EFFECTIVENESS OF EXERCISE ON MUSCULOSKELETAL PAIN AMONG CHILDREN WITH SICKLE CELL DISEASE IN WESTERN REGION OF KENYA

Abstract

Musculoskeletal pain is the most cardinal sign of sickle cell disease among children which occurs due to vaso-occlusion causing disability. Exercise has proven to be helpful in musculoskeletal pain and should be used like any other therapy. World Health Organization guidelines recommend all children to be active for 60 minutes daily for 3 months to achieve health benefits in health and illness. Therefore, the aim of this study was to analyze the effectiveness of exercise in musculoskeletal pain among children with sickle cell disease. Specifically, to determine the relationship between socio demographic characteristics and musculoskeletal pain among children with sickle cell disease, examine strategies used in management of musculoskeletal pain, analyze factors that influence management of musculoskeletal pain and assess the outcome of exercise on musculoskeletal pain. This study was guided by the theory of Bio-psychosocial theory of Health and Illness. The study adapted a quasi experimental pre and post design with two arms control and intervention groups. Intervention group was introduced to a 12 week exercise while the control group continued with their routine. Both groups were recruited live from sickle cell and hemophilic clinics. Quantitative data was collected using questionnaire and analyzed by chisquare test of independence and mixed model anova.Qualitative data was collected using key informant guides and indepth interviews and analysed by thematic content analysis.The study had a sample size of 176 children, 22 respondents participated in indepth interviews.The results found no statistically significant association between socio demographic characteristics and musculoskeletal pain among children with sickle cell disease. The majority of the respondents in intervention group reported mild musculoskeletal pain after the intervention (n=104, 59.1%). The results of the Chi-square test for hemoglobin levels (χ2 (2) = 23.99, p < .001), hospital visits (χ2 (2) = 22.033 p <0.01), exercise participation p <0.01) and painful attacks p <0.01 were significant. There was a statistical significant difference in intervention group on baseline and post intervention pain levels as measured by Wong Baker Faces Pain Rating Scale self-reported pain p<0.01, unlike in control group, where there was no significance difference in baseline and post intervention results. Economic,sociocultural,individual factors influenced musculoskeletal pain management.Drugs were used as one of the strategies. A mixed model analysis of variance (ANOVA) with one within-subjects factor and one between-subjects factor was conducted to determine whether significant differences existed among pain- post and pain-pre between the levels of group. The main effect for group was significant, F (1, 174) = 135.02, p < .001, indicating that there were significant differences in painpost and pain-pre between the levels of group. The main effect for the within-subjects factor was significant, F (1, 174) = 278.76, p < .001, indicating that there were significant differences between the values of pain post and pain pre. For the intervention category of group, pain post was significantly less than pain pre, t (174) = -28.72, p < .001.Effectiveness of exercise was measured using partial eta squared(np2) where by above 0.14 indicates a large effect while 0.01 indicate a small effect. In conclusion, these results suggest that the intervention was effective in reducing musculoskeletal pain in this population with np2 of 0.44,0.62.0.60 . The study recommends use of exercise to reduce musculoskeletal pain among children with sickle cell disease.