RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1.
Name of the candidate and
address (in block letters)
Ms. JITHA P. THOMAS
1 YEAR M. SC. NURSING
DR. M. V. SHETTY COLLEGE OF NURSING
KAVOOR, VIDYANAGAR
MANGALORE
2.
Name of the Institution
DR. M. V. SHETTY COLLEGE OF NURSING
3.
Course of Study and Subject
M. Sc NURSING
OBSTETRICS AND GYNAECOLOGICAL
NURSING
4.
Date of Admission to the
Course
31.05.2010
5.
Title of the study
EFFECTIVENESS
OF
PELVIC
ROCKING
EXERCISE
ON
DYSMENORRHOEA AMONG ADOLESCENT GIRLS IN SELECTED
HIGH SCHOOLS AT MANGALORE, DAKSHINA KANNADA
6. BRIEF RESUME OF THE INTENDED STUDY
Introduction
Physical activity is an excellent stress-buster and
provides other health benefits as well. It also
can improve your mood and self image.
- Jon Wickham
Adolescence is a transition phase passing through which a child becomes an adult.
During this period rapid physical growth and physiological as well as psychological changes,
occurs. Apart from the general issues faced by the adolescents at this stage, health acquires a
major role1.
Adolescents comprise nearly one-fifth of the total population2.Among the total
adolescent population, 47 percent comprise of female adolescents. The period of adolescence
for a girl is the preparation for safe motherhood. The major physiological change that takes
place in adolescent girls is the onset of menarche, which is often associated with
dysmenorrhoea3.Dysmenorrhoea involves menstrual periods that are accompanied by either
sharp, intermittent pain or dull, aching pain, usually in the pelvis or lower abdomen. Other
symptoms include nausea, vomiting, diarrhoea, light headedness and bodyache4.
According to the international reports, dysmenorrhoea is highest in adolescents, about
90 percent. A community-based survey in the United Kingdom found about 80percent of
women with chronic pelvic pain reporting dysmenorrhea.A cohort study conducted among
Swedish women found that 90 percent of the adolescents suffered due to dysmenorrhoea5
While in India 75 percent of adolescents experience pain with menstruation.In recent
times, a study conducted in UP concluded that about 88 percent of adolescents suffered from
dysmenorrhoea. A study conducted in Madras city revealed that 42 percent of the college and
34 percent of the school-going students reported problems during menstruation6.
In Karnataka, a study was conducted on the incidence of dysmenorrhoea among 1648
adolescents, which showed that the incidence was 87 percent. Of these, 47 percent had severe
problems of perceived pain during menstruation.A study was conducted among 104 women in
Belgham, shows that about 92 were affected with dysmenorrhea7
3
Several evidence-based treatments are available for dysmenorrhoea. Exercise is one of
the best remedial measures to overcome this pain. It helps by stretching the lower back
muscles and maintaining good abdominal muscle tone. Women with dysmenorrhoea have
contracted ligamentous bands in the abdomen and a series of exercises could have a high rate
of symptom relief for about 41 percent8.
The previous facts reveal that adolescents face some health problems due to
dysmenorrhoea. As a nurse it is our responsibility to give education on the importance of
regular exercise in maintaining healthy reproductive life.
6.1
Need for the study
There is a necessity for a regulating discipline of exercise
that whilst evoking the human energies,
will not suffer them to be wasted.
- Thomas de Quincey
Dysmenorrhoea is a very common gynecological problem in menstruating women and
reported prevalence rate is as high as 90 percent. Many adolescents report limitations on daily
activities, such as missing school, sporting events, and other social activities because of
dysmenorrhoea. During this phase they experience marked feeling of anxiety and eagerness to
know about this natural phenomenon. However, they do not get appropriate knowledge due to
lack of proper health educational programmes in schools9.
An experimental study was conducted to determine the effects of exercise on primary
dysmenorrhoea among 150 school girls in Iran. The exercise group was given some exercises
and the results of the two periods after exercise were registered. The results revealed that a
statistically significant change in the intensity of pain from nine to five and duration of pain
from eight to four in experimental group, where as, the variation of pain in the control group
was not significant. The researcher concluded that exercise would decrease duration and
severity of primary dysmenorrhoea. Hence, there is a need to provide information regarding
exercise to decrease dysmenorrhoea.9
4
A descriptive study was conducted to determine the prevalence of dysmenorrhoea
among 140 Hispanic adolescents, its impact on academic performance, school attendance,
sports, social activities and its management. Results showed that 85 percent were suffering
from dysmenorrhoea. Of these, 38 percent reported missing school due to dysmenorrhoea.
They also found that the activities affected by dysmenorrhoea included class concentration in
about 59 percent and class participation in 50 percent.Thus,the researcher concluded that
dysmenorrhoea was a common problem among adolescents. This signifies the importance of
teaching remedial measures to adolescents for their good reproductive health11.
A descriptive study was conducted to assess the prevalence of dysmenorrhoea among
970 adolescent girls in Gwalior. The data on menstrual symptoms was collected by a
questionnaire. The results revealed that the prevalence of dysmenorrhoea in adolescent girls
was 77 percent. Symptoms like tiredness, depression and inability to concentrate also affected
their day-to-day activities. The researcher concluded that there was a need to emphasise on
relevant information on possible treatment options. Thus, the nursing interventions for the
management of dysmenorrhoea need to be taught to the adolescents3.
An experimental study was conducted to assess the effectiveness of pelvic rocking
exercise for dysmenorrhoea among 30 adolescent girls in Tamilnadu. The subjects were
selected by lottery method to the experimental group and were administered pelvic rocking
exercise. After 3 weeks, post-test score showed that pain had decreased from eight to four.
The researcher concluded that pelvic rocking exercise was effective in the reduction of
dysmenorrhoea among adolescent girls. Therefore, pelvic rocking exercise can be used as a
supportive therapy in adolescents to alleviate dysmenorrhoea. Therefore, it is vital for
adolescents to know the pelvic rocking exercise to alleviate dysmenorrhoea6.
Thus, pelvic rocking exercise has a vital role in the reducing dysmenorrhoea and can
contribute positively in maintaining a healthy body. Exercise helps to relieve menstrual
discomfort through increased vasodilatation and subsequent decreased ischemia, release of
endogenous opiates and suppression of prostaglandins.8 So there is need to teach exercise to
adolescents in order to decrease pain, fatigue, weakness, and nausea, strengthen abdominal
muscles, and help in physical as well as emotional recovery.
5
6.2
Review of literature
A descriptive study was conducted to assess the prevalence of menstrual problems
among 160 adolescent girls in Hong Kong. The result revealed that the prevalence of
dysmenorrhoea and menstrual symptoms were 69 percent and 37 percent, respectively. One in
eight girls reported having been absent from school, while only six percent had sought
medical care because of menses. Multivariate analysis indicated that seeking medical care for
menorrhagia was dependent on the opinion of a family member and on dysmenorrhoea
severity. The investigator concluded that the prevalence of menstrual problems in adolescence
was higher and may affect their daily activities and significant disruption to their school12.
An experimental study was conducted to estimate the effect of exercise on
dysmenorrhoea among 250 adolescents in Iran. About 55 percent of adolescents were
suffering from dysmenorrhoea. The researcher assessed the effect of 12 week physical fitness
programme on psychological and physical symptoms of dysmenorrhoea. The result showed
that the training programme contributed to substantial reduction in dysmenorrhoea from 55 to
39 percent. The researcher concluded that selected physical fitness exercises positively
influenced menstrual symptoms13.
A correlational study was conducted to determine the relationship between
dysmenorrhoea and exercise among 90 adolescents in New Zealand. Information about
various demographic variables was obtained through questionnaire and direct interviews. The
result of analysis using chi square test showed that there was significant correlation of about
58 percent between the independent variable, exercise and dysmenorrhoea. The results of
study showed that prevalence of dysmenorrhoea was reduced in the presence of exercise.14
A descriptive study was conducted to assess the types and frequency of problems
related to menstruation and the effect of these problems on daily routine among 198
adolescent girls in New Delhi. Data was collected by personnel interviews. Result showed
that 67 were suffering from dysmenorrhoea and daily routine of 60 girls was affected due to
prolonged bed rest and decreased appetite; 18 percent had to miss a class and 25 percent had
to abstain from work. The researcher concluded that there was a need to emphasise on
relevant information on possible treatment options.15
6
6.3
Statement of problem
“Effectiveness of pelvic rocking exercise on dysmenorrhoea among adolescent girls in
selected high schools at Mangalore, Dakshina Kannada.”
6.4
Objectives of the study
The objectives of study are to:

determine the pre-existing dysmenorrhoea level among experimental and control
group of adolescents by using numeric pain scale

demonstrate pelvic rocking exercise only to experimental group.

evaluate the effectiveness of pelvic rocking exercise on dysmenorrhoea among both
groups with same numeric pain scale.

find association between dysmenorrhoea and selected demographic variables among
adolescents.
6.5
Operational definitions
Effectiveness: In this study, it indicates the extent to which the pelvic rocking exercise
on dysmenorrhoea has achieved the desired effect among the adolescent girls which
will be measured in terms of the difference between the post-test and the pre-test pain
scores by numeric pain scale.
Pelvic rocking exercise: It refers to exercises for reducing dysmenorrhoea. The
exercise include the following:
a.
Breathing exercise
b.
Pelvic tilt exercise.6
In this study, it refers to the exercise which helps to contract deep abdominal
muscles, so that a small movement takes place inside the uterus, which helps to relieve
dysmenorrhoea
7
Dysmenorrhoea: In this study,dysmenorrhoea refers to menstrual pain severe enough
to limit normal activities or require medication. Cramps may be accompanied by
headache, dizziness, backache, leg pain, nausea, vomiting or diarrhoea.
Dysmenorrhoea will be measured in terms of numeric pain scale
Adolescents: Adolescent is a person between 10-18 years of age10. In this study, it
refers to girls in the age group of 11-14 years, who have attained menarche and are
studying in the selected high schools at Mangalore.
High schools: In this study, it refers to the selected institutions within the city, which
provide education to higher primary students and are under the supervision of block
education office.
6.6
Assumptions
The study assumes that:

the adolescent girls will have dysmenorrhoea during menstruation.

pelvic rocking exercise will reduce dysmenorrhoea among adolescent girls.
6.7
Delimitations of study
Delimitation means demarcation of the scope and dimension of the study16.
In this study the delimitations are:

fifty adolescent girls.

adolescents who are studying in the selected high schools within the city of
Mangalore.

those items,which included in the pain scale will be assessed.
8
6.8
Hypothesis
The hypothesis will be tested at 0.05 level:
H1:
There will be significant difference between the pain scores before and after the pelvic
rocking exercise among adolescent girls.
H2:
There will be significant association between pain score and selected demographic
variables among adolescent girls.
6.9
Variables
Variable refers to a characteristic or an attribute of a person or objects that varies within the
population under study16.

In this study dependent variable is dysmenorrhoea.

In this study independent variable is pelvic rocking exercise.

In this study selected demographic variables are age, dietary pattern, life style pattern,
practice of regular exercise, and practice of home remedies for dysmenorrhoea.
7. Materials and methods
7.1
Source of data
The data will be collected from fifty adolescent girls who fulfil the inclusion criteria
and are willing to participate in the study.
7.1.1 Research design
The research design is the plan, structure and strategy of investigating of answering
the research question. It is the overall plan or blueprint the researchers select to carry out their
study16. The design involved in this study is quasi-experimental design. The non-equivalent
control group design with pre-test and post-test is the most appropriate method for measuring
the effectiveness of a programme. It involves assessing the dysmenorrhoea level by numeric
pain scale. Pelvic rocking exercise will be taught only to the sample in the experimental group
9
by demonstration. The subjects will be given a grid to mark their regular practice of pelvic
rocking exercise. Post-test will be conducted after 3 weeks of pelvic rocking exercise by the
same numeric pain scale.
7.1.2 Setting
Setting is the physical location and condition in which data collection takes place16.
The study will be conducted in the schools which are under the supervision of the Block
Education Office and are located within the city.
The school select for the study on the basis of:

Geographic proximity.

Feasibility of conducting the study.

Availability of the sample.
7.1.3 Population
Population is an aggregate of elements showing some common set of criteria16. In the
present study the population consists of adolescent girls in the age group 11-14years studying
in selected high schools, Mangalore, who have attained menarche.
7.2
Method of data collection
7.2.1 Sampling procedure
Sampling is the process of selecting representative units of a population for study in a
research16. Non-probability purposive sampling technique was found to be appropriate to
select 50 adolescent girls who have attained menarche.
7.2.2 Sample size
A finite subset of the population, selected from it with the objective of investigating its
properties is called as sample16 The sample for the present study consisted of 50 adolescent
girls, one who met the inclusion criteria from a selected high schools at Mangalore
10
7.2.3 Inclusion criteria
Adolescents girls who are:

in the age group of 11-14 years.

having moderate and severe dysmenorrhoea, as measured by the numeric pain scale.

available at the time of data collection.
7.2.4 Exclusion criteria
Adolescent girls who are:

not willing to participate.

undergoing treatment by physician for dysmenorrhoea.

having physical disabilities.
7.2.5 Instruments used
Level of pain experienced by the adolescent girls will be assessed using numeric pain
scale.
7.2.6 Data collection method
The data will be collected after obtaining permission from the concerned authorities of
the selected high schools at Mangalore. The objectives of the study will be explained and their
written consent will be taken. The researcher will introduce herself to the participants. The
researcher herself will collect the data. Data regarding level of dysmenorrhoea will be
collected using a numeric pain scale. After that pelvic rocking exercise will be demonstrated
to the adolescents. A post-test will be conducted to assess the pain for all participants 3 weeks
after the pre-test.
11
7.2.7 Plan for data analysis
The term analysis refers to the computation of certain measures along with searching
for patterns of relationship that exist among data groups.16 In this study, the following
methods will be planned to analyse the data:
1.
Organise the data in master sheet. The data will be analysed using descriptive and
inferential statistics.
2.
Description of the subjects with respect to demographic variables will be presented
using frequency and percentage.
3.
Mean, standard deviation and mean percent is used to evaluate the effectiveness of
pelvic rocking exercise.
4.
The significant difference between mean pre-test and post-test stress scores of
experimental group will be calculated using Wilcoxon test. The significant difference
between the mean stress score of the experimental and control group will be calculated
using Mann-Whitney test.
5.
Association between dysmenorrhoea and selected demographic variables will be
calculated using chi square test.
6.
Analysed data will be presented in tables, graphs and diagrams.
7.3
Does the study require any investigations or interventions to be conducted on
patients, or other animals? If so please describe briefly.
Yes, pelvic rocking exercise will be demonstrated to the participants.
7.4
Has ethical clearance been obtained from your institution in case of 7.3?
Yes, ethical clearance has been obtained from the ethical committee of the institution.
Consent from the sample will be taken at the time of data collection. Permission has taken
from the selected high schools before data collection.
12
References
1.
Gupta SD . Adolescent reproductive health in India. [online]. 2003 [cited 2003 Jan
23]; Available from: URL:
http://www.policyproject.com/pubs/countryreports/ARH_India.pdf
2.
Kalam APJ. HIV-free India: a mission. [online]. Available from:
URL:http://www.aids-free-india.org/youth-adolescence/hiv-aids-youth-adolescentsprofile-india.htm
3.
Agarwal AK, Agarwal A. A study of dysmenorrhoea during menstruation in
adolescent girls. Indian J Community Med [serial online] 2010 [cited 2010 Oct 4];
35:159-64. Available from:
URL:http://www.ijcm.org.in/text.asp?2010/35/1/159/62586
4.
Dysmenorrhoea clinical trials, diagnosis, and treatment. [online]. 2000 [cited 2001
Aug 22]. Available from: URL:
http://www.clinicalconnection.com/Clinical_Trials/Condition/Dysmenorrhoea.aspx
5.
French L. American family physician: Patient Information Handout . [online]. 2005
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6.
Lakhmi M. Pelvic rocking exercise for dysmenorrhoea among school girls. The nurse
2009 Aug-Sep 15;1(2):3-6.
7.
George A. Incidence of dysmenorrhoea among adolescent girls of Karnataka, its
relationship to selected factors and the effect of yoga and its management.
Unpublished doctoral dissertation submitted to Manipal Academy of Higher
Education; 2001.
8.
Daley A. The role of exercise in the treatment of menstrual disorders: the evidence. Br
J Gen Pract 2009 Apr 1; 59(561):241–2. Available from: URL:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2662100
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9.
Rostami M. The effect of exercise on primary dysmenorrhoea. Pakistan Journal of
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10.
Focus Adolesecnt services. The most comprehensive information,resources,support.
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Available
from:URL:http://www.focusas.com/Adolescence-Early.html
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Banikarim C, Chacko MR, Kelder SH. Prevalence and impact of dysmenorrhoea on
Hispanic female adolescents. Arch Paediatr Adolesc Med.2000 Dec;154(12):1226-9.
12.
Chan SS, Yiu KW, Yeien PM, Sahota DS, Chung TK. Menstrual problems and health
seeking behaviour. Medical Journal 2009 Feb 1;15(1):18-23.
13.
Jahromi KM, Rahimi Z, Gaeini A. Influence of a physical fitness course on menstrual
cycle characteristics. Gynecological Endocrinology [serial online] 2008 [cited 2008];
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http://www.ingentaconnect.com/content/apl/ge/2008/00000024/00000011/art00012?cr
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Brown J, Brown S. Exercise for dysmenorrhoea. Cochrane data base of systematic
reviews [serial online] 2010 [cited 2010]; 42(3): Available from: URL:
http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/frame.html
15.
Sharma P, Malhotra C, Taneja DK, Saha R. Problems related to menstruation amongst
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16.
Basvanthappa BT. Nursing research .2nd edition .New Delhi: Jaypee Publishers; 2007.
14
9.
Signature of a the candidate
10.
Remarks of the guide
11.
Name of designation of (in block letter)
11.1 Guide
PROF. (MRS.) K. SHANTHAKUMARI
H.O.D
OBSTETRICS AND GYNAECOLOGIC
NURSING
DR. M. V. SHETTY COLLEGE OF
NURSING, KAVOOR, VIDYANAGAR,
MANGALORE -575 013.
11.2 Signature
11.3 Co-guide(if any)
11.4 Signature
12.
12.1Head of Department
12.2 Signature
13.
13.1 Remarks of the chairman and
Principal
13.2 Signature
PROF. (MRS.) K. SHANTHAKUMARI
H.O.D
OBSTETRICS AND GYNAECOLOGIC
NURSING
DR. M. V. SHETTY COLLEGE OF
NURSING, KAVOOR, VIDYANAGAR,
MANGALORE -575 013.
15