RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. Name of the candidate and address ( in block letters )

MS. PRASEETHA.K.VK.PANDYARAJAH BALLAL NURSINGINSTITUTE , COLLEGE OF NURSINGSOMESWARA ROAD, ULLALMANGALORE−575 020.

2. Name of the institution K. PANDYARAJAH BALLAL NURSINGINSTITUTE, COLLEGE OF NURSINGULLAL, MANGALORE

3. Course of the study and subject MASTERS DEGREE IN NURSING.OBSTETRIC AND GYNAECOLOGICAL NURSING

4. Date of admission to the course 02-07-2012

5. Title of the topic “EFFECTIVENESS OF PROGRESSIVE MUSCLE RELAXATION VERSUS GINGER POWDER ON DYSMENORRHEA AMONG STUDENTS IN SELECTED NURSING COLLEGES OF MANGALORE”.

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BRIEF RESUME OF THE INTENDED WORK

Introduction

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“Health is wealth” goes the saying. Health is an essential factor for a happy contended

life. Dysmenorrhea means painful menstruation. The prevalence of dysmenorrhea is very high

and at least 50% of women experience this problem throughout their reproductive years. The

uterus is a muscle. Like all muscles, it contracts and relaxes. Most uterine contractions are

never noticed, but severe ones are painful1. Alternative and complementary therapies are

widely accepted and available for dysmenorrhea.2

In India dysmenorrhoea is estimated to be present among 40-50% , in that with severe

focus giving rise to work or school absenteeism in 15% and mild forms requiring no

medication or occasional over the counter analgesics in about 30% 3 . The true incidence and

prevalence of dysmenorrhea is not clearly established, in recent times Nair Parvathi and

Agarwal A.K (2010) concluded that dysmenorrhea (72.96) is a common problem in India4.

Ginger is known as ‘Sunnthi’ in Ayurveda and description of the plant appears in the

old text like Charaka, Sushrutha, and Vagabhatta and Charaka dutta. The use of this drug is

mentioned in form of ‘Trikatu’, a famous Ayurvedic remedy for the treatment of digestive

disorders. In Ashtanga hridaya, the plant has been used in traditional remedy for arthritis and

also indicated in ointment form for local application in pain5.

Anxiety has been shown to increase pain and pain perception (Hosking & Welchew,

1985). If the level of anxiety is decreased, experienced pain and perception of pain will

decrease (Beecher, 1956). Progressive muscle relaxation is one method available to decrease

anxiety (Scandrett, Bean, Breeden, & Powell, 1986). It also decreases skeletal and smooth

muscle tension (Benson, 1984). Decreased muscle tension and decreased anxiety will lead to

decreased pain which in turn will lead to decreased analgesic usage (Hosking

&Welchew,1985)6

6.1 Need for the study

For a girl, menarche is a milestone and sign of becoming woman. A number of

problems occur during menstruation and dysmenorrhea is one such problem.1 Pain is the most

frequent symptom which leads a person to seek medical help. In most cases, it is the symptom

of a disease, treatment of which promotes its resolution. The pain control become even more

important, since it indicates life quality and the possibility of reintegrating the person to his

professional and social activities.7

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Among the menstrual disorders, dysmenorrhea is the most common one being reported

in half of the women of child bearing age and of these 10% experience incapacitating pain for

1-3 days, every month8.Dysmenorrhea is a major cause for absenteeism from school or

restriction of activities and social interaction among 60-90% of adolescents in India2.

An explorative study was conducted to assess the Prevalence of dysmenorrhea among

adolescent girls at selected 5 Govt. aided and private schools in Chennai. Modified mood

menstrual distress questionnaire (MMDQ)was used to assess the severity of dysmenorrhoea

with seven sub scales like pain, water retention, autonomic reactions, negative affect, impaired

concentration, behaviour change and control. Result shows that out of 800 samples

689(86.1%) reported severe pain symptoms, 111(13.9%) had moderate pain symptom and

none of them had mild pain symptoms. In water retention scale 32.9% had mild,42.8% had

moderate and 24.4% had severe symptoms.99.2% had severe autonomic reaction

symptoms,98.4% had severe control symptoms, 99.2% had negative affect symptom,99.6%

experienced severe behavioural change symptoms and 100% of sample had severe impaired

concentration symptoms during menstruation9.

Ginger has been well researched and many of its traditional uses confirmed. It is well

known as a remedy for travel sickness, nausea and indigestion. It is a warming remedy, ideal

for boosting the circulation, lowering high blood pressure and keeping the blood thin in higher

doses. Ginger is anti-viral and makes a warming cold and flu remedy. Due to its antispasmodic

characteristic some people have used it to help ease menstrual cramps.3

Results from various research studies utilizing PMR as a therapeutic intervention have

indicated a reduction in certain symptoms; including a reduction of shortness of breath among

young adults with asthma, pain and anxiety reduction in labour, a reduction of pain and nausea

associated with cancer, a reduction of arthritis pain, menstrual pain, and an increase in gross

and fine motor function and reduction of stress level of individual who have recent heart

attack.7

Consequently, researchers have investigated numerous alternative/ complementary

therapies such as yoga, herbal and dietary therapies, muscle relaxation, behavioural

interventions, acupressure, exercises and aromatherapy.10

A qualitative study was conducted to assess the effectiveness of Chinese herbal medicine

(Xiao Yao Wan) for the treatment of dysmenorrhoea among women in university of East

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London. Modified questionnaires, retrospective questionnaire and a daily questionnaire was

used to assess the severity of dysmenorrhea. The Xiao yao herbal medicine was given for the

first 2 days of their menstruation as two divided dose. The result shows that Xiao Yao Wan

was significantly effective (p≤0.05) for treatment of menstrual pain and reduces the number of

days with pain and the number of days of use of analgesia in primary dysmenorrhea.11

The investigator’s experience with her colleagues with dysmenorrhoea had shown that

quality of work both academic and clinical seems to be affected; peer and social interaction

were also markedly affected during their menstrual days. This motivated the investigator to

research into various methods that can reduce the severity of dysmenorrhoea in a natural way

so as to permit normal activities even during their menstruation.

6.2 Review of literature

A comparative study was conducted on the effect of progressive muscle relaxation

versus ginger powder on dysmenorrhea among the nursing students in Pune. Non probability

purposive sampling technique was used to select the samples. Modified shortened selected

dysmenorrhoea symptoms assessment form, daily symptom calendar, and a 5 point Likert

scale was used to assess the severity of selected symptoms of dysmenorrhea.75 participants

were divided in to three groups: experimental group 1, experimental group 2 and control group

by lottery method, 25 in each group. 1st group was administered with PMR once a day and

ginger powder 1gm per dose was administered twice a day with warm water after meal to the

second experimental group during first three days of their menstruation. Before the

intervention the baseline values of selected symptoms of dysmenorrhea in all three groups

were similar. After post intervention MANNOVA analysis of 1st and 2nd group indicated that

there was a significant difference in scores across each condition and time. The calculated p

value was less than 0.05, so this study statically proved that majority of dysmenorrhoea

symptoms can be prevented by use of ginger powder and progressive muscle relaxation and

study concluded that both ginger powder and PMR has significant effect on selected symptoms

of dysmenorrhea.12

A study was conducted on comparison of ginger, mefenamic acid, and ibuprofen on

pain among 150 students with primary dysmenorrhea from the dormitories of two medical

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universities of Iran who were alternatively divided into three equal groups. A double blind

comparative clinical trial was used for sampling technique and a verbal multidimensional

scoring used for assessing the severity of dysmenorrhoea. Students in the ginger group took

250mg capsule of ginger rhizome powder four times a day for three days from the start of their

menstrual period. Members of the other groups received 250mg mefenamic acid or 400 mg

ibuprofen capsules respectively on the same protocol. Result shows that there was no

differences between groups in baseline characteristics,( p>0.05) At the end of treatment,

severity of dysmenorrhoea decreased in all three groups and no differences were found

between the groups in severity of dysmenorrhoea, pain relief, or satisfaction with treatment,

(p<0.05) No severe side effects occurred. So this study concluded that ginger was as effective

as mefenamic acid and ibuprofen in relieving pain among students with dysmennorrhea.13

A comparative study was conducted on the effect of music assisted and without

music progressive muscle relaxation on self reported symptoms of 24 women with primary

dysmenorrhea in university of Kansas. Random sampling was used for selection of sample and

modified Shortened Premenstrual Assessment Form (SPAF) used to assess the severity of

dysmenorrhoea. Participants in the PMR-only group completed a PMR exercise in their home

for the first three days of their period prior to completing the modified SPAF. Participants in

the PMR with music group completed a music-assisted PMR exercise in their home for the

first three days of their period prior to completing the modified SPAF. Using a MANOVA

analysis of the total modified SPAF scores for the pretest and Days 1-3 across each condition

and time, there was no significant difference in scores. Using Pillai’s Trace, the F-value was

0.833. Although there was no significance across each condition, results of the study indicated

no significant reduction of symptoms among the PMR with music group in comparison

without music group of PMR and the study concluded that PMR is effective for

dysmenorrhoea but no further more effect with music assisted PMR10.

A comparative study was conducted on effect of zingiber officinale R. rhizomes

(ginger) on pain relief in primary dysmenorrhea: a placebo randomized trial among a sample

of 120 students with moderate or severe primary dysmenorrhea in Tehran. Randomized control

trial was used for sampling technique and a verbal multi dimensional scoring system and

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visual analogue scale were used to assess the severity of dysmenorrhoea. Samples were

randomly assigned in two equal groups, one for ginger and other for placebo in two different

protocols with monthly intervals. The ginger and placebo groups in both protocols received

500 mg capsules of ginger root powder or placebo three times a day. In the first protocol

ginger and placebo were given two days before the onset of the menstrual period and

continued through the first three days of the menstrual period. In the second protocol ginger

and placebo were given only for the three days of the menstrual period. There was no

difference in the baseline characteristics of the two groups. The results showed that there is

significant differences in the severity of pain between ginger and placebo group for protocol

one (p=0.015) and protocol two (p=0.029). But there was significant difference in duration of

pain between the two groups for protocol one (p=0.017) and not for two(p=0.210) So study

concluded that treatment of primary dysmenorrhoea with ginger for 5 days had a statistically

significant effect on relieving intensity and duration of pain.14

A quasi experimental study was conducted on the use of progressive muscle

relaxation technique for pain relief in gynaecology and obstetrics among 61 patients, aged 17-

36years who had been admitted in gynaecological ward in Sao Paulo state, Brazil. An

observation instrument was used for selection of sample and pain level was determined by

Huskisson’s analogical visual scale. McNemar test and the χ2 tests are used for statistical

analysis. The analysis of data concerning muscle observations in the pretest and post relaxation

situations, 85.3% of the patient relaxed from the use of the technique. The level of significance

established was α=0.05. Results are positive to study and it was concluded that by means of

relaxation, the perception of pain is decreased.7

6.3 Problem statement

“Effectiveness of progressive muscle relaxation versus ginger powder on dysmenorrhea among

students in selected nursing colleges of Mangalore”.

6.4 Objectives of the study

Objectives of the study are to;

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1. assess the severity of dysmenorrhea among students in control group, experimental

group I and experimental group II.

2. assess the effectiveness of Progressive Muscle Relaxation (PMR) on severity of

dysmenorrhea among students in experimental group I.

3. assess the effectiveness of Ginger powder on severity of dysmenorrhea among students

in experimental group II.

4. compare the effectiveness of Progressive Muscle Relaxation and Ginger powder on

severity of dysmenorrhea.

5. find out the association between severity of dysmennorrhea and selected demographic

variables.

6.5 Operational definitions

Dysmenorrhea: In this study it refers to the degree of pain and other menstrual symptoms

such as nausea, vomiting, giddiness, tiredness, fatigue, discomfort and psychological

disturbances associated with menstruation.

Effectiveness: In this study it refers to the outcome of progressive muscle relaxation and

ginger powder on severity of dysmenorrhea among nursing students.

Progressive muscle relaxation: Progressive muscle relaxation (PMR) is a technique for

reducing anxiety by alternately tensing and relaxing the muscles. PMR entails a physical and

mental component. The physical component involves the tensing and relaxing of muscle

groups over the legs, abdomen, chest, arms and face. With the eyes closed and in a sequential

pattern, a tension in a given muscle group is purposefully done for approximately 10 seconds

and then released for 20 seconds before continuing with the next muscle group.12In this study

Jacobson’s progressive muscle relaxation technique will be administered once a day for first

three days of menstruation.

Ginger powder: Ginger (zingiber officinale rocs.) is a creeping thick tuberous rhizome,

which spread under the ground and commonly used as a carminative, stimulant and

antiemetic.4 In this study ginger powder refers to dry ginger rhizome powder 1 gram in a

packet which can be taken in divided dose twice a day from the start of menstrual period after

having food for first three days of menstruation. The total daily dose of ginger will be 2 grams.

Students: In this study it refers to students currently studying Diploma and Basic BSc nursing

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course in selected nursing colleges of Mangalore, with complaints of dysmenorrhea and

having regular menstrual cycle.

6.6 Assumption

- Dysmenorrhea will be a common menstrual discomfort.

- Ginger powder will be more effective in reducing the severity of dysmenorrhea than PMR.

6.7 Delimitation

This study is delimited to;

nursing students of selected nursing colleges of Mangalore.

those who are having regular menstrual cycle with dysmenorrhea.

6.8 Hypotheses : The hypotheses will be tested at 0.05 level of significance.

H1 - There will be a significant reduction in the severity of dysmenorrhea among those who

receive PMR than those who do not.

H2- There will be a significant reduction in the severity of dysmenorrhea among those who

consume ginger powder than those who do not.

H3- There will be a significant reduction in the severity of dysmenorrhea among those who

consume ginger powder than those who receive PMR.

H4- There will be a significant association between the severity of dysmenorrhea and selected

demographic variables.

Materials and methods

7.1 Source of data

Data will be collected from nursing students of selected nursing colleges, Mangalore.

7.1.1 Research design

Experimental pre- test post- test only design

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R1 O1 X1 O2

R2 O1 X2 O2

R3 O1 ---- O2

R1- group I

R2-group II

R3-control group

X1- PMR

X2- Ginger powder

O1- Pre-test

O2- Post-test

7.1.2 Setting

Selected nursing colleges of Mangalore.

7.1.3 Population

The population comprises of nursing students studying at selected nursing colleges of

Mangalore.

7.2 Methods of data collection

7.2.1 Sampling procedure

Stratified random sampling

7.2.2 Sample size

The sample size will be 75 nursing students with dysmenorrhea, having regular menstrual

cycle.

I group (Progressive muscle relaxation) - 25

II group (Ginger powder) - 25

III group (control group) - 25

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7.2.3 Inclusion criteria

Students who are:

- having dysmenorrhea and regular menstrual cycle.

- unmarried within the age group of 17-30 years.

7.2.4 Exclusion criteria

Students who are:

- not willing to participate in the study.

- taking medication for dysmenorrhea.

- having any chronic gynaecological illness.

7.2.5 Instruments intended to be used

Consists of 3 sections:

Section 1: Socio-demographic proforma and Calibrated metric scale and weighing machine.

Section 2: Checklist to screen the students for dysmenorrhea.

Section 3: Numerical pain rating scale to assess the level of pain and dysmenorrhea symptom

assessment form to assess the severity of dysmenorrhea.

7.2.6 Data collection method

Data will be collected after obtaining written permission from the Principal of Nursing

colleges and written consent from the participants. The maximum duration for data collection

is 4-6weeks. Checklist will be used to screen the students for dysmenorrhea.

The data collection will be conducted in three phases. Students will be randomly allocated to

group I (PMR), group II (ginger powder) and control group.

Phase1: Socio demographic Proforma will be used to collect demographic data. Pre-test will

be conducted two to three days prior to menstruation in all three groups and a dysmenorrhea

assessment form will be used to assess the severity of dysmenorrhea. Calibrated metric scale

and weighing machine will be used to determine the BMI.

Phase 2 Intervention: Demonstration of PMR using Video CD will be done and then

demonstrated by investigator, followed by re-demonstration by subjects. Subjects are made to

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follow the procedure once a day for 10-15 minutes during the first three days of their

menstruation.

The second group of students will be provided with packets containing 1 gram ginger powder.

The subjects are made to consume the provided ginger powder twice a day after meal for three

days from the start of their menstrual period. The total daily intake of ginger powder is 2

grams.

No intervention is carried out to third group (control group).

Phase 3 post test: Severity of dysmenorrhea is assessed by using the same dysmenorrhea

assessment form on 3rd day of menstruation from all three groups.

7.2.7 Data analysis plan

Data will be analyzed by using descriptive statistics and inferential statistics.

Descriptive statistics - Frequency, Mean, Mean percentage, median and standard deviation

will be used to classify demographic variables and to assess the severity of dysmenorrhea.

Inferential statistics

• Paired‘t’ test will be used to compare the effectiveness of interventions within the

groups.

• ANOVA will be used to compare the effectiveness of PMR and ginger powder on

dysmenorrhea between the groups.

• Chi square test will be used to find the association between severity of dysmenorrhea

and selected demographic variables.

7.3 Does the study require any investigation to be conducted on patients or other humans

or animals?

Yes. This study requires interventions to be conducted on nursing students with intake of

ginger and practice of progressive muscle relaxation by the subjects.

7.4 Has ethical clearance been obtained from your institution?

Yes, the permission to conduct the study is obtained from the ethical committee of

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K.Pandyarajah Ballal Nursing Institute, College of Nursing.

List of references

1. Angeline.S, Preethiesther. Dysmenorrhea. Health action journal.2008. October; 16(7):

25-27.

2. Mathias Jesveena. A study on the prevalence of PMS among B.Sc. nursing students of

selected nursing colleges at Mangalore.NNT.2007. March; 15(2):24-27.

3. Danny Sushma S. Effect of acupressure on reducing dysmenorrhea. Nightingale

nursing times. 2009. September; 12(5): 29-32.

4. Dr. Shaji J.C. Helen.controlling dysmennorhea among adolescent girls. Nightingale

nursing times.2012.october; 8(7):24-27.

5. Malhotra Samir, Singh Amrit pal. Medicinal properties of ginger. Natural product

radiance.2003. November; 2(6): 296-301.

6. Martely A Bonnie. Progressive muscle relaxation and pain perception. Honour (Thesis)

submitted to Arizona state university, 2000.July.

7. Aparecida Adriana. De Paul elloiagono d el al. The use of progressive muscle

relaxation technique for pain relief in gynaecology and obstetrics. 2002. March;

3(6):654-659.

8. K.A Avasarala., S. Panchangam. Dysmenorrhea in different settings rural- urban:

Indian Journal of community Medicine. 2008. August; 33(4): 246- 249.

9. Dr. Shaji J.C. Helen. Prevalence of dysmenorrhea among adolescent girls. Prims’s

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nursing practice.2012. July; 7(3):92-97.

10. Memmoot A Jenny. The effect of music assisted muscle relaxation on the self reported

symptoms of women with primary dysmenorrhea. Honour (Thesis) submitted to

department of music education and music therapy university of Kansas, 2002. July.

11. Dr. Law Chris Chinese medicine for management of dysmenorrhea. Honour (Thesis)

submitted to university of east London. 2011. October.

12. Halder Annesa. Effect of progressive muscle relaxation versus Intake of Ginger powder on

Dysmenorrhoea among the nursing students of Pune. The nursing journal of India. 2012.

August; CIII (4):152-156.

13. Ozgoli Giti el al .Comparison of effects of ginger, mefenamic acid and ibuprofen on

pain in women with primary dysmenorrhea. The journal of alternative and

complementary medicine. 2009. November; 15(3):129-132.

14. Rahana Parveen el al.Effect of zingiber officinale R. rhizomes (ginger) on pain relief in

primary dysmenorrhea. a placebo randomized trial. BMC complementary and

alternative medicine .2012.july ;( 12:92) doi: 10.1186/1472-6882-12-92.

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9 Signature of the candidate

10 Remark of the guide Study is feasible. Ginger powder will be a cost effective remedy for reducing the severity of dysmenorrhoea and thereby decreasing school absenteeism.

11 Name and designation in block letters

11.1 Guide MRS.METHILDA. VASSISTANT PROFESSOR & HOD OBSTETRICS & GYNECOLOGICAL NURSING DEPARTMENTK. PANDYARAJAH BALLALNURSING INSTITUTE,ULLALMANGALORE

11.2 Signature

11.3 Co- guide (if any) MS.SONIA SEBASTIANLECTUREROBSTETRICS & GYNECOLOGICAL NURSING DEPARTMENTK. PANDYARAJAH BALLAL NURSING INSTITUTE, ULLALMANGALORE

11.4 Signature

1212.1 Head of the department

MRS. METHILDA. VASSISTANT PROFESSOR& HODOBSTETRICS & GYNECOLOGICAL NURSING DEPARTMENTK. PANDYARAJAH BALLAL NURSING INSTITUTE,ULLALMANGALORE

12.2 Signature

13 13.1 Remark of the Chairman and Principal

13.2 Signature

Recommended for approval

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