J Neurol Res

Journal of Neurology Research, ISSN 1923-2845 print, 1923-2853 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Neurol Res and Elmer Press Inc

Journal website https://www.neurores.org

Original Article

Volume 14, Number 1, June 2024, pages 8-15

Effectiveness of Relaxation and Respiratory Exercise on Sleep Quality, Depression and Spasticity in Hemiplegic Stroke Patients: Preliminary Findings

**Table 1.** Comparison of Demographic Characteristics of Patients
	Group 1 (n = 15), mean ± SD	Group 2 (n = 15), mean ± SD	P^a
^aIndependent sample t-test. Group 1: Bobath exercises group. Group 2: Bobath exercises, breathing, and relaxation exercises. BMI: body mass index; SD: standard deviation.
Age (years)	52.06 ± 8.86	57.13 ± 9.29	0.138
Height (m)	1.71 ± 0.09	1.70 ± 0.08	0.759
Weight (kg)	79.73 ± 11.65	78.46 ± 10.86	0.760
BMI (kg/m²)	27.13 ± 4.15	27.00 ± 2.42	0.915

Table 1. Comparison of Demographic Characteristics of Patients

Group 1 (n = 15), mean ± SD

Group 2 (n = 15), mean ± SD

P^a

^aIndependent sample t-test. Group 1: Bobath exercises group. Group 2: Bobath exercises, breathing, and relaxation exercises. BMI: body mass index; SD: standard deviation.

Age (years)

52.06 ± 8.86

57.13 ± 9.29

0.138

Height (m)

1.71 ± 0.09

1.70 ± 0.08

0.759

Weight (kg)

79.73 ± 11.65

78.46 ± 10.86

0.760

BMI (kg/m²)

27.13 ± 4.15

27.00 ± 2.42

0.915

**Table 2.** Distribution of Patients According to Gender, Marital Status and Education Level
	Group 1, n (%)	Group 2, n (%)	Chi-square (P^a)
^aSquare test. Group 1: Bobath exercises group. Group 2: Bobath exercises, breathing and relaxation exercises.
Gender
Female	4 (26.6%)	6 (40%)	0.705
Male	11 (73.34%)	9 (60%)
Marital status
Married	13 (86.7%)	13 (86.7%)	1.000
Single	2 (13.3%)	2 (13.3%)
Education level
Secondary school	4 (26.7%)	2 (13.3%)	0.377
Middle school	7 (46.7%)	6 (40.0%)
High school	3 (20.0%)	4 (26.7%)
Undergraduate	1 (6.7%)	3 (20.0%)

Table 2. Distribution of Patients According to Gender, Marital Status and Education Level

Group 1, n (%)

Group 2, n (%)

Chi-square (P^a)

^aSquare test. Group 1: Bobath exercises group. Group 2: Bobath exercises, breathing and relaxation exercises.

Gender

Female

4 (26.6%)

6 (40%)

0.705

Male

11 (73.34%)

9 (60%)

Marital status

Married

13 (86.7%)

1.000

Single

2 (13.3%)

Education level

Secondary school

4 (26.7%)

2 (13.3%)

0.377

Middle school

7 (46.7%)

6 (40.0%)

High school

3 (20.0%)

4 (26.7%)

Undergraduate

1 (6.7%)

3 (20.0%)

**Table 3.** Comparison of PUKI Values of Patients Within and Between Groups
	Pre-exercise, mean ± SD	6 weeks after exercise, mean ± SD	Paired sample t-test	In-group change, mean (CI)	Effect size	Independent sample t-test
^aPaired sample t-test. ^bIndependent sample t-test. P < 0.05. *P < 0.01. Group 1: Bobath exercises group. Group 2: Bobath exercises, breathing and relaxation exercises. PUKI: Pittsburgh Sleep Quality Index; SD: standard deviation; CI: confidence interval.
Subjective sleep quality
Group 1	1.06 ± 1.16	0.86 ± 0.91	0.082	0.20 (0.02 - 0.42)	0.172	0.387
Group 2	0.60 ± 0.91	0.60 ± 0.73	1.000	0.00 (0.20 - 0.20)	0.000
Sleep latency
Group 1	2.40 ± 0.50	2.13 ± 0.83	0.41	0.26 (0.06 - 0.59)	0.520	0.141
Group 2	2.66 ± 0.70	1.73 ± 0.59	0.164	0.53 (0.12 - 0.94)	0.757
Sleep duration
Group 1	0.33 ± 0.89	0.33 ± 0.89	0.42	0.00 (0.54 - 0.54)	0.37	0.606
Group 2	0.33 ± 0.48	0.20 ± 0.41	0.10	0.13 (0.39 - 0.65)	0.27
Habitual sleep activity
Group 1	2.00 ± 1.06	1.86 ± 1.06	0.104	0.13 (0.15 - 0.41)	0.122	0.582
Group 2	2.26 ± 1.03	1.66 ± 0.89	0.163	0.60 (0.19 - 1.00)	0.582
Sleep disorder
Group 1	1.20 ± 0.41	1.13 ± 0.51	0.334	0.06 (0.07 - 0.20)	0.146	0.271
Group 2	1.06 ± 0.25	0.93 ± 0.45	0.034*	0.13 (0.06 - 0.32)	0.0520
Sleep medication
Group 1	1.06 ± 1.16	0.73 ± 0.88	0.332	0.33 (0.06 - 0.60)	0.284	0.352
Group 2	0.73 ± 0.96	0.46 ± 0.63	0.054	0.26 (0.01 - 0.52)	0.270
Daytime dysfunction
Group 1	0.53 ± 0.63	0.53 ± 0.63	0.332	0.33 (0.18 - 0.85)	0.14	0.422
Group 2	0.86 ± 0.74	0.73 ± 0.70	0.04*	0.20 (0.30 - 0.70)	0.17
PUKI total result
Group 1	8.60 ± 1.99	8.20 ± 1.56	0.082	0.40 (0.05 - 0.85)	0.201	0.003**
Group 2	7.26 ± 2.71	6.13 ± 1.92	0.03*	1.13 (0.15 - 2.11)	0.416

Table 3. Comparison of PUKI Values of Patients Within and Between Groups

Pre-exercise, mean ± SD

6 weeks after exercise, mean ± SD

Paired sample t-test

In-group change, mean (CI)

Effect size

Independent sample t-test

P^a

P^b

^aPaired sample t-test. ^bIndependent sample t-test. *P < 0.05. **P < 0.01. Group 1: Bobath exercises group. Group 2: Bobath exercises, breathing and relaxation exercises. PUKI: Pittsburgh Sleep Quality Index; SD: standard deviation; CI: confidence interval.

Subjective sleep quality

Group 1

1.06 ± 1.16

0.86 ± 0.91

0.082

0.20 (0.02 - 0.42)

0.172

0.387

Group 2

0.60 ± 0.91

0.60 ± 0.73

1.000

0.00 (0.20 - 0.20)

0.000

Sleep latency

Group 1

2.40 ± 0.50

2.13 ± 0.83

0.41

0.26 (0.06 - 0.59)

0.520

0.141

Group 2

2.66 ± 0.70

1.73 ± 0.59

0.164

0.53 (0.12 - 0.94)

0.757

Sleep duration

Group 1

0.33 ± 0.89

0.42

0.00 (0.54 - 0.54)

0.37

0.606

Group 2

0.33 ± 0.48

0.20 ± 0.41

0.10

0.13 (0.39 - 0.65)

0.27

Habitual sleep activity

Group 1

2.00 ± 1.06

1.86 ± 1.06

0.104

0.13 (0.15 - 0.41)

0.122

0.582

Group 2

2.26 ± 1.03

1.66 ± 0.89

0.163

0.60 (0.19 - 1.00)

0.582

Sleep disorder

Group 1

1.20 ± 0.41

1.13 ± 0.51

0.334

0.06 (0.07 - 0.20)

0.146

0.271

Group 2

1.06 ± 0.25

0.93 ± 0.45

0.034*

0.13 (0.06 - 0.32)

0.0520

Sleep medication

Group 1

1.06 ± 1.16

0.73 ± 0.88

0.332

0.33 (0.06 - 0.60)

0.284

0.352

Group 2

0.73 ± 0.96

0.46 ± 0.63

0.054

0.26 (0.01 - 0.52)

0.270

Daytime dysfunction

Group 1

0.53 ± 0.63

0.332

0.33 (0.18 - 0.85)

0.14

0.422

Group 2

0.86 ± 0.74

0.73 ± 0.70

0.04*

0.20 (0.30 - 0.70)

0.17

PUKI total result

Group 1

8.60 ± 1.99

8.20 ± 1.56

0.082

0.40 (0.05 - 0.85)

0.201

0.003**

Group 2

7.26 ± 2.71

6.13 ± 1.92

0.03*

1.13 (0.15 - 2.11)

0.416

**Table 4.** Comparison of Patients’ In-Group and Between-Group HAD Values
	Pre-exercise, mean ± SD	6 weeks after exercise, mean ± SD	Paired sample t-test	In-group change, mean (CI)	Effect size	Independent sample t-test
^aPaired sample t-test. ^bIndependent sample t-test. *P < 0.05. Group 1: Bobath exercise group. Group 2: Bobath exercises, breathing and relaxation exercises. SD: standard deviation; CI: confidence interval; HAD: Hospital Anxiety Depression; HADS: Hospital Anxiety and Depression Scale.
DHAD depression
Group 1	9.72 ± 2.37	9.33 ± 2.09	0.164	0.40 (0.18 - 0.98)	0.168	0.196
Group 2	11.20 ± 2.51	10.26 ± 1.75	0.017*	0.93 (0.19 - 1.67)	0.370
DHAD anxiety
Group 1	9.13 ± 3.13	8.93 ± 3.03	0.536	0.20 (0.46 - 0.86)	0.063	0.393
Group 2	8.46 ± 2.61	8.06 ± 2.40	0.082	0.40 (0.05 - 0.85)	0.153

Table 4. Comparison of Patients’ In-Group and Between-Group HAD Values

Pre-exercise, mean ± SD

6 weeks after exercise, mean ± SD

Paired sample t-test

In-group change, mean (CI)

Effect size

Independent sample t-test

P^a

P^b

^aPaired sample t-test. ^bIndependent sample t-test. *P < 0.05. Group 1: Bobath exercise group. Group 2: Bobath exercises, breathing and relaxation exercises. SD: standard deviation; CI: confidence interval; HAD: Hospital Anxiety Depression; HADS: Hospital Anxiety and Depression Scale.

DHAD depression

Group 1

9.72 ± 2.37

9.33 ± 2.09

0.164

0.40 (0.18 - 0.98)

0.168

0.196

Group 2

11.20 ± 2.51

10.26 ± 1.75

0.017*

0.93 (0.19 - 1.67)

0.370

DHAD anxiety

Group 1

9.13 ± 3.13

8.93 ± 3.03

0.536

0.20 (0.46 - 0.86)

0.063

0.393

Group 2

8.46 ± 2.61

8.06 ± 2.40

0.082

0.40 (0.05 - 0.85)

0.153

**Table 5.** Comparison of MAS Values of Patients Within and Between Groups
	Pre-exercise, mean ± SD	6 weeks after exercise, mean ± SD	Paired sample t-test	In-group change, mean (CI)	Effect size	Independent sample t-test
^aPaired sample t-test. ^bIndependent sample t-test. *P < 0.05. Group 1: Bobath exercise group. Group 2: Bobath exercises, breathing and relaxation exercises. SD: standard deviation; CI: confidence interval; MAS: Modified Ashworth Scale.
Shoulder belts
Group 1	2.66 ± 0.61	2.60 ± 0.73	0.334	0.06 (0.07 - 0.20)	0.098	0.036*
Group 2	2.33 ± 0.48	2.00 ± 0.75	0.19	0.33 (0.06 - 0.60)	0.687
Dirsek
Group 1	2.60 ± 0.73	2.33 ± 0.61	0.41	0.26 (0.01 - 0.52)	0.356	0.391
Group 2	2.66 ± 0.72	2.53 ± 0.63	0.164	0.13 (0.06 - 0.32)	0.180
Hand
Group 1	3.20 ± 0.77	2.93 ± 0.70	0.42	0.26 (0.01 - 0.52)	0.337	1.000
Group 2	3.73 ± 0.45	2.93 ± 0.59	0.10	0.80 (0.42 - 1.17)	1.777
Hip belts
Group 1	2.46 ± 0.74	2.20 ± 0.14	0.104	0.26 (0.06 - 0.59)	0.351	0.764
Group 2	2.26 ± 0.70	2.13 ± 0.16	0.163	0.13 (0.06 - 0.32)	0.185
Knee
Group 1	2.40 ± 0.63	2.33 ± 0.48	0.334	0.06 (0.07 - 0.20)	0.095	1.000
Group 2	2.40 ± 0.63	2.33 ± 0.61	0.334	0.06 (0.07 - 0.20)	0.095
Foot-ankle
Group 1	3.13 ± 0.51	3.06 ± 0.59	0.332	0.06 (0.07 - 0.20)	0.117	0.042*
Group 2	3.46 ± 0.63	2.46 ± 0.91	0.002*	1.00 (0.44 - 1.55)	1.587

Table 5. Comparison of MAS Values of Patients Within and Between Groups

Pre-exercise, mean ± SD

6 weeks after exercise, mean ± SD

Paired sample t-test

In-group change, mean (CI)

Effect size

Independent sample t-test

P^a

P^b

Shoulder belts

Group 1

2.66 ± 0.61

2.60 ± 0.73

0.334

0.06 (0.07 - 0.20)

0.098

0.036*

Group 2

2.33 ± 0.48

2.00 ± 0.75

0.19

0.33 (0.06 - 0.60)

0.687

Dirsek

Group 1

2.60 ± 0.73

2.33 ± 0.61

0.41

0.26 (0.01 - 0.52)

0.356

0.391

Group 2

2.66 ± 0.72

2.53 ± 0.63

0.164

0.13 (0.06 - 0.32)

0.180

Hand

Group 1

3.20 ± 0.77

2.93 ± 0.70

0.42

0.26 (0.01 - 0.52)

0.337

1.000

Group 2

3.73 ± 0.45

2.93 ± 0.59

0.10

0.80 (0.42 - 1.17)

1.777

Hip belts

Group 1

2.46 ± 0.74

2.20 ± 0.14

0.104

0.26 (0.06 - 0.59)

0.351

0.764

Group 2

2.26 ± 0.70

2.13 ± 0.16

0.163

0.13 (0.06 - 0.32)

0.185

Knee

Group 1

2.40 ± 0.63

2.33 ± 0.48

0.334

0.06 (0.07 - 0.20)

0.095

1.000

Group 2

2.40 ± 0.63

2.33 ± 0.61

0.334

0.06 (0.07 - 0.20)

0.095

Foot-ankle

Group 1

3.13 ± 0.51

3.06 ± 0.59

0.332

0.06 (0.07 - 0.20)

0.117

0.042*

Group 2

3.46 ± 0.63

2.46 ± 0.91

0.002*

1.00 (0.44 - 1.55)

1.587