Effect of progressive relaxation exercises on postoperative pain, sleep quality, and recovery in patients undergoing total knee replacement surgery

The aim of this study was to investigate the effects of progressive muscle relaxation exercises on postoperative pain intensity, sleep quality, and recovery in patients undergoing total knee arthroplasty. The randomized controlled experimental study was conducted with 96 patients who underwent total knee arthroplasty at a state hospital in Zonguldak, Türkiye. Patients were assigned to intervention and control groups using block randomization, with 48 patients in each group. Data were collected between September 1, 2023, and August 1, 2024, using the Patient Information Form, Numeric Rating Scale (NRS), Richard Campbell Sleep Questionnaire (RCSQ), Postoperative Recovery Index (PoRI), a smart mobile device, and a sleep-tracking smart wristband. In the intervention group, patients' baseline information and pain levels were recorded using the NRS one day before surgery. Patients were then taken to a quiet room and taught how to perform progressive muscle relaxation exercises. Patients completed a 30-minute session guided by verbal instructions, and a written instruction sheet was also provided. Pain levels were reassessed 30 minutes after the session using the NRS. A sleep-tracking smart wristband was then placed on each patient, with instructions not to remove it during the study period. Sleep duration before surgery was recorded from the wristbands, and sleep quality was assessed. Pain levels were evaluated again 6 hours after surgery. Progressive muscle relaxation exercises were repeated twice at 4-hour intervals, starting 2 hours after analgesic administration. Pain was reassessed 30 minutes after each exercise session. On the morning of the first postoperative day, total sleep duration, sleep quality, and recovery index scores were recorded. Patients in the intervention group were instructed to perform the exercises twice daily, and pain assessments were conducted after each session. All procedures performed on the first postoperative day were repeated on the second, third, and fourth days. In the control group, data were collected at the same time intervals using the same tools, but without the implementation of progressive relaxation exercises. The data were analyzed using descriptive statistics (mean, standard deviation, percentage, and frequency distribution), Independent Samples t-Test, Chi-square test (χ²), repeated measures mixed ANOVA, and General Linear Model analysis. Effect sizes were calculated for significant results. The level of statistical significance was set at p < 0.05. The findings revealed that pain levels in the intervention group decreased more rapidly and significantly over time (F=14.11; p=0.000; η²=0.131), and sleep quality improved more markedly compared to the control group (F=14.22; p<0.001; η²=0.131). The total PoRI scores significantly decreased over time in the intervention group, whereas the reduction was less prominent in the control group (F=6.531; p=0.000; η²=0.065). A significant decrease in PoRI scores over time was observed in both groups (F=609.107; p=0.000; η²=0.866). The study concluded that progressive muscle relaxation exercises in patients undergoing total knee arthroplasty effectively reduced postoperative pain, improved sleep quality and sleep duration, and positively influenced recovery. Based on these results, it is recommended that progressive muscle relaxation exercises be routinely integrated into nursing care plans.