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Nursing research and practice
By Narulita S, Sumpat D, Avoi R and 7 others.
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Orthostatic hypotension (OH) is a common adverse effect of antipsychotic therapy and represents a significant patient safety concern in psychiatric nursing practice due to its association with falls and cardiovascular instability. Nurse-led, nonpharmacological interventions may offer feasible strategies to manage this condition in inpatient mental health settings. Although nonpharmacological interventions such as hydration and lower limb exercise have shown effectiveness in managing OH in older adults and neurological populations, evidence in psychiatric inpatients remains limited. Patients with schizophrenia receiving antipsychotics present unique physiological and behavioral challenges, including medication-induced autonomic dysfunction, low physical activity, and inconsistent fluid intake. To date, no quasiexperimental study has evaluated the comparative and combined effects of lower extremity exercise and hydration in this specific population.
This study aimed to compare the effectiveness of nurse-led lower extremity exercise, water consumption, and their combination in reducing OH among hospitalized patients with schizophrenia receiving antipsychotic treatment.
This quasiexperimental study was conducted in a psychiatric hospital. A total of 180 patients diagnosed with schizophrenia were enrolled and allocated into four equal groups (n = 45 per group): control, lower extremity exercise, water consumption, and combined intervention groups. Blood pressure was measured in the supine position and at 1, 3, 5, and 10 min after standing. Data were analyzed using repeated measures ANOVA.
The results of the repeated measures ANOVA revealed a statistically significant difference in systolic blood pressure (SBP) change between intervention groups (p = 0.006). The lower extremity exercise group demonstrated the highest estimated marginal mean for SBP improvement, and Bonferroni-adjusted pairwise comparisons showed a significant difference only between the lower extremity exercise and control groups. Repeated measures ANOVA demonstrated a significant difference in diastolic blood pressure (DBP) between intervention groups (p = 0.010). The combined intervention demonstrated the highest estimated marginal mean for DBP, although Bonferroni-adjusted pairwise comparisons showed no statistically significant differences between intervention groups.
This study provides evidence that nursing-led, nonpharmacological interventions, specifically lower extremity exercise and water consumption, are effective in reducing OH among hospitalized patients with schizophrenia receiving antipsychotic treatment. Lower extremity exercise demonstrated the highest estimated marginal mean for SBP improvement, whereas the combined intervention showed the highest estimated marginal mean for DBP. These findings support the implementation of simple, evidence-based nursing interventions to improve hemodynamic stability and enhance patient safety in psychiatric inpatient care. Trial Registration: International Standard Randomized Controlled Trial Number: ISRCTN10651820.
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