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"Penelitian ini bertujuan untuk melihat adakah perbedaan intensitas nyeri, kekuatan otot, dan kemampuan fungsional lutut antara penderita obesitas dan tanpa obesitas dengan osteoartritis genu (OA genu). Dilakukan studi potong lintang pada 50 orang perempuan dewasa, terdiri dari 25 orang penderita obesitas dengan OA genu, dan 25 orang tanpa obesitas dengan OA genu yang datang ke poli unggulan Obesitas dan poliklinik muskuloskeletal Departemen Rehabilitasi Medik RSCM. Intensitas nyeri dinilai menggunakan metode Visual Analogue Scale (VAS), kekuatan otot kuadrisep diukur menggunakan dinamometer jinjing, sedangkan kemampuan fungsional lutut dievaluasi menggunakan indeks Laquesne. Hasil penelitian menunjukkan adanya perbedaan intensitas nyeri dan kekuatan otot kuadrisep, terutama antara obesitas derajat II dengan subjek yang memiliki berat badan normal, berat badan lebih maupun obesitas derajat I. Tidak terdapat perbedaan kemampuan fungsional lutut yang bermakna secara statistik antara penderita obesitas dan tanpa obesitas dengan OA genu.

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The aim of the study was to find wheather there were any differences pain intensity, quadriceps muscle strength, and knee functional abilities between obese and non-obese patient with genu osteoarthritis (OA genu). We conducted a cross-sectional study in 50 adult women outward patient in Obesity Vlinic and Musculoskeletal Division of Physical Medicine and Rehabilitation Departement at Cipto Mangunkusumo Hospital, consisted of 25 obese people with osteoarthritis genu, and 25 non-obese people with osteoarthritis genu. The intensity of pain was assessed using the Visual Analogue Scale method (VAS), quadriceps strength was measured using a hand-held dynamometer, while functional ability was evaluated using the index Lequesne.

The study results showed that there were significant differences in pain intensity and quadriceps muscle strength, particularly between obese grade II and subjects with normal weight, overweight or obese first degree. There were no statistically significant difference in functional abilities knee between obese and non-obese patients with osteoarthritis genu."

"Tesis ini disusun untuk mengetahui efektivitas penggunaan elastic taping terhadap intensitas nyeri, kekuatan otot quadriceps dan status fungsi lutut pada pasien obesitas dengan osteoartritis lutut. Penelitian menggunakan desain uji eksperimental Randomized Control Trial. Subjek penelitian merupakan pasien overweight dan obesitas dengan osteoarthritis lutut, yang dibagi menjadi 2 kelompok yaitu kelompok kontrol dan perlakuan. Semua subjek dari kedua kelompok mendapatkan latihan standar berupa latihan aerobik dengan ergocycle, latihan penguatan otot quadriceps dan hamstring dengan NK table dan latihan keseimbangan dengan balance board sesuai dengan prosedur di Poliklinik Obesitas Departemen Rehabilitasi Medik RSCM Jakarta yang dilakukan 2x/minggu selama 2 minggu. Kelompok perlakuan mendapatkan pemasangan 3 elastic taping dengan tarikan 40- 50%, sedangkan kelompok kontrol mendapatkan pemasangan elastic taping dengan arah pemasangan yang sama namun tanpa penarikan. Pemasangan elastic taping dilakukan sebanyak 3 kali dalam waktu 2 minggu. Hasil keluaran penelitian ini berupa intensitas nyeri berdasarkan nilai VAS, kekuatan otot quadriceps yang diukur menggunakan handheld dynamometer serta penilaian kuesioner KOOS pada sebelum, setelah 1 minggu dan setelah 2 minggu pemasangan elastic taping. Analisis statistik dilakukan untuk membandingkan perubahan nilai VAS, kekuatan otot quadriceps dan nilai keusioner KOOS sesudah intervensi pada kelompok perlakuan dan kontrol. Hasil penelitian menyatakan bahwa pemasangan elastic taping sebagai terapi tambahan efektif dalam menurunkan nilai VAS, meningkatkan kekuatan otot quadriceps, dan nilai kuesioner KOOS pada pasien overweight dan obesitas dengan osteoartritis lutut setelah diberikan intervensi selama 2 minggu. Perbaikan nilai median VAS pada kelompok kontrol dan perlakuan masing-masing sebesar3 (1-4) dan 2 (1-3) dan didapatkan perbedaan signifikan dengan nilai p = 0,008. Peningkatan rerata kekuatan otot quadriceps pada kelompok kontrol dan perlakuan masing- masing sebesar 3,44±0,71 kg dan 5,66±1,71 kg, dan didapatkan perbedaan signifikan dengan nilai p< 0,001. Peningkatan rerata nilai kuesioner KOOS pada kelompok kontrol dan perlakuan masing-masing sebesar 12,92±3,51 dan 17,02±5,59, dan didapatkan perbedaan signifikan dengan nilai p=0,023. Diperlukan penelitian lebih lanjut untuk menilai efektivitas elastic taping dalam jangka waktu yang lebih lama serta untuk membandingkan efektivitas aplikasi elastic taping pada otot quadriceps antara metode dua taping dengan tiga taping untuk melihat perbandingan penurunan intensitas nyeri.

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This thesis was aimed to determine the effectiveness of elastic taping on pain intensity, quadriceps muscle strength and knee function status in obese patients with knee osteoarthritis. The study used an experimental randomized control trial design. The subjects were overweight and obese patients with knee osteoarthritis, which was divided into 2 groups: control and intervention groups. All subjects from both groups received standard exercises: aerobic exercise with ergocycle, quadriceps and hamstring muscle strengthening exercises with NK tables and balance exercises with balance board in accordance with procedures at the Obesity Polyclinic, Department of Medical Rehabilitation of RSCM Jakarta, which was conducted 2x/week for 2 weeks. The intervention group received an application of 3 elastic taping with 40-50% stretched, while the control group received an application of elastic taping with the same mounting direction but without stretching. Installation of elastic taping is done 3 times in 2 weeks. The results of this study include pain intensity based on VAS values, quadriceps muscle strength measured using a handheld dynamometer and KOOS questionnaire assessment before, after 1 week and after 2 weeks of elastic taping application. Statistical analysis was performed to compare changes in VAS values, quadriceps muscle strength and KOOS questionnaire values after the intervention in the control and intervention groups. The results stated that the application of elastic taping as an adjunct therapy was effective in reducing the value of VAS, increasing quadriceps muscle strength, and the value of the KOOS questionnaire in overweight and obese patients with knee osteoarthritis after 2 weeks of intervention. Improvements to the median VAS values in the control and intervention groups were 3 (1-4) and 2 (1-3), respectively, and a significant difference was obtained with p value 0.008. The mean increase in quadriceps muscle strength in the control and intervention groups was 3.44± 0.71 kg and 5.66 ± 1.71 kg, respectively, and a significant difference was obtained with p value <0.001. The increase in the average value of the KOOS questionnaire in the control and intervention groups was 12.92 ± 3.51 and 17.02 ± 5.59, respectively, and a significant difference was obtained with p value 0.023. Further research is needed to assess the effectiveness of elastic taping over a longer period of time and to compare the effectiveness of the application of elastic taping in the quadriceps muscle between the two taping and three taping methods to see a comparison of the decrease in pain intensity."

"Obesitas merupakan suatu trend yang semakin banyak di dunia. Hal ini terjadi karena banyak faktor seperti junk food, globalisasi, dan penurunan aktivitas fisik. Obesitas sendiri merupakan faktor terbesar terjadinya Osteoartritis (OA) lutut. Otot quadriceps adalah salah satu otot yang melindungi sendi lutut. Pasien OA lutut ditemukan memiliki kelemahan otot quadriceps. Hubungan antara obesitas dan OA lutut serta hubungan antara OA lutut dengan kekuatan otot quadriceps sudah banyak diteliti, namun hubungan antara IMT dan kekuatan otot quadriceps masih belum jelas. Penelitian ini diadakan dengan tujuan untuk mengetahui hubungan antara Indeks Massa Tubuh (IMT) dengan kekuatan otot quadriceps pada pasien obesitas dengan OA lutut. Penelitian ini menggunakan desain studi cross-sectional secara analitik. Populasi subjek penelitian merupakan pasien obesitas dengan OA lutut di poli Rehabilitasi Medik RSCM. Data subjek penelitian diambil dari rekam medis elektronik lalu diskrining menggunakan kriteria eligibilitas sehingga didapatkan 18 subjek penelitian berdasarkan jumlah minimum sampel. Analisis data digunakan korelasi spearman di software SPSS. Hubungan dinyatakan bermakna secara statistik apabila p<0.05. Proses analisis data dengan korelasi spearman pada variabel Indeks Massa Tubuh (IMT) dan kekuatan otot quadriceps menghasilkan nilai p<0.05 dengan nilai rho -0,498. Hasil dari analisis data menunjukkan bahwa terdapat inverse correlation antara Indeks Massa Tubuh (IMT) dan kekuatan otot quadriceps yang bermakna secara statistic, maka semakin besar IMT seseorang, semakin lemah kekuatan otot quadriceps subjek pada populasi pasien obesitas dengan OA lutut.

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Obesity is an increasing trend in today’s world. This happens because various factors such as increase in availability of junk food, globalization, and decrease in physical activity. Obesity is one of the biggest risk factor for knee OA. Quadriceps muscle is one of the muscle that protects the knee joint. There is a lot of findings of weakening in quadriceps muscle strength in knee OA patients. There is a lot of evidence for the correlation of obesity and knee OA, there is also a lot of evidence for the correlation of knee OA and quadriceps muscle strength, but there is very little evidence for the correlation between BMI and quadriceps muscle strength. This study is made to find the correlation between BMI and quadriceps muscle strength in obese patients with knee OA. This study has an analytic cross-sectional design. The population of this study’s subject is obese patients with knee OA in the Department of Medical Rehabilitation of dr. Cipto Mangunkusumo Hospital. Subject’s data is acquired through electronic medical records and then screened using a particular eligibility criteria. This study acquired 18 subjects according to the minimum study sample. Data was analysed using spearman correlation in SPSS software. The correlation is stated statistically significant if p<0,05. Data analysis using spearman correlation to search for the correlation between BMI variable and quadriceps muscle strength variable shows a result with p<0.05 and a rho of -0,498. Based on the results of data analysis, it can be concluded that there is an inverse correlation between BMI and quadriceps muscle strength that’s statistically significant. Therefore, in obese patients with knee OA, the higher the BMI means the lower the strength of quadriceps muscle is."

"Latar Belakang : Obesitas diketahui terkait dengan berbagai gangguan kesehatan di antaranya sistem muskuloskeletal, yaitu Osteoarthritis OA lutut yang menyebabkan nyeri sehingga terjadi penurunan aktivitas dan berdampak pada penurunan kekuatan otot lutut yang pada akhirnya menurunkan kapasitas fungsional seseorang. Penatalaksanaan meliputi edukasi dan terapi latihan merupakan hal penting namun terkadang ada kendala untuk melakukan latihan di darat. Penelitian ini bertujuan untuk membandingkan pengaruh latihan di air dan di darat pada penderita obesitas dengan Osteoarthritis OA lutut terhadap penurunan intensitas nyeri dan peningkatan kekuatan otot lututMetode : Quasi experimental terhadap subjek obesitas dan OA lutut usia 40 ndash; 80 tahun dengan sedentary lifestyle PAL

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Background: Obesity is well known to be associated with various health problems, some of which includes musculoskeletal system, such as knee osteoarthritis OA that causes pain, and thus resulting in decreased activity. These would cause an impact to decrease the knee muscle strength, which ultimately lowers the functional capacity of an individual. Management that includes education and exercise therapy are deemed to be important, however often there are obstacles in doing exercises on land. This study aims to compare the effects of water versus land based exercise for obese patients with knee osteoarthritis OA to reduce pain intensity and improve knee muscle strength.Methods Quasi experimental on obesity and knee OA subjects, age ranging from 40 80 years with sedentary lifestyle PAL "

"Tujuan: Mengetahui perbandingan efek latihan isokinetik dan isometrik terhadap nyeri, kekuatan otot dan kemampuan fungsional pada pasien osteoarthritis lutut. Disain: Eksperimental paralel. Subjek: 28 orang pasien berusia antara 50-64 tahun, dibagi secara acak menjadi dua kelompok. Tempat: Bagian Ilmu Kedokteran Fisik dan Rehabilitasi. Perjan RS Dr. Hasan Sadikin. Bandung. Intervensi: Pasien menjalani program latihan isokinetik atau isometrik selama 6 minggu. Parameter: VAS, peak torque, indeks Lequesne yang diukur setiap minggu. Hasil: Kedua kelompok menunjukkan penurunan yang bermakna pada intensitas nyeri (p<0,001) dan indeks Lequesne (p<0,001), juga peningkatan yang bermakna pada peak torque (p<0,001) setelah 6 minggu. Tidak terdapat perbedaan yang bermakna antara kedua kelompok. Kesimpulan: Kedua jenis latihan berguna pada pasien osteoarthritis berusia lanjut Pada kelompok isokinetik tidak didapatkan subjek yang mengeluh nyeri yang bermakna.

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Objective: To compare the effect of isokinetic and isometric strengthening exercise on pain, strength and functional capacity of patients with knee osteoarthritis.

Design: Experimental parallel.

Participants: 28 patients, age 50-64 years, were randomly assigned into two groups.

Setting: Department of Physical Medicine and Rehabilitation. Hasan Sadikin Hospital Bandung.

Interventions: Patients received either a regimen of isokinetic exercise or a regimen of isometric exercise for 6 weeks.

Main outcome measure : VAS, peak torque and Lequesne index were measured each week.

Result: Both training groups showed significant decrease in pain score (pc0, 001) and Lequesne index (p<0, 001) and an increase in peak torque (p<0,001). However there is no significant difference of those parameters between groups.

Conclusion: Both exercises can benefit elderly patients with knee osteoarthritis as shown by the increase of strength and functional capacity. In the isokonetic group there were no subjects who experienced an increase in pain."

"Latar Belakang Osteoartritis (OA) merupakan kondisi degeneratif sendi kronis yang umum terjadi di seluruh dunia, termasuk Indonesia. Nyeri adalah gejala predominan OA yang memengaruhi kualitas hidup pasien. Penyebab OA bersifat multifaktorial dan berat badan berlebih ataupun obesitas merupakan faktor risiko OA yang dapat diubah dan paling berpengaruh. OA bersifat nonreversibel sehingga tata laksananya saat ini berfokus pada manajemen rasa nyeri yang ditimbulkan. Penelitian ini utamanya bertujuan untuk mengetahui hubungan indeks massa tubuh dengan nyeri lutut pada pasien obesitas dengan osteoartritis genu. Metode Penelitian ini dilakukan dengan desain studi potong lintang analitis. Populasi penelitian merupakan pasien obesitas dengan osteoartritis lutut di Indonesia. Data subjek penelitian didapatkan dari rekam medis pasien yang menjalani rehabilitasi di Poli Rehabilitasi Medik RSCM. Hasil data dianalisis dengan menggunakan uji Kolmogorov-Smirnov untuk uji normalitas data. Analisis hubungan variabel dilakukan dengan menggunakan uji Spearman. Hubungan dinyatakan bermakna apabila p<0.05. Hasil Hubungan indeks massa tubuh dengan nyeri lutut memiliki nilai p<0.001 dan nilai r=0.457. Kesimpulan Rerata indeks massa tubuh pasien obesitas dengan osteoartritis genu Poli Rehabilitasi Medik RSCM adalah 30.17 kg/m2. Rerata skor nyeri lutut yang dialami pasien adalah 3.9 dengan semua pasien mengalami nyeri. Terdapat hubungan bermakna antara indeks massa tubuh dan nyeri lutut pada pasien obesitas dengan osteoartritis genu.

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Introduction Osteoarthritis (OA) is a common chronic degenerative joint condition that occurs worldwide, including in Indonesia. Pain is the predominant symptom of OA that affects the quality of life of patients. The causes of OA are multifactorial, and excess body weight or obesity is a modifiable and influential risk factor for OA. OA is nonreversible, so current management focuses on addressing the pain it causes. The main aim of this study is to determine the relationship between body mass index and knee pain in obese patients with knee osteoarthritis. Method This research was conducted with an analytical cross-sectional study design. The study population consisted of obese patients with knee osteoarthritis in Indonesia. Subject data were obtained from the medical records of patients undergoing rehabilitation at the Medical Rehabilitation Clinic of RSCM. Data results were analyzed using the Kolmogorov-Smirnov test for data normality. Variable relationships were assessed using the Spearman test. The relationship was considered significant when p<0.05. Results The relationship between body mass index and knee pain has a p-value of <0.001 and an r-value of 0.457. Conclusion The mean body mass index of obese patients with knee osteoarthritis at the Medical Rehabilitation Clinic of RSCM is 30.17 kg/m2. The mean knee pain score experienced by patients is 3.9, with all patients experiencing pain. There is a significant relationship between body mass index and knee pain in obese patients with knee osteoarthritis."

"Latar Belakang : Otot Kuadrisep pada penderita Osteoarthritis lutut disekitar sendi lutut sering mengalami atrofi, penurunan kekuatan serta fungsi sebagai stabilitas sendi terutama sendi penumpu berat badan. Terapi latihan merupakan salah satu bentuk rehabilitasi untuk peningkatan kekuatan otot sekitar sendi, yang mengalami kelemahan karena nyeri dan tidak digunakan. Volume latihan yang tinggi dapat menyebabkan kerusakan struktural otot skeletal. Secara struktural latihan yang menyebabkan kelemahan sarkomer akibat dari robeknya membran dan rendahnya kadar protein intraseluler (Kreatin Kinase) karena masuk ke dalam aliran darah. Semakin tinggi intensitas latihan penguatan otot semakin tinggi pula terjadinya risiko kerusakan otot, akan tetapi semakin rendah intensitas penguatan otot semakin kurang efektivitas pencapaian penguatan otot. Tujuan : Untuk mengetahui efektivitas latihan penguatan otot intensitas rendah dan sedang untuk mencapai kekuatan otot Kuadrisep dan fungsi yang optimal pada penderita OA lutut serta tidak menyebabkan kerusakan otot yang bermakna. Populasi dan Sampel : Semua pasien OA lutut usia 50-65 tahun di poliklinik Muskuloskeletal Departemen Rehabilitasi Medik RSCM dengan nyeri lutut VAS < 4 dan klinis (kriteria ACR) serta memenuhi kriteria penerimaan. Metode : Dilakukan pengukuran kekuatan otot Kuadrisep dengan dinamometer jinjing, kecepatan jalan 15 meter (detik), dan kadar serum enzim Kreatin Kinase sebelum dan setelah latihan. Responden dibagi menjadi 2 kelompok intensitas ringan (40% dari 10 RM) dan sedang (60% dari 10 RM) dilakukan latihan penguatan otot Kuadrisep isotonik dengan menggunakan NK table 3 set 10 repetisi, frekuensi 3 x/minggu selama 8 minggu dengan kenaikan beban bertahap setiap minggu. Hasil : Terdapat perbedaaan bermakna peningkatan sebesar 27,2 % kekuatan otot Kuadrisep setelah diberikan latihan intensitas ringan (p=0,001) dan sebesar 27,94 % (p <0,001) latihan intensitas sedang. Didapatkan penurunan waktu jalan 15 meter sebesar 39,9 % pada intensitas ringan (p=0,03) dan penurunan sebesar 47,37% pada intensitas sedang (p=0,007). Kedua kelompok tidak menunjukkan perbedaan bermakna pada kekuatan otot, kecepatan jalan, dan kadar enzim Kreatin Kinase. Kesimpulan : Latihan kekuatan otot Kuadrisep intensitas ringan dan sedang efektif mencapai kekuatan otot dan fungsi yang optimal tanpa menyebabkan kerusakan otot yang bermakna.

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Background : Osteoarthritits is rheumatoid disease mostly occurs in knee joint. Quadricep muscle around joint frequently athrophy, reduce strengthening, and functioning as stability joint especially as a role weight bearing joint so that occur deformity and worsen disease. Therapeutic exercise is one of rehabilitation treatment to enhance muscle strengthening around joint that become weakness due to pain and inactivity. Therefore it is important to make exersie prescription to achieve optimal result. High intensity exercise may cause structural damage skeletal muscle. This damage may lead muscle soarness, edema, and weakness. In structural, exercise can lead fraility of sarcomer consequence disruption of membrane and reduction level of protein intraceluller (Creatine Kinase) into bloodstream. Higher intensity of exercise will cause high risk of injury, however lower of intensity of muscle strengthening increasing less effective achievement of muscle strength. Ideally training given to the patient is an effective muscle-strengthening exercises to achieve optimal muscle strength and functional improvement achieved in the absence of muscle damage.

Objective : to find effetctivity of strengthening exercises low and moderate intensity to achieve Quadriceps muscle strength and optimal functional in patient with knee OA without causes significantly muscle damage.

Subject : All of knee OA patient at Inpatient of Musculoskeletal Rehabilitation Departement-Medical Faculty of Indonesia - Cipto Mangunkusumo Hospital, age 50-65 years with knee pain VAS < 4, clinical according American College of Rheumatology, and require inclusion criteria.

Method : Pre and Post Experimental, measurement of Quadriceps muscle strengthening with Hand held Dynamometer before and after exercise, time of walking speed on 15 metre (second), and creatine Kinase enzyme in blood serum. Subject divide to be 2 group, low intensuty (40% of 10 RM) and moderate (60% of 10 RM). Isotonic Quadricep strengthening exercise with NK table, 3 set 10 repetion 3 times in week during 8 week that intensity gradually increase each week.

Result : The study found that significantly increase of 27,2 % muscular strength Quadricep that having given a low intensity exercise ( p = 0,001 ) and significantly increase of muscular strength 27,94 % ( p < 0,001 ) in moderate intensity exercise . Decline significantly time of walking speed on 15 meters of 39,9 % in group low intensity (p = 0.03) and 47,37 % in moderate intensity (p = 0,007). Both of groups did not show the difference activity of Creatine Kinase.This study indicated no difference significantly exercise of muscular strengthen in both groups low and moderate intensity (p = 0,410 ).There was not significantly difference time walking speed both of group (p = 0,514). There were no significantly differences levels of enzyme Creatine kinase in both groups.

Conclusion: Quadriceps muscle exercise low and moderate intensity effective achieve muscle’s strength and functional optimal without causes significantly muscle damage."

"Nyeri merupakan gejala utama pada pasien dengan Osteoartritis OA , dan berdampak terhadap gangguan fungsional serta penurunan kualitas hidup. Latihan isometrik kuadrisep dan Jalan kaki dapat menjadi alternatif latihan pada pasien OA lutut untuk mengurangi keluhan nyeri. Penelitian ini bertujuan untuk mengidentifikasi perbandingan efektifitas jalan kaki dan latihan isometrik kuadrisep terhadap nyeri dan rentang gerak sendi pada pasien dengan osteoartritis lutut. Desain penelitian menggunakan quasi-experimental design dengan pendekatan non equivalent control group before - after. Jumlah sampel terdiri dari 17 responden pada masing-masing kelompok dengan teknik consecutive sampling. Hasil penelitian menunjukkan bahwa latihan jalan kaki efektif menurunkan nyeri dan meningkatkan rentang gerak sendi pasien OA lutut p 0.000. Latihan isometrik kuadrisep efektif menurunkan nyeri dan meningkatkan rentang gerak sendi fleksi lutut pasien OA lutut p 0.000. Namun setelah dibandingkan kedua latihan tersebut menunjukkan bahwa latihan jalan kaki tidak lebih efektif menurunkan nyeri dan meningkatkan rentang gerak sendi fleksi lutut daripada latihan isometrik kuadrisep pada pasien OA lutut p 0.000. Perlu dibuat protap latihan jalan kaki dan latihan isometrik kuadrisep yang terprogram. Pasien dengan obesitas dan derajat OA sedang bisa diarahkan dengan pilihan latihan isometrik kuadrisep. Sedangkan pasien dengan berat badan normal atau indeks masa tubuh kurang dan OA derajat ringan, bisa diarahkan pada latihan jalan kaki, serta pemberian edukasi gaya hidup agar kualitas hidup menjadi lebih baik.

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Pain is known as the main symptom of Osteoarthritis OA which affect on the functional impairment and patient rsquo s quality of life. Alternatively, isometric quadriceps exercise and walking exercise could be employed to reduce the pain among knee OA patients. This study aimed to identify the comparison between walking exercise and isometric quadriceps exercise on pain and joint range of motion in knee osteoarthritis patients. This research was used quasi experimental with non equivalent control group before - after design. The experimental and control group, involved 17 respondents respectively with consecutive sampling technique.

The results showed the walking exercise is significantly reduce pain and increase knee flexion range of motion p 0.000. Similarly, the isometric quadriceps exercise is significantly decrease pain and increase knee flexion range of motion p 0.000. Nevertheless, after being compared showed that walking exercise is no more effective reduce pain and increase knee flexion range of motion rather than isometric quadriceps exercise in knee osteoarthritis patients. A standard operational procedure for walking exercise and isometric quadriceps exercise is programmed. Patients with obesity and moderat OA can be directed by choice of isometric quadriceps exercises. While patients with normal weight or less body mass index and mild OA, can be directed to walking exercise, as well as providing lifestyle education for better quality of life."

"Latar Belakang: Osteoartritis (OA) lutut seringkali menyebabkan disabilitas akibat nyeri dan penurunan kemampuan fungsional berjalan. Low Level Laser Therapy (LLLT) dan High Intensity Laser Therapy (HILT) telah terbukti mampu menurunkan nyeri dan kemampuan fungsional pada OA lutut, namun hingga saat ini belum ada penelitian di Indonesia yang membandingkan kedua modalitas tersebut.Tujuan: Mengetahui perbedaan efek LLLT dan HILT terhadap derajat nyeri dan kemampuan fungsional pasien OA lutut.Metode: Studi ini merupakan uji klinis acak terkontrol tersamar ganda yang melibatkan 61 subjek yang diacak ke dalam kelompok LLLT (n=31) dan HILT (n=30). Subjek adalah pasien OA lutut di Poliklinik Muskuloskeletal Departemen Rehabilitasi Medik RSUPN Cipto Mangunkusumo dengan VAS ≥ 4 dan mampu berjalan 15 meter. Terapi laser diberikan 3 kali seminggu selama 2 minggu. Derajat nyeri dinilai dengan VAS dan kemampuan fungsional dinilai dengan uji jalan 15 meter.Hasil: Setelah 6 kali terapi, didapatkan penurunan VAS kelompok LLLT dan HILT sebesar 3 (2 – 4) dan 3 (2 – 5) serta peningkatan kecepatan berjalan sebesar 0,23(0,02 – 1,24) meter/detik dan 0,22 (0,08 – 0,7) meter/detik) yang bermakna secara statistik (p<0,001) maupun secara klinis. Pada perbandingan antar kelompok didapatkan kelompok HILT mengalami penurunan VAS yang lebih cepat dan lebih besar dibanding kelompok LLLT (p<0.001), namun tidak didapatkan perbedaan perubahan kecepatan berjalan yang bermakna antara kedua kelompok (p=0,655).Simpulan: Pemberian HILT pada pasien OA lutut mampu menurunkan derajat nyeri dengan lebih cepat dan lebih besar dibandingkan dengan pemberian LLLT.

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Background: Osteoarthritis (OA) of the knee causes disability due to pain and decreased functional ability to walk. The degree of pain will affect the functional ability to walk. Low Level Laser Therapy (LLLT) has been shown to reduce pain in knee OA, while High Intensity Laser Therapy (HILT) is able to reach deeper joint areas.

Aim: To compare the differences of LLLT and HILT on pain and functional capacity knee OA.

Methods: This is a double-blind randomized controlled trial with 61 subjects randomized into LLLT (n=31) and HILT (n=30) groups . Subject was knee OA patient with VAS ≥ 4 in Muskuloskeletal Polyclinic of Medical Rehabilitation RSUPN Cipto Mangunkusumo. Laser therapy was given 3 times per week for 2 weeks. Pain measured with VAS and functional capacity evaluated with 50-feet walk test.

Result: After 6 therapy sessions, both LLLT and HILT group showed reduced VAS score [LLLT = 3 (2 – 4), HILT = 3 (2 – 5)] and increased walking speed (LLLT =

0.23 (0.02 – 1.24) m/s, HILT = 0.22 (0.08 – 0.7) m/s) which was statistically (p<0.001) and clinically significant. HILT group had faster and greater VAS reduction compared to LLLT group (p<0.001), but there was no significant difference in walking speed between the two groups (p=0.655).

Conclusion: HILT and LLLT combined with exercise were effective in reducing pain and increasing functional capacity in knee OA patient after 6 sessions of treatment. Pain improvement was faster and greater in HILT group than LLLT group.

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"Tesis ini disusun untuk mengetahui efektivitas latihan back exercise dan yoga terhadap intensitas nyeri, meningkatkan kekuatan otot trunk dan disabilitas fungsional. Penelitian menggunakan desain uji eksperimental Randomized Control Trial. Subjek penelitian merupakan pasien overweight dan obesitas derajat I dengan nyeri punggung bawah mekanik kronik, yang dibagi menjadi 2 kelompok yaitu kelompok back exercise dan yoga. Semua subjek dari kedua kelompok mendapatkan latihan standar berupa latihan aerobik dengan ergocycle sesuai dengan prosedur di Poliklinik Obesitas Departemen Rehabilitasi Medik RSCM Jakarta yang dilakukan dua kali seminggu selama enam minggu. Sebagai tambahan, kelompok back exercise mendapatkan latihan senam punggung dan kelompok yoga mengikuti kelas yoga yang dilakukan 45 menit per sesi, dua kali seminggu, selama enam minggu. Hasil keluaran penelitian ini berupa skala nyeri (Visual Analogue Scale), kekuatan otot fleksor dan ekstensor trunk yang diukur menggunakan handheld dynamometer dan disabilitas fungsional (Oswestry Disability Index). Analisis statistik dilakukan untuk membandingkan perubahan intensitas nyeri, kekuatan otot trunk, dan disabilitas fungsional sesudah intervensi pada kelompok perlakuan dan kontrol. Hasil penelitian menyatakan bahwa tidak terdapat perbedaan intensitas nyeri, kekuatan otot trunk, dan disabilitas fungsional setelah intervensi diberikan selama enam minggu. Median selisih total penurunan VAS pada kelompok back exercise dan yoga masing-masing sebesar 2 (1-3) dan tidak didapatkan perbedaan signifikan dengan nilai p = 0,054. Rerata peningkatan kekuatan otot fleksor trunk pada kelompok back exercise dan yoga masing-masing sebesar 4.45±2.84 kg dan 5.91±2.20 kg dan tidak didapatkan perbedaan signifikan dengan nilai p = 0,139. Rerata peningkatan kekuatan otot ekstensor trunk pada kelompok back exercise dan yoga masing-masing sebesar 7.56±3.73 kg dan 7.06±3.97 kg dan tidak didapatkan perbedaan signifikan dengan nilai p = 0,520. Rerata perubahan skor ODI pada kelompok back exercise dan yoga masing-masing sebesar 4.64±4.11 dan 4.57±4.33 dan tidak didapatkan perbedaan signifikan dengan nilai p = 0,965. Dapat disimpulkan bahwa back exercise dan yoga memiliki efektivitas yang sama dalam menurunkan nyeri, meningkatkan kekuatan otot trunk dan mengurangi disabilitas fungsional pasien overweight dan obesitas derajat I dengan nyeri punggung bawah mekanik kronik. Diperlukan penelitian lebih lanjut untuk menilai efektivitas latihan back exercise dan yoga terhadap aktivitas otot trunk secara lebih spesifik menggunakan Surface Electromiography (sEMG) yang menggambarkan rekruitmen motor unit otot.

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This thesis was aimed to determine the effectiveness of back exercise and yoga exercises on pain intensity, increase trunk muscle strength and functional disability. The study used an experimental randomized control trial design. The subjects were overweight and obese patients with chronic mechanical low back pain, which were divided into 2 groups: back exercise and yoga. All subjects from the two groups received standard training in the form of aerobic exercise with ergocycle in accordance with the procedures at the Obesity Polyclinic of the Department of Medical Rehabilitation at the RSCM Hospital, which was conducted 2x / week for 6 weeks. In addition, the back exercise group received back exercises and the yoga group attended a yoga class conducted 45 minutes / session, 2x / week, for 6 weeks. Statistical analysis was performed to compare changes in pain intensity (Visual Analogue Scale), trunk muscle strength (using handheld dynamometer), and functional disability (Oswestry Disability Index) after the intervention in the treatment and control groups. The results of the study stated that there were no differences in pain intensity, trunk muscle strength, and functional disability after the intervention was given for 6 weeks. The median difference in total VAS reduction in the back exercise and yoga groups was 2 (1-3) respectively and no significant difference was found with a value of p = 0.054. The mean increase in flexor trunk muscle strength in the back exercise and yoga groups was 4.45 ± 2.84 kg and 5.91 ± 2.20 kg, respectively, and no significant difference was found with a value of p = 0.139. The mean increase in extensor trunk muscle strength in the back exercise and yoga groups was 7.56 ± 3.73 kg and 7.06 ± 3.97 kg and no significant difference was found with the p value = 0.520. The mean changes in ODI scores in the back exercise and yoga groups were 4.64 ± 4.11 and 4.57 ± 4.33, respectively, and there were no significant differences with p = 0.965. It can be concluded that back exercise and yoga have the same effectiveness in reducing pain, increasing trunk muscle strength and reducing functional disability of overweight and obese patients with degree I with chronic mechanical low back pain. Further research is needed to assess the effectiveness of back exercise and yoga exercises on trunk muscle activity more specifically using Surface Electromiography (sEMG) which illustrates the recruitment of motor muscle units."