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ORIGINAL RESEARCH

PROGRESSIVE MUSCLE RELAXATION EFFECT ON THE LEVEL

ANXIETY OF CANCER PATIENTS UNDERGOING CHEMOTHERAPY

Enny Virda Yuniarti1, Ima Rahmawati2

Bina Sehat PPNI Health Science Institute of Mojokerto

ABSTRACT Keywords

The physical effects of cancer and its therapy can lead to an unpleasant emotional
experience. Long-term treatment of chemotherapy and the presence of perceived
side effects can cause anxiety. One of the nonpharmacological measures to
overcome this anxiety is the relaxation of Progressive Muscle Relaxation therapy.
To know the effect of relaxation Progressive Muscle Relaxation on the level of
anxiety in cancer patients who underwent chemotherapy. Independent Variables
are Progressive Muscle Relaxation and Dependent Variables of Anxiety Level.
Cancer,
This research design uses Pre- Experiment with Pretest-Posttest approach design.
Sample amounted to 30 people. Sampling technique Purposive Sampling. The tool Chemotherapy,
used in the HRS-A (Hamilton Rating Scale-Anxiety) questionnaire. The research
was conducted from March to April 2017 at Leprosy Hospital Anxiety,
SumberGlagahPacet, Mojokerto. Progressive Muscle Relaxation performed one
Progressive
up to two times for three weeks with a duration of 15 minutes per session. The test
statistic used is to use the Wilcoxon Rank Test test. ρ = 0.046 and α = 0.05, so that Muscle
means H0 rejected and H1 accepted which means there is influence progressive
muscle relaxation to the level anxiety cancer patients who underwent Relaxation
chemotherapy at Leprosy Hospital Pacet, Mojokerto. Progressive Muscle
Relaxation is recommended as one of the non-pharmacological complementary
therapies because this relaxation technique is easy to do and does not cost.

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INTRODUCTION PacetMojokerto, the number of patients
Lifestyle changes and current treated in 2015 Oncology surgery
environmental exposure cause a shift in hospital is 1,660 people, while from the
the pattern and type of disease, one of year 2016 is 2,906 people. While those
which is the increased incidence of who are underwent chemotherapy in
cancer among other diseases (Haryati, 2015 as many as 888 people. In the year
2009 in Nova, 2016).Cancer is a 2016 who underwent chemotherapy as
disease caused by the growth of cells of much as 920 people And based on
body tissue that is not normal. People preliminary study results through
still believe that a cancer diagnosis is interviews using the HRS-A (Hamilton
thought to have an immediate meaning Rating Scale for Anxiety)
of death, and a painful death. As a questionnaire, five respondents of
result of all that the diagnosis of cancer cancer patients in the Chemotherapy
is seen as an enormous life crisis Room of Leprosy Hospital
(Danielle Gale, 2000). Chemotherapy SumberGlagah Pacet Mojokerto. Data
is one of the modalities of cancer obtained 3 Respondents experiencing
treatment selected primarily to deal severe anxiety (60%), one respondent
with locally advanced and metastatic experienced moderate anxiety (20%),
cancer. Patients undergoing and one respondent experienced mild
chemotherapy treatment will anxiety (20%) Which was
experience psychological problems as a characterized by symptoms of chest
result of cancer travel or side effects of pounding, frequent urination, and
chemotherapy that can minimize the anxiety. Some of these symptoms
chances of healing and also result in indicate that the patient has anxiety.
such patients wanting to stop
chemotherapy treatment (Star, 2012). Management Anxiety alone was
associated with pharmacological
Based on GLOBOCAN data. (benzodiazepine) and non-
International Agency for Research on pharmacological (psychotherapy).
Cancer, it is known that in 2012 there However, in general, hospitalization is
are 14,067,894 new cases of cancer and focused on restoring physical condition
8,201,575 cancer deaths worldwide. regardless of the patient's
Nationally prevalence of cancer in the psychological condition (Canisti, 2008
population of all ages in Indonesia in in Yolanda, 2016). Relaxation was first
2013 at 1.4 ‰ or an estimated 347,792 introduced by a Chicago psychologist
people. The province of East Java is the name Jacobson. This physiological
province with the highest estimated method was developed to counteract
cancer patients, ie61,230 people the tension and anxiety called
(Infodatin, 2015). Progressive Relaxation (Solehati and
Kosasih, 2015). Progressive Muscle
Based on medical record data at Relaxation refocuses on a muscle
SumberGlagah Hospital, activity by identifying tense muscles

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International Journal of Nursing and Midwifery Science (IJNMS) , V o l u m e 2 ,
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and decreasing the tension by doing inclusion criteria. The inclusion criteria
relaxation techniques to get relaxed to be respondents in this study are: Able
feelings. The purpose of Progressive to move independently, co-operative
Muscle Relaxation Technique patient and willing to be a research
decreases muscle tension, anxiety, neck respondent, can see, can write and read,
and back pain, high blood pressure, Never had a Progressive Muscle
heart frequency, metabolic rate (Herod, Relaxtation relaxation technique, stage 3
2010 in Setyoadi, 2011). and 4. The exclusion criteria that
become respondents in this research are:
Thus, a study focusing on Progressive Experiencing other comorbid diseases
Muscle Relaxation on the anxiety level that can not be done progressive Muscle
of cancer patients Chemotherapy can Relaxtation, patients who are not
be done to control the level of anxiety anxious. Progressive Muscle Relaxation
in patients as an action to overcome is given to patients who will do
non-pharmacological (psychotherapy) chemotherapy with the following
therapy on cancer clients who procedure techniques: Doing
underwent chemotherapy. Therefore, Progressive Muscle Relaxation exercise
researchers are interested to identify the 1-2 times a day for 3 weeks with a
extent to which the "Effect of duration of 15-20 minutes, Stretch the
Progressive Muscle Relaxation on the muscles for ± 5-7 seconds and relax for
anxiety level of cancer patients ± 10 seconds in 15 movements, Position
undergoing Chemotherapy.” sitting or supine, and Progressive
Muscle Relaxation exercise is done
RESEARCH METHODS before the patient does chemotherapy.
The research design used was Pre-
Experimental. The design used is One The researcher will explain the research
Group Pretest-Postest Population in this objectives, benefits, and research
study is all cancer patients who procedures, then explain the technique of
underwent chemotherapy at the hospital PMR implementation in patients
Source Glagah Pacet Mojokerto. The undergoing chemotherapy. The
average patient who underwent implementation of Progressive Muscle
chemotherapy was 30 people. Sampling Relaxation has conducted on March 20,
in this study using Nonprobability 2017 - April 21, 2017. Then on April 21,
Sampling is a technique that does not 2017, researchers conducted data
provide equal opportunities for members collection posttest questionnaire level of
of the population to be selected to be anxiety but before the researchers
sample. Non- probability sampling conducted the data collection. The
technique. The samples used in this researcher first evaluates PMR exercises
study were some cancer patients who that the patient has done at home and
underwent chemotherapy at then gives an anxiety questionnaire to be
SumberGlagah Hospital, Pacet use as post-test data. Anxiety gauge
Mojokerto. Samples that met the using HRS-A (Hamilton Rating Scale for

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International Journal of Nursing and Midwifery Science (IJNMS) , V o l u m e 2 ,
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Anxiety), which consists of 14 groups of Muscle Relaxation has give that of 30
symptoms. respondents most experienced mild
anxiety 11 people (36.7%), moderate
This study uses Wilcoxon Sign Rank anxiety 13 people (43.3%), and severe
Test statistics. Wilcoxon Signed Rank anxiety 6
statistical test This test is used to test the people (20.0%).
hypothesis difference between two
Table 2.2 Frequency distribution of
observations, with the following
anxiety levels of cancer patients
conditions: a) Used for one sample b)
undergoing chemotherapy after
each sample has 2 observations (before
being given Progressive Muscle
and after) c) is a comparative test
Relaxation
between 2 observations d) scale the
lowest ordinal data or may be used
against quantitative data or intervals or No Anxiety level f %
ratios if the requirements for such data 1 Low 12 40
are not met. If the value of Tw arithmetic 2 mild 15 50
≤ the value of Tw table on the 3 hard 3 10
corresponding α, then Ho is rejected and total 30 100
H1 accepted.

RESULTS Table 2.2 above shows that anxiety

Custom Data levels of cancer clients are undergoing
Table 2.1 Frequency distribution of chemotherapy before being given
anxiety levels of cancer patients Progressive Muscle Relaxation that
undergoing chemotherapy before from 30 respondents mostly
being given Progressive Muscle experienced mild anxiety 12 people
Relaxation (40%), moderate anxiety 15 people
(50%), and severe anxiety three
No Anxiety f % people (10%).
1 low 11 36,7
Tabel 2.3 Frequency distribution of
2 mid 13 43,3
anxiety levels of cancer
3 high 6 20,0
patients undergoing
Total 30 100
chemotherapy before and
after being given
3 Severe 6 20 3 10
Progressive Muscle
Total 30 100 30 100
Relaxation

Table 2.1 above shows that anxiety

levels of cancer clients who underwent
chemotherapy before Progressive
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 PMR Technique DISCUSSION
No Anxiety before after Several factors that influence the
Level being being effectiveness of Progressive Muscle
given given Relaxation are Education. Based on table
PMR PMR 4.5 shows the majority of junior high
F % F % school respondents is 20 people (63.3%).
1 Low 11 36,7 12 40 Where age affects a person
2 Mild 13 43.3 15 50 psychologically, the level of education
can also reduce the sense of being unable
3 Hard 6 20 3 10
to deal with anxiety. The higher a
Total 30 100 30 100
person's education will be easier and
more able to face stress that exists.
Table 2.3 above shows that from 30 People who have a higher education will
respondents before and after being given respond more rationally than those with
Progressive Muscle Relaxation it was lower educated or uneducated. Anxiety
found that before being given is a response that can be learned thus low
Progressive Muscle Relaxation there education becomes a factor supporting
were 11 people (36,7%) experiencing the occurrence of anxiety. This is
mild anxiety after given Progressive because clients with low education are
Muscle Relaxation got that experienced unaware or few his knowledge of various
mild anxiety 12 people (40%), Prior to matters relating to advanced diagnosis
being given Progressive Muscle and management experience. By Kaplan
Relaxation there were 13 people (43.3%) & Sadock theory, 1997 in Lufta &
experiencing moderate anxiety after Maliya, 2007) that a sufficient level of
being given Progressive Muscle education will more easily identify the
Relaxation obtained with moderate stressors within themselves and from
anxiety 15 people (50%), Prior to outside themselves. The level of
Progressive Muscle Relaxation there education also affects awareness and
were 6 people (20%) experiencing understanding of the stimulus. Table 2.3
anxiety weight after being given above shows that from 30 respondents
Progressive Muscle Relaxation obtained before and after being given Progressive
with severe anxiety 3 people (10%). Muscle Relaxation it was found that Pre-
Based on the result of calculation of Test was give Progressive Muscle
statistical test of wilcoxon Signed Ranks Relaxation there were 11 people (36,7%)
test, the Z value obtained is -2,000 with had mild anxiety, 13 people (43,3%)
P value 0.046 <(0,05). The price of experienced moderate anxiety, six
Ztabel (-1,645) and the price of Zhitung people (20%) experienced severe
(-2,000) is bigger than (-1,645) so that anxiety. But after 3 weeks of Progressive
the meaning of H0 is rejected, so there is Muscle Relaxation performed by the
the effect of progressive muscle respondents at home where each 15
relaxtation on the anxiety level of cancer minute session was conducted Post-test
patients undergoing chemotherapy using a Hamilton Rating Scale for

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Anxiety (HRS-A) with mild anxiety as a significant influence as much as three
12 people (40%), moderate anxiety of 15 times the exercise. The time required to
people (15%), and severe anxiety of 3 perform this technique so that it can
people (10%). cause the maximum effect is for 1-2
weeks with a duration of time 15
The result of statistic test of Wilcoxon minutes/times. In this study due to
Signed Ranks test by using SPSS got ρ = chemotherapy patients is a patient of
0,046 and α = 0,05, so that mean H0 One Day Care (ODC), who will go home
refused, and H1 accepted which means on the same day after undergoing
there is influence progressive muscle chemotherapy. So patients do
relaxation to anxiety level of the cancer Progressive Muscle Relaxation exercises
patient who underwent chemotherapy at at home so researchers cannot provide
Leprosy Hospital Pacet, Mojokerto. training to respondents so that when
However, the results obtained from the viewed from the observation results
statistical test Wilcoxon Signed Ranks Progressive Muscle Relaxation exercise
test results obtained data with low average respondents in 3 weeks cycle
significance value. This can happen by time chemotherapy respondents only 12
various factors one of them is the times the exercise and when joining with
environment around the respondent is the theory then with only 12 rehearsals
less conducive so that it can cause the this result will not be seen. Unlike if
concentration of the patient is disturbed, researchers can directly train
the body position of the patient is not in chemotherapy patients and performed by
a relaxed state, no one supervises or SOP Progressive Muscle Relaxation
guides, at the time of the Progressive then the results obtained will have a
Muscle Relaxation there is no significant effect.
controlling of the patient according to
SOP Progressive Muscle Relaxation. CONCLUSION
This is proven based on the theory There is Influence of Progressive
according to Setyoadi (2011), Muscle Relaxation on the anxiety level
Progressive Muscle Relaxation therapy of cancer patients who underwent
techniques there are things that need to chemotherapy at Leprosy Hospital
be considered one of them is the Sumberglagah, Pacet, Mojokerto with
preparation, be it the preparation of tools the results obtained from statistical test
and the environment, the chairs, the Wilcoxon Signed Ranks test obtained
pillow, and the quiet and silent results obtained p-value 0,046 <0,05
environment, really relax, It takes about with price Z table that is ( - 1,645) and
20-50 seconds to make muscles the price of Z arithmetic (-2,000) is
relaxation. larger than (-1,645) so that it means
rejected H0 which means there is a low
Viewed from other factors, According to progressive muscle relaxation effect on
Greenberg 2002, in Damamik 2005 the anxiety level of cancer patients
Progressive Muscle Relaxation will give undergoing chemotherapy at Leprosy

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Hospital Pacet, Mojokerto. e w/4564345) (Diakses tanggal 1
Desember 2016)
SUGGESTION Maryani,F.M.2014.Pengaruh Terapi
It is expect that the results of this study Relaksasi Otot Progresif terhadap
could provide input for hospitals to be tingkat kecemasan pada pasien
considered as a complementary therapy kanker payudara.
to overcome anxiety and can be used as Diaksestanggal30 November 2016
an alternative independent nursing dari http://
actions that can be used by nurses to jurnal.usu.ac.id/ejournal/article/vi
reduce the level of anxiety in cancer e w/4564
patients who underwent chemotherapy Solehati, Kosasih.2015. Konsep & Aplikasi
Relaksasi dalam Keperawatan
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