Application And Evaluation Of Progressive Muscle Relaxation Training In Breast Cancer Patients Receiving Chemotherapy

ObjectiveTo translate Multidimensional Fatigue Inventory-10(MFI-10)and verify its reliability and validity.To investigate the status of sleep quality,fatigue,positive affect,negative affect and quality of life of patients with breast cancer receiving chemotherapy.Evaluate the effect of Progressive Muscle Relaxation Training(PMRT)on patients with breast cancer receiving chemotherapy and provide evidence for reducing symptoms of patients receiving chemotherapy after breast cancer surgery.Methods(1)After obtaining the permission of Multidimensional Fatigue Inventory-10's author,the Brislin translation model was used to translate the scale,and the MFI-10 was translated in Chinese using a combination of expert assessment and cross-cultural adaptations.The Chinese version of the MFI-10 was then administered to 402 patients with breast cancer from three tertiary hospitals in Hengyang,Hunan province to verify their reliability and validity.Sixty-eight patients with breast cancer underwent retest two weeks after the first test.(2)To better understand the status of sleep quality,fatigue,positive affect,negative affect and quality of life of patients with breast cancer,a random sample of 220 breast cancer receiving chemotherapy from three affiliated hospital were investigated using the questionnaire of patients'social demographic,Pittsburgh Sleep Quality Index,Multidimensional Fatigue Inventory-10(Chinese version),Positive and Negative Affect Scale,European Organization for Research and Treatment of Cancer Quality of Life Questionnaire between November,2018 and July 2019.(3)According to the established inclusion and exclusion criteria,78patients with breast cancer treated in a tertiary hospital in Hengyang were recruited,and the participates were divided into intervention group(39)and control group(39)randomly.The patients in both groups received routine treatment and nursing during the treatment,the intervention group also received progressive muscle relaxation training.The Pittsburgh Sleep Quality Index,Multidimensional Fatigue Inventory-10(Chinese version),Positive and Negative Affect Scale,European Organization for Research and Treatment of Cancer Quality of Life Questionnaire were used to evaluate the sleep quality,fatigue,positive and negative affect,and quality of life of the two groups of patients before and after the intervention.Results(1)All 10 items of the original scale were retained.Principal component analysis extracted three factors that explained 78.197%of the total variance.The internal consistency reliability coefficient of MFI-10scale was 0.864,and the Cronbach's alpha coefficient of each dimension was 0.908(cognitive),0.877(physical)and 0.817(emotional).The Guttman Split-Half coefficient reliability coefficient of MFI-10 scale was0.795 and the test-retest reliability coefficient was 0.840.The confirmatory factor analysis was validated using structural equation modelling,and the results showed a good fit to data(?~2=51.638,df=35,NFI=0.943,CFI=0.981,AGFI=0.924,TLI=0.975 and RMSEA=0.049),which represents good construct validity.(2)The sleep quality score of patients with breast cancer receiving chemotherapy was(9.65?3.52).Among the scores,the sleep efficiency score was the highest(1.82?0.94),and the use of hypnotic medication score was the lowest(0.07?0.33).The total fatigue score of patients with breast cancer receiving chemotherapy was(28.39?9.33).The scores of cognitive fatigue,physical fatigue and emotional fatigue were(10.19?4.80),(8.41?3.68)and(9.78?3.31)respectively.The positive and negative affect scores of patients with breast cancer undergoing chemotherapy were(27.90?5.84)and(21.00?5.60).The global health score of patients with breast cancer was(53.94?20.87),and the scores of physical function and cognitive function were high,which were(71.61?18.50)and(72.85?21.76).The two lower scores were dyspnea(6.50?14.80)and diarrhea(4.72?12.97).(3)Spearman's correlation was conducted to examine the correlation between sleep disturbance,fatigue,positive affect,negative affect,and quality of life dimensions.Sleep disturbance was significantly negatively correlated with global health status(r=-0.340 P<0.01)and highly correlated with fatigue(r=0.382,P<0.05).MFI score showed positive correlation with physical function(r=0.448,P<0.01),role function(r=0.403,P<0.01),emotional function(r=0.406,P<0.01),cognitive function(r=0.431,P<0.01)and insomnia(r=0.471,P<0.01).A significant inverse correlation between MFI score and global health status(r=-0.507,P<0.01)was also exited.Regarding the positive affect,there was a significant inverse relationship between positive affect and physical function(r=-0.421,P<0.01).Negative affect was significant related to emotional function(r=0.640,P<0.01)and fatigue(r=0.408,P<0.01).There was also an inverse relationship between negative affect and global health status(r=-0.452,P<0.01).(4)Before the progressive muscle relaxation training intervention,there was no statistical significance in general demographic data,sleep quality,fatigue,positive affect,negative affect,and quality of life between the two groups of patients(P>0.05).(5)After the progressive muscle relaxation training intervention,the PSQI score,subjective sleep quality,sleep duration,sleep efficiency,sleep disturbance and daytime dysfunction scores of the intervention group were lower than those before the intervention,and the differences were statistically significant(P<0.05).The total sleep quality PSQI score,subjective sleep quality,sleep onset latency,sleep efficiency,sleep disturbance and daytime dysfunction scores in the intervention group were lower than those in the control group(P<0.05).(6)After the progressive muscle relaxation training intervention,the total mean score of fatigue and the average score of each dimension in intervention group were all significantly reduced(P<0.05).The level of fatigue and each dimension in intervention were significantly lower than those in the control group(P<0.05).(7)After the progressive muscle relaxation training intervention,the positive affect score of the intervention group was higher than that before the intervention,and the negative affect score was lower than that before the intervention,the difference was statistically significant(P<0.05).The positive affect score in intervention group was significantly higher than control group(P<0.05),and the negative affect score in the intervention group was significantly lower than control group(P<0.05).(8)After the progressive muscle relaxation training intervention,the global health score of the intervention group were higher than before the intervention;the scores of physical function,role function,cognitive function,social function,fatigue,pain,insomnia,loss of appetite,and constipation scores were lower than before the intervention,the differences were statistically significant(P<0.05).The global health score of the intervention group was higher than that of the control group.The scores of physical function,emotional function,cognitive function,fatigue and insomnia in the intervention group were lower than those in the control group,and the differences were statistically significant(P<0.05).Conclusions(1)The Chinese version of the Multidimensional Fatigue Inventory-10(MFI-10)has good reliability and validity and can be used to assess the fatigue of patients with breast cancer.(2)Patients with breast cancer receiving chemotherapy experience a series of problems such as sleep disorders,fatigue,negative affect and low quality of life,and sleep disorders,fatigue,positive affect,negative affect and quality of life are related.(3)Progressive muscle relaxation training can improve the sleep quality,fatigue,positive affect and quality of life of patients with breast cancer receiving chemotherapy,reducing their negative affect.