Comparison between Vibration and Standard Exercises on Shoulder Pain for Patients Post Laparoscopic Cholecystectomy: A Comparative Study

Comparison between Vibration and Standard Exercises on Shoulder Pain for Patients Post Laparoscopic Cholecystectomy: A Comparative Study

Noorah Mahmoud Ali¹, Alaa Jawad Kadhim², Alice Khachian³ 

1. MSN, Clinical Nurse Specialist, AL-kindi Teaching Hospital, Iraqi Ministry of Health. E-mail: noorahmali8@gmail.com
2. Prof. adult Nursing Department, College of Nursing, University of Baghdad, City of Baghdad, Iraq
3. Associate Professor, Nursing and midwifery Care Research Center, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.

Corresponding author: Alaa Jawad Kadhim

Email: alaaj@conursing.uobaghdad.edu.iq

ORCID: https://orcid.org/0000-0002-4306-6830

ABSTRACT:-

Background: Laparoscopic cholecystectomy is one of the most commonly performed general surgical procedures worldwide, especially in Arab countries. About 35%–60% of patients' experience shoulder pain after laparoscopy.

Objective(s): To compare the effects of vibration and Standard exercises on shoulder pain in patients after laparoscopic cholecystectomy.

Methodology: A Comparative Study was carried out at the surgical wards of Al-Kindi Teaching Hospital and Baghdad Teaching Hospital. It started from 16th November, 2022 to 20th June, 2023. Seventy patients participated in this study to achieve the study objective. The interview method was chosen to collect the data.

Results: The results of the data showed that all of the seventy patients with shoulder pain after laparoscopic cholecystectomy had a severe pain level in the pre-test, while the results of the post-test of the application were at a statistically significant high level through the application of vibration and exercise, which effectively decreased shoulder pain.

Conclusion: In this application, both vibration and exercises had a positive relationship in decreasing the intensity of shoulder pain, but vibration had a more significant and obvious role in relieving shoulder pain compared to exercises.

Recommendations: The researcher recommended generalizing the results of the experiment to hospitals and surgical wards by applying the vibration and exercise trial to all patients after laparoscopic cholecystectomy.

Keywords: Vibration, Exercise, Shoulder Pain, Laparoscopic Cholecystectomy

Received: 21 March 2023, Revise Date: 17 May 2023 Accepted:29 May 2023, Available online: 28 July 2023

INTRODUCTION

Cholelithiasis, which is defined as a stone in the gallbladder, is a disease that can be treated surgically (Ahmed et al., 2018). Laparoscopic cholecystectomy (LC) remains one of the more popular abdominal surgical operations in the United States (Kadhim, 2014). In the United States, approximately 750,000 laparoscopic cholecystectomies are performed each year, with the trend predicted to rise (Goh, et al., 2017).

Several advantages provide by LC, including a shorter operation time, positive surgical vision, reduced trauma, decreased bleeding, fast recovery, and a minimized infection rate. It has found favour and acceptance among both physicians and patients, and it has become the standard procedure for cholecystectomy (Barazanchi, et al., 2018; Ibrahim, et al., 2021).

Postoperative pain is still the most common complaint. According to the location, it can be divided into three main groups: incisional pain (somatic pain), visceral pain (deep intra-abdominal pain), and shoulder pain (Kim, et al., 2018; Kadhim et al., 2021). Post-Laparoscopic STP Shoulder Tip Pain may be correlated with inflammatory damage that results from surgical incision pneumoperitoneum or phrenic nerve stretching following surgery and associated neuropraxia (Sao, et al., 2019; Atiyah et al, 2012).

Hajati, et al. (2022) stated that Some people experience shoulder tip pain for over 72 hours following surgery.

The abdominal wall being punctured by a trocar that causes the initial pain. Pain following surgery is also caused by nervousness and peritoneal inflammation. The primary cause of shoulder pain following LC is unclear; however, in theory, high-pressure CO2 insufflation during surgery and gas build up in the sub hepatic region may result in the conversion of residual gas into carbonic acid and diaphragmatic acidosis. This irritates the diaphragm and stretches the fibres, stimulating the phrenic nerve, which results in pain in the shoulder tip (Vafaei, et al., 2021). 

The first therapy approach is vibration, which is frequently used for massage purposes and applies directly to the shoulder (Veqar & Imtiyaz, 2014).

The range of motion exercises (ROM) is measurement of movement around a specific joint or body part. It's reduces pain significantly and reduces shoulder pressure (Srinayanti, et al., 2021). Active exercise has significant physiological advantages in that it promotes blood and lymphatic flow to joints and soft tissues, which can avoid the shortening and weakening of the surrounding muscles and connective tissues that can happen after immobilization following surgery (Scott, et al., 2021).

METHOD

A Comparative Study for patients suffering from shoulder pain after LC. It started from 16th November, 2022 to 20th June, 2023. The study was carried out at the surgical wards of Al-Kindi Teaching Hospital and Baghdad Teaching Hospital.

A sampling technique that is not based on probability of 70 patients with shoulder pain following (LC) in the surgical ward of the Teaching Hospital was selected to achieve the objective of the study. The data collection technique used was the interview method. In intervention group, vibration and exercise were applied to patients with shoulder pain after LC.

THE STUDY INSTRUMENT: The researcher constructed a questionnaire as a checklist which consisted of two parts, these parts are: Part I: Demographical Characteristics of the Patients    This part consists of patients’ sociodemographic characteristics by interview using questions such as age, gender, and chronic disease.

Part II: Numerical Pain Scale to Measure Shoulder Pain after LC, the researchers used the numeric rating pain scale (NRS), which consists of four ratings (no pain, mild, moderate, severe), and scoring (from 0-10). The items of the questionnaire were scored as 0 for no pain, 1–3 for mild pain, 4–6 for moderate pain, and 7–10 for severe pain.

The data were collected through the use of a questionnaire by means direct interviews with patients from December 13, 2022, until March 15, 2023. Study participants were interviewed and informed about the study's purposes and objectives, and demographic data were collected from all participants. The researcher got permission from all participants to record their responses and saved those responses for data analysis.

Statistical analysis

SPSS (Statistical Package for Social Sciences) version 24.0 is used to analyse the data. The following statistical data analysis techniques (frequency, percentage, mean of score, and paired t-test) were used to analyse and evaluate the study's findings.

RESULTS

Table (1.) presented that the mean age of the intervention group was 42.85 years old. In relation to gender, most of the study group (60 percent) was female. while 51.4 percent of patients (51.4%) have chronic diseases.

Table (1): The Distribution of the Intervention Sample According to The Demographic Data (N=70).

F.: frequency, %: percentage, SD: stander deviation

Table (2.) presented highly significant differences on the pain level between pretest and post exercise pain level of the intervention group at P value =.000, and also highly significant difference between pain level at pretest and post vibration of the intervention group at P value=. 000. 

Table (2): Differences of Pre and Posttest Pain Scores for the Intervention (Exercise and Vibration)

N= number, M = mean of score, SD= standard deviation, NS =non-significant at P>0.05, S= significant at P<0.05

DISCUSSION

The findings of the present study have indicated that patients' demographic characteristics are shown in Table 1. The mean age of the study group was 42.85 years old, and the most frequent age group was between 29-38 years old. In relation to gender, the results showed that more than half of the study group was female.

the result is supported by the study that was done by Rashid (2019) which stated that in Al-Kindi Teaching Hospital, 920 participants underwent LC; the mean age of the patients was 40.43 years old; 38 of the participants converted to open surgery; the majority of the sample was female (96.6%); and about 4.1% of individuals had open cholecystectomy.

A single‑blind randomized controlled trial was conducted by Hajati (2022) which asserted that the total of 64 people participated in this study, Half of the study sample were women. The mean age was 46–48 years.

A comparative clinical study, done by the researchers Ibrahim and Ali, (2020) confirmed that the study compared the effects of warm vs massage therapies on shoulder pain in postoperative laparoscopic surgery. Pain intensity measured using a visual analog scale explained that, among patients in the massage group, about 50% had severe pain before intervention, while 60% had mild pain after intervention. found that massage significantly relieved the pain, particularly in the short term. (p =.000).

Results in Table 2 Showed that the comparison of pain levels before and after exercise and vibration showed that the mean score in exercise was 6.68 while the mean score in vibration was 4.05, presenting highly significant differences both in exercise and vibration (P value =.000).

Wang, et al., (2022) confirmed that in Shanghai, the study examined whether a vibration massage intervention had an effect on upper trapezius muscles and then compared the effects of 2 different levels (36 Hz and 46 Hz) of vibratory massage for 5 minutes each. A total of 23 participants were randomly divided into intervention and control groups. The results found the mean score before intervention at 49.04, the mean score after intervention at 38.98. Both the right and left lateral muscles showed a significantly lower percentage of maximal voluntary contractions during the fatigue 90-s task.

The study carried out in Taiwan, a total of 48 patients with frozen shoulder were randomly classified into one of two groups: the experimental group received joint mobilization apparatus (posterior and inferior gliding, 80 N, 5 Hz, 30 min) in addition to regular therapy, while the control group received only regular therapy three times per week. Shoulder range of motion (ROM) and level of pain were evaluated using the VAS score before, during, and after the duration of treatment. The result showed the experimental group's shoulder flexion, abduction, internal rotation, and external rotation significantly improved by 88%, while VAS pain scores decreased by 62%. The experimental group performed 34% better on measures of shoulder range of motion and pain than the control group (Wu et al., 2021).

CONCLUSIONS

study concluded that there was a statistically significant difference in the patients with shoulder pain before and after application of vibration and exercise. The shoulder pain in patients had minimizing reduced after application of vibration and exercise.

ETHICAL CONSIDERATIONS COMPLIANCE WITH ETHICAL GUIDELINES

The researchers distributed an informed consent sheet to all patients with shoulder pain after LC in order to obtain their permission to participate in the study. In addition, they were informed that they could withdraw from the research, refuse to answer a specific question, or participate in the intervention at any time. The study protocol was reviewed and approved by the Ethics Committee of Baghdad University of collage of nursing, Bagdad, Iraq (approval code: 428, 28-11-2022).

FUNDING

This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors.

AUTHOR’S CONTRIBUTIONS

All authors contributed: study concept, writing the original draft, data collection, data analysis, and reviewing the final edition.

DISCLOSURE STATEMENT: The authors report no conflict of interest.

ACKNOWLEDGEMENTS

We would like to thank the patients who participated in the study.

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