Comparing the Effects of Progressive Muscle Relaxation Technique and Aromatherapy With Rosemary Oil on Preoperative Anxiety in General Surgery Candidates

* Corresponding Author: Shirin Madadkar Dehkordi Address: Depatment of Nursing, Islamic Azad University, Shahrekord Branch, Shahrekord, Iran. Tel: +98 (913) 9775406 E-mail: shirinmadadkar@gmail.com 1. Depatment of Nursing, Islamic Azad University, Shahrekord Branch, Shahrekord, Iran. 2. Department of Operating Room, School of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord, Iran. *Shirin Madadkar Dehkordi 1 , Kobra Noorian2


Introduction
urgery is one of the most widely used treatment methods in many diseases that can be considered as a stressful experience. One of the most common problems of patients before surgery is psychological disorders such as anxiety. Anxiety is seen in a quarter of patients admitted to surgical clinics. The prevalence of preoperative anxiety in adults varies between 11 and 80%. Anxiety as a negative deterrent leads to a decrease in the body's immune system against infections, a tendency to use more painkillers, delays in wound healing and loss of physical and mental energy, a negative impact on the patient's mood, and increased hospital stay.
In general, two types of pharmacological and non-pharmacological methods are used to reduce the level of anxiety in patients. Nowadays, the acceptance of the use of complementary therapies in the health system has increased. Progressive Muscle Relaxation (PMR) technique and aromatherapy are non-pharmacological methods. We found no study on comparing the effects of PMR and aromatherapy with rosemary oil on the anxiety of candidates for general surgery. In this regard, and considering the high prevalence of preoperative anxiety, this study aims to compare the effects of PMR and aromatherapy with rosemary oil on the anxiety of candidates for general surgery.

Materials and Methods
This research is a clinical trial. The study population consisted of patients who were candidates for general surgery at Ayatollah Kashani Hospital in Shahrekord, Iran in 2018. The sample size was calculated 90 based on previous studies and according to an error rate of 0.05 and test power of 0.80. The samples were divided into three groups of PMR (30), aromatherapy (30) and control (30) using a random block of 6. Considering the inclusion criteria, the Samples were selected by a convenience sampling method. Data collection tools were a demographic form and the Depression, Anxiety and Stress Scale -21 Items (DASS-21). In the PMR group, after teaching one hour before the surgery, the patient was asked to listen to the relaxation audio file via a handsfree device. Then, s/he performed the exercises in the presence of the researcher for 20 minutes. In the aromatherapy group, 1 hour before the surgery, 3 drops of 10% rose essential oil were poured on a paper towel and pinned to the patients' pillows and they were asked to inhale it for 20 minutes. One hour after the intervention and before the surgery, the DASS was completed again in both groups. The control group received no intervention. Data were analyzed in SPSS v. 21 software considering the significance level at 0.05.

Results
Chi-square test results did not show a statistically significant difference in demographic characteristics between the study groups (P>0.05). Paired t-test results showed that PMR and aromatherapy were significantly effective in reducing preoperative anxiety (Table 1). In comparing the mean changes in anxiety scores before and after the intervention between groups, the significance level of one-way ANOVA was reported 0.954 before the intervention and 0.003 after the intervention. Therefore, the score of anxiety after the intervention was different in at least one of the three groups and it can be said that this difference was due to the effect of intervention. According to Duncan's post hoc test results, the mean scores of anxiety after the intervention in the two groups of aromatherapy and PMR were not significantly different, but they were significantly different compared to the control group. Therefore, both interventions had a positive effect on reducing anxiety but are not superior to each other.

Conclusion
Progressive muscle relaxation and aromatherapy reduce the level of anxiety in patients before general surgery. Considering that, today, the attitude of human societies towards treatment is moving towards traditional medicine and it has always been tried to alleviate patients' anxiety with nonpharmacological interventions, the use of these two methods in clinics is recommended as complementary and inexpensive methods.

Compliance with ethical guidelines
This clinical trial obtained its ethical approval from Shahrekord University of Medical Sciences (Code: SKUMS. REC.IR.1396.264) and was registered by the Iranian Registry of Clinical Trials (Code: IRCT20181122041720N1). All ethical principles were observed.

Funding
The study was extracted from a research project approved by Shahrekord University of Medical Sciences.