders. The feeling of not being able to get air,
especially on a regular basis, can be upsetting. This
anxiety can further deteriorate the shortness of breath.
There is a direct relationship between dyspnea and
anxiety and that if one were reduced, the other also might
lessen. Relaxation exercises are used to improve
functional status of patients with COPD by reducing the
respiratory rate and increasing alveolar ventilation [1-6].
OBJECTIVES
The objectives of the study were to assess the
effectiveness of progressive muscle relaxation on psychophysiological parameters among patients with COPD, and
to associate the psycho-physiological parameters with
selected background variables among patients with
COPD.

MATERIALS AND METHODS

The research design adopted by the investigator
was an experimental pretest-posttest control group design.
A total of 40 patients (study group-20, control group-20)
who were diagnosed with COPD were randomized.
Participants were randomly assigned by simple lottery
method to either the study or the control group. Based on
the inclusion and exclusion criteria patients were selected
for the study. The investigator conducted the pretest after
one day of admission to chest ward on background
variables, Blood pressure, Heart rate, PEFR, Borg CR10
scale and SSAI using standardized tool. The investigator
then demonstrated the PMR on one to one basis at the
bedside and return demonstration was done by them after
each session. PMR was done twice a day and continued
for five days under guidance and a posttest was conducted
on the fifth day. The time spent for data collection
procedure was 20-30 minutes for each study participant:
whereas, control group participants received only the
routine nursing care. After completion of the procedure
each individual was provided with the opportunity to
clarify their doubts. After posttest PMR was demonstrated
to the control group participants.

Corresponding Author:- Naveen Jebakumar M Email:- naveenjebakumar@gmail.com

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Naveen Jebakumar M. et al. / Journal of Science / Vol 4 / Issue 1 / 2014 / 23-26.

ETHICAL CONSIDERATION
The study was conducted after the approval from
the Institutional Ethics committee. Participants were
explained clearly about the study purpose and a written
informed consent was obtained before conducting the
study. Confidentiality of the responses were assured and
maintained throughout the study [7-11].
CONCEPTUAL FRAMEWORK
The investigator has applied the Modified
Ernestine Weidenbachs helping art of clinical Nursing
theory (1964) to be appropriate for the current study.
Weidenbachs in her theory has stated that nursing action
has four distinct kinds of actions that include reflex,
conditioned, impulsive, and deliberate nursing practice.
The deliberate nursing practice further comprises of three
components. They are as follows: 1. Identification of
patients need (assessment of background variables) 2.
Ministration of the help needed (progressive muscle
relaxation) and 3.Validation of action (assessment of
psycho-physiological parameters) [12-16].
RESULTS
Table 1 illustrates that in the pretest 14(70%) of
the study group patients had severe anxiety and in the
control group 19(95%) patients had moderate anxiety.
Whereas in the posttest, 18(90%) patients in the study
group and 11(55%) patients in the control group had
moderate anxiety.
Table 2 illustrates that the physiological
parameters such as diastolic BP and dyspnea were
statistically significant when compared to control group.
Whereas no significant improvement in systolic BP, heart
rate and PEFR.
There was no significant association between
anxiety and demographic variables except residence
during the pretest in the study group which was
statistically significant at p<0.05
NURSING IMPLICATIONS
With prevalence of COPD showing an uphill
trend in most countries it is imperative that implications
drawn from the study are of vital concern to the field of

nursing
including
nursing
administration and research.

service,

education,

Nursing practice
PMR can be implemented as a part of the
treatment and can be carried out by caregivers in the day
to day activities while caring for COPD patients. The
nurse needs to motivate the patients to practice PMR in
their daily life. It is nurses responsibility to carry out and
teach PMR as a part of pulmonary rehabilitation in the
community as well.
Nursing Education
On education perspective it is important that
nurses not only be aware of the techniques but also master
them. Progressive muscle relaxation should be
emphasized in the nursing education so that tomorrows
nurses are better equipped to handle and preserve the
physical, emotional and social disabilities associated with
COPD and other diseases.
Nursing Administration
Nurse administrator should organize programs
on PMR and proper protocols and resources should be
arranged for the nursing staff to implement PMR for
patients to preserve and promote their wellbeing.
Nursing Research
A team response must be generated among the
nurses to perform the research on application of PMR,
standards and protocols and to implement it in practice
[18,19].
RECOMMENDATIONS FOR FUTURE STUDY
1. A similar study can be replicated with a larger sample
size
2. A multicenter study can be done among patients with
COPD
3. A similar study can be done using audio instructed
aids
4. Home based practice of PMR can also be studied
5. A similar study can be done for a longer period and
regular follow up.

Table 1. Frequency and percentage distribution of anxiety during pretest and posttest among patients with COPD in
the study group and the control group (N=40)
Duration
Anxiety
Study group (n=20)
Control group(n=20)
No.
%
No.
%
Mild
Pretest
Moderate
6
30
19
95
Severe
14
70
1
5
Mild
2
10
0
0
Posttest
Moderate
18
90
11
55
Severe
0
0
9
45

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Naveen Jebakumar M. et al. / Journal of Science / Vol 4 / Issue 1 / 2014 / 23-26.

Table 2. Mean, standard deviation, independent t value and p value of physiological parameters among patients with
COPD in the study group and the control group during posttest (N=40)
Study group (n=20)
Control group (n=20)
Physiological
Independent
Sl.No
parameters
t value and p value
Mean
SD
Mean
SD
-1.796
1.
Systolic BP
127
10.8
135.5
18.2
0.081(NS)
-3.126
2.
Diastolic BP
79.5
8.87
88.5
9.3
0.003**
-0.866
3.
Heart rate
73.85
5.47
75.85
8.7
0.392(NS)
-0.101
4.
PEFR
255.50
28.37
256.50
33.91
0.920(NS)
-9.603
5.
Dyspnea
3.55
1.037
6.75
1.070
0.000***
Figure 1. Percentage distribution of age in years (N=40)

Most patients seven (35%) in the study group were between the age group of 51 and 60 years and in the control group six (30%) of them were distributed
between 41 and 50 years, 51-60 years and 61-70 years respectively.

Figure 2. Percentage distribution of gender (N=40)

With regard to gender 16(80%) in the study group and 15(75%) in the control group were male

Figure 3. Percentage distribution of GOLD classification of COPD (N=40)

As per GOLD classification of COPD 17(85%) and 14(70%) were in class II-moderate COPD in both the study group and in the control group
respectively.

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Naveen Jebakumar M. et al. / Journal of Science / Vol 4 / Issue 1 / 2014 / 23-26.

CONCLUSION
There was a significant difference in the psychophysiological parameters among patients who performed
PMR than those who do not. Relaxation reduces anxiety
there by blood pressure, heart rate and dyspnea.
ACKNOWLEDGEMENT
It is my privilege to be a part of the Sri
Ramachandra University and I thank the Managing
Trustee, for allowing me to utilize the resources available
in the University. I express my feeling of deep gratitude,

indebtedness and reverence to my esteemed teachers and

eminent guides Prof. P.V. Ramachandran, M.Sc.(N).,
Chairman Nursing Education, Dr. A. Porkodi, M.Sc(N).,
Ph.D., Reader, Dept of Medical Surgical Nursing and
Mrs. Akila P, M.Sc.(N)., Lecturer, Dept. of Medical
Surgical Nursing Sri Ramachandra College of Nursing,
Sri Ramachandra University for their constant
encouragement, exemplary suggestions, enduring
guidance and all their blessings for the successful
completion of my research.

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