Indian Journal of Public Health Research & Development, March 2020, Vol. 11, No. 03 893 Effects of Dance and Movement Therapy (DMT) Versus Progressive Muscle Relaxation (PMR) on Quality of Life among Elderly Residing in Selected Old Age Homes of : A Quasi Experimental Study

Prakash Jha1, Srinivasan P.2, Uma J Deaver3, Jyoti Sarin4

1Nursing Tutor, Department of Mental Health Nursing, Maharishi Markandeshwar College of Nursing, Maharishi Markandeshwar (Deemed to be University), Mullana, Haryana, , 2Former Professor, HOD of Department of Mental Health Nursing, Maharishi Markandeshwar College of Nursing, Maharishi Markandeshwar (Deemed to be University), Mullana, Haryana, India/(Present Nursing Tutor at AIIMS Patna), 3Professor, Department of Community Health Nursing, Maharishi Markandeshwar College of Nursing, Maharishi Markandeshwar (Deemed to be University), Mullana, Haryana, India, 4Dean Principal, Maharishi Markandeshwar College of Nursing, Maharishi Markandeshwar (Deemed to be University), Mullana, Haryana, India

Abstract Elderly age group is a controversial issue as it is a natural process which presents a unique challenge for every individual in society. Thus it is being considered that quality of life among elderly is poor due to ignorance that is the vulnerable population. The objective of the study was to evaluate the quality of life among elderly before and after administration of dance and movement therapy and progressive muscle relaxation. Methodology: Quantitative research approach, quasi experimental non equivalent control group pretest post test design, with Purposive sampling technique. Data was collected by using Modified WHO- QOL Bref questionnaire for assessing quality of life. Thus findings of the study showed effectiveness of dance and movement therapy and progressive muscle relaxation on quality of life as the calculated Repeated Measure Anova F value (DMT F=1027.03, p=0.00 and PMRF=496.31, p=0.00).Result also shows in PMR group quality of life among elderly was found to be statistically significant with source of income and history of chronic illness i.e (F=3.534, p =0.02) and (t= 2.922, p=0.00) and in DMT group quality of life among elderly was found to be statistically significant with nature of previous occupation and history of chronic illness i.e (F=2.935, p=0.05) and (t=2.408, p=0.02). Conclusion: DMT and PMR was effective intervention given for 30 minutes at once daily for improving quality of life among elderly.

Keywords: Quality of life, Dance and movement therapy (DMT), Progressive Muscle Relaxation (PMR), Elderly residing at old age homes.

Introduction individual who is born must grow older and eventually die.1 Elderly is conventionally considered to be identical Elderly is unavoidable consequence of life. Every process that is shaping the physical andmental health. Ageing has considered itself an important public health challenge. Elderly has a distinct set of medical and social Corresponding Author: problems, which will become increasingly apparent in Prakash Jha elderly.2 Nursing Tutor, Mental Health Nursing, Maharishi Markandeshwar College of Nursing, Maharishi The world population is ageing and by 2025, the Markandeshwar (Deemed to be University), world’s population is expected to include more than 830 Mullana-133207, District, Haryana, India million people at an age of 65 by 2030, the number of e-mail: [email protected] people in the world aged 60 years or over is projected to 894 Indian Journal of Public Health Research & Development, March 2020, Vol. 11, No. 03 grow by 56 percent, from 434 million to 1.4 billion and relaxation on QOL among elderly withnon equivalent by 2050 the global population of elderly is projected to control group pre-test post-test design. reaching nearly 2.1 billion about 901 million.3’4 Thus successfully ageing is dazzling the ability of elderly Inclusion Criteria: Elderly aged 60 years and people to adapt to physical, social and emotional above, residing in old age homes, willing to participate losses and to achieve satisfaction, security, safety and in the study, alert, oriented and comprehend to respond, gratification. able to understand and speak Hindi and able to move without walking aids or any physical assistance. A person with a depressed mood feels distressing, anxious, empty, desperate and powerless, worthless, Procedure: Screening was done on day 1with blameworthy, short-tempered, or ashamed.5 According selected variables and by Modified WHO-QOL Bref to World Health Organization (WHO), the QOL is questionnaire for quality of life assessment with individual’s insight of their situation in life in the interview technique. Dance and movement therapy and perspective of customs and significance in which they progressive muscle relaxation was administered to elderly nd th survive and in relation to the objectives, opportunity, from 2 dayto 8 day as per intervention protocol. DMT interactions and desires.6 contain 3 sessions i.e warm up session of 5 min duration followed by active session that involves all elderly to sit Dance therapy effects changes in feelings, and do the chair step dance together for 20 min, further cognition, physical functioning and behavior.7Dance third session is for cooling or relaxing session for 5 min. as psychotherapy has been used to recover from Similarly Progressive muscle relaxation also include 3 psychological and substantial well- being of a person.8 sessions i.e warm up session that is done for 5 minutes Poco-Poco is the type of dance therapy which is used as followed by active sessions done for 20 minutes in this the psychotherapy along with the music to relieve the muscle are tensed for 5 seconds and relaxed for 20-30 mental illness.9 seconds along with deep breathing and cooling session that is done for 5 minutes. Immediately after completion Progressive muscle relaxation is a psychotherapy of 7 days intervention post test I was taken (day 8) and that is used for relaxing mind and body by gradually then after 1 week of post test I post test II was taken (day 10 tensing and soothing muscle of body. Person will feels 16) for both DMT and PMR group. less pressure and have a good physical and emotional health. When the muscle is relaxed, the feelings of Data Analysis: warmness and enormity are felt as a result.11 Descriptive statistics: Frequency, percentage Elderly at the peak age feels impassiveness, distribution was used to describe selected variables,Chi- worthlessness and insecurity, especially when living square was used to assess the homogeneity between two with these feelings in old age homes. It is very important groups. to understand the factor which affects the quality of life of the elderly persons.12’13 The quality of life also Inferential Statistics: Independent ‘t’ test, Repeated depends upon emotional interpretation that a person measure ANOVA Spearman correlation, ANOVA and feels about life. Thus the quality of life is progressively ‘t’ test more attributed as an estimation that is reliant on the Results person’s prejudice.14 Homogeneity was checked by χ2 test was applied Methodology to compare the DMT and PMR group with respect to The study was conducted during the period from every selected variables. Hence both the group was October 2017- November 2018 in the state of Haryana, homogenous except for gender (p=0.04). India. A sample of 60 elderly participated in this quasi Percentage distribution of DMT and PMR in terms experimental study with the prior permission from of quality of life among elderly before administration of concerned authority of old age homes. Quantitative intervention are shown in Figure 1. All the elderly in research approach was considered to be the most both DMT and PMR group (100%) were having poor appreciated approach to assess the effectiveness of quality of life. dance and movement therapy and progressive muscle Indian Journal of Public Health Research & Development, March 2020, Vol. 11, No. 03 895

Figure 1: Quality of life before Administration of Dance and

Movement therapy and Progressive of intervention in DMT group was 99.33 and in PMR group was 98.57 with mean difference of 0.767. The Muscle Relaxation: In terms of QOL, there was calculated ‘t’ value was found to be 0.58, p= 0.56 in significant difference between DMT and PMR group post-test I. In post-test II mean score after administration found before administration of intervention as the of intervention in DMT group was 96.57 and in PMR calculated ‘t’ value was 7.60, p=0.001 with mean group was 96.97 with mean difference of 0.400. The difference of 1.17 Mean score after administration calculated ‘t’ value was found to be 0.20, p=0.83.

Table 1: Mean, mean difference, standard deviation of difference, Standard Error of Mean Difference and ‘t’ value of quality of life among elderly before and after DMT and PMR in DMT and PMR group N=60

Observation Group Mean±S.D MD SEMD ‘t’ value df p value

DMT group (n=30) 50.17±4.87 Pretest PMR group (n=30) 59.10±4.19 1.17 8.93 7.60 58 0.001*

DMT group (n=30) 99.33±4.49 Post Test I PMR group (n=30) 98.57±5.62 0.767 1.31 0.58 58 0.56NS

DMT group (n=30) 96.57±6.75 Post Test II PMR group (n=30) 96.97±8.18 0.400 0.93 0.20 58 0.83NS

NS -Not significant (p>0.05) t=58(2.00) *- significant (p ≤ 0.05)

In DMT group the mean score of quality of life in score of quality of life in pre test, post test I and post pre test, post test I and post test II was 50.17, 99.33 and test II scores was 59.10, 98.57 and 96.97 respectively. 96.57 respectively. Where the F value is 1027.03 with Where F value is 496.31 with calculated p= 0.00. calculated p=0.00. Whereas in PMR group the mean 896 Indian Journal of Public Health Research & Development, March 2020, Vol. 11, No. 03 Table 2: Repeated measure ANOVA showing the significant difference within groups in terms of Quality of life in DMT group and PMR group N=60

Groups Test Mean F value p value Pre test 50.17 DMT group (n=30) Post test I 99.33 1027.03 0.00* Post test II 96.57 Pre test 59.10 PMR group (n=30) Post test I 98.57 496.31 0.00* Post test II 96.97

*- significant (p ≤ 0.05)

In DMT group there was the predictability of 11 points (-11.051) and if no source of income increase nature of previous occupation in multiple correlation by 1 point then quality of life get decreases by 8 points coefficient, the direction of predictability for the variable (-7.863). In final model if private service increases by 1 is as if chance of private service increases by 1 point, point then quality of life decreases by 14 points (-13.873), the quality of life get decreases by 8 points (-7.880). if presence of history of chronic illness increase by 1 Similarly in second model if private service increases point then quality of life get decreases by 11 points by 1 point then quality of life decreases by 12 points (-10.702), if no source of income increase by 1 point then (-11.695) and if presence of history of chronic illness quality of life get decreases by 7 points (-6.679) and if increase by 1 point then quality of life get decreases chance of Sikh religion increase by 1 point then quality by 10 points (-9.538). In model three if private service of life get decreases by 3 points (-3.133). This infers that increases by 1 point then quality of life decreases by 14 nature of previous occupation i.e private service among points (-13.873), if presence of history of chronic illness elderly had continuous prediction in negative direction increase by 1 point then quality of life get decreases by throughout the models.

Table 3: Step Wise Multiple Regression Showing Predictability of Individual Independent Variables on Quality of Life among Elderly in DMT Group (Regression Coefficient) in Post test II N=30

Unstandardized Coefficient Standardized Model t value p value B Std. Error Coefficients Beta (Constant) 97.880 1.232 - 79.442 0.00* Nature of previous occupation (private) -7.880 3.018 -0.442 -2.611 0.01* (Constant) 95.972 1.020 - 94.048 0.00* Nature of previous occupation (private) -11.695 2.431 -0.657 -4.810 0.00* History of chronic illness -9.538 2.049 0.636 4.655 0.00* (Constant) 97.242 0.862 - 112.818 0.00* Nature of previous occupation (private) -13.873 1.991 -0.779 -6.969 0.00* History of chronic illness -11.051 1.659 0.736 6.662 0.00* Source of income (no source) -7.863 1.891 -0.442 -4.157 0.00* (Constant) 98.078 0.894 - 109.655 0.00* Nature of previous occupation (private) -13.873 1.863 -0.779 -7.446 0.00* History of chronic illness -10.702 1.561 0.713 6.857 0.00* Source of income (no source) -6.679 1.853 -0.375 -3.605 0.00* Religion (Sikh) -3.133 1.448 -0.216 -2.163 0.04*

*- significant (p ≤ 0.05) Indian Journal of Public Health Research & Development, March 2020, Vol. 11, No. 03 897 Presence of History of chronic illness having prediction with variability of R square= 28% (0.289) as prediction with variability of R square = 15% (0.157) calculated F value 5.492 which was significant at 0.05 as calculated F value 5.210 which was significant at level of significance which infers that the chance of 0.05 level of significance which infers that the chance of fluctuation or change in R value is less than 0.01. This fluctuation or change in R value is less than 0.03. Further further infers that presence of history of chronic illness when combined with Educational status – primary alone had higher predictability than the second model. education (reference group- graduation and above) the

Table 4: Step Wise Multiple Regression Showing Predictability of Multiple Independent Variables on Quality of Life among Elderly in PMR Group (Multiple Correlational Coefficient) in Post test II N=30

Adjusted R Std. error Model R Value R square df F value p value square of estimate History of chronic illness 0.396 0.157 0.127 7.645 1/28 5.210 0.03* History of chronic illness & 0.528 0.289 0.237 7.148 2/27 5.492 0.01* Educational status (Primary)

*- significant (p ≤ 0.05)

Discussion Conclusion In the present study, less than half of the elderly in Dance and movement therapy and Progressive DMT and PMR group were in the age group of 70-79 muscle relaxation was effective in improving quality of years of age i.e 13(43.3%) and 14(46.7%) respectively. life among elderly. More than half of elderly in DMT group were females 17 (56.7%) whereas in PMR group most of the elderly 22 Acknowledgement: The authors express their whole (73.3 %) were males. More than half of elderly in DMT hearted thanks to all elderly people who participated in group were living in urban area 16(53.3%) whereas in the study and made my research prosperous. PMR group two third of the elderly were living in urban Conflict of Interest: Nil area 18(60%). These findings are partially consistent and contradictory to a cross sectional study conducted by P. Source of Funding: Nil Gowthami B, Jayabharathi et al. (2016)on prevalence of depression and QOL among elderly where they found Ethical Approval: Research ethics committee of that less than half of the elderly 42 (32.3 %) belongs to Maharishi Markandeshwar (Deemed to be)University the age group of 60-64 years and least no. of elderly 17 Mullana, Ambala (MMDU/IEC/973). (13.1%) were in the age group of 70-74 and above 80 Reference years. More than half of the elderly 73 (56.2 %) were males and less than half 57 (43.8%) were females and 1. Banerjee Mrinmayi, Tyagi Deepak: Role majority of elderly 130 (100.0%) were living in rural Adjustment and Status of Aged - A Case Study of area.15 Bengali Population of Meghayala. Indian Journal of Geriatric 2001;15(3,4) [Cited on Febuary In the present study, it showed that all the elderly 2018]:353–361 [Pubmed] in both the groups (100%) were having poor quality of 2. 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