Effect of Nurse-Led Respiratory Muscle Training on Functional Capacity and Respiratory Muscle Strength In Patients With Haemodialysis: A Quasi-Experimental Study”

Post Haemodialysis respiratory complication can be decrease by respiratory muscle training and health education. These changes can be applied more effectively if the patients involve actively in the process.

therefor a nurse led respiratory muscle training after haemodialysis in India could be used as an intensive approach to reduce the complication and improve the functional outcome.

STEP 1: Enrolment

The patients fulfilling the inclusion criteria in the nephrology department of selected tertiary care teaching hospital will be recruited for the present study. Informed written consent will be obtained from the patients for conducting the study, and the patients will be informed about the intervention.

STEP 2: Baseline Data collection

The baseline data will be collected from the enrolled patients which will include the Socio demographic Variables, Clinical information sheet, 6 minute walk test, breath holding test , pulmonary function test , (MIP+MEP). Firstly data will be collected from the control group after completion of collection interventional group data will be collected to avoid contamination.

STEP 3: Non Randomization Allocation

Participants will be assigned into intervention and control group equally .

STEP 4: Intervention

The control group will be given standard haemodialysis care . The interventional group will receive the nurse led respiratory muscle training along with the standard treatment which includes the following exercises:

ï‚· Deep breathing exercise

Deep breathing exercises, scientifically termed diaphragmatic breathing, involve engaging the diaphragm, the primary muscle responsible for respiration, to facilitate efficient inhalation and exhalation. I will ask my patients to perform this technique: Find a comfortable, quiet place to sit or lie down. Sit in a chair with your feet flat on the floor or lie down on your back with a pillow under your head and knees for support. Place one hand on your chest and the other hand on your abdomen, just below your rib cage, to monitor your breathing patterns. Inhale slowly and deeply through your nose. As you inhale, focus on expanding your abdomen rather than raising your chest. This allows the diaphragm to descend and create more space for the lungs to fill with air. You should feel your abdomen rise and your lower hand move outward while keeping your upper hand relatively still. Once you’ve inhaled fully, pause for a moment to hold the breath. This pause allows for oxygen absorption and provides a brief moment of relaxation. Exhale slowly and completely through your mouth. As you exhale, gently contract your abdominal muscles to facilitate the release of air from the lungs. You should feel your abdomen fall and your lower hand move inward. Repeat this cycle of deep breathing for several minutes, aiming for a smooth, rhythmic pattern of inhalation, brief pause, and exhalation. As you continue with the exercise, try to focus your attention solely on your breathing, letting go of any distracting thoughts or external stimuli.

ï‚· Incentive Spirometary

I will ask the patients to perform deep breathing Exercise.

Patient will follow these steps –

Positioning: Sit up straight or recline slightly in a comfortable position. Make sure your feet are flat on the floor or supported, and your back is well-supported. Patients will Hold the incentive spirometer upright, ensuring the tubing is free from kinks or obstructions. Adjust the flow rate indicator to the appropriate level,

• Place the mouthpiece securely in your mouth, forming a tight seal around it with your lips.

• Inhale slowly and deeply through the mouthpiece, focusing on expanding your lungs as much as possible.

• Aim to raise the floating marker or indicator to the prescribed level on the spirometer. This provides visual feedback on your inhalation effort. Hold your breath for 2-3 seconds at the peak of your inhalation, maintaining lung expansion.

• Exhale slowly and steadily, either through the mouthpiece or normally. The exercise routine involves performing exercises for 20 minute and twice a day (morning and evening), with each session lasting 5 minutes and including 1 minute of rest between exercises.

Participants will be demonstrated the exercise at haemodialysis unit ask the patients to redemonstrate the exercise Patients will be asked to do Exercise at home for 20 minute twice a day . As patients will come to haemodialysis unit weekly I will resolve the doubt of the patients for exercise and reinforce the patients for the exercise continuation.

As part of my research investigating the efficacy of home-based exercise, participants will kindly request my participants in maintaining a detailed exercise log. Which will help in follow up of participants? I will ask my participants to record the following parameters for each exercise session:

1. Date

2. Time of Day

3. Exercise Type

4. Duration

5. Rest Intervals

6. Any Variations or Modifications

7. Subjective Notes on Perceived Exertion or Comfort

STEP 5: Post-intervention data collection

Respiratory muscle capacity and strength will be evaluated after 8 week of intervention. Respiratory muscle capacity will be assess by PFT and 6 minute walk test and respiratory muscle strength will be assess by the MIP+MEP and breath holding time.

STEP 6: Data analysis

Thereafter, collected data will be coded and entered in master sheet for analysis. Data analysis will be done with the help of SPSS 24. Descriptive and inferential statistics will be used for data analysis .

Duration of study

The study will be completed in a period of 1 year.