الفهرس 
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Abstract
Diabetes mellitus is the most common chronic disease in childhood. Stress and fatigue are considered as important symptoms associated with T1DM. Stress enhances cortisol release, increases insulin resistance and elevates blood glucose level. Fatigue affects daily activity of children and affects quality of life. Complementary medicine as Swedish massage and PMR technique had important role in controlling stress, decreasing blood glucose level and reducing fatigue symptoms in diabetic children.
The aim of the current study is to investigate the effect of Swedish massage versus progressive muscle relaxation on blood glucose level and fatigue symptoms in children with T1DM.
A quasi experimental design was used in the study. The present study was conducted at the Outpatient Diabetic Clinic in the Specialized University Hospital at Smouha in Alexandria. A convenience sampling of 75 diabetic children comprised the subjects. Children were assigned to three equal groups: two study groups and one control (every group consisted of 25 diabetic children). Study group (I): Twenty-five diabetic children who received Swedish massage in addition to routine nursing care of the unit for diabetes. Study group (II): Twenty-five diabetic children who received PMR in addition to routine nursing care of the unit for diabetes. Control Group: Twenty-five diabetic children who received the routine nursing care of the unit for diabetes only.
Three tools were used to collect data of the present study. The first and second tools that were developed by the researcher namely: Socio-demographic and Medical History of Diabetic Children Interview Schedule and blood glucose level assessment tool. The third tool is PedsQL Multidimensional Fatigue Scale, which was adopted from Varni et al. (2009).
The results of the present study were as follows:
- More than half (52%) of each of diabetic children who received Swedish massage and those who received PMR were females and 56% of control group were males.
- The highest percentage of each of the diabetic children who received Swedish massage, PMR and control groups were in the age group from 10 to 12 years (44%, 52%, and 40% respectively).
- The majority of diabetic children (92%) who received Swedish massage and nearly three quarters (72%) of PMR group and 52% of the control group were previously admitted to hospital.
- The most common diabetic complications in study group I (SM), study group II (PMR), and control group were hyperglycemia 100%, 96%, and 80% respectively and lack of concentration were 68%, 40%, and 36% respectively.
The effect of Swedish massage versus progressive muscle relaxation on blood glucose level:
- Means of fasting blood glucose level (106.28 ± 15.43), random blood glucose level (150.08 ± 19.72), and HbA1c levels (7.88 ± 0.92) of the SM group at the end of 12th week were less than those of the control group at the same week (141.44 ± 41.0, 244.24 ± 50.66 and 8.78 ± 1.90, respectively). There were statistically significant differences between the two groups in means of fasting and random blood glucose level (P < 0.001), but did not reach the statistical significance in the mean of HbA1c levels.
- Although the means of fasting blood glucose level (133.28 ± 11.05) and random blood glucose level (218.72 ± 46.59) of the progressive muscle relaxation group at the end of the 12th week were less than those of the control group at the same week (141.44 ± 41.0 and 244.24 ± 50.66 respectively), there were no statistically significant differences between the two groups.
- Means of fasting blood glucose level (106.28 ± 15.43), random blood glucose level (150.08 ± 19.72) and HbA1c levels (7.88 ± 0.92) of the SM group at the end of the 12th week were less than those of PMR group at the same week (133.28 ± 11.05, 218.72 ± 46.59, and 9.08 ± 1.08 respectively). There were statistically significant differences between the two groups at the end of the 12th week (P = 0.001, P < 0.001 and P = 0.007 respectively).
- Means of fasting blood glucose level (106.28 ± 15.43), random blood glucose level (150.08 ± 19.72), and HbA1c levels (7.88 ± 0.92) of SM group at the end of the 12th week were less than those at the end of the first week (166.5 ± 42.62, 243.2 ± 71.21 and 9.74 ± 1.11 respectively). There were highly statistically significant differences (P < 0.001).
- Means of fasting blood glucose level (133.28 ± 11.05), random blood glucose level (218.72 ± 46.59) and HbA1c levels (9.08 ± 1.08) of PMR group at the end of 12th week were less than those at the end of the first week (142.16 ± 26.30, 248.52 ± 35.54, and 9.74 ± 1.12 respectively). There were statistically significant differences (P < 0.001).
The effect of Swedish massage versus progressive muscle relaxation on fatigue symptoms (general – rest/sleep – cognitive):
- The highest percentages of diabetic children who received SM were almost never in most of general, sleep/rest, and cognitive fatigue symptoms.
- Diabetic children who received PMR were sometimes feeling general and sleep/rest fatigue symptoms. While most of cognitive fatigue symptoms were almost never occurred.
- The control group was often feeling of general, sleep/rest, and cognitive fatigue symptoms.
- There were statistical significant differences between SM and control groups, PMR and control groups in all of fatigue symptoms (general - sleep/rest – cognitive) (P<0.001* in each items).
- Swedish massage group had the least mean score of overall fatigue (general - sleep/rest – cognitive), which was 25.80 ± 3.27, followed by PMR group, which was 30.44 ± 4.21 and followed by the control group, which was, 50.40 ± 3.28 with statistical significant differences (P <0.001*).