key: cord-0984811-xme1l44v authors: Özlü, İbrahim; Öztürk, Zeynep; Karaman Özlü, Zeynep; Tekin, Erdal; Gür, Ali title: The effects of progressive muscle relaxation exercises on the anxiety and sleep quality of patients with COVID‐19: A randomized controlled study date: 2021-03-02 journal: Perspect Psychiatr Care DOI: 10.1111/ppc.12750 sha: 85777b93078a284b3220fef36c7fade4eed469f1 doc_id: 984811 cord_uid: xme1l44v PURPOSE: This study aimed to determine the effects of progressive muscle relaxation exercises on the anxiety and sleep quality of patients with coronavirus disease 2019 (COVID‐19). MATERIALS AND METHODS: This is an experimental study. Its data were collected in the infectious diseases clinic of a research hospital from May to August, 2020. This study was carried out with 67 COVID‐19 patients (33 in the experimental group and 34 in the control group). The data were collected using a personal information form, the state‐trait anxiety inventory, and the Richards–Campbell Sleep Questionnaire. The progressive muscle relaxation exercises were performed twice a day for 5 days with the researcher's supervision. The data were analyzed using means, numbers, percentage distributions, the χ (2) test, the dependent t test, and the independent t test. RESULTS: Statistically significant differences were found between the experimental and control groups' mean posttest scores on the State‐Trait Anxiety Inventory and the Richards–Campbell Sleep Questionnaire (p < 0.05). The in‐group comparison of the experimental group found a statistically significant difference between their mean pretest and posttest scores on the State Anxiety Scale (p < 0.05). The in‐group comparison of the control group found no statistically significant changes in their mean pretest and posttest scores on the State Anxiety Scale (p > 0.05). CONCLUSION: The progressive muscle relaxation exercises effectively reduced the anxiety and improved the sleep quality of patients with COVID‐19. 2 | METHODS This is an experimental study. This study was conducted in the COVID-19 clinic of a research hospital from May to August, 2020. The study population consisted of COVID-19 patients who were receiving treatment in the clinic. Its sample consisted of 73 patients. All patients who met the inclusion criteria were included in the study. Simple randomization was used. After being informed about the study, 36 patients were assigned to the experimental group, and 37 patients were assigned to the control group. This study was completed with 67 patients with COVID-19, 33 for experimental group and 34 for control group, because 2 patients in the experimental group and 1 patient in the control group were discharged, the clinical status of 1 patient worsened to the extent of being unable to perform progressive muscle relaxation exercises, and 2 patients in the control group were transferred to a different hospital ( Figure 1 ). Post hoc power analysis was performed to determine the adequacy of the sample size of the study. In the power analysis performed to determine the sample's power to represent the population, it was found that the power was 0.99 at the medium effect size and significance level of .05. Higher scores indicate higher levels of sleep quality. The Cronbach's α coefficient was .91 for the RCSQ. The Cronbach's α coefficient in this study was .91 for the RCSQ. The data were collected from May to August, 2020. Pretests and posttests were conducted with patients in both the experimental and control groups. The patients in the control group did not receive any specific intervention, only routine care. The patients in both groups continued their pharmacological treatments and the routine practices of the clinic during the specified period of time. After the data were collected from the patients in the control group, they were informed that they also could receive progressive muscle relaxation exercises at any time. The scheduling of the progressive muscle relaxation exercises was determined with the patients in the experimental group. A compact disc (CD) prepared by the Turkish Psychologists Association was used to teach the muscle relaxation exercises. The muscle relaxation exercises were shown on the TVs in the patients' rooms, and the patients exercised along with their TVs to minimize direct patient contact. The CD included instructions for muscle Data coding and analysis were performed using SPSS 21. The data were analyzed using means, numbers, percentage distributions, the χ 2 test, the dependent t test, and the independent t test. The results of this study, which aimed to determine the effects of progressive muscle relaxation exercises on anxiety and sleep quality of patients with COVID-19, are shown below. Table 1 shows the sociodemographic characteristics of the participants. No significant differences were found between the groups in terms of sociodemographic characteristics (p > 0.05) ( Table 1) . The experimental group's mean posttest score on the SAS was 44.67 ± 5.41, and the control group's mean posttest score on the SAS was 61.29 ± 7.95. A statistically significant difference was found between their mean posttest SAS scores. The mean posttest SAS score of the control group was higher than that of the experimental group (p < 0.05) (Figure 2) . 60. found that progressive muscle relaxation exercises prevent the deterioration of the sleep quality of patients with pulmonary resection. Chegeni et al. 27 conducted a randomized controlled study with COPD patients and reported that progressive muscle relaxation exercises effectively reduce fatigue and improve subjective sleep quality. Studies of a variety of patient groups have shown that progressive muscle relaxation exercises effectively prevent sleep problems. Studies conducted with multiple sclerosis patients, 25 hemodialysis patients, 26 cancer patients, 40 and intensive care patients 41 have determined that progressive muscle relaxation exercises effectively improve sleep quality. The results of this study are similar to those of other studies. Progressive muscle relaxation exercises can be considered a nonpharmacological method of reducing anxiety and improving sleep quality, and this is beneficial because the drugs used for the anxiety and sleep problems of COVID-19 patients have a number of side effects that can prevent the monitoring of their symptoms. Coronavirus disease (COVID-19) Dashboard; 2020 Coronavirus disease (COVID-19) technical guidance COVID-19, an emerging coronavirus infection: advances and prospects in designing and developing vaccines, immunotherapeutics, and therapeutics. Hum Vaccines Immunother Using psychoneuroimmunity against COVID-19 Nutrition, immunity and Covid-19 Prevalence and factors associated with depression and anxiety of hospitalized patients with COVID-19 The psychological impact of quarantine and how to reduce it: rapid review of the evidence Anxiety and depression in COVID-19 survivors: role of inflammatory and clinical predictors Mood, anxiety and olfactory dysfunction in COVID-19: evidence of central nervous system involvement? Analysis of psychological state and clinical psychological intervention model of patients with COVID-19. medRxiv Nervous system involvement after infection with COVID-19 and other coronaviruses The psychiatric impact of the novel coronavirus outbreak Social capital and sleep quality in individuals who self-isolated for 14 days during the coronavirus disease 2019 (COVID-19) outbreak in January 2020 in China Analysis of deaths during the severe acute respiratory syndrome (SARS) epidemic in Singapore: challenges in determining a SARS diagnosis Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: a webbased cross-sectional survey Study of knowledge, attitude, anxiety & perceived mental healthcare need in Indian population during COVID-19 pandemic Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic Is disruption of sleep quality a consequence of severe Covid-19 infection? A case-series examination In the big picture of COVID-19 pandemic: what can sleep do Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan China Poor-sleep is associated with slow recovery from lymphopenia and an increased need for ICU care in hospitalized patients with COVID-19: a retrospective cohort study The world war against the COVID-19 outbreak: don't forget to sleep! Effects of progressive muscle relaxation on anxiety and sleep quality in patients with COVID-19 Effects of progressive muscle relaxation training on sleep and quality of life in patients with pulmonary resection Effects of progressive muscle relaxation technique on fatigue and sleep quality in patients with multiple sclerosis The effect of progressive muscle relaxation on sleep quality of patients undergoing hemodialysis The effect of progressive muscle relaxation on the management of fatigue and quality of sleep in patients with chronic obstructive pulmonary disease: a randomized controlled clinical trial Kronik hastalıklarda progresif gevşeme egzersizlerinin yararı The effect of progressive muscle relaxation training on anxiety levels and quality of life in dialysis patients Manual for State-Trait Anxiety Inventory Durumluk Sürekli Kaygı Envanteri El Kitabı (The Manual of State-Trait Anxiety). Istanbul, Boǧaziçi Üniversitesi Yayınları Techniques for measurement of sleep in critical care Uyku Ölçeği Geçerlilik ve Güvenilirlik Çalışması Relaxation training for anxiety: a ten-years systematic review with metaanalysis Relaxation techniques for people with chronic obstructive pulmonary disease: a systematic review and a meta-analysis. Evidence-Based Complem Altern Med Effects of progressive relaxation exercises on anxiety and comfort of Turkish breast cancer patients receiving chemotherapy The effect of progressive muscle relaxation training on anxiety and quality of life after stoma surgery in colorectal cancer patients Effects of progressive muscular relaxation training on quality of life in anxious patients after coronary artery bypass graft surgery Use of progressive relaxation exercises in chronic obstructive pulmonary patients: a systematic review Effects of relaxation training on sleep quality and fatigue in patients with breast cancer undergoing adjuvant chemotherapy Use of complementary and alternative therapies to promote sleep in critically ill patients