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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / NAME OF THECANDIDATE
AND ADDRESS / Ms. VIJAITHA.V
I YEAR M.Sc. NURSING,
KEMPEGOWDA COLLEGE OF NURSING,
K.R. ROAD, V.V. PURAM,
BANGALORE -560004.
2. / NAME OF THE
INSTITUTION / KEMPEGOWDA COLLEGE OF NURSING, BANGALORE -560004
3. / COURSE OF STUDY
AND SUBJECT / I YEAR M.Sc. NURSING, OBSTETRICAL AND GYNAECOLOGICAL NURSING.
4. / DATE OF ADMISSION
TO COURSE / 21/03/2012
5. / TITLE OF THE TOPIC / “EFFECTIVENESS OF CLOVE OIL MASSAGE ON LOWER BACK PAIN
AMONG POST NATAL MOTHERS, AT SELECTED HOPITALS, BANGALORE.”
1. BRIEF RESUME OF THE INTENDED WORK:
1.1. NEED FOR THE STUDY:
“The beginning of knowledge is the
discovery of something we do not understand”
- Frank Herbat
Childbirth is one of the most marvelous and memorable segment in a woman’s life. It does not really matter if the child is the first, second or the third one. Each experience is unique and calls for a celebration1. One of the most beautiful time periods during a women’s life is the pregnancy period. Because her life will be satisfied by giving birth to her baby. For that she will be ready to suffer all the pains with full happiness2 .
Even though the labor event gives pleasure for the mother it also gives severe pain. Most of the mother will experience some amount of discomfort after the delivery. Some common discomforts are pain in the episiotomy site, breast engorgement, after pain, back pain etc…Among this, back pain is very common during pregnancy and postnatal period, and is a serious cause of morbidity3.
Postnatal is the period beginning immediately after the birth of a child and extending for about six week. Biologically, it is the time after birth, a time in which the mother's body, including hormone levels and uterus size, return to pre-pregnant states. The major focus of postpartum care is ensuring that the mother is healthy and capable of taking care of her new born; equipped with all the information she needs about breast feeding, reproductive health and the immanent life adjustment. In some case this adjustment is not made easily and women may suffer from postpartum depression, post traumatic stress disorder or even puerperal psychosis. So the women need to be taken care properly during postnatal period. Most postpartum women experience relatively little discomfort related to physical changes4.
During postnatal period 68% of women are affected with back pain in 8 weeks and 60% in 8 months. Neither elective caesarian section nor assisted vaginal delivery increase the risk of postnatal back pain compared with spontaneous delivery. Most of the time analgesic is given to the postnatal mothers in order to reduce the pain. The action of analgesic is temporary which helps to reduce pain for very short period but the massage therapy plays very important role in minimizing pain, disability and speedy recovery to normal condition3.
Post-natal massage therapy may be an effective solution for the mothers. The top 6 benefits of postnatal massage therapy for mothers: are Relaxation, Stress Relief, back aches, neck and Shoulders pain, Reduction of fluid retention, help uterus to return to original size, reduction of cellulite and helps to tone up the body. Postnatal massage also provides an important sense of continuing comfort for the new mother. The aim of this massage is to give nurturing and emotional support as well as alleviate the muscle aches from the strain of labor and childbirth5.
A study conducted on “massage therapy during early postnatal life promotes greater lean mass bone growth and mineralization”. The massage therapy was performed daily from day 6 to day 10 of postnatal life, body composition, bone area, mineral content, bone mineral density were measured by Dual energy X-ray absorptiometry (DXA). Massage therapy during early life elicited immediate and prolonged anabolic effect on postnatal growth. On day 21 body weight, lean mass, bone mineral and bone area were significantly found greater6.
Clove is one of the spice we regularly use in our food. The analgesic effect of clove can be attributed to eugenol oil presence of this volatile oil make laugh immensely beneficial for reducing pain. Clove oil reduces inflammation so it will help to eliminate muscle ache are arthritis pain.Cloves may be used internally as a tea and topically as oil forhypotonic muscles, including for multiple sclerosis. Cloves may be used internally as a tea and topically as oil forhypotonic muscles, including for multiple sclerosis7.
It is also often found in the aromatherapy section of health food stores and used in the flavouring of some medicine. Clove are used in Indian Ayurvedic medicine, Tibeten medicine,Chinese medicine, and Western herbalism7.
The researcher during her clinical experience had witnessed many postnatal mothers with severe lower back pain. The investigator felt that nurses are in a position to consider the offering of back massage as option in the management of lower back pain. The technique can be easily learned and applied in clinical setting. This has motivated the researcher to take up this study.
1.2. REVIEW OF LITERATURE:
A study was conducted on “Long term back aches after childbirth: prospective search for causative factors” in US. In this study 599 women were recruited, of whom 450 (75%) replied to a follow up questionnaire. 152 women (33.8% of responders) reported backache lasting three months after delivery and, of these, 33 (7.3%) had not previously suffered with backache. There was no significant differences between the treatment groups in the incidence of postnatal backache overall or of new backache or any symptoms after childbirth. Among all demographic, obstetric, and epidural variables examined the only factors significantly associated with backache after childbirth was backache before and during pregnancy8.
A study was conducted on “physical activity and persistent low back pain and pelvic pain postpartum” in Umea University, Sweden. In this descriptive study they studied 639 women. These women were sent a questionnaire at approximately six months after delivery. Study concludes almost half of women who had experienced LBPP during pregnancy reported PA at six monthspost partum. The number of years of pre-pregnancy PA did not influence the risk of persistent LBPP. Obesity was a risk factor for not practicing PA9.
A study was conducted on “persistence of back pain symptoms after pregnancy and bone mineral density changes”. In this cohort study they studied 60 women. Result shows women had higher BMD loss during pregnancy compared to those without further pain. Study concludes Persistence of back pain symptoms after pregnancy could be related to an inability to recover fully from BMD loss during the index pregnancy10. An experimental study was conducted on “ Spinal manipulative therapy for chronic low- back pain in postnatal mothers” in Netherland. In this study they studied 6070 mothers to find out the effectiveness of spinal manipulation or mobilization in adults with chronic low-back pain were included. The result shows In general, there is high quality evidence that SMT is statistically significant, short-term effect on pain relief (MD: -4.16, 95% CI -6.97 to -1.36) and functional status (SMD: -0.22, 95% CI -0.36 to -0.07) compared to other interventions. Result shows High quality evidence suggests that there is a relevant difference between SMT and other interventions for reducing pain and improving function in patients with chronic low-back pain11.
An experimental study was conducted on “Chinese massage combined with Herbal ointment for postnatal mothers with low back pain. In this study 110 postnatal mothers are randomly selected assigned to experimental group with Chinese massage combined with herbal ointment or control group with simple massage therapy. The primary outcome was pain by Chinese Short Form McGill Pain Questionnaire (C-SFMPQ) After 4 weeks, the experimental group experienced significant improvements in C-SFMPQ and in local muscle stiffness compared with control group (between-group difference in mean change from baseline, −1.24 points,in sensory scores; −3.14 points,in affective scores; −4.39 points,in total scores; −0.64 points,in VAS; −1.04 points,in local muscle stiffness during relaxation state). The study concludes Chinese massage combined with herbal ointment may be a beneficial complementary and alternative therapy for postnatal mothers with LBP12.
A study was conducted on “effectiveness of massage therapy for subacute low-back pain” in Canada. In this randomized controlled trial studied 107 subjects were selected. Subjects with subacute low-back pain were randomly assigned to 1 of 4 groups: comprehensive massage therapy (n= 25), soft-tissue manipulation only (n= 25), remedial exercise with posture education only (n= 22) or a placebo of sham laser therapy (n= 26). Each subject received 6 treatments within approximately 1 month. Result shows of the 107 subjects who passed screening, 98 (92%) completed post-treatment tests and 91 (85%) completed follow-up tests. The comprehensive massage therapy group had improved function, less intense pain and a decrease in the quality of pain compared with the other 3 groups. Study concludes Patients with subacute low-back pain were shown to benefit from massage therapy, as regulated by the College of Massage Therapists of Ontario and delivered by experienced massage therapists13.
An experimental study was conducted on” effectiveness of focused structural massage and relaxation massage for chronic low back pain in postpartum mothers”. in this study 399 postpartum mothers are selected who have low back pain They will be randomized to one of two types ofmassage("focused structuralmassage" or "relaxationmassage"), or continued usual medical care. Tenmassagetreatments will be provided over 10 weeks. Study concludes for chronic lowback pain massage therapy is more effective than usual medical care14.
A study was conducted on “Analgesic effects of clove essential oil” in iran. In this study they selected 30 patients with myalgia and divided them into five groups and applied 1)Saline, 2) Essential oil 2%, 3) Essential 5%, 4) Essential oil 10%,5) Essential oil 20%. Study shows group treated with 2%, 5%, 10%, 20% experienced reduced pain. Study concludes that clove essential oil has analgesic effect15.
A comparative study was conducted on “monitoring the treatment of low back pain using Non steroid anti inflammatory drug and aromatic oil”. In this study 42 people were studied among them 12 were treated with a combination of Clove oil and Glycerine (A) and another 12 with Ketoprofen (P). Result shows treatment A was significantly (P<0.05) more effective than treatment P. Study concludes analgesic treatmentwith vegetable extracts of aromatic oils (A) was more effective than ketoprofen (P)16.
1.3. STATEMENT OF PROBLEM
“Effectiveness of clove oil massage on lower back pain among postnatal mothers at selected hospitals, Bangalore”.
1.4. OBJECTIVES OF THE STUDY
1) To assess the level of lower back pain among control group and experimental group.
2) To assess the effectiveness of clove oil massage on lower back pain among postnatal mothers in the experimental group.
3) To find the association between lower back pain scores of postnatal mothers with the selected demographic variables.
1.5. HYPOTHESIS:
H1: There may be significant difference in mean post- test pain scores compare to
mean pre-test pain score in experimental group.
H2: There may be significant association between pain scores with selected demographic
variables
1.6. OPERATIONAL DEFINITIONS
Effectiveness:
Effectiveness refers to the extent to which the lower back massage has an effect on the reduction of pain perception shown by postnatal mothers.
Back massage:
Back massage refers to the rubbing or kneading on the back especially to aid circulation, relax the muscles, or provide sensual stimulation.
Clove oil:
An aromatic oil obtained from the buds, stems or leaves of the clove tree, used in flavoring and perfuming and as a temporary analgesic for different pains.
Back pain:
Refers to a mild, moderate to severe discomfort and ache in the lower back,
experienced by mothers after child birth.
Postnatal mother:
Refers to primi and multi-parous women after spontaneous or assisted vaginal delivery from the first postnatal day.
2. MATERIALS AND METHODS:
2.1. SOURCE OF DATA : Postnatal mothers.
2.2. METHOD OF DATA COLLECTION
2.2.1. STUDY SUBJECTS : Postnatal mothers who underwent assisted or
normal vagial delivery, admitted at
selected hospital Bangalore
2.2.2. INCLUSION AND EXCLUSION CRITERIA:
INCLUSION CRITERIA : 1. Postnatal mothers suffering from mild,
moderate to severe back pain.
2. Postnatal mothers who are willing to
participate in the study
3. Postnatal mothers with assisted or normal
vaginal delivery.
EXCLUSION CRITERIA : 1. Postnatal mothers with LSCS.
2. Postnatal mothers with high risk group.
2.2.3. RESEARCH DESIGN : Quasi-Experimental Research design.
2.2.4. SETTING : Kempegowda Institute of Medical Science
and Research Centre, Bangalore-04.
2.2.5. SAMPLING TECHNIQUE : Convenient sampling.
2.2.6. (a) SAMPLE SIZE : 60 (30 experimental and 30 control group)
(b) DURATION OF STUDy : 8 weeks.
7.2.7. TOOL OF THE RESEARCH : 1. Structured Interview Schedule
2. Visual Analog Pain Scale.
7.2.8. COLLECTION OF DATA : After obtaining informed written consent
from the participants, based on the inclusion
criteria 60 post natal mothers will be
30 mothers are assigned to the
Experimental group and 30 to the control
group. Demographic data will be collected
by using structured interview Schedule.
Pre treatment assessment and post treatment
assessment will be conducted for both
the groups by using Visual Analog pain
Scales
7.2.9 METHOD OF DATA : 1.The investigator will use appropriate
ANALYSIS AND descriptive statistics like mean, median,
PRESENTATION standard deviation, mean percentage, and
inferential statistics namely student t-test
and Chi-square test to analyze the
data.
2. The analyzed data will be presented in the
form of tables, diagrams and graph,
wherever necessary
7.3. DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO PLEASE DESCRIBE BRIEFLY.
Yes, in this study 20% clove oil is used for the massage over 4-5mts,
two times per day for postnatal mothers
7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3?
· Yes, ethical clearance has been obtained from the concerned authority of selected hospital, Bangalore.
· No Physical and Psychological pain will be caused.