The effect of relaxation therapy on patient's pain following a total knee replacement

Abstract

The objective of this study is to examine the effect of relaxation therapy on patient's pain following a total knee replacement with a quasi-experimental research pre-post test design. In order to achieve the objective of the current thesis, relaxation therapy was performed on 27 total knee replacement patients who were admitted into A university hospital located in Suwon, from July 1, 2004 to November 12, 2004. The patients were randomly assigned to a control group(n=14) and an experimental group(n=13). The relaxation therapy was executed in 4 times (after 6 hours, 24 hours, 48 hours, 72 hours from the moment of total knee replacement). Pain intensity was measured with graphic rating scale and the frequency of prn analgesia was investigated in the nursing record. Systolic and diastolic blood pressure and pulse rate were measured as indicators of physiologic reaction to pain. Data were analyzed with statistically analyzing methods such as frequency, percent, x²-test, Mann-Whitney U test, and Wilcoxon signed rank test using SPSSWIN 10.0 Statistics program. The results of this study are as follows. 1. There is no statistically significant difference between a control group and an experimental group in general properties including age, marriage state, religion, operative experience, past disease presence, the person whom it is nursed by, job, total income, pain intensity, systolic and diastolic blood pressure, and pulse. 2. The result of hypothesis identification is as follows : 1) The hypothesis 1 : "The score of pain of the experimental group with relaxation therapy will significantly decrease than that of the control group who did not receive relaxation therapy after every intervention(after 6, 24, 48, 72 hours)."was supported (after 6 hours p=.006, after 24 hours p=.001, after 48 hours p=.002, after 72 hours p=.002). 2) The hypothesis 2 : "The vital sign of the experimental group with relaxation therapy will significantly decrease than that of the control group who did not receive relaxation therapy after every intervention(after 6, 24, 48, 72 hours)." was supported by the fact that the following three sub - hypotheses are identified. ① Sub - hypothesis 1 : "The systolic blood pressure of the experimental group with relaxation therapy will significantly decrease than that of the control group who did not receive relaxation therapy after every intervention(after 6, 24, 48, 72 hours)." was supported (after 6 hours p= .039, after 24 hours p=.022, after 48 hours p=.002, after 72 hours p=.013). ② Sub - hypothesis 2 : "The diastolic blood pressure of the experimental group with relaxation therapy will significantly decrease than that of the control group who did not receive relaxation therapy after every intervention(after 6, 24, 48, 72 hours)." was supported (after 6 hours p=.013, after 24 hours p=.006, after 48 hours p=.022, after 72 hours p=. 013). ③ Sub - hypothesis 3 : "The pulse rate of the experimental group with relaxation therapy will significantly decrease than that of the control group who did not receive relaxation therapy after every intervention(after 6, 24, 48, 72 hours)." was supported (after 6 hours p=.022, after 24 hours p=.013, after 48 hours p=.021, after 72 hours p=.003). 3) The hypothesis 3 : "The frequency of prn analgesia of the experimental group with relaxation therapy will be significantly less than that of the control group who did not receive relaxation therapy to 72 hours after the operation." was supported (p=.047). To sum up, the relaxation therapy is effective for the pain relief of total knee replacement patients and can be utilized as an independent nursing intervention.

본 연구는 이완요법이 인공 슬관절 전치환술 환자의 통증에 미치는 효과를 파악하기 위해 시도된 비동등성 대조군 전후설계를 이용한 유사실험 연구이다. 이러한 연구의 목적을 달성하기 위하여 2004년 7월 1일에서 11월 18일까지 수원시 소재 A 대학병원에 입원하여 인공 슬관절 전치환술을 받은 환자 중 실험군 14명, 대조군 13명의 총 27명을 대상으로 수술 후 6시간, 24시간, 48시간, 72시간의 4회에 걸쳐 이완요법을 실시하였다. 주관적 통증강도를 도표평정척도로 측정하고 간호기록지를 통해 필요시 진통제 투여횟수를 조사하였고 통증의 생리적 지표로 수축기 혈압, 이완기 혈압, 맥박을 측정하였다. 자료의 분석은 SPSSWIN 10.0 통계 프로그램을 이용하여 실수와 백분율, x²-test, Mann-Whitney U test, Wilcoxon signed rank test 등의 통계분석방법을 사용하였다. 연구결과는 다음과 같다. 1. 실험군과 대조군의 일반적 특성에 따른 동질성 검증결과 연령, 결혼상태, 종교, 과거수술경험, 과거질환유무, 간호하는 사람, 직업, 총수입, 통증강도, 수축기 혈압, 이완기 혈압, 맥박에서 동질성이 확인되었다. 2. 가설검증 결과는 다음과 같다. 1) 제 1 가설: "이완요법을 받은 실험군은 받지 않은 대조군에 비해 매 중재 후 (6, 24, 48, 72시간 후) 통증점수가 유의하게 감소할 것이다." 는 유의수준 5%수준에서 지지되었다. (6시간 후 p=.006, 24시간 후 p=.001, 48시간 후 p=.002, 72시간 후 p=.002). 2) 제 2 가설: "이완요법을 받은 실험군은 받지 않은 대조군에 비해 매 중재 후 (6, 24, 48, 72시간 후) 활력징후가 유의하게 감소할 것이다." 는 아래와 같이 부가설 1, 2, 3이 지지됨에 따라 지지되었다. ① 제 1 부가설: "이완요법을 받은 실험군은 받지 않은 대조군에 비해 매 중재 후 (6, 24, 48, 72시간 후) 수축기 혈압이 유의하게 감소할 것이다." 는 유의수준 5%수준에서 지지되었다(6시간 후 p=.039, 24시간 후 p=.022, 48시간 후 p=.002, 72시간 후 p=.013). ② 제 2 부가설: "이완요법을 받은 실험군은 받지 않은 대조군에 비해 매 중재 후(6, 24, 48, 72시간 후) 이완기 혈압이 유의하게 감소할 것이다." 는 유의수준 5%수준에서 지지되었다(6시간후 p=.013, 24시간 후 p=.006, 48시간 후 p=.022, 72시간 후 p=.013). ③ 제 3 부가설: "이완요법을 받은 실험군은 받지 않은 대조군에 비해 매 중재 후(6, 24, 48, 72시간 후) 맥박이 유의하게 감소할 것이다." 는 유의수준 5%수준에서 지지되었다(6시간 후 p=.022, 24시간 후 p=.013, 48시간 후 p=.021, 72시간 후 p=.003). 3) 제 3 가설: "이완요법을 받은 실험군은 받지 않은 대조군에 비해 수술 후 72 시간까지의 필요시 진통제 투여 횟수가 적을 것이다." 는 유의수준 5%수준에서 지지되었다(p=.047). 이상의 결과를 토대로 이완요법은 인공 슬관절 전치환술 환자의 통증경감에 효과적이고 독자적인 간호 중재로 이용될 수 있다고 사료된다.