A Study to Evaluate the Effectivness of Leg Stretching Exercises and Foot Massage in Reducing Intradialytic Leg Muscle Cramp among Patients Undergoing Hemodialysis in a selected Hospital at Kolar District

 

Bhavani Kiran R.1, Evangelene G.2

1MSc, Medical Surgical Nursing (Gastroenterology),

Sambhram College of Nursing, BEML Nagar K.G.F, Kolar, Karnataka, India.

2HOD Medical Surgical Nursing Department,

Sambhram College of Nursing, BEML Nagar K.G.F, Kolar, Karnataka, India.

*Corresponding Author E-mail: bhavanikiru360@gmail.com

 

ABSTRACT:

Background: Renal failure is a major public health concern and life-threatening illness associated with high morbidity and healthcare costs across all the countries. Dialysis is one of the first innovative major breakthroughs in medical treatments for renal failure, since then; many deaths have been prevented through the use and maintenance of dialysis. Over 3.5 million people worldwide receive dialysis with hemodialysis being one of the most common forms of kidney replacement therapy accounting for 89% of all dialysis. Objectives: The study aimed to evaluate the effectiveness of leg stretching exercises and foot massage on intradialytic leg muscle cramps among patients undergoing haemodialysis between experimental and control group. Methods: A quasi-experimental study was conducted among 60 hemodialysis patients (experimental group 30 and control group 30) were recruited for the study using purposive sampling technique A modified muscle cramp questionnaire chart was used to collect the data. The reliability was established using Cronbach’s alpha with the score r = 0.744 and the tool was found to be reliable. Result: In the pretest the muscle cramp score in experimental group showed that majority patients (50%) had severe muscle cramps, (46.3%) had moderate muscle cramps and only (3.33%) had mild muscle cramps. In control group (56.6%) had moderate muscle cramps, (43.3%) had severe muscle cramps and none of them had mild cramps. Whereas in post test there was a reduction in muscle cramp in experimental group with majority of patients 80% had moderate muscle cramps, 13.3% had mild muscle cramps and only 6.6% had severe muscle cramps. In the control group majority patients 83.3% had severe muscle cramps and only 16.6% had moderate muscle cramp. The chi square test showed that none of the demographic variables showed significant association with pretest muscle cramp scores in the experimental group. Whereas in control group except type of family, none of the demographic variables had significant association with pretest muscle cramps scores in the control group. Conclusion: The finding of the study revealed that Leg stretching exercise and foot massage was effective in reducing the intradialytic muscle cramps among hemodialysis patients.

 

KEYWORDS: Renal Failure, Hemodialysis, Leg stretching exercises, Foot massage, Intradialytic Muscle cramp

 

 


INTRODUCTION:

Renal failure is one of the most serious conditions and hemodialysis had proven to be an effective treatment for patients on hemodialysis.1 Every year about 2.2 lakh new patients of renal failure get added in India, resulting in an additional demand for 3.4 crore dialysis every year.2 The number and distribution of hemodialysis units has increased over the last 20 years due to increase in prevalence. In Karnataka, over 4000 renal patients have been undergoing hemodialysis in 169 government-run centers across the state.3 During hemodialysis, the blood goes through a mission called a dialyzer artificial kidney and purified and then the filtered blood is returned to the body. Cramping of muscles is one of the most common and frequent complaint from patients during hemodialysis.4 Peripheral vascular diseases are associated with increased prevalence of intradialytic cramps which confirms that process related to the dialytic treatment is responsible for the cramps. During hemodialysis the individual lies with the leg in a relaxed position for 4 hours, which also contribute to muscle cramps.5 a total of 73% reported cramps during the last hour and 26% in the middle of dialysis. Intradialytic leg stretching exercise in which the calf, gastrocnemius soleus, hamstring and quadriceps muscles are flexed and stretched at a frequency of once per sitting for 20 minutes followed by foot massage restores blood flow and relax the spasm and tightness.6 Most patient’s complaint of muscle cramps during a hemodialysis especially in the legs. Therefore giving leg stretching exercises and foot massage during the treatment will alleviate pain and improve the overall well-being in patients undergoing hemodialysis.

 

Since hemodialysis is a routine lifesaving treatment in renal failure patients. It is important that nurses identify the physical problems and symptoms that patients experience during hemodialysis and effectively manage it.

 

PROBLEM STATEMENT:

A study to evaluate the effectiveness of leg stretching exercises and foot massage in reducing intradialytic leg muscle cramp among patients undergoing hemodialysis in a selected hospital at kolar district.

 

OBJECTIVES:

1.     To assess intradialytic leg muscle cramps among patients undergoing hemodialysis in experimental and control group.

2.     To evaluate the effectiveness of leg stretching exercises and foot massage on intradialytic leg muscle cramps among patients undergoing haemodialysis in both the groups.

3.     To compare the pretest and post-test intradialytic leg muscle cramps between experimental and control group.

4.     To determine the association between the pre test muscle cramps scores with their selected demographic variables in both the groups

 

HYPOTHESIS:

·       H1: There is a significant difference between the pretest and posttest              muscle cramps scores after intradialytic leg stretching exercises and foot massage in hemodialysis patient in Experimental group at 0.05 level of significance.

·       H2: There is a significant difference in post test muscle cramp scores between the experimental and control group at 0.05 level of significance.

·       H3: There is a significant association between the pretest muscle cramp scores with their selected demographic variables in both the groups at 0.05 level of significance.

 

MATERIALS AND METHODS:

In this study, a quantitative – evaluative research approach was adopted. The quasi- experimental non randomized control group design was used for this investigation. The patients undergoing hemodialysis at Sri Narasimha Raja Hospital, Kolar district were the population for the study. 60 hemodialysis patients on routine follow-up fulfilling selection criteria were recruited for the study with 30 in experimental group and 30 in the control group, using purposive sampling technique. The patients in experimental group were administered leg stretching exercise for 10 minutes followed by foot massage for 10 minutes, whereas the control group underwent standard routine care in the hemodialysis unit. Data was collected using modified muscle cramp questionnaire chart.

 

Criteria for selection of the sample:

Inclusion criteria:

·       Hemodialysis patients who are within the age group of 30 – 70 years

·       Both male and female patients.

·       Patients available at the time of data collection.

·       Patient willing to participate in the study

·       Patients from the selected settings.

 

Exclusion criteria:

·       Emergency hemodialysis patients

·       Patients with femoral dialysis catheter and Internal Jugular Vein catheter

·       Patients on their 1st cycle of hemodialysis.

·       Patients with any lower limb pathology such as amputation, diabetes foot, foot ulcer, sores or wound

·       Pitting edema presents in lower limb greater than 2+

·       Patients who are unstable with altered consciousness

·       Critically ill patients

 

Description of the tool:

It consists of three sections

 

Section-A:

Demographic variables: Demographic variables consist of 15 items which includes age, gender, marital status, type of family, educational qualification, occupation, monthly family income, diet, financial support, reason for undergoing hemodialysis, other associated illness, frequency of undergoing hemodialysis, number of completed hemodialysis, experience of muscle cramps during hemodialysis, vascular access line.

 

Section-B:

Modified muscle Cramp questionnaire chart: In this study the modified muscle cramp questionnaire chart was used 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, and level of pain, temperature and discomfort which was comprehensively scored as level of muscle cramps ranging from (0-13) which is further arbitrarily divided into three levels: 1-4 mild cramps, 5-8 moderate cramps, 9-13 severe cramps. Modified Muscle Cramp questionnaire was prepared by the researcher and obtained validation from experts. The reliability of the muscle cramp questionnaire chart was r = 0.744. This indicates that the tool were reliable.

 

Section C:

Numerical pain scale: The numerical pain scale was used to assess the intensity of pain. The scale ranges from 0 to 10, where 0 indicates no pain, 1-3 indicates mild pain, 4-6 indicates moderate pain, and 7-10 indicates severe pain.


 

RESULTS:

Section I: Findings related to pretest intradialytic leg muscle cramps among hemodialysis patients in experimental and control group                                                                             (N=60)

 

Table 1:

 Cramps Severity

Pretest

Experimental

Control

F

%

F

%

No cramps

00

0%

00

0%

Mild

01

3.33%

00

0%

Moderate

14

46.3%

17

56.6%

Severe

15

50%

13

43.3%

Total

30

100%

30

100%

 

Section II: Findings related to effectiveness of leg stretching exercises and foot massage between experimental and control group                                                                          (N=60).

 

Table 2:  Comparison of pre and post test scores in experimental group.

Cramps

Experimental group

Pre test

Post test

F

%

F

%

No cramps

00

0%

00

0%

Mild

01

3.33%

04

13.3%

Moderate

14

46.6%

24

80%

Severe

15

50.0%

02

6.6%

Total

30

100%

30

100%

 

 

Table 3: Comparison between pre and post test scores in control group

Cramps

control group

Pre test

Post test

F

%

F

%

No cramps

00

0%

00

0%

Mild

00

0%

00

0%

Moderate

17

56.6%

05

16.6%

Severe

13

43.3%

25

83.3%

Total

30

100%

30

100%

 

 

Section III: Comparison of mean, standard deviation in experimental and control group         (N=60)

Table 4: Pre and post test mean and standard deviation in Experimental Group.

Paired Samples Statistics

 

Mean

N

Std. Deviation

Std. Error Mean

Pair 1

Pre-test

8.27

30

2.067

0.377

Post-test

6.83

30

1.763

0.322

 

Table 5: Paired t test in experimental group

Paired Samples Test

 

Paired Differences

t

Df

P-Value

Mean

Std. Deviation

Std. Error Mean

95% Confidence Interval of the Difference

Lower

Upper

Pair 1

Pretest- Posttest

1.433

1.431

0.261

0.899

1.968

5.487

29

<0.001***

 

 

Table 6: Pre and post test mean and standard deviation in control Group

Paired Samples Statistics

 

Mean

N

Std. Deviation

Std. Error Mean

Pair 1

Pretest

9.066

30

1.558

0.284

Posttest

9.533

30

1.737

0.317

 

 

 

Table 7: Paired t test in Control Group

Paired Samples Test

 

Paired Differences

t

df

P-Value

Mean

Std. Deviation

Std. Error Mean

95% Confidence Interval of the Difference

 

Lower

Upper

Pair 1

Pretest- Posttest

-0.467

1.245

0.227

-1.832

-0.902

-6.011

29

<0.001***

 

Table 8: Independent Samples Test on pre-test scores in both groups

Independent Samples Test

 

Levene's Test for Equality of Variances

t-test for Equality of Means

F

Sig.

T

df

P-Value

Mean Difference

Std. Error Difference

95% Confidence Interval of the Difference

Lower

Upper

Pre test

Equal variances assumed

7.349

0.009

-0.436

58

0.665

-0.200

0.459

-1.119

0.719

Equal variances not assumed

 

 

-0.436

51.629

0.665

-0.200

0.459

-1.121

0.721

 

Table 9: Independent Samples Test on post-test scores in both groups

Independent Samples Test

 

Levene's Test for Equalit of Variances

t-test for Equality of Means

 

F

Sig.

t

df

P-Value

Mean Difference

Std. Error Difference

95% Confidence Interval of the Difference

Lower

Upper

Post test

Equal variances assumed

0.040

0.843

-7.077

58

<0.001

-3.000

0.424

-3.849

-2.151

Equal variances not assumed

 

 

-7.077

56.665

<0.001

-3.000

0.424

-3.849

-2.151

 

 

Table 10: Comparison of pre-test scores between experimental and control group.

Group Statistics

 

Group

N

Mean

Std. Deviation

Std. Error Mean

Pre-test

Experimental

30

8.27

2.067

0.377

Control

30

9.06

1.558

0.317

 

Table 11: Comparison of Post-test scores between experimental and control group

Group Statistics

 

Group

N

Mean

Std. Deviation

Std. Error Mean

Post-test

Experimental

30

6.83

1.763

0.322

Control

30

9.83

1.510

0.276

 

Section IV: Data on association between the pre test muscle cramps scores with their selected demographic variables in both the groups                                                                                                                                                                            (N=60).

Table 12: Experimental Group

Demographic Variables

Pre-test scores

Chi- square Value

DF

P-Value

0

1-4

5-8

9-13

No cramps

Mild cramps

Mod cramps

Severe cramps

Age

(30-40) Years

0

0

3

4

2.1707

3

0.537745

(41-50) Years

0

0

7

4

(51-60) Years

0

0

2

4

(60>) Years

0

0

4

2

Gender

Male

0

0

14

10

0.1357

1

0.712547

Female

0

0

3

3

Marital Status

Married

0

0

14

12

0.0206

2

0.989751

Unmarried

0

0

1

1

Others

0

0

1

1

Type of family.

Nuclear

0

0

10

8

0.5357

2

0.765017

Joint

0

0

5

4

Extended

0

0

1

2

Education

Graduate

0

0

0

0

2.0942

4

0.553096

Intermediate diploma

0

0

1

2

High school

0

0

7

4

Primary school

0

0

6

4

Illiterates

0

0

2

4

Occupation

Professional (staff Nurse, teacher)

0

0

0

0

0.46

4

0.794527

Skilled worker (Plumber, carpenter, electrician)

0

0

0

0

Unemployed

0

0

1

1

Semi Professional (Social work, Journalism)

0

0

2

3

Others

0

0

13

10

Monthly Income.

≥ 249044

0

0

0

0

1.4256

6

0.839726

124489 –249043

0

0

0

0

93381 – 124488

0

0

1

1

67325 -93380

0

0

1

2

37325 – 62272

0

0

1

1

12445 – 37324

0

0

8

5

 

<12444

0

0

4

6

 

 

 

Diet

Vegetarian

0

0

2

3

0.4286

1

0.512691

Non vegetarian

0

0

14

11

Financial Support

Family

0

0

14

13

0.2381

3

0.625585

Self-Paying

0

0

2

1

Friends

0

0

0

0

Others

0

0

0

0

Reason for undergoing haemodialysis

Poisoning

0

0

0

0

0.6317

3

0.922085

Kidney disease

0

0

15

13

Electrolyte imbalance

0

0

0

0

Others

0

0

1

1

Frequency of undergoing haemodialysis

Once a week

0

0

1

1

1.069

3

.784561

Twice a week

0

0

9

7

Thrice a week

0

0

6

3

Once a month

0

0

1

2

Number of completed haemodialysis cycles

2 – 4 cycles

0

0

0

0

0.2435

3

0.885379

5 – 7 cycles

0

0

1

1

8 – 10 cycles

0

0

2

3

>10 cycles

0

0

12

11

Other associated medical illness

Hypertension

0

0

8

7

0.3579

4

0.9488

Diabetes mellitus & HTN

0

0

7

4

Heart diseases

0

0

1

1

Others

0

0

0

0

None

0

0

1

1

Have you experienced muscle cramps during haemodialysis

Very much

0

0

3

2

0.1071

2

0.743421

Somewhat

0

0

13

12

Not at all

0

0

0

0

Vascular access line

Neck

0

0

0

0

-

-

-

hand

0

0

14

16

thigh

0

0

0

0

Table 13: Control Group

Demographic Variables

Pre-test scores

Chi- square Value

DF

P-Value

0

1-4

5-8

9-13

No cramps

Mild

cramps

Mod cramps

Severe cramps

Age

(30-40) Years

0

0

5

5

0.2679

3

0.965956

(41-50) Years

0

0

4

4

(51-60) Years

0

0

4

6

(60>) Years

0

0

1

1

Gender

Male

0

0

8

12

1.0714

1

0.300623

Female

0

0

6

4

Marital Status

Married

0

0

11

10

0.1905

2

0.909156

Unmarried

0

0

1

1

Others

0

0

3

4

Type of family.

Nuclear

0

0

5

12

6.6516

2

0.009907

Joint

0

0

10

3

Extended

0

0

0

0

Education

Graduate

0

0

3

2

1.5333

4

0.820721

Intermediate diploma

0

0

1

2

High school

0

0

3

3

Primary school

0

0

3

5

Illiterates

0

0

5

3

Occupation

Professional (staff Nurse, teacher)

0

0

1

1

1.0648

4

0.899814

skilled worker (Plumber, carpenter, electrician)

0

0

1

3

unemployed

0

0

1

1

Semi Professional (Social work, Journalism)

0

0

1

3

Others

0

0

8

10

Monthly Income.

≥ 249044

0

0

0

0

0.4791

6

0.787001

124489 –249043

0

0

0

0

93381 – 124488

0

0

0

0

67325 -93380

0

0

0

0

37325 – 62272

0

0

6

7

12445 – 37324

0

0

5

7

 

<12444

0

0

3

2

 

 

 

Diet

Vegetarian

0

0

2

6

2.0576

1

0.151446

Non vegetarian

0

0

12

10

Financial Support

Family

0

0

10

11

0.0574

3

0.971709

Self-Paying

0

0

3

4

Friends

0

0

0

0

Others

0

0

1

1

Reason for undergoing haemodialysis

Poisoning

0

0

0

0

0.6317

3

0.426716

Kidney disease

0

0

12

14

Electrolyte imbalance

0

0

0

0

Others

0

0

1

3

Frequency of undergoing haemodialysis

Once a week

0

0

1

1

2.6667

3

0.445922

Twice a week

0

0

4

8

Thrice a week

0

0

7

5

Once a month

0

0

3

1

Number of completed haemodialysis cycles

2 – 4 cycles

0

0

2

1

3.9062

3

0.271767

5 – 7 cycles

0

0

1

3

8 – 10 cycles

0

0

4

1

>10 cycles

0

0

7

11

Other associated medical illness

Hypertension

0

0

7

7

1.2691

4

0.530165

Diabetes mellitus & HTN

0

0

5

4

Heart diseases

0

0

0

0

Others

0

0

0

0

None

0

0

2

5

Have you experienced muscle cramps during haemodialysis

Very much

0

0

8

8

.530165

2

0.231998

Somewhat

0

0

10

4

Not at all

0

0

0

0

Vascular access line

Neck

0

0

0

0

-

-

-

hand

0

0

14

16

thigh

0

0

0

0

 


DISCUSSION:

The present study findings showed that the difference in Pre and Post mean muscle cramp scores was highly statistically significant in experimental group (t=5.487, DF=29, P<0.001***) which indicates that the intervention given in the form of leg stretching exercises and foot massage on intradialytic leg muscle cramps had a significant effect in the experimental group. Hence hypothesis H1 is accecepted.

 

The difference in Pre-test means between experimental and control group muscle cramp scores were not statistically significant. (t=0.436, DF=58, P=0.665). Before giving any intervention there is no significant difference in the mean muscle cramp scores between experimental group compared to control.

 

The difference in Post-test muscle cramp scores between experimental and control group were statistically significant. (t=7.077, DF=58, P=<0.0001***). After giving the leg stretching exercises and foot massage on intradialytic leg muscle cramps the differences in post mean cramp scores between Experimental and Control group was highly statistically significant. Experimental group has substantial reduction in cramp scores compared to control group. Hence hypothesis H2 is accecepted.

 

Experimental group the pre- test mean was 8.27 with standard deviation 2.067. In the post -test the mean was 6.83 and standard deviation 1.763.

 

In control group the pre -test mean is 9.066 and standard deviation is 1.558. In the post- test mean was 9.533 and standard deviation 1.737.

 

The difference in Pre and Post mean muscle cramp scores was not statistically significant in control group. (t=2.763, DF=29, P>0.001***)

 

In experimental group the pre test mean is 8.27 and standard deviation is 2.067. In control group the pre test mean is 9.06 and standard deviation is 1.558.

 

In experimental group the post test mean was 6.83 with standard deviation 1.763. In control group the post test mean score was 9.83 with standard deviation is 1.510.

 

LIMITATION:

The study is limited to patients undergoing hemodialysis in selected hospital at Kolar district so, generalizability of the study findings is limited.

 

CONCLUSION:

The main focus of the study was to assess the effectiveness of leg stretching exercises and foot massage in reducing intradialytic leg muscle cramp among patients undergoing hemodialysis in a selected hospital at Kolar district. The findings of the study revealed that Intradialytic leg stretching exercise and foot massage was effective with significant reduction of muscle cramps among patients undergoing haemodialysis. This indicates that the leg stretching exercises and foot massage can be administered among hemodialysis patients to reduce the level of muscle cramps. Nurses can identify the importance of Intradialytic leg stretching exercise and foot massage and it can be used as an adjuvant to pharmacological therapy in reducing muscle cramps. Nurses can demonstrate or teach the Intradialytic leg stretching exercise and foot massage to encourage the patients to practice it for those suffering from muscle cramps during haemodialysis. Nurses can teach Intradialytic leg stretching exercise and foot massage to improve the functional performance of the patients undergoing haemodialysis with muscle cramps. The nurse administrator should take initiatives to make protocol of Intradialytic leg stretching exercises and foot massage for patients undergoing haemodialysis with muscle cramps. Guidelines for the procedure of intradialytic leg stretching exercises and foot massage can be developed.

 

REFERENCES:

1.      Lu, J., Shi, D., Zhao, X., Xi, M., Qi, H., and He, Q. (2022). Comparative Analysis of Efficacy and Prognosis of Hemodialysis and Peritoneal Dialysis for End-Stage Renal Disease: A Meta-analysis. Computational and mathematical methods in medicine, 2022, 6007698. https://doi.org/10.1155/2022/6007698 (Retraction published Comput Math Methods Med. 2023 Jul 26; 2023: 9895787. doi: 10.1155/2023/9895787

2.      ET Health World. Preparing for increased dialysis requirements. ET Health world.com. ET Health World. 2022 [cited 2025 Apr 6]. Available from: https://health.economictimes.indiatimes.com

3.      Afshan Yasmeen. Better facilities promised for dialysis patients in government centers [Internet]. The Hindu. 2023 [cited 2025 Apr 6]. Available from: https://www.thehindu.com/news/national/ karnataka/better-facilities-promised-for-dialysis-patients-in-government-centres/article67053915.ece

4.      Dialysis Information & More [Internet]. Cleveland Clinic. 2021. Available from: https://my.clevelandclinic.org/health/treatments/ 14618-dialysis

5.      Ghimire, M., Sharma, S. K., Chimoriya, R., and Das, G. C. (2014). Intradialytic Muscle Cramp and its Association with Peripheral Arterial Disease in End Stage Renal Disease Patients on Hemodialysis. JNMA; journal of the Nepal Medical Association, 52(196): 967–971.

6.      Ms Jayasrikannan, Kanniammal DC, Mrs Sheebjebakani. A Study to Assess the Effectiveness of Intradialytic Stretching Exercises on Muscle Cramps and Quality of Life in Patients Undergoing Hemodialysis at SRM General Hospital, Kattankulathur. RGUHS Journal of Nursing Sciences [Internet]. 2021 [cited 2025 Apr 6]; 11(1)

 

 

 

 

Received on 25.03.2025         Revised on 19.04.2025

Accepted on 07.05.2025         Published on 21.05.2025

Available online from May 23, 2025

Int. J. of Advances in Nursing Management. 2025;13(2):104-110.

DOI: 10.52711/2454-2652.2025.00021

©A and V Publications All right reserved

 

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.