Rajiv Gandhi University of Health Sciences, Karnataka
Bangalore.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
Name of the candidate andaddress / T. SUHASINI,
KRUPANIDHI COLLEGE OF NURSING,
CHIKKABELLANDUR,
CARMALARAM POST,VARTHUR HOBLI, BANGALORE – 560035.
Name of the institution / Krupanidhi College Of Nursing
Course of study and subject / M.Sc Nursing
Obstetrics and Gynaecological Nursing
Date of admission to course / 01-06-2008
5) TITLE OF THE TOPIC:
A STUDY TO ASSESS THE EFFECTIVENESS OF YOGA ON DYSMENORRHOEA AMONG STUDENTS STUDYING IN A SELECTED HIGH SCHOOL, AT BANGALORE.
6) BRIEF RESUME OF THE INTENDED WORK:
6.1 ) NEED FOR THE STUDY:
Dysmenorrhoea refers to a painful menstruation of sufficient magnitude, so as to incapacitate day to day activities.1 This condition is most common among young women in their teens and twenties. Today’s research have shown that menstrual cramps and pain is common in 30 – 60% of women each month.2
Dysmenorrhoea is the leading cause of recurrent short-term school absenteeism among adolescent girls. Controversy surrounds the relative role of psychologic and biologic variables in the pathogenesis of dysmenorrhoea. Therefore, a study was conducted on the epidemiology of adolescent dysmenorrhoea in Standford University, School of
medicine, California. Data from 2,699 menarcheal adolescents was drawn by using a
national probability sampling method between the age group of 12 to 17 years . The co-relation between biologic, psychologic, and demographic variables were analyzed using bivariate and multivariate analytic techniques. Results showed that out of total, 1,611 (59.7%) adolescents reported dysmenorrhoea and 14% reported frequent missing of school because of cramps. Psychological variable did not predict either dysmenorrhoea or subsequent school absence, where as socio-economic status was positively correlated with dysmenorrhoea. Data in this study suggest that biologic variables play a substantial role in the pathogenesis of dysmenorrhoea.3
To explore the prevalence of dysmenorrhoea and its impact on school, social activities, management strategies and the knowledge of available treatment, a study was carried out among senior high school girls in Perth, Western Austrailia. The data was collected from 388 female students in grades 11 and 12 at three metropolitan schools. Anonymous questionnaire was administered during class time. The reported prevalence of dysmenorrhoea was 80%, out of these, 53% girls reported that it limits their activities, 37% said it affects their school activities. The most common medications used were simple analgesics by 53% followed by use of NSAIDS among 42% and 27% were un aware of the treatment for dysmenorrhoea.4
The above studies revealed that dysmenorrhoea is the most common complaint among the adolescents females, It takes the form of sharp, spasmodic pain in the lower abdomen at the begining of the periods. The cramping is so painful that they can’t walk and thus results in decreased level of activities, hence dysmenorrhoea is the leading cause of recurrent short term school absentism among the adolencent girls.5 To relieve this pain commonly preferred drugs are pain-releavers and NSAIDS, but the studies have shown that long term use of pharmocological drugs causes side effects .6
To examine prescribing of non-steroidal anti-inflammatory drugs (NSAIDs) and cyclo-oxygenase (Cox II) selective drugs in general practice, to compare the results with a 1993 survey and to assess numbers of gastrointestinal adverse events, a study was conducted in the year 2003 using the National Institute for Clinical Excellence (NICE) guidance, data from seven thousand nine hundred and fifty-eight patients with currently prescribed NSAID for 2 months or more was collected from practice records. Results showed that two hundred and four patients were receiving repeat prescriptions for conventional NSAIDs and 63 for Cox II selective drugs. Seventy-three per cent of patients prescribed Cox II selective drugs and 64% of patients prescribed conventional NSAIDs had at least one risk factor for gastrointestinal adverse events. Frequency of co-prescription of aspirin or antacids was similar for conventional NSAIDs and Cox II selective drugs and since 1993 the indications for NSAIDs have not changed.7
There are some alternative therapies to reduce dysmenorrhoea with out causing any side effects. Few scientific studies have been done in this area, many women have reported benefits from acupressure, acupuncture, various herbal remedies, hot application and yoga.7 Among these, yoga was found quiet effective in reducing symptoms of severe premenstrual syndrome, including anxiety and depression in some women. Some postures can reduce pressure on the uterus, relieving cramps, and yoga's gentle stretching can ease stiffness and tension in the lower back. According to the American Yoga Association, irritability, depression and moodiness can be eased by regular meditation, which is a part of many yogic practices. The association also explains that some yogic exercises stimulate the glandular and reproductive systems, helping in balancing body chemistry.8
Yoga is the most renowned and most practiced form of mind and body therapy. The classical technique of yoga dates back more than 5,000 years. In ancient times, the desire for greater personal freedom, health, long life, and hightened self esteem gave birth to this system of physical and mental exercises. The word yoga means “Union” between mind and body, and it brings them together in to a harmonious experiences. The whole system of yoga is built on four main structures i.e exercise (asanas), breathing techniques (pranayama), meditation and relaxation postures. Asanas help to relax and tone the muscles and massage the organs, pranayamas help to regulate the bodys energy levels, meditation to calm the mind and relaxation postures to reduce and eliminate stress and anxiety.9
The investigator has come across many adolescents with dysmenorrhoea who are incapacitated to do daily activities. The up coming benefits of yoga in reduction of other types of pain and discomforts created an intrest and motivated the researcher to conduct a study to assess the effectiveness of yoga on dysmenorrhoea.
6.2) REVIEW OF LITERATURE:
The literature in this study is organized in to;
1) Prevalence of dysmenorrhoea
2) Alternative treatments for dysmenorrhoea
3) Effect of yoga on other conditions
1) Prevalence of Dysmenorrhoea:
A study was conducted on the prevalence and impact of dysmenorrhoea on academic performance, school attendance, sports, social activities and its management on hispanic female adolescents at Chantay Banikaram. Data from 706 hispanic female adolescents in grades 9 to 12 was collected, a 31 item questionnaire was adiministered, results revealed that 85% reported dysmenorrhoea, out of these 38% showed missing school. Activities which affected were decreased class concentration (59%), Sports (51%), Class participation (50%), socialization (46%), and the treatment adopted were rest (58%), medications (52%), heating pads (26%) and (15%) exercises. Study concluded that menstrual pain was significantly associated with school absenteeism and decreased academic performance .10
A prospective cohort study was carried out on the epidemiology of dysmenorrhoea and health care use, in Japanese women of menstrual age between 18-51 years. The data from 832 samples were collected by using a health diary. Among these 15.8% reported dysmenorrhoea between 1-5 days of menstrual cycle. Commonly associated symptoms were head ache (10%), back pain (6.2%), and fatigue (5.38%), 51.5% used self medication, 7.7% used alternative therapies and no participant with dysmenorrhoea visited physician.11
A study was coducted to determine the prevalence of primary dysmenorrhoea, attitudes and behaviour towards dysmenorrhoea in the female students of an university. A total of 1,266 female students were anonymously surveyed by doctors.
It was found that mean age of the surveyed students was 21.02 +/- 2.13 years, mean menarche age was 13.3 +/- 1.4 years, and menstruation frequency was 32.58 +/- 19.8 days. Out of 1,266 students, 45.3% were found to suffer due to pain in each menstruation, 42.5% showed less pain and 12.2% showed no pain. Of those with primary dysmenorrhoea, 66.9% were using analgesic drugs to treat dysmenorrhoea.12
A study was conducted to determine the prevalence and severity of dysmenorrhoea in Wellington region of New Zealand. A total 0f 1,826 women were surveyed between the age group of 16-54 years and who attended general practice surgeries for 1 week duration,in the year 1985 during the month of June. Out of them, a sample of 30 general practice surgeons were randomly selected from a list of 190 doctors. Questions were asked about several aspects of general health as well as about each woman's menstrual, contraceptive, and obstetrical history. Results showed 80% of women menstruating currently, 772 women (53%) responded that they experience pain with their periods, 176 women (12%) reported discomfort, 12% of the total sample reported pain lasting 3 or more days, and 36% reported pain lasting 2 or more days. One third of all the women reported pain only during menstruation, over half reported that it occurrs both before and during menstruation. Both prevalence and severity of dysmenorrhoea were highest among women under the age of 25 years. Women with shorter menstrual cycles reported significantly more dysmenorrhoea than those with average or long cycles. Smoking of cigarettes increased both prevalence and severity of dysmenorrhoea and oral contraceptives were seen to lessen both prevalence and sevearity of dysmenorrhoea.13
2) Alternative treatment for Dysmenorrhoea:
A randomized placebo-controlled clinical trail was carried out on the effectiveness of aroma therapy on menstrual cramps and symptoms of dysmenorrhoea on college students, the subjects were 67 females who rated greater than 6 on a 10 point visual analogue scale. Subjects were randomized into three groups, an experimental group with 25 samples, a placebo group with 20 and a control group with 22 samples. Aroma therapy was topically applied to the experimental group in the form of an abdominal massage using two drops of lavender, one drop of clary sage, and one drop of rose in 5cc of almond oil. The placebo group received treatment with only almond oil and no treatment to the control group. The results reported that the menstrual cramps were significantly lowered in aroma therapy group than in other groups at post test time.14
A study was conducted to evaluate effect of accupuncture on NSAIDS resistant dysmenorrhoea at University Of Degli Firenze, Itally. Data collected from 15 patients by using a visual analouge scale and pain was measured at base line, at mid treatment at the end of treatment and also after 3 and 6 months of interval. Pain reduction was observed in 13-15 patients (87%), intensity was significantly reduced with respect to base line, 64% at mid treatment, 72% at the end of the treatment and 53% - 60% after 3 and 6 months of intervals. Greater reduction of pain was observed in primary as compared with secondary dysmenorrhoea.15
3) Effect of yoga on other conditions:
A study was conducted on the effect of Iyengar yoga therapy for chronic low back pain, 101 adults with chronic low back pain were collected for the study and were divided in to three groups. One group was given 12-weeks of yoga sessions, second group was given classes on conventional therapeutic exercises and another group was given a self-care book. The reports have shown that the reduced pain levels in the yoga group was superior than the book and exercise group.16
A similar study with randomized control trial was conducted in subjects with non-specific chronic low back pain and educational control group for 16 weeks of duration. Iyengar yoga therapy was administered to non specific - chronic low back pain group and no therapy for educational control group. Analyses revealed significant reduction in pain intensity (64%), functional disability (77%) and pain medication usage (88%) in the yoga group at the post-test time and after 3-months of follow-up assessments.16
A study was carried out on the effectiveness of yoga to alleviate depression. The data was collected from 40 hospitalized children and adolescents with diagnosis of adjustment disorder and depression. One group of 20 samples were given a one hour video tape on relaxation therapy and the other group of 20 was administered one hour class on yoga, brief massage and relaxation techniques. The immediate effects were assessed and decreased anxiety and depression was noted in the yoga exercise, brief massage and progressive muscle relaxation group and no changes were noted in the video tape group.17
6.3) STATEMENT OF THE PROBLEM:
A study to assess the effectiveness of yoga on dysmenorrhoea among the students studying in a selected high school, at Bangalore.
6.4)OBJECTIVES OF THE STUDY:
1) To identify the prevalance of dysmenorrhoea among the high school students as measured by structured questionaire.
2) To assess the level of pain and discomfort of dysmenorrhoea among high school girls as measured by numerical pain scale and structured questionqire.
3) To evaluate the effect of yoga on dysmenorrhoea among the high school students.
4) To compare the association between the post test pain scores and discomfort scores and selected demographic variables among the high school students.
6.5) HYPOTHESIS:
H1: There will be a significant difference in the severity of dysmenorrhoea after yoga therapy at 0.05 level of significance.
6.6) OPERATIONAL DEFINITIONS:
v Effectiveness: It refers to the extent to which the yoga therapies help in reducing the pain and discomfort of dysmenorrhoea as measured by numerical pain scale and structured questionnaire.
v Yoga: It refers to a combination of the selected techniques like asanas, pranayamas, relaxation postures and meditation administered for 45 minutes per day for five days a week for four weeks.
v Dysmenorrhoea: It refers to sharp, spasmodic pain beginning with the onset of menstruation and lasting for 12-24 hours.18
In this study dysmenorrhoea refers to pain and discomfort during menstruation.
Pain: It refers to sharp, spasmodic experience that usually occurs in the lower abdomen and radiates towards back and thighs as measured by numerical pain scale.
Discomfort: It refers to the symptoms caused by dysmenorrhoea like cramps, nausea and vomiting, dizziness, breast tenderness, diarrhoea or constipation, mood swings, fatigue as measured by structured questionaire.
v High school students: It refers to a group of adolescent girls between the age group of 13-16 years studying in 8th to 10th standard of a selected high school, at Bangalore.
6.7) ASSUMPTIONS:
ü Students between the age group of 13-16 years experiences dysmenorrhoea.