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"ABSTRAKSaat ini terdapat perbaikan Angka Harapan Hidup (AHH) penduduk Indonesia dan penambahan populasi penduduk lanjut usia. Pada tahun 2017, AHH mencapai 71,06 tahun, dan jumlah lansia 23,4 juta orang (8,97% dari seluruh penduduk Indonesia). Hal ini berisiko meningkatkan kejadian penyakit degeneratif. Osteoartritis (OA) adalah penyakit yang sering dikaitkan dengan kondisi degeneratif dan mengakibatkan ketidakaktifan fisik. Pada Riskesdas 2013, penyakit Artritis berada di urutan kedua penyakit terbanyak diderita lansia dengan prevalensi 45% (55-64 tahun), 51,9% (65-74 tahun) dan 54,8% (usia >75 tahun). Pengobatan simtomatik dengan OAINS yang berkepanjangan dapat mengakibatkan efek samping yang fatal. Terdapat berbagai faktor risiko berkembangnya OA lutut, di antaranya konsentrasi serum Vitamin D (25(OH)D. Proporsi perempuan lansia dengan defisiensi 25(OH)D pada penelitian di Jakarta dan Bekasi mencapai 35,1%. Terdapat hubungan antara kadar Vitamin D (25(OH)D) yang rendah dengan nyeri lutut dan perubahan kartilago sendi lutut pada OA. Serum Cartilage Oligomeric Matrix Protein (COMP) merupakan produk degradasi penting dari kartilago sendi dan dapat menjadi marker diagnosis untuk OA lutut. Penelitian ini bertujuan mengetahui pengaruh pemberian suplemen Vitamin D (Alphacalcidol) selama 12 minggu terhadap derajat nyeri berdasarkan indikator WOMAC, dan kondisi obyektif kartilago sendi dengan perubahan marker serum COMP pada penderita OA lutut lansia. Disain penelitian uji klinis teracak, tersamar ganda, dan terkontrol plasebo. Subyek dengan OA lutut simtomatis direkruit secara consecutive sampling dan dilakukan anamnesis, diperiksa kondisi fisik, radiologi lutut, kadar serum Vitamin D (25(OH)D), serum Calcium dan marker COMP. Subyek dialokasikan secara acak (random allocation) pada kelompok perlakuan yang diberikan suplemen Vitamin D (Alphacalcidol) atau kelompok kontrol yang diberikan plasebo. Populasi sumber xviii Universitas Indonesia pada penelitian ini ialah pasien OA lutut lanjut usia yang berobat ke KPKM FKIK UIN Jakarta. Dari hasil pemeriksaan konsentrasi serum Vitamin D 25(OH)D sebelum dilakukan intervensi, 53,4% responden mengalami insufisiensi dan 12,3% responden mengalami defisiensi Vitamin D. Pemberian suplemen Vitamin D (Alphacalcidol) selama 12 minggu, mempengaruhi penurunan derajat nyeri berdasarkan indikator WOMAC pada penderita OA lutut lansia yang bermakna secara statistik dengan perbedaan perubahan skor pra dan pascaintervensi pada kelompok intervensi dibanding kontrol sebesar 2,174 (p=0,00). Pemberian suplemen Vitamin D (Alphacalcidol) selama 12 minggu, mempengaruhi penurunan konsentrasi serum COMP pada penderita OA lutut lansia, dengan perbedaan perubahan skor pra dan pascaintervensi pada kelompok intervensi dibandingkan kelompok kontrol sebesar 38,15 ng/ml namun tidak bermakna secara statistik (p=0,39)

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ABSTRACTAt present there are improvements in the Life Expectancy (AHH) of the Indonesian population and the addition of the elderly population. In 2017, AHH reached 71.06 yo and the number of elderly people reached 23.4 million people (8.97% of the total population of Indonesia). This has the potential to increase degenerative diseases. Osteoarthritis (OA) is a disease that is often associated with degenerative conditions and physical inactivity. Riskesdas in 2013 stated that Arthritis was the second most common disease suffered by the elderly with a prevalence of 45% (55-64 yo), 51.9% (65-74 yo) and 54.8% (>75 yo). Symptomatic treatment with prolonged NSAIDs can cause fatal side effects. There are various risk factors for developing knee OA, including serum Vitamin D (25(OH)D) concentrations. The proportion of elderly women with 25(OH)D deficiency in studies in Jakarta and Bekasi reaches 35.1%. It has been found an association between low Vitamin D levels (25(OH)D) with knee pain in OA and changes in the knee joint cartilage. Cartilage Oligomeric Matrix Protein (COMP) is an important degradation product of joint cartilage and can be act as a diagnostic marker of knee OA. This study aims to determine the effect of Vitamin D supplementation (Alphacalcidol) for 12 weeks on the degree of pain based on WOMAC indicators, and the objective conditions of joint cartilage with changes in COMP serum markers in patients with knee OA in the elderly. The research design is a randomized, double-blind, and placebo-controlled clinical trials. Subjects with symptomatic knee OA will be recruited by consecutive sampling and continued with history taking, physical conditions examinatons, knee radiology, and blood test for serum vitamin D (25(OH)D), serum calcium and marker COMP. Subjects were then randomly allocated to the treatment group given Vitamin D supplements (Alphacalcidol) or the control group given a placebo. The source population in this study was elderly with knee OA patients xx Universitas Indonesia who went to Primary Health Care Clinic (KPKM) of FKIK UIN Jakarta. We found that before intervention was done, 53.4% of respondents had Vitamin D insufficiency and 12.3% of respondents had Vitamin D deficiency. The administration of Vitamin D supplements (Alphacalcidol) for 12 weeks, influenced the decrease in the degree of pain based on the WOMAC indicator in knee OA of elderly patients significantly, with differences in changes in pre and post intervention scores of 2.174 compare with control (p=0.00). The administration of Vitamin D supplements (Alphacalcidol) for 12 weeks, affected the decrease in the serum concentration of COMP in knee OA of elderly patients, with differences in changes in pre and post intervention scores in the intervention group compared to the control group of 38.15 ng/ml but not statistically significant (p=0.39)."

"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: Sendi lutut adalah sendi yang paling sering terkena OA. Stabilitas dinamik sendi lutut dipengaruhi oleh otot-otot kuadrisep dan hamstring. Untuk mengoptimalkan gaya yang dihasilkan oleh otot, program latihan peregangan harus terintegrasi dalam program latihan penguatan pada OA. Namun, belum ada penelitian yang membandingkan efek berbagai teknik peregangan terhadap hasil latihan isotonik pada pasien OA lutut. Tujuan penelitian ini adalah untuk mengetahui apakah terdapat perbedaan efek teknik peregangan statik dibandingkan Proprioceptive Neuromuscular Facilitation PNF terhadap outcome visual analog scale VAS, lingkup gerak sendi LGS, kekuatan otot, dan kemampuan berjalan latihan penguatan isotonik otot kuadrisep dan hamstring pada pasien OA lutut. METODE: Desain penelitian ini adalah quasi experimental. Populasi terjangkau adalah wanita penderita OA lutut berusia 50 ndash; 70 tahun yang berobat ke Poliklinik Rehabilitasi Medik RSUPN Cipto Mangunkusumo Jakarta yang memenuhi kriteria penelitian. Pengambilan sampel dilakukan secara consecutive sampling dan dibagi menjadi dua kelompok secara randomisasi. Pada kelompok pertama, subjek diberi infra red radiation IRR, latihan peregangan statik, dan latihan isotonik otot kuadrisep dan hamstring. Pada kelompok kedua, subjek diberi IRR, latihan peregangan PNF, dan latihan isotonik otot kuadrisep dan hamstring. Intervensi dilakukan selama 6 minggu. Penilaian nyeri menggunakan skor VAS, LGS menggunakan goniometer, kekuatan otot menggunakan hand held dynamometer, dan kemampuan berjalan menggunakan uji jalan 15 meter. HASIL: Sebanyak 30 responden mengikuti program latihan sampai selesai, kelompok pertama dan kedua masing-masing 15 orang. Setelah 6 minggu, didapatkan perbaikan skor VAS, LGS, kekuatan otot kuadrisep dan hamstring serta uji jalan 15 meter dengan perbaikan bermakna didapatkan pada kekuatan otot hamstring pada kedua kelompok. Delta skor VAS dan uji jalan 15 meter lebih tinggi pada kelompok peregangan statik dibandingkan PNF tetapi tidak berbeda bermakna. Delta kekuatan otot kuadrisep didapatkan lebih tinggi pada kelompok peregangan statik dibandingkan PNF dan berbeda bermakna p=0.033 . Delta LGS dan kekuatan hamstring lebih tinggi pada kelompok peregangan PNF dibandingkan statik tetapi tidak berbeda bermakna. KESIMPULAN: Pemberian latihan peregangan statik maupun PNF tidak memberikan efek yang berbeda bermakna secara keseluruhan terhadap outcome latihan penguatan isotonik otot kuadrisep dan hamstring pada pasien OA lutut.

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BACKGROUND. Knee joints are the joints most commonly affected by OA. The dynamic stability of the knee joint is affected by the quadriceps and hamstring muscles. Stretching exercise programs should be integrated into strengthening exercise programs in OA to optimize the force that generated by the muscle. However, there have been no studies comparing the effects of various stretching techniques on the outcome of isotonic exercise in knee OA patients. The aim of this study was to find out whether there is a difference between the effect of static stretching compared to the Proprioceptive Neuromuscular Facilitation PNF to the outcomes visual analog scale VAS, range of motion ROM, muscle strength, and walking ability of quadriceps and hamstring muscle isotonic strengthening exercises in knee OA patients.

METHODS. The design of this study was quasi experimental. The study population is women suffering from knee OA aged 50-70 years who went to the Medical Rehabilitation Clinic RSUPN Cipto Mangunkusumo Jakarta that meet the criteria of the study. Sampling was done using consecutive sampling and divided into two groups by randomization. In the first group, subjects were given infra red radiation IRR, static stretching exercises, and isotonic exercises of quadriceps and hamstring muscles. In the second group, subjects were given IRR, PNF stretching exercises, and isotonic exercises of quadriceps and hamstring muscles. Intervention is done for 6 weeks. Pain assessment using VAS scores, ROM measurement using a goniometer, muscle strength measurement using a hand-held dynamometer, and walking ability measurement using a 50-feet walking test.

RESULTS. Thirty respondents were completed the exercise program, the first and second group consists of 15 people, respectively. After 6 weeks, the improvement of VAS, ROM, quadriceps and hamstring muscle strength and 50 feet walking test with significant improvement was obtained only hamstring muscle strength in both groups. Delta VAS scores and 50 feet walking test were higher in the static stretching group than PNF but not significantly different. Delta quadriceps muscle strength was significantly high er in the static stretch group than in PNF p = 0.033 . Delta ROM and hamstring muscle strength were higher in the PNF stretching group than in static but not significantly different.

CONCLUSIONS. There is no significant difference between the effect of static stretching techniques and the PNF on the outcomes visual analog scale VAS, range of motion ROM, muscle strength, and walking ability of quadriceps and hamstring muscle isotonic strengthening exercises in knee OA patients. "