Volume 8, Issue 9, September – 2023 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

A Study to Assess the Effectiveness of Progressive

Muscle Relaxation Technique on Pain, Quality of
Sleep and Anxiety among Women Undergone
Cesarean Section at Sharda Hospital, Greater Noida,
Uttar Pradesh
1. 2.
Anjela Marandi Neha Barari
Nursing Lecturer Assistant Professor
Obstetric and Gynecological Nursing Department Obstetric and Gynecological Nursing Department
School of Nursing, Noida International University Sharda School of Nursing Science and Research,
Sector 17 A, Greater Noida, Uttar Pradesh- 203201 Sharda University Knowledge Park- III,
Greater Noida, Uttar Pradesh- 201306

Abstract:- Pain, sleeplessness, and anxiety are the most intervention group and the control groups at the post
often reported symptoms in women who have had test.
cesarean sections. Aim: To assess the effectiveness of
Progressive Muscle Relaxation technique on pain, Conclusion: The findings demonstrate that the
quality of sleep and anxiety among women under gone intervention group and control group’s scores were
cesarean section. Methodology: A quantitative research different. The pain level was reduced, there was an
approach was applied, quasi-experimental pretest- improvement in the quality of sleep, and there was a
posttest control group design was used. Women who had reduction of anxiety in the intervention group.
undergone cesarean sections were the target population.
The sample size was 40. In this study, demographic Keyword:- Effectiveness, Progressive Muscle Relaxation,
performa and standardized tools were used to evaluate Women undergone caesarean section, Pain, Anxiety, Sleep.
the pain levels, sleep quality and level of anxiety-Visual
Analog Pain Scale (VAS), Groningen Sleep Quality I. INTRODUCTION
Scale, and Hamilton Anxiety Rating Scale were used.
Cesarean delivery is a surgical operation in which the
Result: The study shows that the mean pretest of Visual incision is made in the abdomen and uterine to deliver a
Analog Pain Scale score in intervention group and baby. Cesarean Section is preferred if there any
control group were 3.9±0.30 and 3.85±0.50 respectively, complication or risk is involved in the normal delivery. The
and the post test in intervention group and control group world’s most popular surgical operation is a cesarean
were 1.70±0.47 and 2.90±0.30 respectively. The study section. More than one in five (21%) of all deliveries world
demonstrates a statistically significant mean difference wide currently take place via cesarean section. Over the
in Visual Analog Pain Scale score between the following decade, these number is anticipated to rise further.
[1]
intervention and the control groups at the post test.

In the intervention group and control group, the mean Women who gave birth surgically are more prone to
pretest Groningen Sleep Quality scale scores were experience loss anxiety, grief, negativity, and personal
2.90±0.30 and 2.85±0.36 respectively, while the mean failure. Women frequently experience symptoms such as
post-test scores were 1.05±0.22 and 1.85±0.36 sadness, anxiousness, mood fluctuations, difficulties
respectively. The study demonstrates a statistically sleeping, problems focusing, and a general lack of self-
significant mean difference in Groningen Sleep Quality awareness. Post-traumatic stress disorder can affect women
score between the intervention and the control groups at who have a cesarean delivery, particularly if it wasn't
the post test. expected.[2]

In the intervention group and controls, the mean pretest Effective treatment for these symptoms is Progressive
Hamilton Anxiety Rating scores were 2.75±0.44 and Muscle Relaxation. when the person contract and release the
2.80±0.41 respectively, while the mean post-test scores group of muscle gradually all over the body, the body
were 1.05±0.22 and 1.85±0.36 respectively. The study changes from a state of stress to a relaxation state. The stress
demonstrates a statistically significant mean difference hormones are less secreted and the heart rate, blood pressure
in Hamilton Anxiety Rating scale scores between decreases and relax the entire body. [3,4]

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Volume 8, Issue 9, September – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
With this context, the researcher sought to evaluate the  Informed consent from the participants of the study
effectiveness of Progressive Muscle Relaxation on pain,
sleep quality, and anxiety in women who had undergone  Inclusive Criteria:
caesarean section.  The women who had undergone cesarean section.
 Post cesarean women available at the time of data
 Objectives collection.
 To assess the effectiveness of Progressive Muscle
Relaxation technique on pain among women undergone  Exclusive Criteria:
caesarean section.  Women who experienced any post-operative
 To assess the effectiveness of Progressive Muscle complications following a cesarean.
Relaxation technique on quality of sleep among women  Post cesarean women who are not willing to participate
undergone caesarean section. in the study.
 To assess the effectiveness of Progressive Muscle
Relaxation technique on anxiety among women  To collect data for the study, the following tool was
undergone caesarean section. used:
 To find out the association between pain, quality of sleep Demographic Performa and Standardized tools have
and anxiety scores with selected demographic variables been used to gather the data.
of women under gone cesarean section. Tool 1: Demographic Performa
Tool 2: Visual Analog Pain Scale (VAS)
 Research Hypotheses: Tool 3: Groningen Sleep Quality Scale
 H1: Post cesarean women who practice Progressive Tool 4: Hamilton Anxiety Rating Scale
Muscle Relaxation have lower pain intensity than those
who do not practice it.  Statistical Analysis
 H2: Post cesarean women who practice Progressive To evaluate the data, inferential and descriptive
Muscle Relaxation have higher quality of sleep than statistics were employed in accordance with the objectives
those who do not practice it. and hypotheses using the statistical application EZR-
 H3: Post cesarean women who practice Progressive Version 2.4.
Muscle Relaxation have lower level of anxiety than
those who do not practice it. III. RESULTS
 H4: There will be a significant association found between
pre-test and post-test pain, quality of sleep and anxiety Section I: Baseline characteristics and baseline outcome
scores among women in interventional group with the measures of women undergone cesarean section in
selected demographic variables. intervention group and control group.
 H5: There will be a significant association found between The present study shows that majority of women
pre-test and post-test pain, quality of sleep and anxiety undergone cesarean section were 26-30 years i.e., 40% and
scores among women in control group with the selected 31-35 years i.e., 40% in intervention group and 26-30 years
demographic variables. i.e., 75% in control group. Majority of women were having
secondary education i.e., 75% in intervention group and
II. METHODOLOGY 75% in control group. Majority are non-working women i.e.,
90% in intervention group and 95% in control group.
A quasi-experimental pretest-posttest control group Majority of them had 1-4 antenatal visit i.e., 80% in
design was used to assess the effects of Progressive Muscle intervention group and 85% in control group. Majority of
Relaxation on pain, sleep quality, and anxiety in women the women were having two children i.e., 70% in
who had undergone caesarean sections. Women who had intervention group and 65% in control group. Majority of
undergone caesarean sections at Sharda Hospital were the women had gestational age more than 37 weeks i.e.,
included in the study population. This research was 90% in intervention group and 85% in control group.
conducted in 2022 between May and June. The sample size Majority of women had previous cesarean section i.e., 70%
was 40 (independent t-test formula were used) and the in intervention group and 65% in control group. Both groups
purposive sampling approach was employed. were similar in their baseline characteristic (were
homogenous). (P>0.05).
 Ethical Consideration:
The ethical clearance was obtained from To evaluate the outcome measures' homogeneity
 Institutional Ethical committee of Sharda University (Visual Analog Pain Scale, Groningen Sleep Quality Scale
 Dean of concerned schools, Sharda University and Hamilton Anxiety Rating Scale) at baseline,
 Chief Medical Officer, Sharda Hospital, Greater Noida independent t-test was employed, it was discovered that both
groups' measure of baseline was similar. (Were
 Head of Department, Obstetrics and Gynecology, Sharda
homogenous) (p>0.05).
Hospital

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Volume 8, Issue 9, September – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Section II: Effectiveness of Progressive Muscle Relaxation techniques on pain among women undergone caesarean section.

Table 1: Comparison of Mean and Standard Deviation between Pre- and Post-Test of visual Analog pain scale scores among
women undergone cesarean section in intervention group and control group. (N=40)
Groups
Intervention Control

Visual Mean Difference t-test & pvalue

Analog painScale n Mean SD n Mean SD
score

Pre-test(N=40) t=.46
20 3.9 0.30 20 3.85 0.36 0.50 p=.35 (NS)

Post- test(N=40) t=9.55

20 1.70 0.47 20 2.90 0.30 1.20 p= 0.01(S)
(p<0.05 significant level) S: Significant & NS: Non-Significant

The data in Table 1. showed that the post-test scores on the Visual Analogue Pain Scale between the intervention group and
control group have a statistically significant mean difference. To determine the significant mean difference, an independent t-test
was employed. This demonstrates that the progressive muscle relaxation approach is a successful intervention for lowering pain
among women undergone caesarean section. Hence the researcher accepted research hypotheses (H1).

Section III: Effectiveness of Progressive Muscle Relaxation techniques on quality of sleep among women undergone caesarean
section.

Table 2: Comparison of Mean and Standard Deviation between Pre- and Post-Test of Groningen sleep quality scale scores among
women undergone cesarean section in intervention group and control group. (N=40)
Groningen Sleep Group
Quality Intervention Control Independentt-test, p
Scale score Mean Difference Value
n Mean SD n Mean SD

Pre-test(N=40) t=0.46 p=0.35 (NS)

20 2.90 0.30 20 2.85 0.36 0.05

Post test(N=40) t=8.33 p=0.03 (S)

20 1.05 0.22 20 1.85 0.36 0.80
(p<0.05 significant level) S: Significant & NS: Non-Significant

The data in Table 2. showed that the post-test scores on the Groningen Sleep Quality Scale between the intervention group
and control group have a statistically significant mean difference. To determine the significant mean difference, an independent
t-test was employed. This demonstrates that the Progressive Muscle Relaxation approach is a successful intervention for
improving sleep quality among women undergone caesarean section. Hence the researcher accepted research hypotheses (H2).

Section IV: Effectiveness of Progressive Muscle Relaxation techniques on anxiety among women undergone caesarean section.

Table 3: Comparison of Mean and Standard Deviation between Pre- and Post-Test of Hamilton Anxiety Rating Scale scores
among women undergone cesarean section in intervention group and control group.
(N=40)
Group
Hamilton Intervention control
Anxiety Rating Scale Independentt-test & p
Score n mean SD n mean SD Mean Difference value

Pre-test(N=40) 20 2.75 0.44 20 2.80 0.41 0.05 t=0.37 p=0.46 (NS)

Post-test(N=40) 20 1.05 0.22 20 1.85 0.36 0.80 t=8.33 p=0.03 (S)

(p<0.05 significant level) S: Significant & NS: Non-Significant

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Volume 8, Issue 9, September – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
The data in Table 3. showed that the post-test scores conducted by Nagrale et al. The outcome demonstrates that
on the Hamilton Anxiety Rating Scale scores between the the controlled group's mean before the intervention was
intervention group and control group have a statistically 7.38 and decrease to 5.08 after the intervention. In the
significant mean difference. To determine the significant experimental group, the mean value before the intervention
mean difference, an independent t-test was employed. This was 7.76 and decreased to 3.29 after the intervention. The
demonstrates that the Progressive Muscle Relaxation results of the study demonstrate a substantial difference in
approach is a successful intervention for reducing anxiety the mean VAS pain scores between the experimental and
among women undergone caesarean section. Hence the the control groups.[5]
researcher accepted research hypothesis (H3).
 Second objective of the study was to assess the
Section V: Association between pre-test and post-test on effectiveness of Progressive Muscle Relaxation
pain, quality of sleep and anxiety scores among women techniques on quality of sleep among women undergone
undergone cesarean section in intervention group with the caesarean section.
selected demographic variables. According to the study the mean pretest of Groningen
Sleep Quality scale score among women undergone
To find out the association between pretest and post- cesarean section in intervention group and control group
test of Visual Analog Pain Scale scores, Groningen Sleep were 2.90±0.30 and 2.85±0.36 respectively. The mean post-
Quality scale scores, Hamilton Anxiety Rating scale scores test of Groningen Sleep Quality scale score among women
of intervention group with demographic variable of the undergone cesarean section in intervention group and
participants a one-way ANOVA was applied. It shows that, control group were 1.05±0.22 and 1.85±0.36 respectively.
there was no statistically significant association (p>0.05) According to the study, there is a statistically significant
found. except for education in post-test Hamilton Anxiety mean difference between the intervention group and control
Rating Scale scores. Hence researcher failed to accept group's Groningen Sleep Quality Scale scores at the post-
research hypothesis (H4). test. In order to identify the significant mean difference, an
independent t-test was applied. (t=8.33, p=0.03). This
Section VI: Association between pre-test and post-test on demonstrates that the Progressive Muscle Relaxation
pain, quality of sleep and anxiety scores among women approach is a successful intervention for improving sleep
undergone cesarean section in control group with the quality among women undergone caesarean section.
selected demographic variables. Support for the study was given by another study conducted
by Ibrahim et al. The findings demonstrated that JPRT
To find out the association between pretest and post- enhanced sleeping quality as evidenced by the fact that the
test of Visual Analog Pain Scale scores, Groningen Sleep intervention group's mean sleeping quality score fell
Quality scale scores, Hamilton Anxiety Rating scale scores significantly when compared to the control group
of control group with demographic variable of the (F1=361.49, p0.001). A significant improvement in
participants, a one-way ANOVA was applied. It shows that, sleeping quality was observed following JPRT, with 12% of
there were no statistically significant association (p>0.05) the improvement attributable to the intervention, according
found. Except for education in Post-test Groningen sleep to ANCOVA results using pre-test data as a baseline.[6]
quality scale scores. Hence researcher failed to accept
research hypothesis (H5).  Third objective of the study was to assess the
effectiveness of Progressive Muscle Relaxation
techniques on anxiety among women undergone
IV. DISCUSSION
caesarean section.
According to the study the mean pretest Hamilton
 First objective of the study was to assess the
Anxiety Rating scale score among women undergone
effectiveness of Progressive Muscle Relaxation
cesarean section in intervention group and control group
techniques on pain among women undergone cesarean
were 2.75±0.44 and 2.80±0.41 respectively. The mean post-
section.
test of Hamilton anxiety rating scale score among women
According to the study the mean pretest of Visual
undergone cesarean section in intervention group and
Analog pain Scale score among women undergone cesarean
control group were 1.05±0.22 and 1.85±0.36 respectively.
section in intervention group and control group were
According to the study, there is a statistically significant
3.9±0.30 and 3.85±0.50 respectively. The mean post-test of
mean difference between the intervention group and control
visual analog pain scale score among women undergone
group's Hamilton Anxiety Rating Scale scores at the post-
cesarean section in intervention group and control group
test. In order to identify the significant mean difference, an
were 1.70±0.47 and 2.90±0.30 respectively. The study
independent t-test was applied. (t=8.33, p=0.03). This
shows that a statistically significant mean difference has
demonstrates that the Progressive Muscle Relaxation
been observed in Visual Analog pain Scale scores, at post-
approach is a successful intervention for reducing anxiety
test between intervention group and control group. In order
among women undergone caesarean section. Essa et al.'s
to identify the significant mean difference, an independent t-
additional research supported the study's findings by
test was applied (t=9.55, p=0.01). This demonstrates that the
showing that there was a difference of statistical significance
progressive muscle relaxation approach is a successful
between the two groups (p .0000). Whereas, 5% of the study
intervention for lowering pain among women undergone
group and 35% of the control group both still had significant
cesarean section. In support of the study, a different study

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Volume 8, Issue 9, September – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
anxiety. Additionally, one fifth (20%) of the study group had [7]. Essa R, Ismail N, Hassan N. Effect of progressive
entirely lost their anxiety, as opposed to no one in the muscle relaxation technique on stress, anxiety, and
control group (0.00%). The study group saw a statistically depression after hysterectomy. Journal of Nursing
significant decline at the same period (p =.000). [7] Education and Practice. 2017 Feb 20;7:77.

 Fourth objective of the study was to find out the

association between pain, quality of sleep and anxiety
scores with selected demographic variables of women
under gone cesarean section.
The results of the current study demonstrated that there
was no statistically significant correlation (p>0.05) between
the pain, quality of sleep and anxiety scores with
selected demographic variables of women under gone
cesarean section.

V. CONCLUSION

According to findings, the study reveals that women

who had undergone cesarean sections identify that using the
Progressive Muscle Relaxation technique it was effective in
reducing pain, improving quality of sleep and reducing
anxiety level. Progressive Muscle Relaxation technique is an
effective intervention for managing pain, quality of sleep
and anxiety among women undergone cesarean section.
Progressive Muscle Relaxation technique should be
implemented as part of routine nursing care for the women
undergone cesarean section.

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