مقايسه اثربخشي خنده درماني و درمان راه حل محور گروهي بر اميد به زندگي، معناجويي، شفقت به خود و كاهش قند خون بيماران سالمند مبتلا به ديابت نوع دو

Comparing the Effectiveness of Laughter Therapy and Solution-based Therapy on Hopefulness, Meaningfulness, Self-compassion, and Hyperglycemia Reduction among Elderly Patients with Type II Diabetes

زمينه يكي از مشكلات ديابت در افراد مسن، احتمال ابتلا به بيماري ديگر همزماني است كه كنترل قند خون را مشكل تر مي سازد. هدف پژوهش حاضر، مقايسه اثربخشي خنده درماني و درمان راه حل محور گروهي بر اميد به زندگي، معناجويي، شفقت به خود و كاهش قند خون بيماران سالمند مبتلا به ديابت نوع دو بود. روش و مواد پژوهش حاضر يك تحقيق كاربردي و از نظر روش تحقيق از نوع تحقيقات شبه آزمايشي از نوع پيش‌آزمون- پس‌آزمون و پيگيري همراه با گروه كنترل بود. جامعه آماري پژوهش شامل بيماران سالمند 60 تا 75 سال مبتلا به ديابت نوع دو مراجعه كننده به مراكز درماني تحت پوشش انجمن ديابت ايران در شهر تهران بودند كه از بين آن ها تعداد 90 نفر به صورت تصادفي در سه گروه خنده درماني (30=n)، درمان راه حل مدار (30=n) و گروه كنترل (30=n) جايگزين شدند. داده ها با استفاده از پرسشنامه شفقت به خود، اميد به زندگي، معناجويي و آزمايش هموگلوبين گليكوزيله (HbA1c) به دست آمد. جهت پيگيري و بررسي پايداري تاثير روش هاي درماني، تكميل پرسشنامه ها و آزمايش A1c دو ماه پس از پايان دوره آموزشي مجددا انجام شد. داده ها با استفاده از روش تحليل واريانس با اندازه گيري مكرر(repeated measure) و با بهره گيري از نرم افزار SPSS.26 تحليل شد. يافته ها نتايج نشان داد كه ميانگين معناجويي، و شفقت خود در گروه خنده درماني در پايان پس آزمون بالاتر از گروه راه حل مدار بوده است. اما دو گروه از نظر اميد به زندگي و كاهش قند خون تفاوت معناداري تا مرحله پس آزمون با هم نداشتند (0/05p). نتيجه گيري مي توان نتيجه گرفت گفت هر دو گروه خنده درماني و درمان راه حل محور تاثير معناداري بر اميد به زندگي، معناجويي، شفقت خود و كاهش قند داشتند و مي توان از اين دو درمان در مراكز درماني براي بهبود وضعيت بيماران مبتلا به ديابت استفاده كرد.

Background and Objective Diabetes is an incurable disease among the elderly. Itis estimated that it affects the quality of life, and non-pharmacological and psychological therapies can help reduce the problems of the elderly with diabetes. The objective of this study was to compare the effectiveness of laughter therapy and solution-based therapy on hopefulness, meaningfulness, self-compassion, and hemoglobin A1C elderly patients with type 2 diabetes. Materials and Methods The present study was quasi-experimental with pretest-posttest, follow-up, and control group. The statistical population of the study included elderly patients 60-75 years old with type 2 diabetes referred to the Iranian Diabetes Association in Tehran. Among them, 54 were randomly selected and replaced in three groups: laughter therapy, solution therapy, and controlgroup. Data were obtained by self-compassion questionnaire, hopefulness scale, meaningfulness questionnaire, and glycated hemoglobin test. Before the beginning of the sessions, the pretest was administered for all three groups. After two months, the posttest was administered. In the first experimental group, laughter therapy, in the second experimental solution-centered intervention, and in the control group, no intervention was done. Glycated hemoglobin test was completed again two months after the end of the training in order to follow up and evaluate the sustainability of treatment effects. Data were analyzed by repeated measure ANOVA and SPSS software. Results The mean (SD) of self-compassion in the laughter group increased from 67.5 (5.2) at pretest to 85.8 (6.2) at posttest and 86.2 (6.1) at the end of the follow-up period (P<0.001) and increased in solution-based therapy group from 69.2 (4.7) in pretest to 81.3 (8.3) in posttest and 81.7 (8.4) at the end of the follow-up period (P<0.001). The mean (SD) of meaningfulness in the laughter group increased from 43.9 (6.2) at pretest to 50.3 (6.8) at posttest and 50.7 (6.5) at the end of the follow-up period (P<0.001). It increased in the solution-based therapy group, from 44.8 (6.7) at pretest to 49.5 (7.9) at posttest and 49.8 (7.7) at the end of the follow-up period (P <0.001). The mean (SD) of hopefulness in the laughter group increased from 40.3 (8.1) at pretest to 45.6 (8.1) at posttest and 46.1 (7.7) at the end of the follow-up period (P<0.001) and increased in solution-based therapy from 40.2 (7.9) at pretest to 43.7 (8.1) at posttest and 43.7 (7.7) at the end of the follow-up period (P<0.001). The mean (SD) of hemoglobin A1C in the laughter group decreased from 7.3 (1.6) at pretest to 6.4 (1.1) at posttest and 6.3 (0.9) at the end of the follow-up period. (P<0.001). Moreover, it decreased in the solution-based therapy, from 7.2 (1.1) at pretest to 6.6 (1.1) at posttest and 6.6 (1.1) at the end of the follow-up period (P<0.001). In the control group,there was no significant difference in mean (SD) self-compassion, hopefulness, meaningfulness, and A1C hemoglobin levels in pretest, posttest, and follow up. A comparison of two treatments showed that laughter therapy was more effective in self-compassionand meaningfulness in the posttest period than solution-based therapy (P<0.001). Conclusion The study showed that both laughter therapy and solution-based therapy led to increased hopefulness, self-compassion, and reduced hyperglycemia. Laughter therapy was more effective than solution-based therapy in enhancing self-compassion and meaningfulness in patients with diabetes. However, there was no difference between hope and hyperglycemia in two therapy methods.