Pengaruh fisioterapi terhadap perbaikan rasa nyeri pada penderita osteoartritis lutut yang mendapat terapi parasetamol

TAUFIQURROKHMAN, dr. Nyoman Kertia, SpPD-KR

2006 | Tesis | PPDS I Ilmu Penyakit Dalam

Latar belakang. Osteoartritis (OA) lutut adalah penyakit yang disebabkan oleh berbagai macam etiologi tetapi mempunyai gambaran biologi, morfologi dan klinis yang serupa. Penyakit ini tidak saja mengenai kartilago sendi, tetapi juga melibatkan tulang subkondral, ligamentum, kapsul, membran sendi dan otot periartikuler. Keluhan utama pada penderita OA adalah nyeri dan disabilitas fisik. Pada penderita OA lutut sering didapatkan kelemahan otot ekstremitas bawah terutama otot kuadrisep dan derajat kelemahan berhubungan dengan derajat nyeri dan besarnya disabilitas. Tujuan. Membandingkan antara kombinasi fisioterapi dan parasetamol dengan parasetamol terhadap pengurangan rasa nyeri pada penderita OA lutut. Metode. Penelitian uji klinik secara acak terhadap penderita OA lutut dengan derajat nyeri sedang di Poli Penyakit Dalam RS. Dr. Sardjito Yogyakarta. Penderita OA lutut diacak secara random menjadi 2 kelompok. Kelompok coba (17 penderita) mendapat kombinasi fisioterapi dan parasetamol. Kelompok kontrol (19 penderita) mendapat parasetamol. Fisioterapi dilakukan di Poli Rehabilitasi Medik dengan fisioterapi secara isometrik 3 kali perminggu dan dosis parasetamol 3 kali sehari 500 mg selama 4 minggu. Intensitas nyeri dinilai dengan VAS 100 mm sebelum dan setelah terapi. Hasil. Didapatkan perbedaan yang bermakna rerata intensitas nyeri sebelum dan setelah perlakuan pada kelompok coba sebesar 36,65 ± 5,134 mm (p < 0,0001; KI 95% 32,14–41,15) dan kelompok kontrol sebesar 28,84 ± 8,760 mm (p < 0,0001; KI 95% 26,37–31,32). Penurunan rerata intensitas nyeri pada kelompok coba berbeda secara bermakna dibandingkan kelompok kontrol (p=0,002; KI 95% 3,004–12,606) setelah 4 minggu terapi. Tidak didapatkan efek samping yang bermakna akibat terapi parasetamol. Simpulan. Terdapat perbaikan intensitas nyeri yang bermakna pada penderita OA lutut yang mendapat terapi kombinasi fisioterapi dan parasetamol 500 mg 3 kali perhari dibandingkan dengan parasetamol 500 mg 3 kali selama 4 minggu terapi.

Background: Osteoarthrtitis (OA) of the knee is a disease caused by several etiologies but similar biology, morphology and clinical presentation. It doesn’t only affect joint cartilage, but also subcondral bone, ligament, capsule, membrane of joint and periarticular muscles. Chief complaint in OA of the knee patients is pain and physical disability. In OA of the knee patients, there is lower limb weakness, particularly quadriceps muscles and weakness severity is related to pain and disability. Objective: To compare the combination of physiotherapy and paracetamol with paracetamol alone in OA of the knee. Methods: This study is a randomized controlled trial in OA of the knee in patients with moderate pain in Internal Medicine Department Outpatients Clinic, Dr. Sardjito Hospital, Yogyakarta. Patients were randomly divided into 2 groups. Treatment group (17 patients) took physiotherapy and paracetamol. Control group (19 patients) took paracetamol only. Physiotherapy was performed in Medical Rehabilitation Clinic with isometric exercise three times weekly and paracetamol 500 mg three times daily for 4 weeks. Pain intensity was measured by visual analogue scale (VAS) 100 mm before and after treatment. Result: There was significant decrease in the mean of pain intensity before and after treatment between treatment and control groups as much as 6.65 ± 5.134 mm (95% CI 32.14 to 41.15; p < 0.0001) and 28.84 ± 8.760 mm (95% CI 26.37 to 31.32; p < 0.0001), respectively. The decrease of pain intensity was significantly different between two goups (95% CI 3.004 to 12.606; p=0.002) after 4 weeks of treatment. No serious adverse events were attributable resulted from paracetamol treatment. Conclusion: Pain intensity in OA of the knee patients who took paracetamol 500 mg three times daily and physiotherapy improved significantly than paracetamol only for 4 weeks of treatment.

Kata Kunci : Osteoartritis Lutut,Nyeri,Fisioterapi,Parasetamol, knee osteoarthritis, pain, VAS, physiotherapy, paracetamol