A Study To Assess The Effect o 231021 102014

DECLARATION
CERTIFICATE BY THE HOD, PRINCIPAL / HEAD OF THE INSTITUTION
This is to certify that the dissertation / thesis entitled “A study to assess the effect of
intradialytic stretching exercises on muscle cramps among patients undergoing
hemodialysis in selected hospitals at kolar district, karnataka” is bonafide genuine research
work done by Mrs. Pandaluru gowthami under the guidance of, Prof Mrs. Shiyamala Rani
M.sc [N], HOD of Medical Surgical Nursing, Pavan College of Nursing, Kolar.
Seal & Signature of the Principal
MRS. DEEPA.S M.sc [N],
PRINCIPAL & Prof
Pavan College of Nursing, Kolar.
Place: Kolar
Date: July 2018

DECLARATION
CERTIFICATE BY THE HOD, PRINCIPAL / HEAD OF THE INSTITUTION
This is to certify that the dissertation / thesis entitled “A study to assess the effect of
intradialytic stretching exercises on muscle cramps among patients undergoing
hemodialysis in selected hospitals at kolar district, karnataka” is bonafide genuine research
work done by Mrs. Pandaluru gowthami under the guidance of, Prof Mrs. Shiyamala Rani
M.sc [N], HOD of Medical Surgical Nursing, Pavan College of Nursing, Kolar.
Seal & Signature of the Principal
MRS. DEEPA.S M.sc [N],
PRINCIPAL & Prof
Pavan College of Nursing, Kolar.
Place: Kolar
Date: July 2018

COPYRIGHT
DECLARATION BY THE CANDIDATE
I Hereby Declare That Rajiv Gandhi University of Health Sciences, Karnataka,
Bangalore, Shall Have the Rights to Preserve, Use and Disseminate This Dissertation /
Thesis in Print or Electronic Format for Academic / Research Purpose.
Signature of the Candidate
[Mrs. pandaluru gowathmi]
Place: Kolar
Date: July2018
© Rajiv Gandhi University of Health Sciences, Karnataka
ACKNOWLEDGEMENT
It is my pleasure and pride to record my gratitude and thanks to those who have
contributed to the successful completion of this endeavour.
In all my work I first invoke the blessings of GOD ALMIGHTY” Whose grace and
blessings for sustaining me in completion of this study. I praise and thank the Almighty for His
blessings and abundant grace that enriched me throughout this study.
I wish to express my sincere thanks to the Chairman / Managing Committee, Pavan
College of Nursing for giving me an opportunity to undertake this course in this esteemed
institution.
I owe my heartfelt gratitude and sincere thanks to Prof. MRS. DEEPA M.Sc. (N) the
Principal, pavan college Of Nursing for her efficient guidance, creative suggestions, constant
encouragement, which helped me to lay strong foundation for this study.
I am deeply indebted Prof. Mrs. Shiyamala Rani M.Sc (N), HOD, Medical Surgical
Nursing, pavan College of Nursing, kolar for being the guide and providing valid suggestions,
and excellent guidance.
I express my gratitude to Prof Mrs. GLORY. TS M.Sc.(N)., OBG Dept., Asso prof.
Mr. Srinivas, Mrs Lavanya kumari, Mrs Nirmala M.Sc., Ms Annie for their constant support
during the course of this study. It’s my pride and pleasure to express my gratitude to all
study experts who have contributed their efforts towards the validity of the tool. My deepest
thanks to all for their co–operation without which it could have been impossible to conduct the
study.
I express my sincere thanks to Medical officer 0f SNR & ETCM hospital, kolar for
extending helpful support throughout this study.
I express my gratitude to Mr. Ravi Shankar Statistician, for his expert guidance in the
statistical analysis of the data.
I express my sincere gratitude to all Faculty Members of pavan college of Nursing and
special thanks to staff of Medical Surgical Nursing Department for their timely assistance and
encouragement throughout the study.
I am thankful to the Librarian for allowing me to utilize the library facilities. I am
grateful to all those helping hands and not mentioning of their name is purely unintentional.
I have no words to express my gratitude and thanks to my beloved parents my husband,
my loved children for their constant support, help, encouragement and fervent prayers during this
study period.
I extend my thanks to my beloved friends, classmates, for their encouragement, constant
support, prayer and never ending love during the study period.
Above all I owe my success to the Almighty.
Mrs Pandluru Gowthami
DATE: July 2018

LIST OF ABBREVIATIONS
ISS Intradialytic stretching exercises
Df Degree Of Freedom
P Level Of Significance
F Frequency
N Sample Size
H Hypothesis
SD Standard Deviation
Et.al And Others
WHO World Health Organization
Fig Figure
Govt Government
LIST OF TABLES
TABLE NO. CONTENT PAGE NO.
1. Demographic profile. 27
2. Pre-test scores of muscle cramps among hemodialysis 34
patients according to age
3. 36
Pre-test scores of muscle cramps among hemodialysis
patients according to their monthly income
patients according to their educational status .
patients according to their dietary pattern .
patients according to their marital status
patients according to their duration of dialysis
8. Post test scores with intervention of intradialytic stretching 42
exercise in both experimental and control group
9. Comparison of pre-test and post-tests level of muscle 47
cramps among hemodialysis patients
10. Association between pre-test level of muscle cramps score 49
and demographic variables

LIST OF FIGURES
Figure Description Page No.

No.
1 Conceptual framework based on Imogene M. King’s 25
“Goal Attainment Model Theory
2. Schematic Representation of the Research Design 28
3. Percentage Distribution of hemodialysis patients with 29
their age
their monthly income in experimental group
respect to educational status in experimental group

respect to type of diet in experimental group.
7 Percentage Distribution of hemodialysis patients with 33
respect to marital status in experimental group
respect sex in experimental group.
respect duration of dialysis in experimental group
11 Post-test level of muscle cramps among hemodialysis 38
patients in experimental group
12 Comparison of pre and post-tests mean score of muscle 40
cramps
ABSTRACT
Background and Objectives of the study
“A study to assess the effect of intradialytic stretching exercises on muscle cramps among
patients undergoing haemodialysis in selected hospitals at kolar district, Karnataka „‟
was conducted by Mrs.Pandluru Gowthami in partial fulfillment of the requirement for the
degree of Master of Science in nursing at pavan College of Nursing kolar , under the RGUHS
University, Bangalore during the year of October 2018.
The objectives of the study were,
 To assess the existing level of muscle cramps among patients undergoing hemodialysis.
 To determine the effectiveness of intradialytic stretching exercises on muscle cramps
among patients undergoing hemodialysis
 To find out the association between the pre-test level of muscle cramps among patients
undergoing hemodialysis with their selected demographical variables
The following hypotheses were set for the study
All hypotheses were tested at 0.05 level of significance
H1: there will be a significant difference between pre-test and post-test scores on muscle
cramps among patients undergoing hemodialysis
H2: There will be a significant association between the pre-test level of muscle cramps
among patients undergoing hemodialysis with their selected demographical variables.
The study was based on Modified wiedenbach‟s helping art of clinical nursing model. The
quantitative approach was used. The study was conducted in and SNR& ETCM hospital kolar.
The design adopted for the study was true experimental pre and posttest control group design.
Simple random sampling technique was adopted for this study. The data collection tools
developed for generating the demographic data of the samples which consists of age, sex, family
income, dietary pattern, marital status and duration of hemodialysis. Cramp questionnaire chart
and visual analogue scale.
The cramp questionnaire chart was developed by Basemath.S.S. Morris. The cramp
questionnaire chart was designed to assess the level of muscle cramps during hemodialysis,
before and after intervention. It contains various features of muscle cramps such as the frequency
of muscle cramps, duration of muscle cramps, level of pain, temperature and discomfort which
was comprehensively scored as level of muscle cramps ranging from (0-13).
Score Interpretation:
 0 No cramps
 1-4 Mild cramps
 5-8 Moderate cramps
 9-13 Severe cramps
Data was collected IN SNR & ETCM hospital. Sixty hemodialysis patients were selected by
simple random sampling technique method. The data related demographic variables were
collected from the samples. The samples were scattered in two areas. The hemodialysis of the
experimental group & control group was. The cramp questionnaire chart was designed to assess
the level of muscle cramps during hemodialysis, before and after intervention Experimental
group received intradialytic stretching exercise for 1 weeks were as the control group did not.
Post-test level of muscle cramps was assessed by using same numerical scale. The data was
analyzed using descriptive and inferential statistics.
The major findings of the study were, ™
 The findings of the study revealed that majority of hemodialysis patients are 76.6% (23)
of experimental group and 73.4% (18) of control group had moderate cramps and about
26.6%(08) of control group and 23.4%(07) of experimental group subjects had sever
cramps. None of them has No cramps in both the group.
 In experimental group, during pre-test the mean score was 34 with the standard deviation
of 3.1. Whereas in post-test the mean score was 23.8 with the standard deviation of 3.2.
The computed t-value between pre-test and post-test score is 31.56 (P<0.001) which is
highly significant muscle cramps among hemodialysis patients with the providing of
intradialytic stretching exercise
 The post test score in the table disclosed that, in experimental group majority of
hemodialysis patient are not having muscle cramps 28 (93.3%), only 02 (6.67%) had
moderate cramps and none of them had severe cramps. These results showed that the
scores were reduced due to the effect of intradialytic stretching exercise among
haemodialysis patients. Whereas in the control group 20 (66.7%) had moderate cramps,
10 (33.3%) had severe cramps and none of them had no cramps.
 While comparing pre-test and post test scores computed t-value (Unpaired) between
experimental and control group in the pre-test is 0.235 (P>0.001) at 58 degrees of
freedom is less than the t-table value which is not statistically significant. But in the post-
test the computed unpaired t-value between experimental and control group is 15.2
(P<0.001) at 58 degrees of freedom is greater than the t-table value which is highly
significant.
 There is a significant difference between the levels of muscle cramps among
hemodialysis patients in experimental and control group. The findings indicate that the
computed “t” – value is 15.2 is greater than “t” table value (3.46), so the hypothesis-2 is
accepted.
.The results exhibited that the selected demographic variables include age, family
income per month, dietary pattern, educational status, duration of dialysis, sex and
marital status, experimental and control group has no significant association with the
level of muscle cramps among hemodialysis patients at P>0.05 level.
The association between post-test scores of muscle cramps and selected demographic
variables of in experimental group. By using chi-square, it is evident that there was no significant
association between age, family income per month, dietary pattern, educational status,
duration of dialysis, sex and marital status at P>0.05 level.
CONCLUSION:
 The major findings of the study are in the accordance with the objectives of the
study and hypothesis. Results showed that there is reduction in the level of muscle
cramps after providing of intradialytic stretching exercise in the experimental group
than compared to the level of muscle cramps in the control group. The computed
mean, standard deviation value, the paired and unpaired t‟ value suggest the
effectiveness of intradialytic stretching exercise in muscle cramps among

hemodialysis patients. The chi-square values indicate that there is no significant
association between the level of muscle cramps and most of with them.
demographical variables
CHAPTER I
PART I
“ The functional basis of quality of life involves continuous functioning

reciprocal interactions between persons and their environment .”
INTRODUCTION: -
The crucial areas of human life are physical wellbeing, social activities, personal
development, recreation and economic circumstances and these factors largely influence the
person’s relationship with environment.
To a greater extent, the quality of life led by his physical wellbeing. physical
wellbeing depends upon the accurate balance of core components like fluid, solutes and even
some waste materials. thus maintenance of volume of the various body fluids is essential to
man’s survival. given unrelenting daily acquisition of food and fluids, preservation of the
internal environment requires the continuous excretion of these dietary substance in amounts
that balance precisely the quantities acquired by ingestion or metabolic transformation.
although losses from skin, lungs and intestine normally contribute to this excretory capability,
kidney are bearing the greatest responsibility for solute and water removal.1
Kidneys - the vital organ plays a main role in the maintenance of homeostasis mechanism in
human body1. Healthy kidneys are the sophisticated reprocessing machine that cleans the
blood by removing fluid, salt and wastes from the body. Deficit in blood supply to the kidney
will lead to decreased function. Prolonged decrease in the blood supply or in the blood
pressure will lead to acute or sudden kidney failure2. Renal failure is characterized by
progressive destruction of renal mass with irreversible sclerosis and loss of nephrons over a
2
period of at least few .
1
months to years, depending upon the underlying etiology. Renal failure is classified into two;
they are acute and chronic renal failure. Acute Renal Failure (ARF) is a rapid decrease in
kidney function leading to collection of metabolic wastes in the body2.
When the Glomerular Filtration Rate (GFR) decreases Blood Urea Nitrogen (BUN) level
increases, waste products build up in the blood causing uremia and azotemia. This acute
syndrome may be reversible with prompt intervention. ARF may lead to Chronic Renal
Failure (CRF)3
According to American Society of Nephrology (2005), review of discharge data on a
projected total of 29,039,599 hospitalizations identified 558,032 cases of ARF, with a
frequency of 19.2 per 1000 hospitalization. According to WHO (2012), global burden of CRF
is approximately 11,010,107 and 850,000 deaths per year4. CRF is a common clinical
syndrome characterized by decline in glomerular filtration, perturbation of extracellular fluid
volume, electrolyte and acid base homeostasis and retention of nitrogenous waste from
protein catabolism. Chronic renal failure (CRF) results from partial or total loss of renal
function. It exists when residual renal function is less than 15% of normal. Renal failure can
be treated by dialysis3.
Dialysis is one of the main replacement therapies in patients with renal failure. It removes
many of the toxins responsible for the uremic syndrome and prolongs survival. However,
dialysis treatment doesn’t fully cure the uremia. During Dialysis many complications may
occur like tiredness, fatigue, hypotension and muscle cramps4.
Jean L stated that muscle cramps are a common complication of hemodialysis treatment,
occurring in 33 to 86 percent of patients; they often result in the early termination of
2
hemodialysis session. A cramp is a prolonged involuntary muscle contraction that occurs in a
muscle that voluntarily contracts when it is already in its most shortened position. The
increased frequency of cramps at rest and during the night may be caused by the placement
(by the plantar-flexed foot) of the calf and ventral foot muscles in the most shortened and
vulnerable position during sleep5.
The exact etiology of cramps in dialysis patients is unknown. Since cramps tend to occur
most frequently near the end of hemodialysis treatment, changes in plasma osmolality and/or
extracellular fluid volume have been implicated6. Muscle cramps can involve the legs, most
commonly in the feet, but can also involve arms and hands, as well as abdominal muscles.6
It is estimated that 33% to 86% of patients receiving hemodialysis have experienced muscle
cramps. Since cramps are a common intradialytic event, the discomfort leads to premature
termination of the treatment, noncompliance with the prescription and therefore under
dialysis. Thus interfering with the muscle cramps and even preventing the occurrence become
a major responsibility of the patients. Since nurses are taking care of hemodialysis patients
almost everywhere, it becomes predominantly the nurses’ role7
Magda Mohamed et al., conducted a study at Assiut University, Egypt on impact of
stretching exercise protocol on reduction of muscle cramps during hemodialysis among CRF
patients8. There are many uses of complementary therapies to reduce muscle cramps and it is
becoming a significant part of modern day health care with millions of treatments taking
place every year. The most used non pharmacological therapies are stretching exercise,
strengthening exercise and oil massage9. Thus the investigator provided passive stretching
exercise effective to relieve muscle cramps during hemodialysis session.
3
Nurses, patient’s family and others health care providers share the interest in maximizing
positive outcome of hemodialysis. this can be achieved by intervening the patient’s problems
during the procedure.
In this study, the investigator is interested to elicit the effect of intradialytic stretching
exercises on muscle cramps experienced by the patients during hemodialysis.
NEED FOR THE STUDY:
Chronic kidney diseases (CKD) is an important non communicable diseases epidemic
that effects the world population including India. The prevalence of end stage renal
disease(ESRD) is rising throughout the developed and developing countries mainly due to
diabetes mellitus and hypertension.
There are currently 10,65,000/- people on hemodialysis worldwide (European dialysis and
transplant nurses’ association /European renal care association journal,2005). CKD kills 36
million people by the year 2015. In India ,10 lakhs suffer from kidney failure and more than
four crores are at risk (Tamil Naidu kidney research foundation,2006).
In south India, an average of 500 patients register for hemodialysis each year (health
management Centre ,2005).
In government hospital nearly 40-50 patients undergo hemodialysis each day (40% twice
,20% twice a week, others once a week).
Dialysis saves lives. however, dialysis alone cannot make those lives active and meaningful.
measures should be employed to improve the physical well-being of the patients. exercise is
crucial in the rehabilitation of many individuals with chronic renal insufficiency.
4
Almost all patients complain of muscle cramps at one or other time during dialysis usually
of lower extremities that too of calf muscles. they are managed with normal saline infusion,
simple calf massages and even by temporarily stooping the ultrafiltration till cramps go off .
some of them are prescribed carnitine preparations regularly for preventing muscle cramps.8
In early days, physicians were the ones who prepared the equipment for hemodialysis,
monitored the patient and terminated the treatment .it was not long before physicians began
rely on nurses to perform most of the patient care decisions doing entire hemodialysis.
currently nurses carry out 20 to 100% of the technical functions. This reveals the high
responsibility and multiple roles (cares, advocate, technical supervisor).
Patients on chronic maintenance hemodialysis are confronted with several complications
related to the treatment. muscle cramps being among the most common complaint is
estimated to occur in up to 20% of hemodialysis sessions.9
Lee (1999) quoted in dialysis and transplantation journal that in a specific study involving
14,000 hemodialysis treatments on 103 patients the cumulative incidence of cramps was
estimated to be 86%.
Muscle cramps are a common discomfort experienced by patients undergoing hemodialysis
which is characterized by a sudden, painful, involuntary contraction of a muscle originates
from the peripheral nerves. The most commonly affected muscles are the gastrocnemius (calf
muscles), triceps (the muscles in the upper arms), the hamstrings (the muscles behind the
thighs), and the quadriceps (the muscles in front of the thighs).10
Many non-pharmacologic therapies are employed by patients prior to treatment, but there is
only a little evidence to support the use of non-pharmacological measures. Almost all
patients complain of muscle cramps during dialysis. They are managed with normal saline
5
and dextrose 25% routinely in hospital. Prophylactic stretching exercises can prevent the
muscle cramps. The patients can practice stretching exercises during the post dialysis period.
Brenner I (2009) mentioned that regular physical activity can reduce the complications
associated with CKD by inducing adaptations in the cardiovascular, nervous, and
musculoskeletal systems. This increases the functional capacity and enhances quality of life
in patients on HD. 11
Hemodialysis patients can safely participate in a variety of exercise programs with minimal
adverse effects. Intradialytic exercise programs that can incorporate aerobic and resistance
exercise that promote exercise adherence and should be encouraged on dialysis units6.
Johansen. KL (2007) illustrated that interventions during haemodialysis sessions have
become more popular and have been shown to be safe. The risks of exercise in this
population have not been rigorously studied, but there have been no reports of serious injury
as a result of participation in an exercise training program. It is time that we incorporate
exercise into the routine care of patients who are on dialysis7.
A telephone survey was conducted in Australia and found that intradialytic exercise
programs are essentially nonexistent and there is a lack of randomized, controlled trials of
intradialytic exercise training. The study concluded that there is a need of intradialytic
stretching exercises for hemodialysis patients, which may influence the current standard
clinical practice among nephrologists and thus improve the health and quality of life of the
vulnerable patients8. Hence there is a need to practice some interventions for muscle cramps
during hemodialysis. Intradialytic stretching exercises help to improve the efficacy of
hemodialysis thus preventing or reducing the muscle cramps.
6
Thus the investigator has opted to provide passive calf stretching exercises
prophylactically during hemodialysis to relive or prevent muscle cramps.
Based on the reviews of literature and the investigators personal clinical experience in
dialysis unit, the researcher found may of the patient developed muscular cramps. In
conclusion the muscular cramps can be minimized by effective intradialytic passive calf
stretching prophylactically during hemodialysis to relieve (or) prevent muscle cramps.
7
CHAPTER-II
OBJECTIVES
STATEMENT OF THE PROBLEM
“A study to assess the effect of intradialytic stretching exercises on muscle

cramps among patients undergoing hemodialysis in selected hospitals at kolar district,
karnataka „‟
6.5 OBJECTIVES
1. To assess the existing level of muscle cramps among patients undergoing

hemodialysis.
2. to determine the effectiveness of intradialytic stretching exercises on

muscle cramps among patients undergoing hemodialysis
3. to find out the association between the pretest level of muscle cramps
among patients undergoing hemodialysis with their selected demographical
variables
6.6 OPERATIONAL DEFINITION:
 EFFECT: In this study, effect refers to the result of intradialytic
stretching exercises after administration to patients during hemodialysis.
 Intradialytic: pertaining to the end of second hour of a hours
hemodialysis session.
 Stretching exercises: exercise performed by the investigator for the
gastrocnemius and soleus (calf) muscle of the patients during
hemodialysis
 Muscle cramps: painful involuntary spasms of the calf muscles of
patients during hemodialysis
1
 Hemodialysis: it is a treatment employed for renal failure is rapid
change of plasma solute composition within four hours
6.7ASSUMPTION
 Hemodialysis results in sodium depletion in muscles

 Calf muscles exercise improves perfusion
 Exercise involves stimulation of muscles, bones and nerves
6.8 HYPOTHESIS:
H1: there will be a significant difference between pretest and posttest scores on
H2: There will be a significant association between the pretest level of muscle
cramps among patients undergoing hemodialysis with their selected
demographical variables.
Delimitations:
The study is limited to:
 The period of study will be limited to 6 weeks

 The sample size is limited to 60
 The study is limited to patients undergoing hemodialysis
 The stretching exercises were limited to calf muscles only
RESEARCH VARIBLES:
Dependent variables
Level of muscle cramps among patients undergoing hemodialysis
Independent variable:
Intradialytic stretching exercises on muscle cramps among patients undergoing

hemodialysis
2
CONCEPTUAL FRAMEWORK
A conceptual framework is a group of concepts and set of propositions that

spells out the relationship between them. Conceptual framework plays several inter
related roles in the progress of science. Their overall purpose is to make specific
findings meaningful and generalizable.
Conceptual framework facilitates communication and provides for a

systematic approach to nursing research, education, administration and practice.38
1. The conceptual framework related for this study is based on Imogene M.

King’s “Goal Attainment Model” The theories focus on interpersonal
systems reflecting king‟s belief that the practice of nursing is differentiated
from that of other health professions by what nurses do with and for
individual. The major elements of the theory of goal attainment are seen “in
the interpersonal systems in which two people, who are usually strangers,
come together in a health care organization to help and be helped to maintain a
state of health that permits functioning in roles”38
The concepts of the theory are perception, action, interaction and transaction.
These concepts are interrelated in every nursing situation. These terms are
defined as concepts in the conceptual framework. 39
Perception
Perception is “each person‟s representation of reality”. The elements of

perception are importing of energy from the environment and organizing it by
information, transforming energy, processing information, storing information and
exporting information in the form of overt behaviors”.
In this study, investigator perceives that Patients undergoing hemodialysis are

having muscle cramps.
3
Action
Action refers to the activity to achieve the goal what the individual perceives.
In this study, it leads to mutual goal setting to explain the intradialytic stretching
exercises to reduce muscle cramps in hemodialysis patient.
Interaction
Interaction refers to the process of perception and communication between a

person and the environment or between two or more persons. In this study, the
investigator assesses the level of muscle cramps in hemodialysis patient.
Transaction
Transaction is a process of interaction in which human beings communicate

with the environment to achieve goals that are valued and directs human behavior. In
this study, “the effect of intradialytic stretching exercises on muscle cramps among
patients undergoing hemodialysis
4
PERCEPTION ACTION INTERACTION TRANSACTION
INVESTIGATOR PERCEPTION
hemodialysis patients are INVESTIGATOR ISSUED
NURSE INVESTIGATOR
having muscle cramps ASSESS THE INFORMATIO

MUTUAL
LEVEL OF N
GOAL
INTRADIALYTIC EXERCISES
HEMODIALYSIS PATIENTS
MUSCLE REGARDING
SETTING
JUDGEMENT CRAMPS BY INTRADIALYTI
TO REDUCE MUSCLE
DEVELOPMENT OF
To the PAIN C
MOBILIZE THE RESOURCES muscle ASSESSMENT STRETCHING
TO REDUCE THE MUSCLE EXERCISES
CRAMPS IN
cramps SCALE
CRAMPS IN HEMODIALYSIS among
PATIENTS MOTIVATE
hemodialysis
HEMODIALY
patients by
SIS PATIENT
providing
TO FOLLOW
intradialytic
REGULARLY
stretching
THE
Hemodialysis patient
HEMODIALYSIS PATIENTS exercise HEMODIALYSIS PATIENTS

EXERCISES
PERCEPTION ARE HAVING ANSWERS THE DATA ASKED
TO REDUCE
MUSCLE CRAMPS AND COOPERATES TO
MUSCLE
ASSESS THE LEVEL OF
CRAMPS
MUSCLE CRAMPS
FIG.1: CONCEPTUAL FRAMEWORK BASED ON IMOGENE M. KING’S GOAL ATTAINMENT MODEL
5
9
Chapter III
Review of literature
Review of literature” is an important step in the development of research project. The
written literature review provides the investigators and readers with a background for
understanding what has been already learnt on the subject and illuminates about the
significance of the new studies.
Literature review refers to the activities involved in identifying and searching for
information on a topic and developing a comprehensive picture of the state of knowledge on
that topic. This chapter deals with the review of published and unpublished research studies
and non-research literature related to the present study.
“Extensive review of research and non-research literature is being done to broaden the
understanding and to gain insight into the selected problems for the study. Along with the
review of books and journals, an attempt was also made to review literature through internet
research and non-research literature were reviewed and organized under the Following
headings
1. Studies related to muscle cramps:
Brass,Adler, siestema ,et al (2002) had studied 122 patients on maintenance
hemodialysis .peripheral arterial disease was determined by measurement of ankle –
branchial index pre and post dialysis ,in lower extermities,intradialytic cramps
experience was assessed from history ,52.1% patients reported intradialytic cramps
.old age people were only 37.5% and it was inferred that there was no relationship
between cramps during dialysis and peripheral arterial disease .12
Pratecpavanich (1999) studied 24 patients with nocturnal calf cramps they are divided
into groups to quantitatively compare the effect of trigger point injection and oral
12
quinine .the study was conducted for four weeks and followed up to after four weeks
of the study .parameters were cramp frequency, duration ,pain intensity and cramp
index, the outcome of all measures were found to be significantly better in group
treated with trigger point injection .result supported that gastrocnemius trigger point
was one cause of nocturnal calf cramps 13.
Tonge (1998) studied an alcoholic poly neuropathy main sequential spreading of
cramps from unilateral to contralateral leg muscles and phasic discharges observed by
needle electromyography. he interfered that sensory inputs from peripheral nerves
played a critical role in the generation of cramps.14
Mandal (1995) projected that quinine appeared to decline the excitability of motor end
plate, thus reducing muscle contractibility.
Naylor and young (1994) surveyed a population of 218 patients and found that overall
prevalence of muscle cramps was 37% and most commonly experienced in the
muscles of the leg in 83% of cramps suffers.15
Dial (1978) studied 46 complete dialysis treatment sessions, electromyography(EMG)
activity was recorded from a leg muscle in patients who had cramps. results indicated
that the mean muscle cramp latency from start of dialysis was 248 minutes and
average cramp was 10 minutes in duration also tonic electromyograpgic activity in
patients with muscle cramps showed a continued increase through the latter part of
dialysis. this suggested that increase in electromyography activity might be casually
related to muscle cramps.16
SECTION II: studies related to stretching exercises.
13
A pre experimental study to assess the effect of intradialytic stretching exercises on
muscle cramps among patients undergoing haemodialysis was conducted in selected
hospitals at Chennai. Forty-five patients undergoing haemodialysis who experienced
muscle cramps were included purposively. Intradialytic exercises were performed
every 30 minutes during the last two hours of dialysis. It was found that in the pretest
53.3% had severe muscle cramps, 46.7% had moderate muscle cramps. After
performing the exercises 40% had no cramps, 24.4% had mild and 35.6% had
moderate cramps. The study concluded that intradialytic stretching exercises during
the last two hours of haemodialysis helps to reduce and prevent the muscle cramps.
(Basemath.S.S. Morris, 2014). 17
A randomized controlled trial was done in Hanze University, Groningen to assess the
stretching before sleep reduces the frequency and severity of nocturnal leg cramps in
older adults. Eighty adults over 55 years with nocturnal leg cramps who were not
being treated with quinine were selected. Pretest posttest with comparison group
design was adopted. Participants recorded the frequency of nocturnal leg cramps. At
six weeks,the frequency of nocturnal leg cramps decreased significantly more in the
experimental group with the mean difference of 1.2 cramps per night (95% CI 0.6 to
1.8). The severity of the nocturnal leg cramps had also decreased significantly more in
the experimental group than in the control group with the mean difference 1.3 cm
(95% CI 0.9 to 1.7) on the 10-cm visual analogue scale. The study concluded that
stretching before going to sleep reduces the frequency and severity of nocturnal leg
cramps in older adults (Hallegraeff.J.M, et al., 2013)18.
A study to assess the physical therapy during haemodialysis in patients with chronic
kidney disease was conducted. The therapy consists of muscle strengthening
exercises, stretching and stationary exercises. Fifty-six chronic kidney disease patients
14
were participated. They underwent evaluation before the start of the program and after
the training. The mean values of HR, RR, BP at the end of the test were 97.57 ± 16.82
beats per minute 22.26 ± 2.46 breaths per minute and 133.43 ± 15.52 mmHg. The
Scale scores had a mean initial value of 0.97 ± 0.98 and a median of 0.50. After
performing the exercises the mean value was 0.43 ± 0.47 and median value equal to
the initial, 0.50 (p < 0.001). Thus there was a significant difference between these
scores and concluded that there is an improvement in the quality of life and physical
ability of patients with chronic kidney disease (Silva. S.F, et al., 2013). 19
A study was conducted in Michigan, U.S.A to prevent the haemodialysis related
muscle cramps cramps by intradialytic use of sequential compression devices. Four
patients on thrice-weekly haemodialysis who experienced two or more episodes of
lower extremity cramps weekly in the month before the study were
selected.Sequential compression devices were applied before each haemodialysis on
both the legs and compressions were intermittently applied at 40 mmHg during
treatment. All four patients were reported the complete resolution of cramping during
the study period that lasted 1 month or 12 consecutive dialysis treatments. The study
concluded that application of sequential compression devices to lower extremity may
prevent the generation of lower extremity haemodialysis -related cramping in a
selected group of patients (Ahsan M, et al., 2010). 20
A prospective, randomized single-blinded controlled trial was done in Sriraj hospital,
Mahidol University, Thailand to assess the effect of calf stretching box on stretching
calf muscle compliance. Eighty patients older than 45 years with calf muscles
tightness were enrolled. Patients were randomized into two groups, the study group
(stretching by using calf stretching box) and the control group (stretching by the
conventional exercise method). Patients in both groups were asked to hold the stretch
15
for at least 1 minute and to perform the stretching program at least two times per day,
every day for two weeks. They were asked to record the real frequency and duration
of their exercise and complications in a logbook every day. It was found that there
was a reduction in the calf muscle tightness with less pain than the control group (p <
0.05).The study concluded that the stretching calf muscle with calf stretching box can
increase compliance, decrease calf muscle tightness and decrease complications when
compared with the conventional exercise method. (Chadchavalpanichaya, Srisawasdi,
Suwannakin, 2009).21
A quasi experimental study to assess the impact of stretching exercises protocol on
reduction of muscle cramps during haemodialysis among chronic renal failure patients
was conducted in kidney dialysis department of Assuit University hospitals. Among
60 patients the calf stretching exercises were taught for a duration of 5minutes per
hour. It was found that there was a lack of knowledge and skills related to muscle
cramps before nursing instruction protocol. But there was a statistical significant
difference after performance of exercises as 8.3% and 55.0% respectively at p<0.001
and concluded that there is a need of effective education programme to help the
patient with muscle cramps. (Magda Mohamed, Amal Mohamed, Shalabia Abo Zead,
2007).22
Tuney (2006) published that the severe muscle cramps are experienced near the end
of the dialysis treatment. he suggested to try a program of gentle stretching and toning
exercises targeted at the muscles which tend to cramp during dialysis.
Coppin (2005) quoted an uncontrolled study which suggested that calf
stretching exercise could prevent nocturnal leg cramps.23
16
Kannan (2005) recommended a non-pharmacologic approach of stretching and
massaging as the first line treatment for idiopathic nocturnal leg cramps.
Hansen (2005) published a treatment protocol for cramps in end stage renal
disease which concluded that to relive an established cramp, one must passively
stretch the contracting muscle. in some cases, this could be accomplished by simply
walking around which produced a relative dorsiflexion of foot. prophylactic stretching
can also prevent attacks, as position in bed might prevent foot dorsiflexion24
Lee (1999) stated that massage and vigorous stretching of the cramped muscle
would cause the spasm to yield in hemodialysis patients.
Sontag (1998) hypothesized that cramps are caused by muscle and tendon
shortening. he had discussed several simple stretching exercises which mime the
effect of squatting that frequently resulted in immediate and dramatic relief of cramps.
Schurellnus (1997) described that during muscle cramps, electromyography
activity was high and passive stretching was effective in reducing this. stretching
relived cramp by probably invoking the inverse stretch reflex, stretching also invoked
afferent activity from golgi- tendon organ to relive cramps.25
Leclere (1996) emphasized that mechanical treatment of an acute muscle cramp
involved stretching the affected muscle and this could be done prophylactically also .
Riley (1995) reviewed that treatment for leg cramps included stretching
exercises, quinine and vitamin E.26
Mc Gee (1990) proposed that the best evidence supported stretching exercises for
ordinary muscle cramps. He also proposed for future study areas of this common
symptom.27
17
Section III : Studies related to effectiveness of physical exercises during and outside
hemodialysis sessions .
Stores ,casaburi ,sawelson ,et al .(2005) studied 12 maintenance hemodialysis
patients by providing them incremental and constant work rate cycle exercises for 6-8
weeks and found out that eight weeks of leg cycling during hemodialysis in
maintenance patients improves not only cardiopulmonary fitness and endurance but
28
also muscle strength ,muscle power fatigability and physical function
Banerjee , kong and farrington (2004) studied two groups of 10 patients in each by
exercising them submaxim ally using a stationary cycle during isovolemic dialysis
for 10 minutes rest and again 10 minutes of exercises.cardic output, peripheral
resistance ,blood volume and stroke volume were measured using ultrasound dilution
and concluded that the hemodialysis response to exercises during hemodialysis is
comparable with that in normal individuals.29
Rizzeoli ,cerretano ,normanno,et al (2004) did a study in eight patients who
participated in physical traning with motorized cycle during dialysis treatment .the
study suggested that exercises during dialysis treatment was safe and consented either
better psychosocial performance or better dialytic efficiency .30
De paul , moreland, eagor, et al (2002) conducted a study on the background
that individuals with end stage renal diseases on hemodialysis therapy had reduced
aerobic exercise capacity and muscle strength . thus had done a single blind
randomized placebo controlled trial of an exercise intervention in hemodialysis
patients . it consisted of progressive resisted isotonic quadriceps and hamstring
exercise and training on a cycle ergometer weekly twice for 12 weeks. they interfered
that the exercise program improved physical impairment measures.31
18
Cappy ,jablonka and schroedes (1999) studied 32 hemodialysis patients who
participated in progressive self-faced exercise programme including cycling before or
during hemodialysis . they were assessed after a duration of 3.6 and 12 months of
participation for physical strength, weight, blood pressure, electrolytes, hematocrit,
glucose and intradialytic cramping. Results showed that all patients had improvement
in measures of physical performance.32
Ridley, hoey and ballagh –hoves (1999) conducted a quasi-experimental one
group pre and posttest design study. eight subjects completed a 12-week excise
programme involving warm-up, stretching, strengthening and cardiovascular training.
the result demonstrated improvements in participants, physical capacity, quality of life
and ability to perform activities of daily living. They concluded that an exercise
during dialysis, programme was safe and had the potential to result in positive patient
outcomes. 33
19
20
CHAPTER IV
RESEARCH METHODOLOGY
“Research methodology is a way to solve problems. It is a systemic procedure in which the
researcher starts from initial identification of the problems to final conclusion”. It refers to
investigation of the way of obtaining, organizing and analyzing data. Methodology studies
address the development, validation and evaluation of research tools or methods.
The study is designed to provide intradialytic stretching exercises on muscle cramps among
patients undergoing hemodialysis in selected hospitals at kolar.
This chapter includes the research design, setting, population and sampling criteria for
selection of samples and instruments and tool for data collection.
This chapter deals with brief description of different steps undertaken for the study
Research approach
Research design
Research settings
Variables understudy
Population
Sample and sampling technique
Development of the tool
Description of the tool
Content validity
19
Reliability
Pilot study
Data collection procedure
Plan for data analysis
RESEARCH APPROACH
Research approach is a procedure for conducting research. The research approach selected for
this study is evaluatory approach. This study is to provide intradialytic stretching exercise on
muscle cramps among hemodialysis patients in selected hospitals at kolar
RESEARCH DESIGN
Research design is conceptual structure within which research is conducted; it constitutes the
blue print for the collection, measurement and analysis of the data. “A research design is the
arrangement of condition for collection and analysis of data in a manner that aims to
combined relevance to the research purpose with economy in procedure’’
The present study was designed to provide intradialytic stretching exercises to reduce
muscle cramps among hemodialysis patients in selected hospital at kolar and their
relationship with selected variables.
20
Fig: 2, SCHEMATIC REPRESENTATION OF RESEARCH
DESIGN
Research approach: Evaluatory approach
Research design: Pre Experimental design
Study setting: ETCM, SNR HOSPITAL AT KOLAR
Target population: Hemodialysis patient
Sample: patients undergoing hemodialysis
Sample size: 60 hemodialysis patients
Sampling technique: random sampling technique
Dependent variable
Intradialytic stretching Attributing variables: Demographic variables

exercises.
 Age
 Sex
 Marital status
Data collection  education status
 Family income per month
 Dietary pattern
 Duration of dialysis
Data analysis:
21
1. Frequency and percentage of socio-demographic variables.
2. Frequency and percentage of muscle cramps with haemodialysis
3. Frequency and percentage of mean, standard deviation of hemodialysis
VARIABLES UNDER THE STUDY
“A variable is a potentially measureable component of an object of event that may fluctuate
in quantity and quality.”
 DEPENDENT VARIABLE:
Reduce muscle cramps among hemodialysis patient in selected hospital at kolar
 INDEPENDENT VARIABLE
Intradialytic stretching exercises among hemodialysis patients in selected hospitals at
kolar
ATTRIBUTED VARIABLES
Preexisting characteristic of the entity under investigation, in which the researcher
simply observes & measures.
In this study attributed variables are
 Age
 Sex
 Marital status
 education status
 Income per month
 Diet
 duration of dialysis
22
SETTING OF THE STUDY
It is the physical location & condition in which data collection takes place in a study.
The Investigator selected ETCM & SNR hospital at kolar for the
present study. Samples were selected from ETCM & SNR hospital which is situated 02 kms
away from pavan College of nursing at Kolar. It has a 100 bedded in SNR hospital and 50
bedded hospitals in ETCM hospital, were investigator selected 60 samples in the two
hospitals
POPULATION
“The entire set of individuals having some common characteristic some time referred
to as Universe”.
“The target population consists of total membership of a defined set of subjects from
whom the study subjects are selected and to whom the data will be generalized.
Target population is the entire population in which the researcher is interested and to
which she would like to generalize a result of a study. The target population of the study are
those who are undergoing hemodialysis in selected hospital at kolar.
SAMPLE
A sample consists of subject of the population selected to participate in a research
study. In the present study on the patients who are undergoing hemodialysis in selected
hospital at kolar.
SAMPLE SIZE
23
study. In the present study the sample consisted of 60 patients who are undergoing
hemodialysis in selected hospitals at kolar.
SAMPLING TECHNIQUE
“Sampling technique is the process of selecting the representative units of a
population for research. It is a process of selecting a subject of a population in order to obtain
information regarding a phenomenon in a way that represents the entire population”.
The technique adopted for this study was random sampling. all the patients
who fulfilled selection criteria were included in this study patients were selected
randomly by lottery method. Convenient sampling technique was used to select the
samples because the investigator felt that convenient sampling will be reliable in selecting the
samples whomever undergoing hemodialysis in selected hospital at kolar.
CRITERIA FOR SELECTION OF SAMPLE.
Inclusion criteria
 Patients of age group 20-50 years
 Patients who could understand either kannada or English
 Patients who are willing to participate.
 Patients who underwent haemodialysis for a duration of four hours.
Exclusive criteria
 Emergency hemodialysis
 Patient with femoral catheter
 Patients with any lower limb pathology.
DEVELOPMENT OF TOOL:
24
“The instrument is a vehicle that could best obtain data pertinent to the study and at
the same time to the body of general knowledge in discipline”.
The investigator developed a structured interview schedule to collect the socio-
demographic data and research has used schedules, interview techniques to assess the pain
level of hemodialysis patients. The interview schedule questionnaires were elected on the
basic of objective of the study, if the tool is not relevant and appropriate, the studies objective
will never be meet.
The tool was developed
 After reviewing the related literature.
 Based on the opinion of the subject experts.
Based on the obtained information from these means and according to the objective of the
study blue print on the subject matter was prepared. According to the content area in the blue
print, adequate number of question items was prepared, and then the prepared items were
given to subject experts for content validity along with the blue print.
DESCRIPTION OF THE TOOL:
Tool consists of two sections,
Part-1 Structured interview schedule was to collect the socio-demographic data.
Part-2: Cramp questionnaire chart and visual analogue scale. The cramp questionnaire
chart was developed by Basemath.S.S.Morris. The cramp questionnaire chart was designed to
assess the level of muscle cramps during hemodialysis, before and after intervention. It
contains various features of muscle cramps such as the frequency of muscle cramps, duration
of muscle cramps, level of pain, temperature and discomfort which was comprehensively
scored as level of muscle cramps ranging from (0-13).

25
0 - No cramps
1-4 Mild cramps
5-8 Moderate cramps
9-13 Severe cramps.
CONTENT VALIDITY:
“Content validity concerns the degree to which an instrument has an appropriate sample of
items for the construct being measured”
The prepared instrument along with the statement of the problem, objectives, tool and
intradialytic stretching exercise were submitted to10 experts comprises of six nurse educators
from the department of medical surgical nursing, one psychologists, one physician and one
statistician to establish the content validity. List of experts are given in the annexure.
Suggestions by experts were subsequently incorporated into the tool.
RELIABILITY:
“Reliability of an instrument is the degree of consistency with its measure the attribute is
supposed to measure”.
It is concern with consistency, accuracy, precision, stability, equivalence and homogeneity.
The reliability was established by using split half method and it was found to be r= 0.94,
which indicates that the tool was reliable.
DEVELOPMENT OF SELF INSTRUCTION MODULE:
26
The intradialytic stretching exercises to reduce muscle cramps among hemodialysis
patient was developed based on the review of the related and non-research literature and the
objective of the study.
CONTENT VALIDITY OF THE SELF INSTRUCTIONAL MODULE:
The initial draft of intradialytic stretching exercises to reduce muscle cramps the were
given to experts comprises of six nurse educators from the department of medical surgical
nursing, one psychologist, one physician and one statistician along with the cramp
questionnaire chart based on the criteria and to give suggestion, on the adequacy and
relevance of the content. Based on the expert’s opinion some of the content has been
modified.
PILOT STUDY
“Pilot study is the study carried out at the end of the planning phase of the research, in
order to explore and test the research element”.
It is a small scale trial run of the majority study, to assess the feasibility in conducting
main study and to obtain information for improving the study.
The pilot study of this study was conducted I, with 6 hemodialysis patient at SNR hospital
kolar from 10/03/2018 to25/03/2018. A convenient sampling technique was used to select the
sample were the inclusion and exclusion criteria were considered during sample selection.
The purpose study was explained and oral consents were taken. The data was collected by
administration of validated tool. A concise data analysis was done by using descriptive
statistics. As result of the pilot study the tool was found satisfactory in term of simplicity,
clarity and found feasible to conduct the main study.
The findings reveled most of the hemodialysis patients are having muscle cramps and The
intradialytic stretching exercises on muscle cramps will help the to reduce muscle cramps.
27
DATA COLLECTION PROCESS:
The data collection was scheduled from 10/04/2018 to25/05/2018 for the
period of 6 weeks. Before the investigator obtain the formal permission from the concerned
authority of hospitals at kolar Karnataka then the investigator introduced herself to the
subject and explain the purpose of the study to the hemolysis patients and by convenient
sampling method selected the patients, Participants were explained about the purpose of the
study and verbal consent was obtained from them prior to the data collection.
PLANS FOR THE DATA ANALYSIS:
The data was planned and analysis on the basis of objectives and assumptions of the
study using the descriptive and inferential statistical test.
The plan for data analysis is as follows:
Section – 1
Data on demographic variables of the hemodialysis patients having muscle cramps
Section – 2
a) Data on assessment of muscle cramps among haemodialysis patients
b) . Distribution of intradialytic stretching exercises score, mean, difference in mean and
standard deviation among haemodialysis patients.
Section – 3
Data on association between the levels of pain among hemodialysis patients having muscle
cramps with their selected demographic variables.
SUMMARY:
Research methodology gives a bird’s eye view of the entire process of tackling a research
problem in scientific and systematic manner
28
29
CHAPTER IV
RESEARCH METHODOLOGY
“Research methodology is a way to solve problems. It is a systemic procedure in which the
researcher starts from initial identification of the problems to final conclusion”. It refers to
investigation of the way of obtaining, organizing and analyzing data. Methodology studies
address the development, validation and evaluation of research tools or methods.
The study is designed to provide intradialytic stretching exercises on muscle cramps among
patients undergoing hemodialysis in selected hospitals at kolar.
This chapter includes the research design, setting, population and sampling criteria for
selection of samples and instruments and tool for data collection.
This chapter deals with brief description of different steps undertaken for the study
Research approach
Research design
Research settings
Variables understudy
Population
Sample and sampling technique
Development of the tool
Description of the tool
Content validity
19
Reliability
Pilot study
Data collection procedure
Plan for data analysis
RESEARCH APPROACH
Research approach is a procedure for conducting research. The research approach selected for
this study is evaluatory approach. This study is to provide intradialytic stretching exercise on
muscle cramps among hemodialysis patients in selected hospitals at kolar
RESEARCH DESIGN
Research design is conceptual structure within which research is conducted; it constitutes the
blue print for the collection, measurement and analysis of the data. “A research design is the
arrangement of condition for collection and analysis of data in a manner that aims to
combined relevance to the research purpose with economy in procedure’’
The present study was designed to provide intradialytic stretching exercises to reduce
muscle cramps among hemodialysis patients in selected hospital at kolar and their
relationship with selected variables.
20
Fig: 2, SCHEMATIC REPRESENTATION OF RESEARCH
DESIGN
Research approach: Evaluatory approach
Research design: Pre Experimental design
Study setting: ETCM, SNR HOSPITAL AT KOLAR
Target population: Hemodialysis patient
Sample: patients undergoing hemodialysis
Sample size: 60 hemodialysis patients
Sampling technique: random sampling technique
Dependent variable
Intradialytic stretching Attributing variables: Demographic variables

exercises.
 Age
 Sex
 Marital status
Data collection  education status
 Family income per month
 Dietary pattern
 Duration of dialysis
Data analysis:
21
1. Frequency and percentage of socio-demographic variables.
2. Frequency and percentage of muscle cramps with haemodialysis
3. Frequency and percentage of mean, standard deviation of hemodialysis
VARIABLES UNDER THE STUDY
“A variable is a potentially measureable component of an object of event that may fluctuate
in quantity and quality.”
 DEPENDENT VARIABLE:
Reduce muscle cramps among hemodialysis patient in selected hospital at kolar
 INDEPENDENT VARIABLE
Intradialytic stretching exercises among hemodialysis patients in selected hospitals at
kolar
ATTRIBUTED VARIABLES
Preexisting characteristic of the entity under investigation, in which the researcher
simply observes & measures.
In this study attributed variables are
 Age
 Sex
 Marital status
 education status
 Income per month
 Diet
 duration of dialysis
22
SETTING OF THE STUDY
It is the physical location & condition in which data collection takes place in a study.
The Investigator selected ETCM & SNR hospital at kolar for the
present study. Samples were selected from ETCM & SNR hospital which is situated 02 kms
away from pavan College of nursing at Kolar. It has a 100 bedded in SNR hospital and 50
bedded hospitals in ETCM hospital, were investigator selected 60 samples in the two
hospitals
POPULATION
“The entire set of individuals having some common characteristic some time referred
to as Universe”.
“The target population consists of total membership of a defined set of subjects from
whom the study subjects are selected and to whom the data will be generalized.
Target population is the entire population in which the researcher is interested and to
which she would like to generalize a result of a study. The target population of the study are
those who are undergoing hemodialysis in selected hospital at kolar.
SAMPLE
study. In the present study on the patients who are undergoing hemodialysis in selected
hospital at kolar.
SAMPLE SIZE
23
study. In the present study the sample consisted of 60 patients who are undergoing
hemodialysis in selected hospitals at kolar.
SAMPLING TECHNIQUE
“Sampling technique is the process of selecting the representative units of a
population for research. It is a process of selecting a subject of a population in order to obtain
information regarding a phenomenon in a way that represents the entire population”.
The technique adopted for this study was random sampling. all the patients
who fulfilled selection criteria were included in this study patients were selected
randomly by lottery method. Convenient sampling technique was used to select the
samples because the investigator felt that convenient sampling will be reliable in selecting the
samples whomever undergoing hemodialysis in selected hospital at kolar.
CRITERIA FOR SELECTION OF SAMPLE.
Inclusion criteria
 Patients of age group 20-50 years
 Patients who could understand either kannada or English
 Patients who are willing to participate.
 Patients who underwent haemodialysis for a duration of four hours.
Exclusive criteria
 Emergency hemodialysis
 Patient with femoral catheter
 Patients with any lower limb pathology.
DEVELOPMENT OF TOOL:
24
“The instrument is a vehicle that could best obtain data pertinent to the study and at
the same time to the body of general knowledge in discipline”.
The investigator developed a structured interview schedule to collect the socio-
demographic data and research has used schedules, interview techniques to assess the pain
level of hemodialysis patients. The interview schedule questionnaires were elected on the
basic of objective of the study, if the tool is not relevant and appropriate, the studies objective
will never be meet.
The tool was developed
 After reviewing the related literature.
 Based on the opinion of the subject experts.
Based on the obtained information from these means and according to the objective of the
study blue print on the subject matter was prepared. According to the content area in the blue
print, adequate number of question items was prepared, and then the prepared items were
given to subject experts for content validity along with the blue print.
DESCRIPTION OF THE TOOL:
Tool consists of two sections,
Part-1 Structured interview schedule was to collect the socio-demographic data.
Part-2: Cramp questionnaire chart and visual analogue scale. The cramp questionnaire
chart was developed by Basemath.S.S.Morris. The cramp questionnaire chart was designed to

25
0 - No cramps
1-4 Mild cramps
5-8 Moderate cramps
9-13 Severe cramps.
CONTENT VALIDITY:
“Content validity concerns the degree to which an instrument has an appropriate sample of
items for the construct being measured”
The prepared instrument along with the statement of the problem, objectives, tool and
intradialytic stretching exercise were submitted to10 experts comprises of six nurse educators
from the department of medical surgical nursing, one psychologists, one physician and one
statistician to establish the content validity. List of experts are given in the annexure.
Suggestions by experts were subsequently incorporated into the tool.
RELIABILITY:
“Reliability of an instrument is the degree of consistency with its measure the attribute is
supposed to measure”.
It is concern with consistency, accuracy, precision, stability, equivalence and homogeneity.
The reliability was established by using split half method and it was found to be r= 0.94,
which indicates that the tool was reliable.
DEVELOPMENT OF SELF INSTRUCTION MODULE:
26
The intradialytic stretching exercises to reduce muscle cramps among hemodialysis
patient was developed based on the review of the related and non-research literature and the
objective of the study.
CONTENT VALIDITY OF THE SELF INSTRUCTIONAL MODULE:
The initial draft of intradialytic stretching exercises to reduce muscle cramps the were
given to experts comprises of six nurse educators from the department of medical surgical
nursing, one psychologist, one physician and one statistician along with the cramp
questionnaire chart based on the criteria and to give suggestion, on the adequacy and
relevance of the content. Based on the expert’s opinion some of the content has been
modified.
PILOT STUDY
“Pilot study is the study carried out at the end of the planning phase of the research, in
order to explore and test the research element”.
It is a small scale trial run of the majority study, to assess the feasibility in conducting
main study and to obtain information for improving the study.
The pilot study of this study was conducted I, with 6 hemodialysis patient at SNR hospital
kolar from 10/03/2018 to25/03/2018. A convenient sampling technique was used to select the
sample were the inclusion and exclusion criteria were considered during sample selection.
The purpose study was explained and oral consents were taken. The data was collected by
administration of validated tool. A concise data analysis was done by using descriptive
statistics. As result of the pilot study the tool was found satisfactory in term of simplicity,
clarity and found feasible to conduct the main study.
The findings reveled most of the hemodialysis patients are having muscle cramps and The
intradialytic stretching exercises on muscle cramps will help the to reduce muscle cramps.
27
DATA COLLECTION PROCESS:
The data collection was scheduled from 10/04/2018 to25/05/2018 for the
period of 6 weeks. Before the investigator obtain the formal permission from the concerned
authority of hospitals at kolar Karnataka then the investigator introduced herself to the
subject and explain the purpose of the study to the hemolysis patients and by convenient
sampling method selected the patients, Participants were explained about the purpose of the
study and verbal consent was obtained from them prior to the data collection.
PLANS FOR THE DATA ANALYSIS:
The data was planned and analysis on the basis of objectives and assumptions of the
study using the descriptive and inferential statistical test.
The plan for data analysis is as follows:
Section – 1
Data on demographic variables of the hemodialysis patients having muscle cramps
Section – 2
a) Data on assessment of muscle cramps among haemodialysis patients
b) . Distribution of intradialytic stretching exercises score, mean, difference in mean and
standard deviation among haemodialysis patients.
Section – 3
Data on association between the levels of pain among hemodialysis patients having muscle
cramps with their selected demographic variables.
SUMMARY:
Research methodology gives a bird’s eye view of the entire process of tackling a research
problem in scientific and systematic manner
28
29
CHAPTER V
RESULTS
DATA ANALYSIS AND INTERPRETATION
The data themselves do not provide us with answer to research questions. In order to be
meaningful answer to the research questions the data must be presented and analyzed in some
orderly, so that relationship can be described.
This chapter deals with analysis and interpretation to “A study to assess the effect of
intradialytic stretching exercises on muscle cramps among patients undergoing hemodialysis
in selected hospitals at kolar district, Karnataka „‟
the purpose of this analysis is to reduce the data to a manageable and interpretable form so
that research problem can be studied and tested.
Analysis is described as “categorizing, ordering, manipulating and summarizing the
data to obtain answer to research questions”. The purpose of analysis is to reduce the data to
an intelligible and interpretable form so that the relation of research can be studied.
This section presents the analysis and interpretation of the data collected through
Wong–Baker scale was in order to assess the effectiveness of intradialytic stretching exercise on
muscle cramps among hemodialysis patient The data collected were organized, tabulated,
analyzed and interpreted by means of descriptive and inferential statistics. The data collection
was done based on the objectives of the study.
26
Objectives of the study are:

hemodialysis.
2. to determine the effectiveness of intradialytic stretching exercises on muscle

3. to find out the association between the pretest level of muscle cramps among
patients undergoing hemodialysis with their selected demographical variables
Presentation of the data
To begin, the data were entered in master sheet for tabulation and statistical
processing. In order to find the relationship, the data were tabulated, analyzed and interpreted
using descriptive and inferential statistics.
The data are presented under the following headings:
Section A: Demographic variables of the subjects studied.
Section B: Data on assessment and distribution of muscle cramps among hemodialysis

patients in pretest and posttest.
Section C: Assess the effectiveness of intradialytic stretching exercise in management of

muscle cramps among hemodialysis patients in experimental group and without intradialytic
stretching exercise in control group. (Analysis of test of significance of hypothesis)
Section D: Data on association between posttest scores of muscle cramps among

hemodialysis patients with their selected demographic variables of experimental and control
group.
27
Section – A
Data on demographic variables include age, sex, family income per month, dietary
pattern, duration of dialysis, marital status, education
Table - 1
Frequency and percentage distribution of the adolescents according to

their age in years
N=60
Experimental group Control group

Age
Frequency Percentage Frequency Percentage
20-30 years 2 2% 2 2%
30-40 years 6 18% 6 18%
40-50years 22 78% 22 78%
Total 30 100% 30 100%
The above table depicts that most of the subjects i.e.22 (80%) were in the age group
of 40-50years and 6 (20%) subjects were in the age group of 30-40 years in both
experimental and control group. And 20-30 years‟ age group of (2%)years both in the
experimental and control group.
28
Fig :1
Cylindrical diagram representing frequency distribution of the

hemodialysis patient according to their age in years
25
22 22
20
Frequency
15
10
6 6
5
2 2
20-30 years
30-40 years
40-50 years
Age in years
29
Table -2
Frequency and percentage distribution of the hemodialysis patient

according to their family monthly income
N=60
Family Experimental group Control group

monthly
Income (in
rupees) Frequency Percentage Frequency Percentage
Below 3000 8 26.7% 11 36.7%
3001 - 6000 6 20% 8 26.7%
6001 – 9000 8 26.6% 4 13.3%
9001 and 8 26.7% 7 23.3%

above
Total 30 100% 30 100%
The data presented in the above table reveals that in experimental group, equal
number of respondents i.e. 8 (26.7%) have monthly income ranging from below 3000, 3001
– 6000 and 9001 and above and above in their family and only 6 (20%) respondents have
their family monthly income ranging from 3001-6000. Whereas in control group 11 (36.7%)
30
respondents have their family income of below 3000 per month, 8 (26.7%) of them have their
income ranging from 3001-6000 per month, 7 (23.3%) of the respondent‟s family monthly
income ranges from 9001 and above and only 4 (13.3%) respondents have their family
monthly income ranging from 6001-9000.
Figure-2
Cone diagram representing frequency distribution of hemodialysis patients

according to their family monthly income
0.4 36.70%
0.35
0.3 26.70% 26.70% 26.60% 26.70%

23.30%
0.25
20%
0.2
13.30%
0.15
0.1
0.05
0
Below 3000 3001 - 6000 6001 – 9000 9001 and
above
31
Table – 3
Frequency and percentage distribution of the hemodialysis patients

according to their marital status
N=60
marital Experimental group Control group
status
Married 17 56.7% 23 76.7%
Unmarried 13 43.3% 7 23.3%
Divorce 0 0% 0 0%
Total 30 100% 30 100%
Table No-3 reveals that 56.7% (17) of the hemodialysis patients are married and
43.3% (13) of the unmarried in experimental group. Whereas in the control group 76.7% (23)
of them from married and 23.3% (7) un married. None of the subjects belong to Divorce.
32
Figure-3
Bar diagram representing frequency distribution of hemodialysis patient
according to their marital status
Type of family Experimental group Type of family Control group
76.70%
80.00%
70.00%
56.70%
60.00%
50.00% 43.30%
40.00%
30.00% 23.30%
20.00%
10.00%
0% 0%
0.00%
Married divorce un married
33
Table - 4
Frequency and percentage distribution of the haemodialysis patient

according to their Educational Status
N=60

Educational
Status Frequency Percentage Frequency Percentage
No formal
0 0% 0 0%
Education
Primary
4 13.3% 3 10%
Education
Secondary
26 86.7% 27 90%
Education
Graduate and
0 0% 0 0%
Above
Total 30 100% 30 100%
The above table 4 shows that 86.7 %( 26) of the hemodialysis patient were secondary
education; only 13.3 %( 4) were primary education in the experimental group. Whereas in the
control group, 90 %( 27) of the respondents were secondary education and 10 %( 3) were
primary education. None of the were belongs to graduate and above, and other category in
both the groups.
34
Figure-4
Bar diagram representing frequency distribution of hemodialysis patient
according to their Educational Status
90%
86.70%
90%
80%
70%
60%
50%
40%
30%
20% 13.30%
10%
10%
0% 0% 0% 0%
0%
No formal Primary Education Secondary Graduate and
Education Education Above
35
Table - 5

according to duration of dialysis
Duration Of Experimental group Control group
Dialysis Frequency Percentage Frequency Percentage
1.17 hour 20 70% 20 70%
2.18 hour 6 16.7% 6 16.7%
3.5 hour 4 13.3% 4 13.3%
Total 30 100% 30 100%
Table -5 reveals that 70%(20) of hemodialysis patients duration of dialysis is 1.17 hour ,
16%(6) were having 2.18 hour of dialysis and 13%(4) were having 3.5 hour of dialysis both
in experimental and control group.
36
Figure-5
Cylindrical diagram representing frequency distribution of the hemolysis

patient according to duration of dialysis
20 20
20
18
16
Frequency
14
12
10
8
6 6
6
4 4
4
0
3.5 hour 2.18 hour 1.17 hour
Duration of dialysis
37
Table-6

according to dietary pattern

Dietary pattern
mixed 20 70% 20 70%
Non vegetarian 6 16.7% 6 16.7%
Vegetarian 4 13.3% 4 13.3%
Total 30 100% 30 100%
Table -6 reveals that 70%(20) of hemolysis patients are having mixed diet , 16%(6) were
having non vegetarian and 13%(4) were having only vegetarian both in experimental and
control group.
38
Figure-6
Cylindrical diagram representing frequency distribution of diet pattern

among hemodialysis patient
20 20 20
18
16
14
Frequency
12
10
8
6 6
6
4 4
4
vegeterian
non vegertian
mixed
Diet pattern
39
Table - 7

according to sex

Place of
residence Frequency Percentage Frequency Percentage
Male 18 55% 18 55%
Female 12 45% 12 45%
Total 30 100% 30 100%
40
Fig - 7
Distribution of sex according to hemodialysis patient in both experimental

and control group
male 55.0%
female
[PERCENTAGE]
Regarding sex of the hemolysis patient 55.0% are males and 45.0% are females in
area both in experimental and control group
41
Section B:
Data on assessment and distribution of level of muscle cramps among
hemodialysis patients
muscle cramps among hemodialysis patients in pretest and posttest
Cramp questionnaire chart and visual analogue scale. The cramp questionnaire chart
was developed by Basemath.S.S. Morris. The cramp questionnaire chart was designed to
 0 No cramps
 1-4 Mild cramps
 5-8 Moderate cramps
 9-13 Severe cramps
42
Table - 8
Assessment and distribution of muscle cramps scores among hemodialysis
patient in pretest
N=60

Total score
No cramps 0 0% 0 0%
Mild cramps 0 0% 0 0%
Moderate cramps 23 76.6% 22 73.4%
Severe cramps 07 23.4% 08 26.6%
Total 30 100% 30 100%
The pretest score in the above table disclosed that majority of hemodialysis patients
are having moderate cramps 76.6% (23) of experimental group and 73.4% (22) of control
group had severe pain and about 26.6%(08) of control group and 23.4%(07) of experimental
group subjects had severe cramps. None of them having No cramps and mild cramps in the
group.
43
Figure-8
Bar diagram representing scores of muscle cramps among hemodialysis
patients in pre test
76.60%
0.8 73.40%
0.7
0.6
0.5
0.4
26.60%
0.3 23.40%
0.2
0.1
0% 0%
0
No cramps moderate cramps severe cramps
44
Table - 9
Assessment and distribution of muscle cramps scores among hemodialysis
patient in post test

Total score
No cramps 28 93.3% 0 0%
Mild cramps 0 0% 0 0%
Moderate cramps 02 6.67% 20 66.7%
Severe cramps 0 0% 10 33.3%
Total 30 100% 30 100%
N=60
The post test score in the table disclosed that, in experimental group majority of hemodialysis
patient are not having muscle cramps 28 (93.3%), only 02 (6.67%) had moderate cramps and
none of them had severe cramps. These results showed that the scores were reduced due to
the effect of intradialytic stretching exercise among hemolysis patient. Whereas in the control
group 20 (66.7%) had moderate muscle cramps, 10 (33.3%) had severe muscle cramps and
none of them had no cramps.
45
Figure-9
Cylindrical diagram representing muscle cramps scores of hemodialysis
patient in post test
100.00% 93.30%
90.00%
80.00%
66.70%
70.00%
60.00%
50.00%
40.00% 33.30%
30.00%
20.00%
6.67%
10.00%
0% 0%
0.00%
Total score Experimental group Total score Control group
No cramps moderate cramps severe cramps
46
Section C
Assess the effectiveness intradialytic stretching exercise in muscle cramps
among hemodialysis patient in experimental group and without
intradialytic stretching exercise in control group.
Table – 10
Mean, standard deviation and‘t’ value of pretest and post test scores of
experimental and control group
N=60

Scores
M SD t-value M SD t-value
Pretest 34 3.1 t=31.56 33.6 2.7 t=0.6
df=29 df=29
Post test 23.8 3.2 p<0.001 34 3.4 p>0.001
HS NS
Ttab=3.659
KEYS:
M: Mean N: Number of samples SD: Standard Deviation
df: Degrees of freedom HS: Highly Significant NS: Not Significant
The data presented in the above table represents that in the experimental group, during
pretest the mean score was 34 with the standard deviation of 3.1. Whereas in posttest the
mean score was 23.8 with the standard deviation of 3.2. The computed t-value between
47
pretest and posttest score is 31.56 (P<0.001) which is highly significant in muscle cramps and
with the use of intradialytic stretching exercises among hemodialysis patient.
Similarly, in the control group, during pretest the mean score was 33.6 with the
standard deviation of 2.7. Whereas in posttest the mean score was 34 with the standard
deviation of 3.4. The computed t-value between pretest and posttest score is 0.6 (P>0.001)
which is not significant in muscle cramps among hemodialysis patient without the use of
intradialytic stretching exercise.
There is a significant reduction in the level of muscle cramps after providing of intradialytic
stretching exercise in experimental group. The findings indicate that the computed‟ value is
31.56 is greater than t‟ table value (3.659) at 29 degrees of freedom, so the hypothesis-1 is
accepted.
48
Figure-10
Pyramid diagram representing the distribution of mean value of muscle
34 33.6 34
35
30
23.8
25
20
15
10
0
Mean Mean
Pretest Post test
Table -11
49
Comparison between the pretest and post test scores of Experimental and
Control groups
N=60
Pretest Post test
t-test (Unpaired) t-test (Unpaired)
Calculated value 0.235 15.2
Table value 3.46 3.46
Degrees of freedom df=58 df=58
p>0.001 p<0.001
Significance
Not Significant Highly Significant
KEY: df- Degrees of freedom
The above table depicts that the computed t-value (Unpaired) between experimental
and control group in the pretest is 0.235 (P>0.001) at 58 degrees of freedom is less than the t-
table value which is not statistically significant. But in the posttest the computed unpaired t-
value between experimental and control group is 15.2 (P<0.001) at 58 degrees of freedom is
greater than the t-table value which is highly significant.
There is a significant difference between the levels of muscle cramps among
accepted.
Section D
50
Data on association between posttest scores of muscle cramps among
hemodialysis patients with their selected demographic variables of
experimental and control group
Table – 12
hemodialysis patients with their selected demographic variables of
experimental group
N = 60
Muscle cramps among
DEMOGRAP hemodialysis patient

Sl. Chi-square
HIC DESCRIPTION Moder
No N0 SEVER value
VARIABLES ate
cramps cramps
cramps
20-30 years χ2=0.071

0 0 0
df=4
NS
30-40 years 1 5 0
1 Age in years P>0.05
40-50 years
2 21 1
No formal
Educational 0 0 0 χ2=12.62
2 Status of Education
the df=6
Primary 1 3 0
haemodialy
51
sis patient Education SS
Secondary P<0.05
6 20 0
Education
Graduate and
0 0 0
Above
Below 3000 1 6 1 χ2=1.21
Family
monthly 3001 - 6000 2 4 0 df=6
3 Income (in
rupees) 6001 – 9000 1 7 0 NS
9001 and 0 8 0 P>0.05

above
3 10 0 χ2=0.247
Vegetarian
Dietary df=2
4
pattern 2 15 1 NS
Non -
vegetarian
P>0.05
mixed
married 4 11 2 χ2=3.49
Divorce df=4
6 Marital status 0 0 0
NS
Unmarried 4 9 0 P>0.05
0 3 6 χ2=3.911
df=6
8 sex Female
0 17 5 NS
P>0.05
3.5 hours 0 0 0 χ2=0.071
2.18 hours 1 5 0 df=4

Duration of
9
dialysis
1.17 hrs NS
2 21 1
P>0.05
52
KEY: NS- Not Significant SS- Statistically Significant df- Degrees of freedom χ2- Chi
square
The above table depicts that the association between posttest scores of muscle cramps and
selected demographic variables of hemodialysis patient‟s in experimental group. By using
chi-square it is evident that there was no significant association between Age in years, sex,
Family monthly Income (in rupees), Dietary pattern, marital status, educational status
,duration of dialysis P>0.05 level.
Table – 13

hemodialysis patient with their selected demographic variables of control
group
N:60
Muscle cramps score

DEMOGRAP
Sl. Moder Chi-square
HIC DESCRIPTION N0 Severe
No ate value
VARIABLES cramps cramps
cramps
53
18-20 0 0 0
χ2=0.071
1 5 0 df=4
21-23 years
Age in years
NS
1 24-26 years 2 21 1 P>0.05
Below 3000 1 8 2 χ2=1.21

Family
monthly 3001 – 6000 2 6 0 df=6
2 Income (in
rupees) 6001 – 9000 1 3 0 NS
9001 and 0 7 0 P>0.05

above
χ2=0.247
3 20 0
Vegetarian
df=2
Dietary
3
pattern NS
Non - 2 5 1
P>0.05
Vegetarian
Nuclear Family 4 21 2 χ2=3.49
Divorce df=4
4 Marital status 0 0 0
NS
Joint Family 2 5 0 P>0.05
1 day 1 3 0 χ2=3.911
df=6
5 sex 2 day
0 4 0
NS
3 day 3 18 01 P>0.05
54
3.5 hours 0 0 0 χ2=0.071
2.18 hours 1 5 0 df=4

Duration of
6
dialysis
1.17 hrs NS
2 21 1
P>0.05
No formal
0 0 0
Education
Primary χ2=3.911
1 3 0
Education
Educational df=6
7
status Secondary
2 21 0
NS
Education
Graduate and P>0.05
0 0 1
Above
KEY: NS- Not Significant df- Degrees of freedom χ2- Chi square
The above table depicts that the association between posttest scores of muscle
cramps and selected demographic variables of hemodialysis patients in control group. By
using chi-square, it is evident that there was no significant association between Age in years,
, Family monthly Income (in rupees), Dietary pattern of, sex, marital status ,educational
status and duration of dialysis P>0.05 level in the control group
55
CHAPTER VI
DISCUSSION
The present study is conducted to “A study to assess the effect of intradialytic stretching
exercises on muscle cramps among patients undergoing hemodialysis in selected hospitals at
kolar district, Karnataka „‟.
In order to achieve the objectives of the study, experimental (pretest- posttest control
group) design was adopted. Convenient sampling technique was used to select sixty samples.
The data was collected by structured interview schedule method. The findings of the study
have been discussed with reference to the objectives. The data is organized and presented
here. The results of study revealed some interesting findings which are discussed as follows:
Description of demographic variables
Age: the subjects i.e.22 (80%) were in the age group of 40-50years and 6 (20%) subjects
were in the age group of 30-40 years in both experimental and control group. And 20-30
years‟ age group of (2%)years both in the experimental and control group.
Family monthly income (in rupees): Depicts that in experimental group, equal number of
respondents i.e. 8 (26.7%) have monthly income ranging from below 3000, 3001 – 6000 and
9001 and above and above in their family and only 6 (20%) respondents have their family
monthly income ranging from 3001-6000. Whereas in control group 11 (36.7%) respondents
have their family income of below 3000 per month, 8 (26.7%) of them have their income
ranging from 3001-6000 per month, 7 (23.3%) of the respondent‟s family monthly income
51
ranges from 9001 and above and only 4 (13.3%) respondents have their family monthly
income ranging from 6001-9000.
Marital status: 56.7% (17) of the hemodialysis patients are married and 43.3% (13) of the
unmarried in experimental group. Whereas in the control group 76.7% (23) of them from
married and 23.3% (7) un married. None of the subjects belong to Divorce.
Educational status : 86.7 %( 26) of the hemodialysis patient were secondary
education; only 13.3 %( 4) were primary education in the experimental group. Whereas in the
control group, 90 %( 27) of the respondents were secondary education and 10 %( 3) were
primary education. None of the were belongs to graduate and above, and other category in
both the groups.
Duration of dialysis: reveals that 70%(20) of hemodialysis patients duration of
dialysis is 1.17 hour , 16%(6) were having 2.18 hour of dialysis and 13%(4) were having 3.5
hour of dialysis both in experimental and control group.
Dietary pattern of: reveals that 70%(20) of hemolysis patients are having mixed diet,
16%(6) were having non vegetarian and 13%(4) were having only vegetarian both in
experimental and control group.
Sex: Regarding sex of the hemolysis patient 55.0% are males and 45.0% are females in
area both in experimental and control group
52
FINDINGS OF THE STUDY BASED ON THE OBJECTIVES WERE
Objective 1
 To assess the level of muscle cramps among haemodialysis patient before the providing
The findings of the study revealed that majority of hemodialysis patients are 76.6%
(23) of experimental group and 73.4% (18) of control group had moderate cramps and about
26.6%(08) of control group and 23.4%(07) of experimental group subjects had sever cramps.
None of them has No cramps in both the group.
In experimental group, during pretest the mean score was 34 with the standard
deviation of 3.1. Whereas in posttest the mean score was 23.8 with the standard deviation of
3.2. The computed t-value between pretest and posttest score is 31.56 (P<0.001) which is
highly significant muscle cramps among hemodialysis patients with the providing of
Objective 2
 To determine the effectiveness of intradialytic stretching exercise among haemodialysis
patients with muscle cramps
The post test score in the table disclosed that, in experimental group majority of hemodialysis
patient are not having muscle cramps 28 (93.3%), only 02 (6.67%) had moderate cramps and
none of them had severe cramps. These results showed that the scores were reduced due to
the effect of intradialytic stretching exercise among haemodialysis patients. Whereas in the
control group 20 (66.7%) had moderate cramps, 10 (33.3%) had severe cramps and none of
them had no cramps.
53
While comparing pretest and post test scores computed t-value (Unpaired) between
experimental and control group in the pretest is 0.235 (P>0.001) at 58 degrees of freedom is
less than the t-table value which is not statistically significant. But in the posttest the
computed unpaired t-value between experimental and control group is 15.2 (P<0.001) at 58
degrees of freedom is greater than the t-table value which is highly significant.
There is a significant difference between the levels of muscle cramps among
accepted.
Objective 3
 To associate post-test level of muscle cramps among haemodialysis patients with their
selected demographic variables.
The results exhibited that the selected demographic variables include age, family
income per month, dietary pattern, educational status, duration of dialysis, sex and
marital status, experimental and control group has no significant association with the level
of muscle cramps among hemodialysis patients at P>0.05 level.
The association between posttest scores of muscle cramps and selected demographic
variables of in experimental group. By using chi-square, it is evident that there was no
significant association between age, family income per month, dietary pattern,
educational status, duration of dialysis, sex and marital status at P>0.05 level.
54
SUMMARY:
The major findings of the study are in the accordance with the objectives of the study
and hypothesis. Results showed that there is reduction in the level of muscle cramps after
providing of intradialytic stretching exercise in the experimental group than compared to the
level of muscle cramps in the control group. The computed mean, standard deviation value,
the paired and unpaired t‟ value suggest the effectiveness of intradialytic stretching exercise
in muscle cramps among hemodialysis patients. The chi-square values indicate that there is
no significant association between the level of muscle cramps and most of with their selected
demographic variables.
Validity and Reliability
Validity of the tool was assessed using content validity. Content validity was determined by
experts form Nursing and Medical. They suggested certain modifications in tool. After the
modifications they agreed this tool for evaluate the “
55
After pilot study, reliability of the tool was assessed by using Test-retest method and its
correlation coefficient r –value was 0.83(knowledge). This correlation coefficient is very high
and it is good tool for evaluate the “
STATISTICAL ANALYSIS
Demographic variables in categorical/dichotomous were given in frequencies with their
percentages. Knowledge score was given in mean and standard deviation. Difference between
pretest and posttest was analyzed using student paired t-test.
Categorical variables difference between pretest and posttest was calculated using Extended
McNemars test.
Differences between pretest and posttest score was analyzed using percentage with 95% CI
and mean difference with 95% CI.
Association between posttest knowledge score with demographic variables are analyzed
using chi square test.
Association between knowledge gain score with demographic variables are analyzed using
one-way analysis of variance and student independent t-test.
P<0.05 was considered statistically significant.
56
CHI-SQUARE TEST
The Chi square test is a non-parametric test of proportions. It is used to test a hypothesis. If
the association between two varies is to be tested this test is commonly used. It was
introduced by Karl pearson.
The chi-square test is designed to examine whether a series of observed numbers in various
categories of the data are consistent with the numbers expected in these categories on some
specific hypothesis. (called null hypothesis)
2
describes the magnitude of discrepancy between theory and observation.
2
test, we are in a position to know whether a given discrepancy between
theory and observation may be attributed to chance or not.
2
is defined as:
2
=  ( O-E )2 / E
 (Observed frequency- expected frequency)2/ Expected frequencies
Where O= observed frequencies
E = expected frequencies
Conditions of Chi-square test
1. There must be large number of observations (say >50)
2. All the observations must be independent
57
3. Values/categories on independent and dependent variables must be mutually
exclusive and exhaustive.
4. The sample must be randomly drawn from the population.
5. Calculations must be based on actual numbers of observations and not on
percentages, ratios, observed values etc)
6. When overall total is between 20 and 40, all expected values are at least 5
Arithmetic Mean
n
 xi
x i 1
n
where  xi  x1  x2  x3  x4 ...... xn
i1
Standard Deviation: A measure of the dispersion among the elements in a set of data.
Standard deviation can be defined as follows:
58
Student t- test
It was introduced by W.S. Gosset in the year 1905 under the pen name „student‟ and it
is popularly known as t-test or t-distribution or student’s distribution. It is used when the
sample is in small size and the population standard deviation is unknown. It is a symmetrical
distribution similar in shape to the normal distribution and in fact it approaches the normal
distribution as N, the sample size, increases.
We can use this method to test the statistical significance difference between the means of
two different groups.
In t test we examine the logic
t= ________difference in sample means_____
standard error of difference of sample means
when this ratio is small, we will conclude that the data are compatible with the hypothesis
that both samples were drawn from a single population. When the ratio is large, we will
conclude that it is unlikely that the samples were drawn from a single population and assert
that the treatment produced an effect.
Independent t-test/ unpaired t-test
59
When we compare the means two independent sample groups, we can use the student
independent t-test . It is obtained using the formula.
When the difference between the means is divided by this standard error the result is t. Thus,
sp2 is the pooled variance
The standard error of the difference between the means is
60
Where n1 is the sample size of first sample
n2 is the sample size of second sample
s1 is the standard deviation of first sample
s2 is the standard deviation of first sample
x1 is the mean of first sample
x2 is the mean of second sample
Paired / Matched /Dependent t-test
When we use same group of samples in the pretest and in post test then we can analyze the
data using paired t-test using the following formula.
Find the mean of the differences, .
Find the standard deviation of the differences, SD.
Calculate the standard error of the mean
To calculate t, divide the mean of the differences by the standard error of the mean
61
Where
. Is the mean of the differences
SE is the standard deviation of the differences
N is the number of pairs.
62
CHAPTER VII
CONCLUSION
The present study was aimed “A study to assess the effect of intradialytic stretching
exercises on muscle cramps among patients undergoing hemodialysis in selected hospitals at
kolar district, Karnataka „‟
The study findings revealed that muscle cramps were reduced in hemodialysis patient
by the effect of intradialytic stretching exercises. Thus intradialytic stretching exercise is an
effective to reduce the muscle cramps in patients undergoing hemodialysis.
IMPLICATIONS
The findings of the study have several implications in the following field. It can be
discussed of in four areas namely nursing practice, nursing administration, nursing education
and nursing research.
IMPLICATIONS FOR NURSING PRACTICE
“Prevention is better than cure” so the nurse plays an active role in prevention of
complications through teaching module.
Nursing Implications: The present study has implications for nursing practice, nursing
education, nursing administration and nursing research.
Nursing Practice: Intradialytic stretching exercises can be adapted as a procedure to the
patients undergoing hemodialysis. Nurses can introduce the evidenced based practice of
doing this stretching exercises during the hemodialysis session. Nurses must emphasize the
patients comfort during hemodialysis thus helps to reduce the muscle cramps experienced by
the patients.
60
IMPLICATIONS FOR NURSING EDUCATION
 Nursing Education: Intradialytic stretching exercises can be included in the literature
on reduction of level of muscle cramps. The procedure of performing intradialytic
stretching exercises for reducing the level of muscle cramps. Nursing students and
staff nurses can be taught about the intradialytic stretching exercises for the reduction
of muscle cramps.
IMPLICATION FOR NURSING ADMINISTRATION
 Policies for the procedure of intradialytic stretching exercises can be developed based
on the study findings by incorporating the stretching exercises in to the procedure.
Nurse Managers can educate the medical surgical nurses regarding the intradialytic
stretching exercises through in service education programs. Nursing administrators
can take up initiatives in planning and implementation of non- pharmacological
therapies along with the routine therapy.
IMPLICATIONS FOR NURSING RESEARCH
 Nurse researchers can conduct studies to verify the scientific rationale and the
physiology behind the effect of intradialytic stretching exercises on level of muscle
cramps. Randomized clinical trials could be under taken so that the validity of the
results can be increased and it can be incorporated into the evidence based nursing
practice. Guide lines for the procedure of intradialytic stretching exercise.
RECOMMENDATIONS
 A similar study which includes attitude and practice can be undertaken

61
 A similar study can be conducted for a larger group
 This study can be conducted to find the factors responsible life style modification
Similar study can be conducted with the posttest after the month and one year, to see
the update of knowledge.
 A similar study can be conducted with different audio visual aids.
 A comparative study can also be done between effectiveness of learning module and
structured teaching program me.
62
CHAPTER VIII
SUMMARY
““A study to assess the effect of intradialytic stretching exercises on muscle cramps among
patients undergoing hemodialysis in selected hospitals at kolar district, Karnataka ‘’
The objectives of the study were:
hemodialysis.
2. to determine the effectiveness of intradialytic stretching exercises on
3. To find out the association between the pretest level of muscle cramps
among patients undergoing hemodialysis with their selected demographical
variables
The following hypothesis were set for the study are:
H1: there will be a significant difference between pretest and posttest scores on muscle
H2: There will be a significant association between the pretest level of muscle cramps
among patients undergoing hemodialysis with their selected demographical variables.
All hypotheses were tested at 0.05 level of significance
The study was based on Modified wiedenbach’s helping art of clinical nursing model. The
quantitative approach was used. The study was conducted in selected hospital at kolar. The
63
design adopted for the study was true experimental pre and posttest control group design.
Simple random sampling technique was adopted for this study. The data collection tools
developed for generating the demographic data of the samples which consists of age, age at
menarche, family income, religion.
The Numerical rating pain scale was used to assess the level of muscle cramps among
hemodialysis patient. The tool was validated by six clinical experts consisting of three
nursing experts and two medical experts and the reliability of the tool was established by.
Cramp questionnaire chart and visual analogue scale. The cramp questionnaire chart was
developed by Basemath.S.S. Morris The instrument was found to be reliable. Pilot study was
conducted in snr hospital kolar to find out the feasibility of the study and to plan for data
analysis.
Data was collected in SNR and ETCM hospital kolar, sixty hemodialysis patients were
selected by simple random sampling technique method. The data related demographic
variables were collected from the samples. The samples were scattered in two areas. The
experimental group and the control group. Numerical rating cramps scale was used to assess
the pre-test level of muscle cramps in hemolysis patients, Experimental group received
intradialytic stretching exercise for 1 weeks per day 2 sitting were as the control group did
not. Post-test level of cramps was assessed by using same numerical scale. The data was
analyzed using descriptive and inferential statistics.
The major findings of the study were, ™
 The mean post-test level of muscle cramps among hemodialysis patients in
experimental group was significantly lower than the mean posttest level of muscle
cramps among hemodialysis patients in control group (t=5.03,p<0.05)
64
 The mean post - test level of muscle cramps among hemodialysis patients in
experimental group was significantly lower than the mean pretest level of muscle
cramps among hemodialysis patients (t=5.61,p<0.005)
 There was no significant association between the posttest level of muscle cramps
among hemodialysis patients in experimental and control group with their selected
demographic variables.
On the basis of findings of the study it is recommended that
The study recommends the following future research.
 Similar kind of study can be conducted to a large group to generalize the
findings.
 A comparative study can be done to determine the effect of intradialytic
stretching exercise and pharmacological management in reduction of muscle
 A descriptive study to assess the prevalence of muscle cramps among the
dialysis patients in Karnataka.
 A study to assess the pharmacologic management and home remedies for
muscle cramps.
 The effectiveness of exercise can be tested for other conditions like low back
pain and incontinence of urine.
 A study can be conducted to assess the knowledge and attitude of nurses on
pharmacological management and other physical activities for reduction of muscle
 Recommendations based on the suggestions of the study subjects
 The nurse educates the community regarding the techniques of intradialytic
stretching exercise dialysis patients
65
 Conduct in-service education program and continuing education program for
effective management in reducing the level of intradialytic stretching among
dialysis patients
 Ensure and conduct workshops, conferences, seminars on no pharmacological
methods to reduce the level of muscle cramps among hemodialysis.
 The research findings need to be publishing through conferences, seminars
and publishing in nursing journal to the nursing staff.
 The research findings help to building and strengthening the knowledge about
the effects of intradialytic stretching among dialysis patients
CONCLUSION:
from the result of the study, it was concluded that rendering intradialytic
stretching exercise to the hemodialysis patient was effective in reduction of muscle
cramps. Therefore, the investigator felt that, more importance should be given for
intradialytic stretching exercise to the hemodialysis patient was effective in reduction
of muscle cramps.
66
.
67
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ANNEXURES
ANNEXURE –I
Letter seeking permission to conduct the pilot and main study
From,
The principal
AECS PAVAN COLLEGE OF NURSING, KOLAR
To,
Respected Sir/ Madam,
Sub: Requisition for permission to conduct the pilot study and main study
We wish to state that MRS PANDLURU GOWATHAMI is one of our final year
M.Sc. (N) student has to conduct a research project on “A STUDY TO ASSESS
THE EFFECT OF INTRADIALYTIC STRETCHING EXERCISES ON MUSCLE
CRAMPS AMONG PATIENTS UNDERGOING HEMODIALYSIS IN SELECTED
HOSPITALS AT KOLAR DISTRICT, KARNATAKA.” This is to be submitted to
Rajiv Gandhi University of Health sciences Karnataka, as a partial fulfilment of

the university requirement for the award of Master of nursing degree.
We request you to kindly permit her to do his research work

Thanking you
Yours faithfully
Date: July 2018 Principal

Place: Kolar AECS Pavan College of nursing
Kolar
136
ANNEXURE-II
Letter requesting expert opinion to establish content validity

From,
Mrs. Pandluru Gowathami
2nd Year M.Sc. Nursing
AECS Pavavn College of nursing
Kolar
To,
Subject: Request for expert’s opinion and suggestion to establish content validity of the
research tool.
Respected Sir/Madam,
I, Mrs. Baby rani P, 2nd yr. M.SC Nursing student in Medical surgical Nursing at Pavan
College of Nursing kolar, has selected the following topic for my dissertation to be submitted
to Rajiv Gandhi University of health sciences in partial fulfilment for the requirement for
award of Master of Science in Nursing.
Topic: “A STUDY TO ASSESS THE EFFECT OF INTRADIALYTIC STRETCHING

EXERCISES ON MUSCLE CRAMPS AMONG PATIENTS UNDERGOING
HEMODIALYSIS IN SELECTED HOSPITALS AT KOLAR DISTRICT,
KARNATAKA.”
I have enclosed here with

 Problem statement
 Objectives of the study
 Operational definition
 Hypothesis.
 Demographic Preformed
 Standardized Tool –
a. Basemath.S.S. Morris. The cramp questionnaire chart was designed to
assess the level of muscle cramps during hemodialysis,
b. Content on providing intradialytic stretching exercises
 Criteria checklist for tool validation
In view of the above, I request you to kindly go through the items and give your valuable
suggestions and opinions to develop the content validity of the tool. Your expert opinion and
kind co-operation will be highly appreciated and gratefully acknowledged.
Thanking you
Yours sincerely,
Place: Kolar Mrs. Pandluru Gowathami
137
ANNEXURE-III
Acceptance form for tool validation
Name :
Designation :
Name of the institution :
Statement of acceptance or non-acceptance :
I give Acceptance/Non-acceptance to validate the tool:
Topic- “A STUDY TO ASSESS THE EFFECT OF INTRADIALYTIC STRETCHING

EXERCISES ON MUSCLE CRAMPS AMONG PATIENTS UNDERGOING
HEMODIALYSIS IN SELECTED HOSPITALS AT KOLAR DISTRICT,
KARNATAKA.”
Date: Signature
138
ANNEXURE-IV
Criteria check list for validation of the tool
Respected Sir/Mam
Kindly review the items in the tool. If you agree with the criteria, place a tick ( √ ) mark in
the “Agree” column, otherwise, place a tick mark in the “Disagree” column, if modification
needed please mention that in “Need modification” column and give your comments in the
remarks column.
SOCIO -DEMOGRAPHIC PROFORMA
SI.NO Agree Disagree Need modification Remarks
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
139
ANNEXURE-V
Content validation certificate
This is to certify the tool for this study titled “A STUDY TO ASSESS THE EFFECT
OF INTRADIALYTIC STRETCHING EXERCISES ON MUSCLE CRAMPS
AMONG PATIENTS UNDERGOING HEMODIALYSIS IN SELECTED HOSPITALS
AT KOLAR DISTRICT, KARNATAKA.” has been validated by me.
Date: 1. Signature of the expert.

Place:
2. Designation and address.
140
ANNEXURE -VI
List of experts who validated the tool
1. Mrs. Shyamala rani

Professor, medical surgical dept.
Kuppam.
2. Mrs. Lavanaya kumari

Assoc prof, medical surgical dept.
Pavan college of nursing, kolar
3. Mrs. Saji Thomas

Assoc prof, medical surgical dept.
Pavan college of nursing, kolar
4. Mrs shanthi
Assoc. prof. hope hospital
Kolar
5. MRS Shanthakka
prof, medical surgical dept.
Govt. Bangalore
6. Mr shivanands
KIMS Assoc. prof,
Bangalore.
7. Mrs jayandhi
Assoc. prof, Norrie CON
141
KGF
8. Dr siddhalinga
Physician
kolar
9. Dr surendra
Asso, prof statistic Bangalore
10.Mr Basavaraju
prof govt college of nursing,
Bangalore.
142
ANNEXURE –VII
The tool consists of two sections
Section –I: Demographic Variables
Section-II: muscle cramps questionaries’ scale
CRAMPS QUESTIONNARIE CHART
S.NO Feature of muscle cramps Scores PRETEST POST TEST
I Frequency of cramps
1 Does not occur 0
2 Cramps occurs less than 3 times /hour 1
3 Cramps occurs more than 3 times /hour 2
II Duration of the cramps
1 Cramps does not occur 0
2 Cramps lasts for less than 5 minutes 1
3 Cramps last for more than 5 minutes 2
III Level of pain (VAS)
1 No pain 0
2 Pain 1-3 1
3 Pain 4-6 2
4 Pain 7-10 3
IV Temperature – leg
1 Warm 0
2 Cold 1
3 Cold clammy 2
V Discomfort
1 No cramps 0
2 Perceptible 1
3 Sensitive 2
4 Painful 3
5 Unbearable 4
143
0 - No cramps
1-4 Mild cramps
5-8 Moderate cramps
9-13 Severe cramps.
Instructions to the participants:
The interviewer introduces herself and explains the purpose of the study. The
interviewer asks the participants give free and frank response, attempt all the items and
place a () mark against the appropriate response in the box provided. The information
collected will be used for the purpose of study only. Confidentiality of the collected
information will be maintained.
144
ANNEXURE-VIII
DATA COLLECTION TOOL
Introduction: Read the following items carefully and complete them by putting the relevant
number of alternate is provided
SECTION – A
Name of Client: Sample No:
Demographic Data
1. Age
a. 20-30 years
b. 30-40 years
c. 40-50 years
2. education
a. Illiterate
b. Primary school
c. Higher secondary
d. Graduate(UG/PG)
3. Type of dietary pattern
a. Vegetarian
b. Non vegetarian
145
d. Mixed
4. Marital status
a. Married
b. Un married
c. Divorce
5. Family income per month
a. Less than Rs10000
b. Rs10000 to Rs20000
c. Rs20001 to Rs30000
d. More than Rs30000
6. Sex
a. Male
b. Female
7. Duration of hemodialysis
a. 1.17 hour
b. 2.18 hour
c. 3.5 hour
146
SECTION B
Content Providing Intradialytic Stretching Exercises on muscle cramps

among hemodialysis patients
Sl.No Exercise Description Picture Image
1 Ankle Dorsification  Place the non-

dominant hand over
the knee to stabilize
the knee
 Place the dominant
hand under the heel,
with the foot against
the forearm, and push
the heel downward
with this hand.
 Hold the position for
20-30 seconds.
Repeat the action for
5 times.
Gastrocnemius Passive  To stretch one muscle
2 Stretch (the gastrocnemius),
extend the knee, place
the other hand on top
of the ankle, and push
in the opposite
direction
3 Soleus-Passive Stretch  To stretch the second

muscle (the soleus),
flex the knee, place
the other hand under
147
the calf, and push in
the opposite direction.
4 Hamstring Stretching. METHOD 1

 Kneel between the
legs and support the
ankle with your arm
or shoulder. ‡ The
knee will be straight.
‡ Place one or both
hands just above your
knee, stabilizing the
hip joint. ‡ Raise the
leg straight up to
approximately 90
degrees. ‡ Hold it for
20-30 seconds. ‡
Repeat the action for
5 times.
METHOD 2
 Place one hand under
the knee and the other
hand under the heel.
 With the knee
straight and the
kneecap pointed
toward the ceiling,
raise the whole leg
toward the ceiling.
 When the raised knee
begins to bend
slightly, the hand
under your knee
148
should be moved to
the top of your
5 Quadriceps Stretch  Flex the knee of the
patient until the heel
touches his back.
 Place the non
±dominant hand over
the pelvis to restrict
the pelvic rotation.
 Hold the flexed knee
on the hands and try
to extend the hip as
much as possible.
 Hold the position for
20-30 minutes and
relaxes. ‡ Repeat the
procedure for 5
minutes
149
Demographic Variable of Hemodialysis patients
s. no d1 d2 d3 d4 d5 d6
1 a b a a a b
2 b b c a b a
3 c a a a b d
4 b b a b b a
5 b b a c a d
6 b a b d b d
7 a a a d a a
8 a b a d b a
9 a a c d a a
10 a a a d a a
11 a a a d b b
12 a a a d a d
13 b a d a b c
14 b a a a b a
15 c a a d a a
16 c a a d b d
17 d a a d a b
18 a b a d a a
19 d b a d b d
20 a a a d a a
21 a a d d a a
22 a b a a b b
23 b b a a b a
24 b b b d a b
25 b b a d b b
26 c a b d a a
27 a a b d a a
28 a b a d a a
29 b b c b b a
30 c a a b b a
31 b b a a b c
32 b b a a a a
33 b a b d b a
34 a a a d a a
35 a b a d b a
36 a a c d a b
37 a a a d a b
38 a a a d b b
39 a a a d a a
40 b a d b b a
41 b a a c b a
42 c a a c a a
43 b a a c b b
44 d b b d a b
45 c a a d b b
46 a a b d b b
47 a a b d a b
48 a a a d a a
49 b sb b d b a
50 b a b d b A
150
51 a a a d b a
52 a a a a b A
53 b b a a b A
54 b a a d b A
55 a a c d b C
56 c a a d a A
57 d a b d a A
58 b d c d b B
59 a a a d a A
60 a b a d b a
151
pretest scores in experimental group
Subjects 0 1 2 3 4 5 6 7 8 9 10 11 12 Total
1 0 0 0 o o o 0 0 8 0 0 0 0 8
2 0 0 0 0 0 5 0 0 0 0 0 0 0 5
3 0 0 0 0 0 0 0 7 0 0 0 0 0 7
4 0 0 0 0 0 0 0 0 0 0 0 0 0 9
5 0 0 0 0 0 0 0 0 0 9 0 0 0 9
6 0 0 0 0 0 0 0 0 0 9 0 0 0 9
7 0 0 0 0 0 0 0 0 0 0 10 0 0 10
8 0 0 0 0 0 0 0 7 0 0 0 0 0 7
9 0 0 0 0 0 0 6 0 0 0 0 0 0 6
10 0 0 0 0 0 0 0 0 0 0 10 0 0 10
11 0 0 0 0 0 0 0 0 0 9 0 0 0 9
12 0 0 0 0 0 0 0 7 0 0 0 0 0 7
13 0 0 0 0 0 0 0 7 0 0 0 0 0 7
14 0 0 0 0 0 5 0 0 0 0 0 0 0 5
15 0 0 0 0 0 0 6 0 0 0 0 0 0 6
16 0 0 0 0 0 5 0 0 0 0 0 0 0 5
17 0 0 0 0 4 0 0 0 0 0 0 0 0 4
18 0 0 0 0 0 0 0 7 0 0 0 0 0 7
19 0 0 0 0 0 0 6 0 0 0 0 0 0 6
20 0 0 0 0 0 5 0 0 0 0 0 0 0 5
21 0 0 3 0 0 0 0 0 0 0 0 0 0 3
22 0 0 3 0 0 0 0 0 0 0 0 0 0 3
23 0 0 0 4 0 0 0 0 0 0 0 0 0 4
24 0 0 0 4 0 0 0 0 0 0 0 0 0 4
25 0 0 0 0 0 0 7 0 0 0 0 0 0 7
26 0 0 0 0 5 0 0 0 0 0 0 0 0 5
27 0 0 0 0 0 6 0 0 0 0 0 0 0 6
28 0 0 0 0 0 0 0 0 0 0 0 0 0 9
29 0 0 0 0 0 0 0 0 0 0 0 0 0 6
30 0 0 0 0 0 0 0 0 0 0 0 0 0 8
152
pretest scores in control group
Subjects 0 1 2 3 4 5 6 7 8 9 10 11 12 Total
1 0 0 0 o o o 0 0 8 0 0 0 0 8
2 0 0 0 0 0 5 0 0 0 0 0 0 0 5
3 0 0 0 0 0 0 0 7 0 0 0 0 0 7
4 0 0 0 0 0 0 0 0 0 0 0 0 0 9
5 0 0 0 0 0 0 0 0 0 9 0 0 0 9
6 0 0 0 0 0 0 0 0 0 9 0 0 0 9
7 0 0 0 0 0 0 0 0 0 0 10 0 0 10
8 0 1 0 0 0 0 0 7 0 0 0 0 0 7
9 0 0 0 0 0 0 6 0 0 0 0 0 0 6
10 0 0 0 0 0 0 0 0 0 0 10 0 0 10
11 0 0 0 0 0 0 0 0 0 9 0 0 0 9
12 0 0 0 0 0 0 0 7 0 0 0 0 0 7
13 0 0 0 0 0 0 0 7 0 0 0 0 0 7
14 0 0 0 0 0 5 0 0 0 0 0 0 0 5
15 0 0 0 0 0 0 6 0 0 0 0 0 0 6
16 0 0 0 0 0 5 0 0 0 0 0 0 0 5
17 0 0 0 0 4 0 0 0 0 0 0 0 0 4
18 0 0 0 0 0 0 0 7 0 0 0 0 0 7
19 0 0 0 0 0 0 6 0 0 0 0 0 0 6
20 0 0 0 0 0 5 0 0 0 0 0 0 0 5
21 0 0 3 0 0 0 0 0 0 0 0 0 0 3
22 0 0 3 0 0 0 0 0 0 0 0 0 0 3
23 0 0 0 4 0 0 0 0 0 0 0 0 0 4
24 0 0 0 4 0 0 0 0 0 0 0 0 0 4
25 0 0 0 0 0 0 7 0 0 0 0 0 0 7
26 0 0 0 0 0 0 0 0 0 0 0 11 0 11
27 0 0 0 0 0 6 0 0 0 0 0 0 0 6
28 0 0 0 0 0 0 0 0 0 0 0 0 0 9
29 0 0 0 0 0 0 0 0 0 0 0 0 0 6
30 0 0 0 0 0 0 0 0 0 0 0 0 0 8
153
post test scores in experimental group
Subjects 0 1 2 3 4 5 6 7 8 9 10 11 12 Total
1 0 0 0 o o o 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 0 0 2 0 0 0 0 0 0 0 0 0 0 2
8 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 0 0 3 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 0 0 0 3 0 0 0 0 0 0 0 0 0 3
29 0 0 0 0 0 0 0 0 0 0 0 0 0 0
30 0 0 0 0 0 0 0 0 0 0 0 0 0 0
154
post test scores in control group
Subjects 0 1 2 3 4 5 6 7 8 9 10 11 12 Total
1 0 0 0 o o o 0 0 8 0 0 0 0 8
2 0 0 0 0 0 5 0 0 0 0 0 0 0 5
3 0 0 0 0 0 0 0 7 0 0 0 0 0 7
4 0 0 0 0 0 0 0 0 0 0 0 0 0 9
5 0 0 0 0 0 0 0 0 0 9 0 0 0 9
6 0 0 0 0 0 0 0 0 0 9 0 0 0 9
7 0 0 0 0 0 0 0 0 0 0 10 0 0 10
8 0 0 0 0 0 0 0 7 0 0 0 0 0 7
9 0 0 0 0 0 0 6 0 0 0 0 0 0 6
10 0 0 0 0 0 0 0 0 0 0 10 0 0 10
11 0 0 0 0 0 0 0 0 0 9 0 0 0 9
12 0 0 0 0 0 0 0 7 0 0 0 0 0 7
13 0 0 0 0 0 0 0 7 0 0 0 0 0 7
14 0 0 0 0 0 5 0 0 0 0 0 0 0 5
15 0 0 0 0 0 0 6 0 0 0 0 0 0 6
16 0 0 0 0 0 5 0 0 0 0 0 0 0 5
17 0 0 0 0 4 0 0 0 0 0 0 0 0 4
18 0 0 0 0 0 0 0 7 0 0 0 0 0 7
19 0 0 0 0 0 0 0 0 0 9 0 0 0 9
20 0 0 0 0 0 5 0 0 0 0 0 0 0 5
21 0 0 3 0 0 0 0 0 0 0 0 0 0 3
22 0 0 3 0 0 0 0 0 0 0 0 0 0 3
23 0 0 0 0 0 0 0 0 0 0 10 0 0 10
24 0 0 0 4 0 0 0 0 0 0 0 0 0 4
25 0 0 0 0 0 0 7 0 0 0 0 0 0 7
26 0 0 0 0 0 0 0 0 0 0 0 11 0 11
27 0 0 0 0 0 6 0 0 0 0 0 0 0 6
28 0 0 0 0 0 0 0 0 0 9 0 0 9 9
29 0 0 0 0 0 6 0 0 0 0 0 0 0 6
30 0 0 0 0 0 0 0 0 8 0 0 0 0 8
155
156
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A Study To Assess The Effect o 231021 102014

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DECLARATION

CERTIFICATE BY THE HOD, PRINCIPAL / HEAD OF THE INSTITUTION

intradialytic stretching exercises on muscle cramps among patients undergoing

hemodialysis in selected hospitals at kolar district, karnataka” is bonafide genuine research

Seal & Signature of the Principal

MRS. DEEPA.S M.sc [N],

PRINCIPAL & Prof

Pavan College of Nursing, Kolar.

Date: July 2018

CERTIFICATE BY THE HOD, PRINCIPAL / HEAD OF THE INSTITUTION

intradialytic stretching exercises on muscle cramps among patients undergoing

hemodialysis in selected hospitals at kolar district, karnataka” is bonafide genuine research

Seal & Signature of the Principal

MRS. DEEPA.S M.sc [N],

PRINCIPAL & Prof

Pavan College of Nursing, Kolar.

Date: July 2018

DECLARATION BY THE CANDIDATE

I Hereby Declare That Rajiv Gandhi University of Health Sciences, Karnataka,

Thesis in Print or Electronic Format for Academic / Research Purpose.

Signature of the Candidate

[Mrs. pandaluru gowathmi]

contributed to the successful completion of this endeavour.

blessings and abundant grace that enriched me throughout this study.

I wish to express my sincere thanks to the Chairman / Managing Committee, Pavan

encouragement, which helped me to lay strong foundation for this study.

and excellent guidance.

extending helpful support throughout this study.

statistical analysis of the data.

encouragement throughout the study.

I am thankful to the Librarian for allowing me to utilize the library facilities. I am

I have no words to express my gratitude and thanks to my beloved parents my husband,

I extend my thanks to my beloved friends, classmates, for their encouragement, constant

Above all I owe my success to the Almighty.

Mrs Pandluru Gowthami

DATE: July 2018

ISS Intradialytic stretching exercises

Et.al And Others

WHO World Health Organization

TABLE NO. CONTENT PAGE NO.

2. Pre-test scores of muscle cramps among hemodialysis 34

patients according to age

patients according to their monthly income

4. Pre-test scores of muscle cramps among hemodialysis 37

patients according to their educational status .

5. Pre-test scores of muscle cramps among hemodialysis 39

patients according to their dietary pattern .

6. Pre-test scores of muscle cramps among hemodialysis 40

patients according to their marital status

7. Pre-test scores of muscle cramps among hemodialysis 41

patients according to their duration of dialysis

8. Post test scores with intervention of intradialytic stretching 42

exercise in both experimental and control group

9. Comparison of pre-test and post-tests level of muscle 47

cramps among hemodialysis patients

10. Association between pre-test level of muscle cramps score 49

and demographic variables

Figure Description Page No.

6. Percentage Distribution of hemodialysis patients with 32

Background and Objectives of the study

patients undergoing haemodialysis in selected hospitals at kolar district, Karnataka „‟

University, Bangalore during the year of October 2018.

The objectives of the study were,