하지불안증후군을 경험하는 혈액투석 환자를 위한 하지복합운동 프로그램 적용효과

Abstract

This Nonequivalent control group pretest-posttest experimental study aims to investigate the effects of combined lower leg exercise program on the severity of restless legs syndrome, sleep quality, depression, and physical performance in hemodialysis patients. Study subjects comprised patients who were diagnosed with restless legs syndrome or those who satisfied the evaluation items of the IRLSSG (International Restless Legs Syndrome Study Group) among outpatients with end-stage renal failure undergoing hemodialysis at the artificial kidney room of a hospital based in J city. Forty-four individuals participated in the study. The experimental group comprised 18 patients, and the control group comprised 20 patients. The study was conducted from August 1, 2017 to October 13, 2017. The combined lower leg exercise program included 5 minutes of smile therapy, 5 minutes of warm-up exercise, 20 minutes of combined exercise, stretching and muscle training, and 5 minutes of cool-down exercise. Restless legs syndrome is limited only to the legs; therefore, the exercise was designed for leg movements, excluding the upper limbs. A professional health trainer performed the movements comprising the exercise program, which was filmed, and a video clip was created. The final video clip was sent to the mobile phones of the study participants to allow them to perform the movements while watching the video clip during dialysis. The exercise program was provided between 30 minutes and 2 hours after the start of dialysis when the vitality of the subjects was relatively stable. When any change was observed in the subjects' physical condition, the exercise was terminated and resumed after a rest. The researcher and research assistant closely monitored the entire process of exercise and note any physical changes in subjects to provide effective intervention. The experimental group performed the combined lower leg exercise program while watching the video clip during hemodialysis 3 times a week for 8 weeks, for a total of 24 times. The control group received standard nursing care in the artificial kidney room. Regarding the study tools, the IRLS (International Restless Legs Scale) was used to measure the severity of restless legs syndrome developed by the IRLSSG(International Restless Legs Syndrome Study Group); sleep quality was measured by the PSQI (Pittsburgh Sleep Quality Index), which measures the subjective degree of sleeping disorder; depression was measured with the Self-rating depression scale (SDS) developed by Zung (1967); the Short Physical Performance Battery (SPPB), which was developed by EPESE (Established Population for Epidemiologic Studies of the Elderly) in the US and consists of three items, namely standing balance, gait speed, and repeated chair stand, was used to assess physical performance. For data collection, the general characteristics of the experimental and control groups were measured before the study. Their health-related characteristics, severity of restless legs syndrome, sleep quality, depression, and physical performance were assessed. Of these, the severity of restless legs syndrome, sleep quality, depression, and physical performance were measured again after the 8-week experimental intervention. Collected data were analyzed with the Chi-square test, Fisher's exact test, and independent t-test using the SPSS WIN 22.0 program. The analysis results are as follows. 1. The severity of restless legs syndrome statistically significantly decreased in the experimental group after the experimental intervention (t=2.476, p=.018). 2. Sleep quality did not show any statistically significant difference between the two groups after the intervention (t=.660, p=.513). 3. Depression statistically significantly decreased in the experimental group after the intervention (t=2.218, p=.033). 4. Physical performance did not show any statistically significant difference between the two groups after the intervention (t=.289, p=.774). Based on the experiment and its analysis, it was found that the combined lower leg exercise implemented in this study had positive effects in easing restless legs syndrome and depression.. The application of this combined lower leg exercise program using video clips in clinical settings will help hemodialysis patients perform more exercise, thus allowing for better management of symptoms and complications caused by chronical diseases. Finally, as it reduces the workload of nurses, the program will be an effective nursing intervention that can be applicable to busy clinical environments.