Prevalence of Fibromyalgia in caregiver of stroke patients

RESEARCH PROPOSAL

PREPARED

BY

HAFIZAH AMBREEN MEHMOOD

OBJECTIVES:

To determine the prevalence of fibromyalgia in caregivers of stroke patients.

BACKGROUND:

Physical illness has been remained a stressful factors for the patients and their caregivers. In our society where cultural values remained very important part of life and with no awareness of how to deal with these situations like supporting a stroke patient (e.g. how to transfer, toileting, mobilized out of bed, etc.) the care giver may cause so many harms to his body. Usually in this part of world (Pakistan) the caregiver is generally the untrained family member mostly the woman (mother or wife). Through studies it has been observed that fibromyalgia has more prevalence in women than men but these studies are not done in this part of the world specially Pakistan.

Researchers believe fibromyalgia results not from a single event but from a combination of many physical and emotional stressors and the stroke patient’s caregiver suffers not only form emotional but also from physical stressors especially when they are woman.

Fibromyalgia characterized by extensive pain, tenderness, insomnia, usual morning fatigue and generalized body ache.

Literature review:

published in the Archives of Internal Medicine in 1999, divided 156 men and women with depression into three groups. One group took part in an aerobic exercise program, another took the SSRI sertraline (Zoloft), and a third did both. At the 16-week mark, depression had eased in all three groups. About 60%–70% of the people in all three groups could no longer be classed as having major depression. In fact, group scores on two rating scales of depression were essentially the same. This suggests that for those who need or wish to avoid drugs, exercise might be an acceptable substitute for antidepressants. Keep in mind, though, that the swiftest response occurred in the group taking antidepressants, and that it can be difficult to stay motivated to exercise when you’re depressed.

A follow-up to that study found that exercise’s effects lasted longer than those of antidepressants. Researchers checked in with 133 of the original patients six months after the first study ended. They found that the people who exercised regularly after completing the study, regardless of which treatment they were on originally, were less likely to relapse into depression5.

Dr. Trivedi and his collaborators, recruited 126 people with depression who had been using S.S.R.I.’s for a minimum of two months, without achieving remission. None of the patients exercised.Dr. Trivedi and his colleagues divided these volunteers into two groups. One began a gentle aerobic exercise routine walked for about 10 minutes a day, on a treadmill or by strolling around the block, at a pace of three miles an hour. Others chose an equivalent easy cycling workout.

The second group was more energetic, walking briskly for about 30 minutes a day at a pace of four miles an hour, or the cycling equivalent,each volunteer exercised for four months, while continuing to take an antidepressant. At the end of that time, according to the study published recently in The Journal of Clinical Psychiatry, 29.5 percent had achieved remission6.

In 1999, a randomized controlled trial showed that depressed adults who took part in aerobic exercise improved as much as those treated with Zoloft. A 2006 meta-analysis of 11 studies bolstered those findings and recommended that physicians counsel their depressed patients to try it. A 2011 study took this conclusion even further: It looked at 127 depressed people who hadn’t experienced relief from SSRIs, a common type of antidepressant, and found that exercise led 30 percent of them into remission—a result that was as good as, or better than, drugs alone7.

The current study, by researchers from Duke University in North Carolina, was an extension of a previous trial in which 156 depressed adults aged 50 and over were randomly assigned to four months of exercise training (three supervised session per week, including 30 minutes of cycling, walking or jogging at 70-85% of heart rate reserve) or medication (with the antidepressant drug sertraline) or a combination of the two.

After four months, patients in all three groups showed significant and similar reductions in depressive symptoms: 60.4% of patients in the exercise group, 65.5% in the medication group and 68.8% in the combined group no longer met the criteria for major depressive disorder12.

Researchers suggest that patients participate in three to five exercise sessions per week, for 45 to 60 minutes per session. In terms of intensity, for aerobic exercise, they recommend achieving a heart rate that is 50 to 85 percent of the individual’s maximum heart rate.

For resistance training, they recommend a variety of upper and lower body exercises — three sets of eight repetitions at 80 percent of the maximum weight that the person can lift one time.

The findings suggest that patients may experience a relief in depression in as little as four weeks after starting exercise13.

PROCEDURE:

We will include all those patients who are diagnosed as depression by their doctor (psychiatrist) and they fulfill the criteria of moderate depression to severe depression which are shown in my questionnaire. For these patients treatment i will perform cycling, treadmill and multigym exercise by the patient.

Treatment session:

30min-45min session/day

3 times in a week.

For 1-2 months.

Inclusion criteria:

In my research I’ll include all those patients who are diagnosed as depression patient. Major depressive disorder. Age in between 20-50 years. Include only females.

Exclusion criteria:

Other psychological illness. Age lesser than 20 years and greater than 50years. Postpartum depression, seasonal affective depression, bipolar depression. Males.

Study design:

ProspectiveDescriptive Study

Sample size:

The sample size is calculated by using sample size formula

n = (Z2*pq) / d2

With57.5% prevalence of depressionand margin of error of 8%. The sample size

will be 147 patients.

Duration of study:The duration of the study will be 6 months from the time of approval.

Data collection:This study will be conducted after approval of RABIA MOON Institute of

neurosciences and institutional ethical review board. A total of 147 patients, fulfilling the

inclusion criteria, will be included in the study. Informed consent will be taken from every

patient or their relatives.

Data analysis:

Data will be analyzed by using SPSS version 17.0 on computer. Mean and standard deviation

will be computed for quantitativevariable like age; whereas frequency and percentages will be

employed to assess the categorical variable like gender.

Budget: The expected budget of expense is 15,000 rupees and will be incurred by researcher herself. This include cost of printing, photocopy, internet access, travel expense etc.

Ethical concern:

Subject were informed about the research. Permission was taken from all subject for the use of data for research and publication.

References:

1. http://www.pkhope.com/prevalence-of-depression-in-pakistan/ Ref: Jan,-June 2007, Volume 4, No.1 Depression in Pakistan: An epidemiological critique.

2. Cochrane Database Syst Rev. 2012;7:CD004366.[pubmed] 3. http://www.webmd.com/depression/guide/exercise-depression.

4. http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Depression_and_exercise.5. http://www.health.harvard.edu/newsweek/Exercise-and-Depression-report-excerpt.htm .6. http://well.blogs.nytimes.com/2011/08/31/prescribing-exercise-to-treat-depression .7. http://www.theatlantic.com/health/archive/2014/03/for-depression-prescribing-exercise-before-

medication.8. http://www.beyondblue.org.au/the-facts/depression/what-causes-depression .9. https://apa.org/topics/depress/index.aspx 10. http://www.medicalnewstoday.com/articles/8933.php .11. http://psychcentral.com/lib/types-of-depression/000908 .12. http://www.pponline.co.uk/encyc/fighting-depression-aerobic-exercise-is-proven-to-be-more-

effective-than-antidepressants-214#.13. http://psychcentral.com/news/2013/05/11/new-guidelines-for-using-exercise-as-an-

antidepressant/54728.html.14. http://www.medilexicon.com/medicaldictionary.php?t=23832 .15. http://www.ibx.com/pdfs/providers/resources/PHQ9_depression_screening_unbranded.pdf16. http://www.integration.samhsa.gov/images/res/PHQ%20-%20Questions.pdf 17. http://www.psychpage.com/learning/library/assess/depression.htm