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IJCRR - 7(9), May, 2015

Pages: 85-90

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A COMPARATIVE STUDY ON EFFECTIVENESS OF ABDOMINAL BINDER ON BLOOD PRESSURE IN LYING TO STANDING POSITION AMONG YOUNG SELF REPORTED HEALTHY COLLEGE STUDENTS

Author: Dhivakar Murugan, Moushami Purkayastha, Raja Senthil Kandasamy, Thangavelu L. Perichi Gounder, Sankar Sahayaraj Muthukaruppan

Category: Healthcare

Abstract:Aim: The Cardiovascular changes may take place during upright standing position. Several types of compression bandage areused to treat the orthostatic hypotension, mainly abdominal compression bandages are recommended for the reduction of gravity induced blood pressure drop. The aim of the study was to determine the effect of abdominal binder on blood pressure in lying and standing position among self-reported college students. Methodolgoy: The blood pressure was measured in both the groups from lying to standing position by the use of sphygmomanometer.Subjects in group B wear abdominal binder in lying and standing position while measuring blood pressure. The values in both the positions were recorded. Results: The result showed there were significant changes within group analysis of systolic blood pressure in lying and standing position (p< 0.01)and there were significant changes in within group analysis of diastolic blood pressure without abdominal binder (p< 0.01)when used abdominal binder from lying to standing position (p=0.083) it did not show any significant changes. The unpaired 't' test result showed insignificant changes in lying to standing in systolic blood pressure (p = 0.892 and 0.386) and diastolic blood pressure (p = 0.811 and 0.403). Conclusion: The abdominal binder is not an effective means in maintaining blood pressure during lying to standing position. Butonly in diastolic blood pressure it gives significant changes in maintaining the blood pressure.

Keywords: Blood pressure, Abdominal binder, Orthostatic hypotension, Positional variation

Full Text:

INTRODUCTION

The autonomic nervous system plays major role in regulation of blood pressure and heart rate1 .Generally, the term blood pressure refers to arterial blood pressure. Arterial blood pressure is defined as the lateral pressure exerted by the contained column of blood on the wall of arteries. The pressure is exerted when the blood flows through the arteries2 . In standing position the blood goes down from chest to the distensible venous capacitance system below the diaphragm. The abdominal contents are unsupported in anterior and inferior surface because of the gravity. It results in drop in blood pressure, cardiac output, venous return and ventricular filling this is due to the fluid shift, approximately 500 to 1,000 ml of pooling of blood into the lower extremities is takes place within ten seconds and the total transfer occurs within 3 to 5 minutes. It will stimulate the sympathetic outflow, which results increases peripheral vascular resistance; it will limit the reduction in blood pressure3 . Any pathological variations may cause alteration in the blood pressure2 . Reflex mechanisms and hemodynamics prevent drop in blood pressure and bring the cardiovascular changes during upright standing position. Failure of one of the subsystems can leads to gravitation-induced shifts in blood volume. It results in a clinical symptoms termed orthostatic hypotension4 . In orthostatic hypotension, this complex system does not allow the circulatory system to compensate the gravity induced drop in the blood pressure3 . Wearing an abdominal binder helps to support the abdominal contents and decreases the drop in blood pressure. The function of abdominal binder is to improving the respiratory mechanism. Several types of compression bandage are used to treat the orthostatic hypotension mainly abdominal compression bandages are recommended for the reduction of gravity induced blood pressure drop3 . The abdominal binder increases the intra-abdominal pressure. This negative pressure help prevent redistribution of blood into the abdomen and lower extremities when in standing position5 .The elastic abdominal binder that exerted 15 to 20 mmHg of blood pressure during standing position. The effect of compression therapy and beneficial effect of this treatment in orthostatic hypotension is unclear. In India there are only few studies to investigate the effect of abdominal compression stocking to control the drop in blood pressure. Orthostatic hypotension commonly found in upper spinal card injury. In India a study conducted at 2014 presented about 2716 cases of spinal cord injury patients, on that 1400 were cervical and 1316 were thoraco-lumbar, with male to female ratio of 4.2:1 and 71% in the age group of 20 to 49 years6 . Studies are required to examine the effectiveness of the abdominal binder in orthostatic hypotension for spinal cord injuries. Unnoticed orthostatic hypotension during the home programs may leads immediate medical attentions. Studies in healthy subjects will provide a clear picture about the blood fall changes with binder. The present study aimed to determine the effect of abdominal binder on blood pressure in lying and standing position among young healthy self-reported college student.

MATERIAL AND METHOD

The study design was a comparative study design. After getting the approval from the institutional ethical committee, willing subjects were communicated through appropriate channels. The selection criteria includes both gender students with the age group of between 18 to 25 years within normal blood pressure (systolic blood pressure 110 to 140 and diastolic blood pressure 60 to 80) were included for screening in the present study. Subjects with the history of hypertension or hypotension, cardiovascular, respiratory, and neurological problems, underwent recent abdominal surgeries, period of menstrual cycle in females, chronic abdominal pain, obese subjects, recent blood donors and other problems such as gastritis; spinal disc lesion, kidney stone, stomach cancer, urinary incontinence and spinal deformity were the exclusion criteria. 87 students enrolled their names to involve in the study. In which 63 students were selected based on the selection criteria. They were randomly allocated into two groups by using closed envelop method. After the commencement of the study, three students were withdrawn from the study. Group A consisted of 30 members (control group) and Group B consisted of 30 members (experimental group). Both the groups received explanation in details about the present study. The subjects were instructed not to wear tight cloths or bands and lie down in table for blood pressure settlement and general relaxation for 5 min. Then subjects were instructed to be in supine lying position on manual tilting table and were made to wear the safety straps. The blood pressure was measured in lying position by using sphygmomanometer and stethoscope. After the measurement the table was tilted to 90 degree to achieve upright standing position and then the blood pressure was measured in this position immediately (Figure-1). The group ‘A’ subject’s blood pressure was measured without the abdominal binder application and the group ‘B’ subject’s blood pressure was measured with the application of abdominal binder in both the lying and standing position. The values of blood pressure in lying and standing position were recorded.

DATA ANALYSIS AND RESULTS

The values of systolic and diastolic blood pressure with and without abdominal binder was analyzed by ‘t’ test.

WITHIN GROUP ANALYSIS

Results of systolic blood pressure of group A and Bin which p values (p<0.01)showed significant difference between pre and post mean values (Table: 1and Graph: 1). Results of diastolic blood pressure of group A in which p value (p<0.01) showed significant difference between pre and post mean values (Graph: 1), butin group, B p value(p = 0.083)showed no significant changes in pre and post mean values (Table: 2 and Graph: 1).

BETWEEN GROUP SYSTOLIC BLOOD PRESSURE ANALYSIS

Results of post systolic blood pressure in which p value (p= 0.386) showed no significant difference between with and without binder groups (Table: 3). Result of post diastolic blood pressure in which p value (p=0.403) showed no significant difference between with and without binder groups (Table: 4).

DISCUSSIONS

Abdominal binders are commonly advised among patients with orthostatic hypotension11. The present study investigated the effect of an abdominal binder on blood pressure in lying and tilted position. Hollister AS, et al., (1992) did the study on orthostatic hypotension, its Causes, evaluation, and management. He states that a normal hemodynamic response to changes during changing postures controlled by normal function of the cardiovascular and autonomic nervous systems. While in standing position, he found about 5 to 10 mm of Hg systolic blood pressure was decreased and the diastolic blood pressure decreased up to 5 to 10 mm of Hg and increases in pulse rate through his study3 . Tanaka H, et al., (1996) and Choe MA, et al., (1993) investigated the effect of changing position from supine to standing upright and blood pressure changes they found out the active standing result in reduction in blood pressure reduction caused by activation of cardiopulmonary baroreflex, due to a shift of blood from the splanchnic vessels8 .These two studies states that there is fall in blood pressure level when changing posture from supine to standing position. It is due to the effect of gravity. The present study revealed that there was a drop in blood pressure after obtaining standing position. The blood pressure drop is about 10mm of Hg in systolic blood pressure and 5 to 7mm of Hg in diastolic blood pressure. Smit AA, et al., (2004) done his study on use of lower abdominal compression to combat orthostatic hypotension in patients with autonomic dysfunction. The study was to investigate in patients with neurogenic orthostatic hypotension the mechanism and uses of abdominal compression during standing position with 23 patients. The blood pressure with 40-60 degrees head tilted position was evaluated in three main protocols that are the effect of abdominal compression on caval vein, the level of compression and the arterial pressure response, and investigated the ability of the abdominal binder to maintain standing blood pressure. He found that the elastic abdominal binding increased standing blood pressure with 15/6 mmHg (range -3/3 to 36/14, p < 0.05). He concluded that the abdominal compression increases standing blood pressure to a varying degree by increasing stroke volume9 .This conclusion was supporting this current study by increasing standing blood pressure when applying abdominal binder only on diastolic blood pressure not in systolic blood pressure. H.E. Smeenk, et al., (2014), did his study on Compression therapy in patients with orthostatic hypotension. He apply compression bandage in four different levels in the treatment of orthostatic hypotension: up to knee level, up to thigh level, full length and abdomen. Full length compression (lower limbs and abdomen) and compression of solely the abdomen were found to be increase in blood pressure when compared to other two level of compression. The significant reduction in systolic blood pressure was seen after postural change. This review states that compression of abdomen has greatest beneficial effect4 and stating that the compression of the abdomen has the greatest beneficial effect when comparing other area. Goldman et al., compared girth measurement without the abdominal binder for normal and tetraplegia subjects, and found that the girth was 6% greater from supine to sitting in the tetraplegia group above that of the normal group10.The abdomen to be compressed more easily in the supine position than in the sitting position. Inconsistent levels of compression result in lack of standardization of compression11, 12, 13, 14 and15. It may alter physiological effects of an abdominal binder. Both the studies emphasized the amount of pressure and the position of binder. However, the degree and percentage of compression of the abdominal binder was not well controlled in the present study. The type of material used to making up the abdominal binder differed. The elastic material used in some of abdominal binders, which allow the abdomen to expand and recoil during breathing. If a rigid support is applied to the abdomen, it completely restricts the abdominal expansion during inspiration. The study by Goldman et al., evaluate the use of a standard elastic abdominal binder against a custom thermoplastic rigid abdominal binder for the same subject, and found that both abdominal binder enhanced respiratory volume outcome10. However, binding the abdomen with a rigid support may be expected to alter the pattern of breathing, and expansion of the lower ribs. Here elastic abdominal binder was used, but didn’t investigate about the effect of elastic type of abdominal binder during respiration. The adverse effect was reported when using an abdominal binder in female subjects, this was discomfort because of the abdominal binder impinging on the breast line5 .It may limit the physiological benefit of the abdominal binder because of the noxious stimulus. The height of the abdominal binder in the present study was 30cm and discomfort was not reported. Goldman et al10and Boaventura et al11used 20cm, Kerk et al5 used 30cm, Huang et al16 used 20cm and McCool et al15and Boaventura et al11 used an abdominal binder that ranged from the pubis to the costal margin. During inspi-ration, the diaphragm moves caudally, it presses the abdominal contents17.Theabdominal binder that interferes with the rib cage. It will limit the ability of the abdominal binder to expands10. B M Wadsworth, et al., (2009) done his study on abdominal binder used in people with spinal cord injuries: a systematic review and meta-analysis. He conducted a review on the evidence for the use of an abdominal binder on breathing and cardiovascular function in people with spinal cord injury. Comparison of studies involving elastic and non-elastic binders was performed. A mean score of 4.3 out of 8 (range: 3–6) was found. The study states that the use of abdominal binders improved vital capacity by (weighted mean difference (95% confidence interval) 0.32 (0.09, 0.55) liters, decreased functional residual capacity by 0.41 (0.14, 0.67) liters, but did not significantly influence total lung capacity18. This current study states that the abdominal binder is not effective in maintaining the blood pressure during lying and standing position. But only in diastolic blood pressure it gives the significant difference.

CONCLUSIONS

The study showed significant changes in systolic blood pressure in within group analysis and insignificant changes in intergroup analysis. It showed binder is ineffective since there is marked difference in blood pressure changes in within group analysis and inter group analysis. In diastolic blood pressure there were significant changes when abdominal binder was not used. But use of abdominal binder showed insignificant changes in diastolic blood pressure. It showed binder stabilize the diastolic blood pressure changing lying to standing. But there was no insignificant change in between this group.

ACKNOWLEDGMENT

Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Authors would like to express sincere gratitude to the subjects, who participated in the study; the teachers, who nurtured them in this field; and IJCRR, for lime lighting the study to the world. AUTHOR’S

CONTRIBUTION

All the authors provided concept / idea / Research design. Apart from that Mr. Dhivakar Murugan provided data collection, Dr. Moushami Purkayastha provided data analysis, Dr. Raja Senthil Kandasamy provided project management, Dr. Thangavelu L Perichi Gounder provided study facilities / equipment and subjects and Dr. Sankar Sahayaraj Muthukaruppan provided writing and consultation.

ABBREVATIONS:

SBP: Systolic Blood Pressure

DBP: Diastolic Blood Pressure

References:

1. A. A. Smit et al., Pathophysiological basis of orthostatic hypotension in autonomic failure. J Physiol, 519, pp. 1-10, (1999).

2. K. Sembulingam Ph.D., school of health science, Health campus university sains Malaysia. Essentials of medical Physiology (third edition)

3. Hollister AS. Orthostatic hypotension – causes, evaluation and management, West J Med. 1992; 157: 652-7.

4. H. E. Smeenk et al., Compression therapy in patients with orthostatic hypotension: a systematic review. Vol: 72, no: 2 February: 2014.

5. Kerk JK et al., Effect of an abdominal binder during wheelchair exercise. Med Science Sports Exercise; 27: 913-919, 1995.

6. N Mathur et al., Spinal Cord Injury: Scenario in an Indian State. Spinal Cord, doi:10.1038/sc.2014.153.,16 September 2014.

7. Choe, MA et al., The effect of changing position from supine to standing upright on the circulation of young men and women.

8. Tanaka H et al., Cardiac output and blood pressure during active and passive standing.

9. A. A. Smit et al., Use of lower abdominal compression to combat orthostatic hypotension in patients with autonomic dysfunction. Clin Auton Res, pp. 167-175, 2004.

10. Goldman JM et al., Effect of abdominal binders on breathing in tetraplegic patients. Thorax, 41:940-945, 1989.

11. Boaventura CD et al., Effect of an abdominal binder on the efficacy of respiratory muscles in seated and supine tetraplegic patients. Physiotherapy; 89: 290 -295, 2003.

12. Estenne M et al., Effects of abdominal strapping on forced expiration in tetraplegic patients. Am J Respiratory Care Med; 157:95-98, 1998.

13. Hart N et al., Respiratory effects of combined truncal and abdominal support in patients with spinal cord injury. Arch Physical Med Rehabilitation; 86: 144-145, 2005.

14. Maloney FP et al., Pulmonary function in quadriplegia: effects of a corset. Arch Phys Med Rehabilitation; 60: 261- 265, 1979.

15. Mc Cool FD et al., changes in lung volume and rib cage configuration with abdominal binding in quadriplegia. J Applied Physiology; 60: 1198-1202, 1986.

16. Huang CT et al., Cardiopulmonary response in spinal cord injury patients: effect of pneumatic compressive devices. Arch Physical Medicine and Rehabilitation; 64: 101=106, 1983.

17. De Troyer A et al., Rib cage motion and muscle use in high tetraplegics. Am Rev Respiratory Disorder; 133: 1115- 1119, 1986.

18. BM Wadsworth et al., Abdominal binder use in people with spinal cord injuries: a systematic review and meta-analysis. Spinal cord 47, 274-285, 2009.

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A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR.
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award

A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award

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