Professional Documents
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KARNATAKA, BANGALORE
ANNEXURE – II
MANGALORE.
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6.1 Need for the study
Renal failure refers to temporary or permanent damage to the kidneys resulting in the
loss of normal kidney function. There are two different types of renal failure – acute and
chronic. Acute renal failure has an abrupt onset and is potentially reversible. Chronic failure
progresses slowly over at least three months and can lead to permanent renal failure1.
Chronic kidney disease (CKD) is a worldwide public health problem, both for the
number of patients and cost of treatment involved. Chronic Kidney diseases progresses slowly
over at least three months and can lead to permanent renal disease. End-stage renal disease is
when the kidneys permanently fail to work. Chronic kidney disease (CKD) is a condition
characterized by a gradual loss of kidney function over time. Kidney failure may be treated
with haemodialysis, peritoneal dialysis or kidney transplantation. Haemodialysis treatments
are usually performed three times a week2.
According to WHO Global Burden of Disease Project, CKD is the 12th cause of death
and the 17th cause of disability, respectively. Prevalence is estimated to be 8-16% worldwide 3.
In community-based studies, the CKD prevalence has been reported between 0.16% and
0.79%. Approximately 30% of patients with diabetes mellitus (DM) have diabetic nephropathy
and with the growing number of DM patients and aging population there is likely a parallel
increase in CKD incidence2.
Haemodialysis is the most common method used to treat advanced and permanent
kidney failure. Since the 1960s, haemodialysis became a practical treatment for kidney
failure. Although haemodialysis may be done for acute kidney failure, it is more often
employed for chronic renal disease. It is a major life change that can cause a great deal of
stress and anxiety5. Possible complications of haemodialysis include muscle cramps and
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hypotension (sudden drop in blood pressure). Hypotension may cause you to feel dizzy or
weak, or sick to your stomach. Anxiety as a primary symptom includes all conditions of
indefinite fear and psychic disorders dominated by fear. Anxiety is a normal emotion. All
human beings develop it as a means of protection from danger and threat when we perceive
danger. Human body undergoes a number of autonomic physiological changes such as
perspiration, restlessness, discomfort, palpitation and tightness in the chest5.
In a global perspective, the term anxiety has become a part of our every day life. The
concepts of anxiety may differ according to the individual’s state of contexts and
interpretations. It is recognized that certain amount of anxiety is desirable, productive and can
facilitates the individuals to grow but when the anxiety exceeds disturb the normal functions.
Aging is a natural process and an inevitable one.6
It is estimated that about 25% of the world population will experience an anxiety at
some stage of their life. Women are twice more likely to suffer from an anxiety than men.
Unfortunately, only 50% of people receive treatment for their disorder. Anxiety problem often
leads to mental disorders. So it needs to be addressed before an anxiety can be effectively
treated. In India, 51.4% of people have anxiety while doing haemodialysis.7
Muscle tightening
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By using Jacobson’s Progressive Muscle Relaxation Technique (JPMRT), you can
counter these physical changes and sensations to achieve a “relaxation response.” A relaxation
response comes from using relaxation techniques to calm your body. During Jacobson’s
Progressive Muscle Relaxation Technique (JPMR), breathing slows and heart rate and blood
pressure decrease. When muscles are relaxed, they don’t require as much oxygen as when they
are tense. This allows redirection of blood flow from the tense muscles to other areas of the
body, which reduces many of the unpleasant physical effects of anxiety8.
From the above studies it is inferred that there has been increasing trend in the
prevalence of anxiety disorders among patients undergoing haemodialysis. So researcher has
found need to relieve the anxiety among haemodialysis patients by using Jacobson’s
Progressive Muscle Relaxation Technique (JPMRT) which is effective in reducing anxiety by
alternately tensing and relaxing the muscles.
Following are the studies and related researches regarding occurrence of anxiety among
Haemodialysis patients and the importance of Jacobson’s Progressive Muscle Relaxation:
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This study showed that a substantial number of haemodialysis patients experienced depression
and anxiety9.
quality of life in dialysis patients. The sample size was 46 dialysis patients. The duration of
PMRT was 6 weeks. State-trait anxiety inventory scale and quality of life rating scale were
used for data collection before and after training. The study revealed that PMRT for dialysis
patients helps to decrease state and trait-anxiety levels and has a positive impact on quality of
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life The mean state-anxiety score before and after PMRT was found as 43.4±4.3 and 28.9±2.8,
respectively (P<0.001). Similarly, the mean trait-anxiety scores before and after PMRT were
found as 43.6±9.5 and 31.1±6.5, respectively (P<0.001). When the QoLI-dialysis score was
examined it was 28.7±3.2 before PMRT and 29.6±2.3 after PMRT (P<0.01). The results of the
study demonstrate that PMRT for dialysis patients helps decrease state- and trait-anxiety levels
and has a positive impact on QoL.13
A study on relaxation therapy for anxiety was conducted in elderly persons. The study
evaluates the effects of an 8 week progressive muscle relaxation therapy regimen for a sample
of 10 elderly anxious clients using Beck anxiety inventory. The Results shows that the overall
anxiety level (50% or greater) in 7 subjects were significantly reduced 16.
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An experimental study on “depression, anxiety, body image, sexual functioning, and
dyadic adjustment associated with dialysis type in chronic renal failure” by Qanakkale Onsekiz
Mart University School of Medicine, Turkey. The study shows that depression (20.64±15.20)
and anxiety levels (14.72±12.36) were significantly higher in haemodialysis group compared
to peritoneal dialysis (13.54±12.51; 12.74±11.21) and control groups (7.17±5.58; 9.86±9.19).
In peritoneal dialysis group, as depression and anxiety levels increased, body image was
disturbed and sexual satisfaction decreased. In peritoneal dialysis group, body image
(86.98±23.63) was better than haemodialysis group (101.58±26.51) and was not different from
the control group (83.67±22.11). In haemodialysis group, as depression and anxiety levels
increased, body image was disturbed. In both groups, long-term dialysis disturbed body image
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.
find the association between pre-level anxiety scores and selected demographic
variables.
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reduce the anxiety level of haemodialysis patients. Here the investigator teaches ways
to relax the whole body slowly, by making the person concentrate on each part of the
body from feet to face, until a stage of complete relaxation for 15-20 minutes. It is
administered to the experimental group only.
Hospital: Hospital is the setting where patients with chronic kidney disease are
admitted and undergoing haemodialysis.
Hamilton Anxiety Rating Scale: In this study, Hamilton anxiety scale refers to a scale,
used to assess the level of anxiety of patients undergoing haemodialysis in a selected
hospital.
6.6 Assumptions
Jacobson’s progressive muscle relaxation technique may help reduce anxiety related to
haemodialysis.
6.7 Hypotheses
H11: There will be a significant difference between the mean pre-test score and the mean
post test score of anxiety among experimental group and control group.
H12: There will be a significant association between pre-test scores of anxiety and the
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selected demographic variables.
6.8 Variables
The data will be collected from chronic kidney disease patients undergoing
haemodialysis in selected hospital, Mangalore.
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Experimental Assessment of Administration Assessment of
Group anxiety using of Jacobson’s anxiety using
Hamilton progressive the same
anxiety score muscle Hamilton
relaxation anxiety rating
technique scale.
E= O2-O1
Control Assessment of Assessment of
Group anxiety using anxiety using
Hamilton the same
anxiety rating Hamilton
scale anxiety rating
scale
7.1.2 Setting
The study will be conducted in a selected hospital at Mangalore where chronic kidney
disease patients are undergoing haemodialysis.
7.1.3 Population
Population selected for the study would comprise of chronic kidney disease patients
undergoing haemodialysis in a selected hospital, Mangalore.
In this study, a type of non-probability sampling, that is, purposive sampling technique
will be used.
Forty chronic kidney disease patients undergoing haemodialysis would comprise the
sample. Out of the 40 patients, 20 will be in the experimental group and 20 will be in the
control group.
Patients:
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who are available during the period of data collection.
whose anxiety score is between 18-30 on the Hamilton Anxiety Rating Scale.
both gender.
Patients:
Step I: Prior to data collection, permission will be obtained from the authority for conducting
the study.
Step II: Assessing the anxiety level using Hamilton anxiety rating scale for both groups.
Step III: Forty patients undergoing haemodialysis with anxiety scores between 18-30 will be
selected based on inclusion criteria and randomly assigned to control group and experimental
group.
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Step IV: Patients of the experimental group will be taught Jacobson’s progressive muscle
relaxation technique for 15-20 minutes everyday for 2 weeks.
Step V: Reassess the anxiety level by using the same Hamilton Anxiety Rating Scale.
The data collected will be analyzed using descriptive and inferential statistics. The
investigator will use descriptive statistical techniques such as mean, median, mode, standard
deviation and percentage and inferential statistical technique like paired ‘t’ test and chi square
test.
Yes.
7.4. Has ethical consideration been obtained from the institution in case of the above?
Yes. Ethical clearance has been obtained from the ethical committee of the college.
Consent from the sample will be taken at the time of data collection.
8. References
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3. Rastogi S R .Global scenario of chronic kidney disease.[updated on 2012;Cited on
2013 Nov 15];Available from: URL:http://renalcareindia.org/statistics.aspx
4. Alladi J. Life after kidney failure. [online][ Updated on 2007 Oct ;Cited on 2013 Dec
20];Availablefrom:URL:http://www.thehindu.com/2007/08/24/stories/20070824531211
00.htm
6. Arora K .Introduction of anxiety, medicine net. [online] [updated on 2006 Jul 9; cited
on2013Nov23];Available from:URL:http://www.medicinenet.com/anxiety/article.htm.
7. Boemer RJ. Anxiety in elderly people. Fort Scholar Neurological Psychiatry. Published
on 2004 [cited on 2013 dec12];72(10):564-73.Available from:URL:http://
http://www.docstoc.com/anxiety in elderly people.htm
8. Davis M, Eshelman E, Mckay M. The relaxation and stress reduction workbook, 5 th ed.
Oakland: New Harbinger Publications Inc. published on 2000 Jul 6,[cited on 2013 Nov
18];38(5):234-36.Available from:URL:http://www.pubmed.com/relaxation and stress
reduction workbook/htm.
10. Tanvir S, Butt G, Taj R. Prevalence of depression and anxiety in chronic kidney disease
patients on haemodialysis. Published on 2012,[Cited on 2013 Nov 25]52(5):152-
4.Available from:URL:http://www.medinet/depression and anxiety in CKD patients on
hemodialysis/com
11. Rankin EJ, Gilner FH. Efficacy of progressive muscle relaxation training in reducing
anxiety among elderly. Journal of Aging :Published on 2004 Dec [cited on 2013 Nov
13
18];77(3):1395402.Availablefrom:http://www.ncbi.nlm.nih.gov/pubmed/8170796_Effi
cacy of progressive Muscle relaxation for reducing state anxiety among elderly adults
on memory tasks.
12. Tanvir S, Butt G, Taj R. Prevalence of depression and anxiety in chronic kidney disease
patients on haemodialysis. Published on 2012,[Cited on 2013 Nov 25]52(5):152-
4.Available from:URL:http://www.medinet/depression and anxiety in CKD patients on
hemodialysis/com
13. Yildirim YK, Fadialogla C. Study on effect of PMRT on anxiety levels and quality of
life in dialysis patients. Edtna Ercaj 2006 Apr–Jun[cited on 2013 Nov 25];32(2):86-
8.Available from:URL:http://www.pubmed.com/effect on PMRT on anxiety/htm
15. Arena JG. Relaxation therapy for anxiety in elderly. Psychological Aging, published on
1988 Mar,[cited on 2013 Dec 20] ;3(1):121-6. Available from:
URL:http://www.recentmedicalfindings.com/relaxation therapy for anxiety in
elderly.htm.
16. Oyekçin DG, Gülpek D, Sahin EM, Mete L. Depression, anxiety, body image, sexual
functioning, and dyadic adjustment associated with dialysis type in chronic renal
failure. published on 2012,[cited on 2013 Oct 22];43(3):227-41. Available
from:URL:http:// http://recentmedicalfindings.com/depression anxiety body image and
dynamic adjustement in dialysis patients.
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9. Signature of the candidate
10. Remarks of the guide It is very common that the patients who are
undergoing haemodialysis will have anxiety .The
JPMRT, is a cost effective method to reduce
anxiety .Hence it is recommended.
11.2 Signature
11.4 Signature
12.2 Signature
13.2 Signature
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