الفهرس 
Difference between total mean scores of pain severity among the studied patients throughout the different study phases.Only 14 pages are availabe for public view
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Abstract
Orthopedic surgeries are associated with a high incidence of pain, which often arise from multiple pre and postoperative factors leading to increased morbidity and delayed recovery (Li et al., 2019). Several interventions and strategies are used to decreased the pain intensity as used various means of pain control, including opioids, non steroidal anti inflammatory drugs (NSAIDs), local anesthetic infiltration and nerve blocks, for managing the analgesic requirements after orthopedic surgery that affects patients’ quality of life in terms of patient physiology, psychology, and social characteristics (Chunduri & Aggarwal, 2022).
Non pharmacological interventions as diaphragmatic breathing technique has long been component of postoperative care with aim of relieving or reducing pain after orthopedic procedures. Additionally, diaphragmatic breathing technique after orthopedic surgeries is supported by advantages in term of a better postoperative recovery with beneficial effects on physical and mental health leading to short hospital stay and early return to normal activities as well as improves patients’ quality of life (Ma et al., 2017).
Aim of the study:
The present study was conducted with the aim to evaluate the effect of diaphragmatic breathing technique on pain intensity for adult patients post orthopedic surgeries.
Study hypotheses
The following research hypotheses have been put in place to achieve the aim of the study.
H1: The mean scores of patients’ level of knowledge post implementing diaphragmatic breathing technique could be significantly higher than their scores before implementation.
H2: The mean scores of patients’ level of practices post implementing diaphragmatic breathing technique could be significantly higher than their scores before implementation.
H3: Patients’ level of pain could be significantly decreased after implementation of the diaphragmatic breathing technique than before.
Subjects and Method:
Study design:
A quasi-experimental pre and post intervention comparison study design was implemented to achieve the aim of the current study.
Study setting:
This study was conducted in orthopedic department affiliated to Benha University Hospital, Qalyubia Governorate, Egypt.
Subjects:
Purposive sample of 65 adult patients, with age ranging from 20-60 years old, from both sexes post orthopedic surgeries, who are able to communicate and agree to participate in the study.
Tools of data collection
Four tools were used to collect data for this study as follows:
Tool I: Structured interview questionnaire: This questionnaire was be designed by the researcher in simple Arabic structure items after reviewing recent relevant literatures and scientific references (Boateng, 2018). It aims to assess patient personal and medical data about pain and it involved three parts it consisted of 15 questions in the form of multiple choice questions as following:
Part (1): It contains (6 questions)
Concerning patient’s personal data: It was include data related to age, gender, marital status, level of education, occupation and residence.
Part (2): It includes (6 questions).
Regarding patient’s medical and surgical data as diagnosis, patient present and past history, patient complaint.
Part (3): It was concerned with physical assessment of patients such as vital signs and pain assessment (site of pain, the nature of pain and the place of pain radiation) pre, post one month and after three months implementation of the diaphragmatic breathing technique, it included 3 multiple choice questions.
Tool II: Patient’s knowledge questionnaire: (4 questions)
It was designed by the researcher after reviewing recent relevant literatures and scientific references (Fink, 2019). To assess patient’s knowledge regarding the diaphragmatic breathing technique pre, post one month and after three months implementation of the technique and it was include a set of questions as regard definition of diaphragmatic breathing technique, the positions in which the diaphragmatic breathing exercise was practiced, the duration of the diaphragmatic breathing exercise at one time and the number of times per day, benefits of diaphragmatic breathing exercise.
Tool III: Patient’s practice observational checklist: It aimed to assess the patients’ practice pre, post one month and three months follow up post implementation of the implementing of diaphragmatic breathing technique, this tool was adapted from (Ibrahim et al., 2020). This tool consisted of 5 steps related to diaphragmatic breathing technique instructions that should be followed during the application of the technique.
Tool IV: The Brief Pain Inventory:
The Brief Pain Inventory (BPI) rapidly assesses the severity of pain and its impact on function pre, post one month and after three months implementation of the diaphragmatic breathing technique. The (BPI) is available in two formats: The BPI short form and the (BPI) long form, the investigator used the short form of the BPI, and it was adopted from (Shahid et al., 2011). The BPI is a 15-minute questionnaire that can be self-administered. It includes several questions about the characteristics of the pain, including its origin, effects of prior treatments, Severity of pain that score it at its best, worst, and on average, and includes the perceived level of interference with normal functions as general activity, mood, walking ability, relation with other people, sleep, enjoyment of life.
Results:
The study findings revealed that:
- Regarding patients’ personal data; showed that 47.7% of the studied patients aged from 40 to less than 50 years old with Mean ± SD was 39.49± 0.98 years, also (76.9, 83.1% & 49.2 %, respectively) of the studied patients were females, married as well as read and write. Whereas 83.1% were working, and 72.2% of them were performing manual work, and 78.5% were residing in rural area.
- As regard to patients’ current health status the study illustrated that 84.6 % of the studied patients had undergone major surgery, with the main presenting complain post-surgery was pain among 100.0% and 61.5% of patients were administered antibiotic as a pre anesthetic medication.
- In relation to patients’ surgical intervention the finding of the study showed that the highest percent 30.8% of the studied patients were undergone surgical intervention for fracture of the femur.
- The current result showed that overall patients’ knowledge regarding for breathing technique where, 83.1% of the studied patients had unsatisfactory knowledge pre applying the technique while improved significantly to be satisfactory as observed in 76.9% at post 1 month period diaphragmatic breathing technique implementation however, return to decline to 73.8%, three months post breathing technique implementation with highly statistically significant difference between total score of knowledge pre and post applying of diaphragmatic breathing technique among studied patients.
- Concerning to total patients’ practice regarding for breathing technique implementation there was a significant statistical difference in overall practice where, 95.4% of the studied patients had an inadequate level of total practice during pre-breathing technique implementation, while improved significantly to be an adequate as observed in 92.3% at post 1month period of diaphragmatic breathing technique implementation however, return to decline to 86.2%, three months post breathing technique implementation.
- Pertaining to patients’ reported pain intensity level pre and post diaphragmatic breathing technique, there was a significant statistical difference in pain intensity level throughout breathing technique periods. Where, (67.7% & 32.3%, respectively) of the studied patients had a moderate and severe pain level pre-breathing technique implementation, to be reduced only to a moderate level among (63.1% & 3.1%, respectively) during post 1 month period and at follow-up of the technique in three months which indicates marked decrease in pain intensity.
- With regards to correlation, there was no significant correlation between total knowledge and practice for the studied patients during pre-breathing technique with p-value 0.875, while a positive and highly significant correlation during post 1 month period and three months post breathing technique implementation with p value <0.001**.
- Concerning of predictor for pain intensity among the studied patients after three months of diaphragmatic breathing technique which assessed by pain interference level, the present study revealed that it was best predicted by knowledge, practice and respiration rate which were significantly correlated with pain intensity (p= 0.047, 0.028, and 0.015*, respectively), accounting for 51.8% of the variance of pain intensity.
Conclusion
According to the results of present study, it might be concluded that
Applying of diaphragmatic breathing technique was very effective in reducing pain intensity for post orthopedic surgery patients, which was best predicted by knowledge and practice scores and respiration rate that can be recommended as a pain relief technique, which supports the study hypotheses.
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