RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE ANNEXURE - I

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1.

Name of the Candidate and Address (in block letters)

MS. GLORY S KOSHY 1st YEAR M.Sc. NURSING CANARA COLLEGE OF NURSING PRAFULL ENCLAVE HALADY ROAD, KOTESHWAR P.O KUNDAPUR TALUK UDUPI DISTRICT-576222

2.

Name of the Institution

CANARA COLLEGE OF NURSING KUNDAPURA

3. 4.

Course of study and subject Date of admission to course

1ST YEAR M.Sc. NURSING OBSTETRICS & GYNAECOLOGY NURSING 31-05-2010

5.

Title of the Topic

EFFECTIVENESS OF FOOT REFLEXOLOGY ON MENOPAUSAL SYMPTOMS AMONG MENOPAUSAL WOMEN.

6.

BRIEF RESUME OF THE INTENDED WORK

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6.1 Need for the study Menopause is inevitable for every woman. Above all, it signifies the end of a reproductive period in womans life. Biological clock tics more and more quietly for these younger women and it scares them. Menopause is a fertility loss and its hard for them to go through it.1 According to United Nation statistics, the population of the world is 6.8 billion in the year 2010.According to Indian menopause society, India has a large population which has already crossed the one billion mark with 71 million people over 60 years of age and the number of menopausal women about 43 million. It is estimated that in the year 2026, the population in India will be 1.4 billion, people over 60 years will be 173 million and the menopausal population will be 103 million. The average age of Indian menopausal women is 47.5 years.2 A study was conducted in Udupi, which revealed that the mean age at menopause of women in South Karnataka was 48.7 years.3 According to Indian menopausal society, the most common symptoms of menopause in menopausal women in the rural set up was found to be fatigue, lack of energy, lack of interest, pressure, tightness, headache, mood swings, insomnia, hot flushes, cold sweats, cold hands, weight gain and urogenital problems. The various available treatment for menopausal symptoms include hormone replacement therapy, herbal treatment, complementary therapies among which hormone replacement therapies has proved to have various side effects, whereas other alternative therapies and complementary therapies do not have side effects. Reflexology is a complementary therapy which was proved to be effective in reducing the menopausal symptoms in western countries.4 In view of lack of studies been conducted among Indian women to find the effectiveness of foot reflexology on menopausal symptoms, the researcher is interested in conducting the study.

6.2 Review of literature

The supporting literatures for the study has been broadly obtained from written text books, published articles in journals and online data bases. The obtained literature has been broadly classified as follows: SECTION A : studies related to prevalence of menopausal symptoms. SECTION B : studies related to effectiveness of foot reflexology on menopausal symptoms. SECTION C : studies related to effectiveness of foot reflexology on other disease conditions. SECTION A : studies related to prevalence of menopausal symptoms A study was conducted on menopausal women in India to establish the age and symptomatology at menopause in Indian women. Four hundred and ninety five menopausal women with minor complaints were interviewed for the study among whom 370 belonged to Group1 and 125 belonged to Group2. Group 1 subjects belonged to lower socioeconomic group. Group 2 belonged to higher socioeconomic group. The study reveals that the age of women from Group1 was 54.26 8.68 years and that of women from Group2 was 58.18 9.26years. Both groups differed significantly in the prevalence of menopausal symptoms, particularly with reference to headache and irritability. Those women with a history of dysmenorrhoea were more prone to have menopausal symptoms than women without history of dysmenorrhoea. Hypertension was more prevalent in Group1 than compared to Group2 women. The difference between the two was statistically significant.5 A cross sectional study was conducted on 550 female teachers aged 35 and above in Malaysia to determine the prevalence of menopause and menopausal symptoms. The study revealed that the prevalence of menopause was 21.9%. There was a high prevalence of skin dryness (44.2%), hot flushes (43.2%), fatigue (41.0%) and excessive sweating (34.7%) among the menopausal respondents. The prevalence of menopause and each menopausal symptom were high in the present group of women. Improved health care programs about the menopause might help give women a better quality of life.6 SECTION B : studies related to effectiveness of foot reflexology on menopausal symptoms.

An experimental study was conducted to assess the effectiveness of foot reflexology in menopausal women on menopausal symptoms. The sessions were for 45 minutes duration , 9 times over 19 weeks (once a week for six weeks followed by once a month for three months). The study revealed that both foot reflexology and foot massage reduced menopausal symptoms of anxiety, depression, hot flushes and night sweats by 30%-50% of what they were at onset.7 An experimental study was done on 76 menopausal women in the age group between 45-60 years in United Kingdom to find the effectiveness of reflexology on menopausal symptoms. Intervention group received true reflexology and control group received non specific foot

massage. Nine sessions were given for a period of nineteen weeks. The study findings revealed that, Mean (SD) scores for anxiety fell from 0.43 (0.29) to 0.22 (0.25) in the reflexology group and from 0.37 (0.27) to 0.27 (0.29) in the control group over the course of treatment. Similar changes were found for severity of hot flushes and night sweats Foot reflexology was not shown to be more effective than non-specific foot massage in the treatment of psychological symptoms occurring during the menopause.8 SECTION C : studies related to effectiveness of reflexology on other disease conditions. An experimental study was conducted on 12 cancer patients using reflexology to improve the quality of life. The placebo group was given gentle foot massage, that does not stimulate reexology points. Both Placebo and reexology groups received three 40 minute sessions, every other day over a ve-day period. From the study results, it was concluded that all participants received some comfort from the intervention, be it reexology or placebo reexology. However, only 33% of the placebo group beneted from an improvement in quality of life compared to 100% of the reexology group.9 An empirical study was done in Australia among 87 cancer patients to find the effects of foot reflexology in treating hospitalised cancer patients. Ten minutes foot reflexology was given ,five minutes for each legs . The study findings revealed that the treatments produced a significant and

immediate effect on the patients' perceptions of pain, nausea and relaxation when measured with a visual analog scale. The use of reflexology foot massage as a complementary method is recommended as a relatively simpler nursing intervention for patients experiencing nausea or pain related to the cancer experience.10 6.3 Problem Statement A Randomized Controlled Trial To Assess The Effectiveness Of Foot Reflexology On Reduction Of Severity Of Menopausal Symptoms Among Menopausal Women In Areas Of Udupi District, Karnataka.. 6.4 Objectives of the study: The objectives of the proposed study are to: 1. assess the menopausal symptoms and its severity among menopausal women in rural areas of Udupi district. 2. determine the effectiveness of foot reflexology on reduction of severity of menopausal symptoms as perceived by the menopausal women. 3. find out the association between severity of menopausal symptoms and selected demographic variables. 4. find out the correlation between foot reflexology and severity of menopausal symptoms. 6.5 Operational definitions Effectiveness : In this study effectiveness refers to the extend to which foot reflexology achieves the desired effect in reducing severity of menopausal symptoms among menopausal women in rural areas. Foot reflexology : In this study, foot reflexology is the teaching and demonstration technique of strategically applying pressure to sole of the feet as they correspond with specific 5 Rural

body organs, utilizing thumb, fingers for 15-20 minutes in the morning and evening, daily for a duration of one month without the use of oil, cream or lotions which will bring physiological, psychological changes in the body. Severity of menopausal symptoms : In this study, severity of menopausal symptoms refers to the degree to which the menopausal symptoms are present in the menopausal women, which will be assessed using a modified menopause specific quality of life questionnaire. Menopausal symptoms: In this study, menopausal symptoms include physiological

symptoms which includes hot flushes, cold sweats, weight gain, flooding, rheumatic pains, ache in back of neck and skull, cold hand and feet, numbness and tingling sensation, breast pain ,constipation, diarrhea, skin crawls, fatigue, lack of energy, headache, palpitation of heart, dizzy spells, blind spots before eyes, diminished acquity of vision. Psychological symptoms which includes irritability and nervousness, depression, forgetfulness, excitability or anxiety, sleep disturbance, poor concentration, feeling of suffocation, worry about body, fright, panic, worry about nervous breakdown, loss of interest in anything, pressure or tightedness in head and body experienced during perimenopausal and postmenopausal period in menopausal women between the age group of 40 and 55 years of age which are to be present for atleast three months. Menopausal women: In this study ,menopausal women include those who are between the age group of 40 and 55 years who have menopausal symptoms. 6.6 Assumptions The proposed study assumes that the menopausal women: may be willingly cooperative for the study. may not have any knowledge regarding reflexology. may have some interest to implement foot reflexology.

may not be on certain medications or therapies to manage menopausal symptoms.

6.7 Hypothesis All the hypothesis will be tested at 0.05 and 0.01 level of significance H01 : There will be no significant association of pretest selected variables of the study. H02 : There will be no significant correlation between foot reflexology and severity of menopausal symptoms among the menopausal women. 6.8 Delimitation The proposed study is delimited to menopausal women who are: between the age group of 40 and 55 years. willing to participate in the study with written informed consent. menopausal symptoms scores with

MATERIALS AND METHOD:. 7.

7.1 Source of data The data will be collected from menopausal women of rural areas of Udupi district, Karnataka. 7.1.1 Research design A true experimental design will be adopted to conduct the study. 40 menopausal women will be selected from rural areas. There will be an experimental and a control group. Group-1 is experimental group to which reflexology will be demonstrated and Group-2 is a control group to which placebo intervention will be given. 7.1.2 Research setting The study will be conducted in rural areas of Udupi district, Karnataka.

7.1.3 Population The population of the study will be menopausal women.

7.2 Method of data collection 7.2.1 Sampling procedure Cluster sampling technique will be used to select the samples for the study from the defined sampling frame who will meet the inclusion criteria. 7.2.2 Sample size The approximate sample size will be 40. The actual sample size will be calculated ,using the formula n = 2 [(z +z) s/d]2 after the pilot study. 7.2.3 Inclusion criteria for sampling The proposed study will be conducted on menopausal women who : are clinically diagnosed with menopausal symptoms. are between the age group of 40 and 55 years of age . can communicate in Kannada, Hindi, English.

7.2.4 Exclusion criteria for sampling Exclusion criteria for this study includes menopausal women who : are currently taking hormone replacement therapy. 8

are currently taking psychoactive drugs. are having foot pathology. were on previous reflexology treatments. are on current complementary therapy for menopausal symptoms. are having history of mental illness.

7.2.5 Data Collection Instrument The data collection instruments proposed for this study are : Tool 1 : Tool 2 : Demographic Proforma. Modified Menopause Specific Quality Of Life Questionnaire.

7.2.6 Data collection method Interview schedule will be adopted for the data collection and a facilitator guide will be developed in order to guide the researcher in conduction of foot reflexology.

7.2.7 Data analysis method Data will be analyzed using appropriate descriptive and inferential statistics

7.3 Does the study requires any investigation or intervention to be conducted on patients or other humans or animals. Yes 7.4 Has ethical clearance been obtained from your institution in case of 7.3 Permission to conduct the proposed study will be obtained from : 9

Ethical committee, Canara College of Nursing, Kundapur. The Principal, Canara College of Nursing, Kundapur. District Health officer of Udupi district. Informed written consent will be obtained from menopausal women who are participating in the proposed study.

8. LIST OF REFERENCES
1. Menopause as a physiological and social womens [Online]. 2010 Aprl 1 [cited 2010 Sept 21]; Available from: URL: http:www.osteoporosissolution.com/menopause-as-a-physiological10

and-social-womens-problem 2. Unni J. Third consensus meeting of Indian Menopause Society (2008): A summary. J Mid-life Health. [serial online] 2010 [cited 2010 Oct 9]; Available from: URL:http://www. jmidlifehealth.org/text.asp?2010/1/1/43/66987 3. Bairy L, Adiga. S. Prevalence of menopausal symptoms and quality of life after menopause in women from South India. ANZJOG [serial online] 2009 March [cited 2010 Sept]; 49(1):[106109]. Available from: URL: www.iomcworld.com/ijcrimph/ijcrimph-v02-n05-01-f.htm 4. Munshi, Dr.Atul.M.D. Menopause and management in rural women, problems, symptoms realistic goals, practical therapeutic & preventive options. [Online]. 2010 [cited 2010 Sept 27]; Available from: URL: http://www.apmf2010.com/.../Indian%20menopause%20society% 20program.pdf 5. Bharadwaj JA, Kendurkar SM, Vaidya PR. Age and symptomatology of menopause in Indian women. JPGM [serial online] 1983 October [cited 2010 Oct 9]; 29(4):[218-222]. Available from: URL: http://www.jpgmonline.com/text.asp?1983/29/4/218/5509 6. Mohd Zulkefli N A, Mohd Sidik S. Prevalence of menopausal symptoms among female teachers in Seremban, Negeri Sembilan. APFM [serial online] 2003 December [cited 2010 Sept 22]; 2(4):[235-238]. Available from: URL:http://www.onlinelibrary. wiley.com/doi/10.1111/j.1444-1683.2003.../full 7. Barbara kunz, Kevin Kunz. Menopause and reflexlogy. [Online][cited 2010 Oct 10]; Available from: URL:http://www.myreflexologist.com 8. Jan Williamson, Adrian White, Anna Hart, Edzard Ernst. Randomised controlled trial of reflexology for menopausal symptoms. BJOG [serial online] 2003 December [cited 2010 Oct 22]; 109(9):[1050-1055]. Available from: URL :http://www.onlinelibrary.wiley.com/ doi/10.1111/j.1471-0528...x/abstract 11

9. Hodgson, H.. Does reexology impact on cancer patients quality of life?. Nursing Standard [serial online] [cited 2010 Oct 21]; 14[ 31-8]. Available from: URL: www.reflexologyresearch.com/nurse.html 10. Grealish L, Lomasney A, Whiteman B. Foot Massage a nursing intervention to modify the distressing symptom of pain and nausea in patients hospitalised with cancer. [Online]. 2000 [cited 2010 Sept]; Available from: URL:www.ncbi.nlm.nih.gov/pubmed/10851775

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9. 10.

Signature of the Candidate Remarks of the guide

11.

Name and Designation of (in block letters) 11.1 Guide

MRS.ANITHA.C.RAO ASSOCIATE PROFESSOR, OBSTETRICS AND GYNAECOLOGICAL NURSING CANARA COLLEGE OF NURSING KUNDAPUR

11.2 Signature 11.3 Co Guide (if any) --

11.4 Signature 12. 12.1 Head of Department MRS.ANITHA.C.RAO ASSOCIATE PROFESSOR, OBSTETRICS AND GYNAECOLOGICAL NURSING CANARA COLLEGE OF NURSING KUNDAPUR 12.2 Signature 13. 13.1 Remarks of the Principal 13.2 Signature

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