Anda di halaman 1dari 48

“The Effect of Aromatherapy Massage on Knee Pain and Functional Status in

Participants with Osteoarthritis”

ANALISIS JURNAL

oleh :

Tria Mega Holivia


NIM 152310101141

KEMENTERIAN RISET, TEKNOLOGI, DAN PENDIDIKAN TINGGI


UNIVERSITAS JEMBER
FAKULTAS KEPERAWATAN
Jl. Kalimantan No. 37 Kampus Tegal Boto Jember Telp./Fax (0331) 323450
“The Effect of Aromatherapy Massage on Knee Pain and Functional Status in
Participants with Osteoarthritis”

ANALISIS JURNAL

disusun untuk memenuhi tugas Mata Kuliah Keperawatan Komplementer dengan


dosen pengampu Ns.Mulia Hakam,M.Kep.,Sp.Kep.MB

oleh :

Tria Mega Holivia


NIM 152310101141

KEMENTERIAN RISET, TEKNOLOGI, DAN PENDIDIKAN TINGGI


UNIVERSITAS JEMBER
FAKULTAS KEPERAWATAN
Jl. Kalimantan No. 37 Kampus Tegal Boto Jember Telp./Fax (0331) 323450
BAB 1. PENDAHULUAN

1.1 Latar Belakang


Osteoartritis merupakan bentuk/salah satu dari artritis yang paling umum dan sering
terjadi, dengan jumlah pasiennya sedikit lebih banyak dari jumlah pasien artritis.
Osteoartritis adalah penyakit sendi degeneratif yang progresif dimana tulang rawan
(kartilago) yang berfungsi untuk melindungi ujung tulang mulai rusak sehingga kehilangan
sifat kompresibilitasnya yang unik, disertai perubahan reaktif pada tepi sendi dan tulang
subkondral yang dapat menimbulkan rasa nyeri dan berkurang/hilangnya kemampuan
gerak (CDC, 2014).
Secara Global terdapat 9,6% laki-laki, dan 18,0% wanita di atas usia 60 tahun yang
mengalami osteoatritis simtomatik (WHO,2017). Di Amerika Serikat terdapat 30 juta orang
yang mengalami Osteoatritis (CDC,2017), dan 8 juta orang mengalami OA di Inggris.
Prevalensi OA sendiri dapat berbeda-beda berdasarkan usia,jenis kelamin,dan etnis. OA
akan terus meningkat seiring dengan bertambahnya usia, 80-90% pasien yang berusia 65
tahun keatas (Lozada.,C et al, 2017 ; Central For Disease Control (CDC) 2017 & National
clinic 2014)
Di Indonesia, angka kejadian osteoartritis masih cukup tinggi, yaitu mencapai 36,5
juta orang. Prevalensi terbesar terjadi pada usia lebih dari 75 tahun, sebesar 58,8%. Pada
usia 65-74 sebesar 51,9 %, usia 55-64 sebesar 45,0%, dan usia 45-54 sebesar 37,2 %
(RISKESDAS,2013). Secara khusus penderita osteoartritis di Indonesia berjumlah 65%
terjadi pada usia > 60 tahun dan diketahui bahwa sebanyak 80% mempunyai keterbatasan
gerak dalam berbagai derajat dari ringan sampai berat.
Sedangkan di Jawa Timur angka prevalensinya juga masih tinggi yaitu sekitar 27%
(Riskesdas,2017).
Terdapat beberapa teknik nonfarmakologi yang dapat digunakan untuk mengurangi
nyeri pada penderita Osteoatritis (OA) diantaranya yaitu , stimulasi kulit (message kutaneus
atau pijat,kompres panas atau dingin,akupuntur,stimulasi kontralateral),stimulasi elektrik
saraf kulit transkutan,teknik relaksasi, teknik distraksi, dan istirahat (Anas 2006 dalam
Indah Lestari___)
Pijat aromaterapi, merupakan suatu metode pemijatan yang dilakukan dengan
menggunakan minyak aromaterapi tertentu yang diolekan ke tubuh. Terapis biasanya
menggunakan satu atau lebih minyak esensial ke dalam minyak pijat, seperti lavender,
minyak kayu putih, atau minyak lainnya sesuai kebutuhan
Dari penjelasan diatas penulis Tertarik membahas pengontrolan nyeri OA
menggunakan terapi pijat aromaterapi.

1.2 Rumusan Masalah


Bagaimanakah efektivitas pengontrolan nyeri osteoatritis dengan menggunakan pijat
aromaterapi ?

1.3 Tujuan

Untuk mengetahui pengontrolan nyeri lutut pada penderita osteoatritis dengan


menggunakan pijat aromaterapi
BAB 2. TINJAUAN PUSTAKA

2.1 Pijat Aromaterapi


2.1.1 Pengertian Pijat
Menurut Lee (2009)Pijat adalah terapi sentuh tertua yang dikenal manusia dan yang
paling populer. Pijat adalah alat pengobatan sederhana yang efektif untuk
menghilangkan sakit pada tubuh, mengurangi stress, dan memacu relaksasi
Pijat juga diartikan sebagai seni perawatan kesehatan dan pengobatan yang
dipraktekkan sejak berabad – abad silam lamanya. Bahkan ilmu ini telah dikenal
sejak awal manusia diciptakan di dunia.
2.1.2 Jenis-Jenis Pijat
Dalam buku yang ditulis Adji Suranto (2011) ada 10 jenis pijat yang sering
digunakan yaitu
1. Pijat swedia
Pijat swedia meupakan salah satu jenis pijat yang banyak dipraktikkan oleh orang
Amerika Serikat. Saat melakukan pemijatan, biasanya terapis mengoleskan
minyak urut atau lotion yang berguna untuk melicinkan permukaan kulit.
2. Pijat aromaterapi
Pijat aromaterapi, merupakan suatu metode pemijatan yang dilakukan dengan
menggunakan minyak aromaterapi tertentu yang diolekan ke tubuh. Terapis
biasanya menggunakan satu atau lebih minyak esensial ke dalam minyak pijat,
seperti lavender, minyak kayu putih, atau minyak lainnya sesuai kebutuhan
3. Pijat batu panas
Pijat batu panas memberikan efek hangat dan bermanfaat memanjakan tubuh.
Pijat ini dilakukan dengan memanfaatkan batu yang sebelumnya telah direndam
dalam air panas. Batu ini diletakkan pada titik-titik tubuh yang terganggu maupun
otot-otot yang kaku.
4. Pijat otot
pijat otot ditujukan untuk membantu mengatasi masalah pada jaringan otot dan
jaringan dibawah otot. Ketika melakukan pemijatan, terapis akan memijat
dengan sedikit penekanan, lalu bergerak lambat menyusuri otot. Manfaat pijat ini
adalah untuk mengatasi otot kaku atau nyeri otot, kejang berulang, salah posisi
(salah duduk/salah jongkok), serta pemulihan pasca cidera.
5. Shiatsu
Shiatsu adalah jenis pijat dari Jepang yang menggunakan tekanan jari pada urutan
jalur meridian akupuntur. Tekanan jari yang dilakukan secara berirama tersebut
berlangsung selama 2-8 ketukan. Hal tersebut bertujuan untuk meningkatkan
aliran energy dan menyeimbangkan tubuh. Pijatan yang diberikan dengan
tekanan kuat pada beberapa meridian tubuh, akan tetapi mereka akan merasakan
sakit dan lebih nyaman setelah dipijat.
6. Pijat Thailand
Pijat ini mirip dengan pijat shiatsu Jepang. Kemiripannya terletak pada tujuan
pemijatannya, yakni untuk meningkatkan aliran energy dan menyeimbangkan
tubuh. Pijatan yang dilakukan dengan memberikan tekanan lembut pada bagian
tertentu
7. Pijat ibu hamil
Pijat ibu hamil ditujukan untuk para ibu yang sedang hamil agar kelak dapat
melahirkan bayinya dengan selamat dan lancar. Oleh karena itu, terapis yang
melakukan pijat ini harus sudah terampil.
8. Pijat refleksi
Refleksi sering kali diidentikkan dengan pijat kaki meskipun pada kenyatannya
tidak sepesti itu, bagian lain juga dipijat. Pada pijat refleksi dilakukan penekanan
di titik tertentu di telapak dan punggung kaki yang berhubungan dengan system
organ tubuh.
9. Pijat olahraga
Ciri khas pijat olahraga adalah gerakan pemijatan yang lebih keras dan cepat
dibandingkan pijat swedia. Pijat ini dirancang khusus untuk olahragawan
professional maupun yang hobi olahraga.
10. Pijat tulang belakang
Pijat tulang belakang tidak hanya difokuskan untuk memijat bagian tulang
belakang saja. Pijat ini juga digunakan untuk meringankan leher yang pegal.
2.1.3 Teknik-Teknik Pijat
Menurut buku terjemahan drh Budi Tri Akoso (2009), disebutkan bahwa ada 4
teknik dasar pemijatan diantaranya yaitu ;
1. Effleurage

Gambar 1. Teknik Efflurage

Cara melakukan effleurage yaitu dengan menggosok otot


dengan lembut menggunakan telapak tangan, teknik ini menciptakan kehangatan
dan membuat otot-otot bagian luar menjadi rileks. Biasanya dipraktikkan pada
awal dan akhir suatu sesi.
2. Meremas-remas

Gambar 2. Teknik Meremas

Cara yang dilakukan dengan mengambil sebagian otot dan


kulit (Seperti mencubit), gerakkan ke belakang dan ke depan. Gunakan jari dan
telapak tangan seolah-olah sedang menguleni adonan roti. Teknik ini ideal untuk
menghilangkan pegal-pegal, terutama pada bahu, pinggul,pantat, dan kaki
3. Petrissage

Gambar 3. Teknik Petrissage

Petrissage yaitu menggerakkan dan menekan menggunakan


kedua ibu jari. Caranya dengan menggunakan kedua ibu jari terapis, lakukan
gerakan memutar dengan tekanan yang tetap dan kuat. Ini akan membuat jaringan
otot yang kaku,keras,dan akan mengumpul, terangkan dan melentur. Teknik ini
ideal untuk menghilangkan sumbatan-sumbatan pada otot, terutama untuk otot-
otot yang dekat dengan tulang belakang dan bahu.
4. Tapotement

Gambar 4. Teknik Tapotement

Teknik tapotement atau biasa disebut teknik perkusi.


Teknik ini ideal untuk merangsang dan membangkitkan energy tubuh. Cara yang
dilakukan dengan menerapkan tepukan-tepukan ringan pada otot menggunakan
bagian tepi telapak tangan.
Peringatan. Jangan menggunakan teknik ini pada tulang (iga dan tulang
belakang)
2.1.4 Aromaterapi yang sering digunakan
1) Lavender, dianggap paling bermanfaat dari semua minyak astiri. Lavender dikenal
untuk membantu meringankan nyeri, sakit kepala, insomnia, ketegangan dan stress
(depresi) melawan kelelahan dan mendapatkan untuk relaksasi, merawat agar
tidakinfeksi paru-paru, sinus, termasuk jamur vaginal, radang tenggorokan, asma,
kista dan peradangan lain. Meningkatkan daya tahan tubuh, regenerasi sel, luka
terbuka, infeksi kulit dan sangat nyaman untuk kulit bayi, melenturkan otot-otot
2) Jasmine : Pembangkit gairah cinta, baik untuk kesuburan wanita, mengobati
impotensi, anti depresi, pegal linu, sakit menstruasi dan radang selaput lendir.
3) Orange : Baik untuk kulit berminyak, kelenjar getah bening tak lancar,debar jantung
tak teratur dan tekanan darah tinggi.
4) Peppermint : Membasmi bakteri, virus dan parasit yang bersarang di pencernaan.
Melancarkan penyumbatan sinus dan paru, mengaktifkan produksi minyak dikulit,
menyembuhkan gatal-gatal karena kadas/kurap, herpes, kudis karena tumbuhan
beracun.
5) Rosemary : Salah satu aroma yang manjur memperlancar peredaran darah,
menurunkan kolesterol, mengendorkan otot, reumatik, menghilangkan ketombe,
kerontokan rambut, membantu mengatasi kulit kusam sampai di lapisan terbawah.
Mencegah kulit kering, berkerut yang menampakkan urat-urat kemerahan.
6) Sandalwood : Menyembuhkan infeksi saluran kencing dan alat kelamin, mengobati
radang dan luka bakar, masalah tenggorokan, membantu mengatasi sulit tidur dan
menciptakan ketenangan hati.
7) Green tea : Berperan sebagai tonik kekebalan yang baik mengobati penyakit paru-
paru, alat kelamin, vagina, sinus, inveksi mulut, inveksi jamur, cacar air, ruam saraf
serta melindungi kulit karena radiasi bakar selama terapi kanker.
8) Ylang-Ylang/ Kenanga : Bersifat menenangkan, melegakan sesak nafas, berfungsi
sebagai tonik rambut sekaligus sebagai pembangkit rasa cinta.
9) Lemon : Selain baik untuk kulit berminyak, berguna pula sebagai zat antioksidan,
antiseptik, melawan virus dan infeksi bakteri, mencegah hipertensi, kelenjar hati
dan limpa yang tersumbat, memperbaiki metabolisme, menunjang system
kekebalan tubuh serta memperlambat kenaikan berat badan.
10) Frangipani/ Kamboja : Bermanfaat untuk pengobatan, antara lain, bisa untuk
mencegah pingsan, radang usus, disentri, basiler, gangguan pencernaan, gangguan
penyerapan makanan pada anak, radang hati, radang saluran napas, jantung
berdebar, TBC, cacingan, sembelit, kencing nanah, beri-beri, kapalan, kaki pecah-
pecah, sakit gigi, tertusuk duri atau beling, bisul dan patekan. Aromaterapi dari
wewangian ini melambangkan kesempurnaan. Ini dapat digunakan untuk meditasi
dan memberikan suasana hening yang mendalam.
11) Strawberry : Dapat meningkatkan selera makan, mengurangi penyakit jantung,
tekanan darah tinggi dan kanker.
12) Lotus : Meningkatkan vitalitas, kosentrasi, mengurangi panas dalam, meningkatkan
fungsi limpa dan ginjal.
13) Appel : Dapat menyembuhkan mabuk, diare, menguatkan sistem pencernaan,
menjernihkan pikiran, mengurangi gejala panas dalam.
14) Vanilla : Dengan aroma yang lembut dan hangat mampu
menenangkan pikiran.
15) Nigth Queen : Membuat rasa nyaman dan rileks.
16) Opium : Menggembirakan, memberi energi dan semangat tertentu.
17) Coconut : Memberikan efek ketenangan, menghilangkan stress, mampu
mempertahankan keremajaan kulit wajah sehingga wajah selalu nampak bersinar
sepanjang masa.
18) Sakura : Di antaranya, disentri, demam, muntah, batuk darah, keputihan, tumor,
insomnia, mimisan, sakit kepala, hipertensi.

Gambar 5. lavender Gambar 6. jassmine Gambar 7. Orange

Konsep Osteoatritis

2.1.5 Definisi Osteoatritis

Osteoartritis adalah gangguan pada sendi yang bergerak (Price dan Wilson, 2013).
Disebut juga penyakit sendi degeneratif, merupakan ganguan sendi yang tersering.
Kelainan ini sering menjadi bagian dari proses penuaan dan merupakan penyebab
penting cacat fisik pada orang berusia di atas 65 tahun (Robbins, 2007). Sendi yang
paling sering terserang oleh osteoarthritis adalah sendi-sendi yang harus memikul
beban tubuh, antara lain lutut, panggul, vertebra lumbal dan sevikal, dan sendi-sendi
pada jari (Price dan Wilson, 2013). Penyakit ini bersifat kronik, berjalan progresif
lambat, tidak meradang, dan ditandai oleh adanya deteriorasi dan abrasi rawan sendi
dan adanya pembentukan tulang baru pada permukaan persendian. Osteoarthritis
adalah bentuk arthritis yang paling umum, dengan jumlah pasiennya sedikit
melampaui separuh jumlah pasien arthritis. Gangguan ini sedikit lebih banyak pada
perempuan daripada laki-laki (Price dan Wilson, 2013).
2.1.6 Etiologi Osteoatritis
Osteoartritis terjadi karena tulang rawan yang menjadi ujung dari tulang yang
bersambung dengan tulang lain menurun fungsinya. Permukaan halus tulang rawan
ini menjadi kasar dan menyebabkan iritasi. Jika tulang rawan ini sudah kasar
seluruhnya, akhirnya tulang akan bertemu tulang yang menyebabkan pangkal tulang
menjadi rusak dan gerakan pada sambungan akan menyebabkan nyeri dan ngilu.
2.1.7 Klasifikasi Osteoatritis

Gambar 9. Fase Osteoathritis


Gambar 8. Osteoathritis

Osteoatritis dibagi menjadi 2 yaitu ;


1) OA primer disebut idiopatik,
disebabkan karena adanya faktor genetik yaitu adanya abnormalitas kolagen
sehingga mudah rusak.
2) OA sekunder
OA yang didasari oleh kelainan seperti kelainan endokrin, trauma,
kegemukan, dan inflamasi.
2.1.8 Gambaran klinis Osteoatritis
1) Rasa nyeri pada sendi : Merupakan gambaran primer pada osteoartritis, nyeri
akan bertambah apabilasedang melakukan sesuatu kegiatan fisik.
2) Kekakuan dan keterbatasan gerak : Biasanya akan berlangsung 15 – 30 menit
dan timbul setelah istirahat atau saatmemulai kegiatan fisik.
3) PeradanganSinovitis sekunder, penurunan pH jaringan, pengumpulan cairan
dalam ruangsendi akan menimbulkan pembengkakan dan peregangan simpai
sendi yangsemua ini akan menimbulkan rasa nyeri.
4) Mekanik : Nyeri biasanya akan lebih dirasakan setelah melakukan aktivitas
lama danakan berkurang pada waktu istirahat. Mungkin ada hubungannya
dengan keadaan penyakit yang telah lanjut dimana rawan sendi telah rusak
berat.Nyeri biasanya berlokasi pada sendi yang terkena tetapi dapat
menjalar,misalnya pada osteoartritis coxae nyeri dapat dirasakan di lutut,
bokong sebelah lateral, dan tungkai atas. Nyeri dapat timbul pada waktu dingin,
akan tetapi hal ini belum dapatdiketahui penyebabnya.
5) Pembengkakan Sendi : Pembengkakan sendi merupakan reaksi peradangan
karena pengumpulan cairan dalam ruang sendi biasanya teraba panas tanpa
adanyapemerahan.
6) Deformitas : Disebabkan oleh distruksi lokal rawan sendi.
7) Gangguan Fungsi : Timbul akibat Ketidakserasian antara tulang pembentuk
sendi
2.1.9 Penatalaksanaan
a. Konservatif
1) Pendidikan kesehatan mengenai hal berikut ini;
i. Aktivitas yang menurunkan tekanan berulang pada sendi
ii. Upaya dalam penurunan berat badan.
2) Terapi fisik.
Osteoarthritis pada lutut akan menyebabkan kondisi disuse atrofi pada otot
kuadriseps. Latihan kekuatan otot akan menurunkan kondisi disuse atrofi.
Latihan fisik juga akan membantu dalam upaya penurunan berat badan dan
meningkatkan daya tahan.
3) Terapi obat simtomatis
Nonsteroidal anti-inflammatory drugs (NSAIDs) adalah obat-obat yang
digunakan untuk mengurangi nyeri dan peradangan pada sendi-sendi.
Contoh-contoh dari NSAIDs termasuk aspirin dan ibuprofen. Saat ini obat
pilihan utama yang digunakan dalam terapi osteoarthritis adalah natrium
diklofenak. Adakalanya adalah mungkin untuk menggunakan NSAIDs
untuk sementara dan kemungkinan menghentikan mereka untuk periode-
periode waktu tanpa gejala-gejala yang kambuh, dengan demikian
mengurangi resiko-resiko efek samping.
i. Analgetik seperti tramadol.
ii. Obat relaksasi otot (muscle relaxants).
iii. Injeksi glukokortikoid intraartrikular.
b. Intervensi Bedah
Operasi umumnya direncanakan untuk pasien-pasien dengan osteoarthritis yang
terutama parah dan tidak merespons pada perawatan-perawatan konservatif.
Beberapa prosedur yang mungkin dilakukan adalah sebagai berikut.
1) Antroskopi.
2) Osteotomi.
3) Fusion (arthrodesis)
4) Penggantian sendi (artroplasti) (Helmi, 2012).
Tujuan pengobatan pada pasien OA adalah untuk mengurangi gejala dan
mencegah terjadinya kontraktur atau atrofi otot. Terapi OA pada umumnya
simptomatik, misalnya dengan pengendalian faktor-faktor resiko, latihan
intervensi fisioterapi dan terapi farmakologis. Pada fase lanjut sering diperlukan
pembedahan (Imayati, 2011)
2.2 Analisis Jurnal
2.2.1 PICO Frame Work
Osteoartritis adalah penyakit sendi degeneratif yang progresif dimana tulang rawan
(kartilago) yang berfungsi untuk melindungi ujung tulang mulai rusak sehingga kehilangan
sifat kompresibilitasnya yang unik, disertai perubahan reaktif pada tepi sendi dan tulang
subkondral yang dapat menimbulkan rasa nyeri dan berkurang/hilangnya kemampuan
gerak (Central For Disease Control (CDC), 2014).
Nyeri adalah gejala yang sering muncul pada penderita osteoartritis (OA).
Penelitian sebelumnya telah melaporkan bahwa pasien dengan OA mengalami berbagai
tingkat rasa sakit (Kiper & Kılıc¸ Akc a, 2012; Dogan, Goris, & Demir, 2016; Panah,
Baharlouie, Rezaeian, & Hawker, 2016). Dogan dkk. (2016) telah melaporkan persentase
pasien osteoartritis yang mengalami nyeri 78,5%. Nyeri pada osteoarthritis diinduksi oleh
osteofit irri-tating periosteum, tekanan di tulang subchondral, distensi kapsul, bursitis,
tenosynovitis, perubahan neurogenik serpens, dan kejang otot di sekitar sendi yang
terkena.
Pasien dengan osteoartritis lutut mengalami kekakuan sendi di pagi hari ketika
mereka bangun dan / atau setelah imobilisasi untuk jangka waktu tertentu. Kekakuan
sering berlangsung selama kurang dari 30 menit, tetapi rasa sakit dan kekakuan dalam
penurunan fungsi hasil fisik kekakuan dalam penurunan fungsi fisik (Karadakovan &
Arslan, 2009).
Gumus¸and Unsal, (2014) melaporkan bahwa belanja (32%) dan masuk ke
kendaraan transportasi (28,5%) adalah kegiatan sehari-hari utama di mana individu dengan
OA merasa tergantung. Nyeri, kekakuan, penurunan fungsi fisik, gangguan tidur,
kecemasan, dan depresi yang dialami oleh pasien dengan OA lutut menurunkan kualitas
hidup (Hafez, Alenazi, Kachanathu, Alromi, & Mohamed, 2014). Masalah-masalah
tersebut harus diatasi melalui pendekatan perawatan dan praktik perawatan terbaru (Atalay-
Gumus¸,Alkan, & Aytekin, 2013; Guler Uysal & Basaran, 2009; Karadakovan & Arslan,
2009).
Secara Global terdapat 9,6% laki-laki, dan 18,0% wanita di atas usia 60 tahun yang
mengalami osteoatritis simtomatik (WHO,2017). Di Amerika Serikat terdapat 30 juta orang
yang mengalami Osteoatritis (CDC,2017), dan 8 juta orang mengalami OA di Inggris.
Prevalensi OA sendiri dapat berbeda-beda berdasarkan usia,jenis kelamin,dan etnis. OA
akan terus meningkat seiring dengan bertambahnya usia, 80-90% pasien yang berusia 65
tahun keatas (Lozada.,C et al, 2017 ; Central For Disease Control (CDC) 2017 & National
clinic 2014)
Di Indonesia, angka kejadian osteoartritis masih cukup tinggi, yaitu mencapai 36,5
juta orang. Prevalensi terbesar terjadi pada usia lebih dari 75 tahun, sebesar 58,8%. Pada
usia 65-74 sebesar 51,9 %, usia 55-64 sebesar 45,0%, dan usia 45-54 sebesar 37,2 %
(RISKESDAS,2013). Secara khusus penderita osteoartritis di Indonesia berjumlah 65%
terjadi pada usia > 60 tahun dan diketahui bahwa sebanyak 80% mempunyai keterbatasan
gerak dalam berbagai derajat dari ringan sampai berat.
Sedangkan di Jawa Timur angka prevalensinya juga masih tinggi yaitu sekitar 27%
(Riskesdas,2017).

2.2.2 Intervention:
Pijat aromaterapi adalah sebuah metode pengobatan nonfarmakologis yang dapat
digunakan untuk mengontrol/mengurangi gejala. Dengan kata lain pijat aromaterapi ini
bukan untuk menhilangkan penyakit, akan tetapi hanya untuk mengontrol gejala dari
penyakit(Bas¸aran, 2009; Buckle, 2001; Lindquist, Snyder, & Tracy, 2014; Ozdemir &
Oztunc¸, 2013 dalam Dilek Efe et al,2018).
Penggunaan pijat aromaterapi di dalam perawatan lebih penting untuk memulihkan
kesehatan seseorang. Selain itu pijat aromaterapi juga memiliki banyak manfaat seperti
misalnya mengurangi nyeri, meningkatkan system imun, menghilangkan infkamasi,
dan meningkatkan kualitas tidur dan kualitas hidup pasien (Fontaine, 2005; Gok Metin
& Ozdemir, 2016). Pijat aromaterapi juga dapat menyembuhkan atau mengurangi nyeri
salah satunya yaitu nyeri lutut akibat osteoatritis ( Yip & Tam, 2008 dalam Dilek Efe
et al,2018). Komponen minyak esensial yang digunakan selama akses pijat aromaterapi
dapat melancarkan sistem peredaran darah melalui getah bening dan pembuluh darah
di epidermis dan bertindak untuk meringankan rasa sakit dan meningkatkan fungsi
tubuh ( Basaran, 2009; Gesper, 1998; Gok Metin & Ozdemir, 2016; Ozata, 2009; Tasci
& baser 2015 dalam Dilek Efe et al,2018 ). Telah dinyatakan bahwa komponen-
komponen tertentu dengan karakteristik analgesik dalam minyak esensial mengurangi
rasa sakit pada pasien dengan mempengaruhi pelepasan neurotransmitter seperti
dopamin, endorfin, noradrenalin, dan serotonin (Basaran, 2009; Gul & Eti Aslan, 2012;
Tasci & baser 2015 dalam Dilek Efe et al,2018). Berbagai penelitian juga telah
menekankan bahwa minyak kayu putih, minyak lavender, dan minyak jahe dapat
digunakan untuk terapi pijat untuk mengontrol rasa sakit dan meningkatkan fungsi
tubuh pasien dengan penyakit sendi (Barbar, 2015; Kim, Nam, & Paik, 2005; Varghese,
Rajeswari, Gayathri Priya, & Kalpana, 2014; Yip & Tam 2008 dalam Dilek Efe,2018).
Dalam mengatasi pasien dengan OA, minyak jahe lebih disukai untuk efek
meningkatkan fungsi sendi, minyak lavender untuk efek menurunkan nyeri, dan minyak
kayu putih untuk efek menurunkan nyeri lokal melalui jaringan saraf (Huang, Fang, &
Fang, 2014; Ozata, 2009; Tasci & Baser 2015; putih 2007 dalam Dilek Efe,2018).
Penelitian yang dilakukan oleh Dilek Efe (2018), menyampaikan bahwa pijat
aromaterapi adalah sebuah terapi non konvensional/terapi komplementer yang dapat
digunakan untuk mengurangi nyeri. Hasil dari intervensi pijat aromaterapi tersebut
menunjukkan bahwa ada penurunan skala nyeri pada kelompok (sampel) yang
mendapat pijat aromaterapi dimulai pada minggu pertama terapi dan berlanjut di
minggu-minggu berikutnya. Penurunan skala nyeri ini cukup signifikan dibandingkan
kelompok (Sampel) yang hanya mendapatkan terapi pijat konvensional (tanpa
aromaterapi). Penurunan yang signifikan pada kelompok pijat aromaterapi mungkin
terjadi akibat dari minyak aromaterapi yang digunakan selama terapi pijat, yang
mungkin meningkatkan efektivitas pijat, bersama-sama dengan efek menguntungkan
dari pijat itu sendiri pada sirkulasi. minyak lavender, salah satu minyak aromatik yang
umum digunakan, mampu memperlambat impuls saraf berkat linalool yang ditemukan
di lavender. Hal ini dapat membantu menurunkan ketegangan otot, mengurangi persepsi
nyeri, dan kecemasan.
Pijat dilakukan dengan menggunakan langkah-langkah berikut ;
1) Peserta ditempatkan pada posisi semi-Fowler.
2) Tangan praktisi digosok bersama-sama (antara tangan kanan dan kiri) 10-15 kali untuk
menghangatkan tangan.
3) Jumlah minyak yang digunakan untuk setiap teknik adalah 20 tetes-1 mililiter. Minyak
ini pertama kali diterapkan pada tangan agar tangan menjadi licin. Kemudian menunggu
beberapa menit agar bisa terserap melalui kulit.
4) Kemudian digunakan 1 mililiter minyak untuk lutut dan menggunakan teknik effleurage
untuk menerapkannya, diikuti oleh satu tangan '' menepuk '' lutut selama 2-3 menit.
5) Menggunakan 1 mililiter minyak, menggunakan teknik petrissage untuk menerapkannya
ke lutut dengan dua tangan diikuti dengan satu tangan (menggenggam otot-otot dengan
telapak tangan dan jari-jari dan meremas mereka dengan memutar dan tanpa sliding
sebagainya) dari lutut selama 2-3 menit.
6) Menggunakan lain 1 mililiter minyak, teknik gesekan dengan telapak tangan dan
kemudian dengan empat jari dan ibu jari digunakan untuk menerapkannya ke lutut
dengan gesekan dalam dan menggosoknya dengan cara melingkar lutut selama 4-5
menit.

2.2.3 Comparation:
Dalam jurnal “Penatalaksanaan Fisioterapi Pada Kondisi Osteoarthritis Knee Dekstra
Dengan Modalitas Ultrasound Dan Terapi Latihan Di Rsud Prof. Dr. Margono Soekarjo”

Dijelaskan bahwa, modalitas fisioterapi yang digunakan untuk mengatasi permasalah-


permasalahan tersebut adalah ultrasound dan terapi latihan.Setelah dilakukan tindakan
fisioterapi sebanyak 6x terapi dengan menggunakan modalitas. Ultrasound dan terapi latihan
terjadi perubahan atau dengan hasil :Nyeri gerak mulai berkurang dari T1=4 menjadi 3 setelah
6 kali terapi. Adanya peningkatan kekuatan otot quadriceps T1=4 menjadi setelah 6 kali terapi
Peningkatan LGS pada knne dekstra aktif T1 S = 0° - 0 - 120° menjadi S = 0° - 0 - 125°.pada
knee dekstra pasif S = 0° - 0 - 125° menjadi S = 0° - 0 – 130°.Data-data tersebut menunjukan
adanya perkembangan pasien kearah perbaikan. Akan tetapi terapi latihan ini masih memiliki
kelemahan yang harus benar-benar diperhatikan diantaranya yaitu ;
1. Harus memperhatikan derajat penyakit dan aligment sendinya karena derajat OA dapat
nenpengaruhi respon penderitanya terhadap latihan yang akan diberikan.
2. Nyeri, karena nyeri merupakan gejala utama pada pasien OA yang sering menyebabkan
membatasi aktivitasnya

2.2.4 Outcome:
Dalam jurnal berjudul “The Effect of Aromatherapy Massage on Knee Pain and
Functional Status in Participants with Osteoarthritis” dikatakan bahwa pijat
aromaterapi lebih unggul pijat daripada pengobatan secara konvensional dalam hal
mengurangi rasa sakit dan kekakuan otot serta dapat meningkatkan fungsi fisik, dan hal
ini dapat berfungsi sebagai pelengkap modalitas pengobatan pada pasien OA dan juga
berguna bagi perawat yang dapat melakukan pijat aromaterapi untuk manajemen gejala
OA. Namun, melatih para praktisi dan memastikan mereka berpengalaman dalam pijat
aromaterapi juga sangat penting untuk mencapai hasil yang sukses. Penelitian ini
penting karena bertujuan untuk menentukan efficacy pijat aromaterapi menggunakan
lavender, eucalyptus, dan minyak jahe untuk mengembangkan metode yand dapat
digunakan di rumah oleh individu dengan OA dan untuk meringankan gejala yang
paling umum seperti nyeri, kekakuan, dan penurunan fisik fungsi.

2.2.5 Sumber Literatur


a. Jurnal utama:
“The Effect of Aromatherapy Massage on Knee Pain and Functional Status in Participants
with Osteoarthritis”

Penelitian yang dilakukan oleh Dilek Efe (2018), menyampaikan bahwa pijat
aromaterapi adalah sebuah terapi non konvensional/terapi komplementer yang dapat
digunakan untuk mengurangi nyeri. Dijelaskan bahwa pijat aromaterapi lebih unggul pijat
daripada pengobatan secara konvensional dalam hal mengurangi rasa sakit dan kekakuan
otot serta dapat meningkatkan fungsi fisik, dan hal ini dapat berfungsi sebagai pelengkap
modalitas pengobatan pada pasie OA dan juga berguna bagi perawat yang dapat melakukan
pijat aromaterapi untuk manajemen gejala OA.
b. Jurnal pendukung:
“Aromatherapy massage with lavender essential oil and the prevention of disability in ADL
in patients with osteoarthritis of the knee: A randomized controlled clinical trial”

Dari hasil penelitian Ahmad Nasiri, Mohammad Azim Mahmodi tersebut,


didapatkan bahwa kelompok peserta yang mendapatkan intervensi pijat aromaterapi
memiliki penurunan yang signifikan dalam nyeri sehingga terjadi peningkatan kualitas
ADL peserta tersebut, dibandingkan dengan peserta yang mendapatkan intervensi pijat
menggunakan minyak almond manis (non-aromatik). Aromaterapi yang digunakan yaitu
lavender, jahe, marjoram, dan minyak zaitun. Intervensi pijat ini dilakukan selama 2x
seminggu dalam 4 minggu pada ke-2 kelompok.
Mekanisme dari pijat aromaterapi ini yaitu, pengaruh aromaterapi pada otak,
terutama sistem limbic, dan sistem penciuman. Sistem limbic mengontrol emosi dan
mempengaruhi sistem saraf dan hormon. Berdasarkan jenis aroma, sel-sel saraf melepaskan
berbagai neurotransmitter yang terdiri dari enkephalins, endorfin, noradrenalin dan
serotonin. Penjelasan lain mengacu pada efek farmakologis secara langsung. Efek dari
lavender adalah mungkin karena lynalyl asetat dan linalool, yang secara efektif dapat
menurunkan rasa sakit dan peradangan dan mencegah kejang otot dan mengurangi
ketegangan, dengan demikian dapat meningkatkan ADL.

c. Jurnal pembanding:
“Penatalaksanaan Fisioterapi Pada Kondisi Osteoarthritis Knee Dekstra Dengan
Modalitas Ultrasound Dan Terapi Latihan Di Rsud Prof. Dr. Margono Soekarjo”

Dijelaskan bahwa, modalitas fisioterapi yang digunakan untuk mengatasi permasalah-


permasalahan tersebut adalah ultrasound dan terapi latihan.Setelah dilakukan tindakan
fisioterapi sebanyak 6x terapi dengan menggunakan modalitas. Ultrasound dan terapi latihan
terjadi perubahan atau dengan hasil :Nyeri gerak mulai berkurang dari T1=4 menjadi 3 setelah
6 kali terapi. Adanya peningkatan kekuatan otot quadriceps T1=4 menjadi setelah 6 kali terapi
Peningkatan LGS pada knne dekstra aktif T1 S = 0° - 0 - 120° menjadi S = 0° - 0 - 125°.pada
knee dekstra pasif S = 0° - 0 - 125° menjadi S = 0° - 0 – 130°.Data-data tersebut menunjukan
adanya perkembangan pasien kearah perbaikan. Akan tetapi terapi latihan ini masih memiliki
kelemahan yang harus benar-benar diperhatikan diantaranya yaitu ;
3. Harus memperhatikan derajat penyakit dan aligment sendinya karena derajat OA dapat
nenpengaruhi respon penderitanya terhadap latihan yang akan diberikan.
4. Nyeri, karena nyeri merupakan gejala utama pada pasien OA yang sering menyebabkan
membatasi aktivitasnya
BAB 3. PENUTUP

3.1 Kesimpulan
Osteoartritis adalah gangguan pada sendi yang bergerak. Disebut juga penyakit
sendi degeneratif, merupakan ganguan sendi yang tersering. Kelainan ini sering menjadi
bagian dari proses penuaan dan merupakan penyebab penting cacat fisik pada orang berusia
di atas 65 tahun. Sendi yang paling sering terserang oleh osteoarthritis adalah sendi-sendi
yang harus memikul beban tubuh, antara lain lutut, panggul, vertebra lumbal dan sevikal,
dan sendi-sendi pada jari. Penyakit ini bersifat kronik, berjalan progresif lambat, tidak
meradang, dan ditandai oleh adanya deteriorasi dan abrasi rawan sendi dan adanya
pembentukan tulang baru pada permukaan persendian.
Di Indonesia, angka kejadian osteoartritis masih cukup tinggi, yaitu mencapai 36,5
juta orang. Prevalensi terbesar terjadi pada usia lebih dari 75 tahun, sebesar 58,8%. Pada
usia 65-74 sebesar 51,9 %, usia 55-64 sebesar 45,0%, dan usia 45-54 sebesar 37,2 %
(RISKESDAS,2013). Secara khusus penderita osteoartritis di Indonesia berjumlah 65%
terjadi pada usia > 60 tahun dan diketahui bahwa sebanyak 80% mempunyai keterbatasan
gerak dalam berbagai derajat dari ringan sampai berat.
Pijat aromaterapi, merupakan suatu metode pemijatan yang dilakukan dengan
menggunakan minyak aromaterapi tertentu yang diolekan ke tubuh. Terapis biasanya
menggunakan satu atau lebih minyak esensial ke dalam minyak pijat, seperti lavender,
minyak kayu putih, atau minyak lainnya sesuai kebutuhan Penggunaan pijat.
Pijat aromaterapi telah dibuktikan memiliki efek positif dan sejalan dengan
tujuannya. Beberapa studi dan penelitian telah membuktikan hal tersebut. Baik penelitian
nasional maupun internasional. Salah satunya dalam jurnal berjudul “The Effect of
Aromatherapy Massage on Knee Pain and Functional Status in Participants with
Osteoarthritis” dikatakan bahwa pijat aromaterapi lebih unggul pijat daripada pengobatan
secara konvensional dalam hal mengurangi rasa sakit dan kekakuan otot serta dapat
meningkatkan fungsi fisik, dan hal ini dapat berfungsi sebagai pelengkap modalitas
pengobatan pada pasien OA dan juga berguna bagi perawat yang dapat melakukan pijat
aromaterapi untuk manajemen gejala OA. Selain itu pijat aromaterapi lebih efektif daripada
fisioterapi.

3.2 Saran
3.2.1 Bagi Mahasiswa
Mahasiswa diharapkan mampu memahami bagaiamana cara pijat aromaterapi yang baik dan
benar serta belajar lebih matang lagi untuk dapat mengaplikasikan terapi tersebut.
3.2.2 Bagi Perawat
Perawat harus memberikan terapi pijat aromaterapi dengan baik kepada klien agar tujuan yang
dicapai sesuai dengan yang diinginkan. Selain itu, perawat mengikuti pelatihan-pelatihan agar
lebih kompeten dalam melakukan terapi pijat tersebut.
3.2.3 Bagi Pasien Dan Keluarga
Pasien dan keluarga diharapkan mampu bekerjasama dengan tim kesehatan demi kelancaran
terapi yang diberikan, dan dapat mengaplikasikannya untuk mengurangi gejala OA terutama,
dan nyeri yang lain.
DAFTAR PUSTAKA

Adji Suranto.2011.Pijat Anak.Jakarta;Penebar Plus

Akoso, Budi Tri drh dan Akoso, Galuh H.E, (2009). Med Express Seri Penyembuhan Alami
Bebas Insomnia. Yogyakarta: KANSIUS
Arslan, D. E., Kutlutürkan, S., & Korkmaz, M. (2018). The Effect of Aromatherapy Massage on
Knee Pain and Functional Status in Participants with Osteoarthritis. Pain Management
Nursing.
Atalay-Gumus ¸, S., Alkan, B. M., & Aytekin, M. M. (2013). Osteoartritte guncel yaklas ¸ım.
Ankara Medical Journal, 13(1), 26–32.
Balitbang Kemenkes RI. 2013. Riset Kesehatan Dasar; RISKESDAS. Jakarta: Balitbang
Kemenkes RI
Balitbang Kemenkes RI. 2017. Riset Kesehatan Dasar; RISKESDAS. Jakarta: Balitbang
Kemenkes RI
Central for Disease Control and Prevention. Osteoarthritis. CDC. 2017 Diunduh dari:
https://www.cdc.gov/arthritis/basics/osteoarthritis.htm. Diakses tanggal 10 September
20173. World Health Organization. Chronic rheumatic conditions. WHO. 2017. Diundah
dari: http://www.who.int/chp/topics/rheumatic/en/. Diakses tanggal 15 Maret 2018
Dogan, N., Goris, S., & Demir, H. (2016). Osteoartritli bi-reylerin agrı ve oz etkililik duzeyleri.
Agri, 28(1), 25–31.
Gumus ¸, K., & Unsal, A. (2014). Osteoartritli bireylerin gunluk yasam aktivitelerinin
degerlendirilmesi. Turk Osteoporoz Dergisi, 20(3), 117–124.
Helmi Z.N., 2012, Buku Ajar Gangguan Muskuloskeletal; jilid 1, Salemba Medika, Jakarta, hal.
226-231, 534-535.
Indah lestari. DI PANTI WREDA, S. T. TERAPI KOMPRES JAHE DAN MASSAGE PADA
OSTEOARTRITIS.
Kiper, S., & Kılıc ¸ Akc ¸a, N. (2012). Osteoartritli bireylerin aggrı durumlarının degerlendirilmesi.
Bozok Universitesi Tıp Dergisi, 2(2), 29–38
.Lozada C, Pace S, Diamond H, et al. Osteoarthritis. Medscape. 2017. Diunduh dari:
http://emedicine.medscape.com/article/330487-overvie
Metin, Z. G., & Ozdemir, L. (2016). The effects of aromatherapy massage and reflexology on
pain and fatigue in patients with rheumatoid arthritis: a randomized controlled trial. Pain
Management Nursing, 17(2), 140-149
National Clinical Guideline Centre (UK). Osteoarthritis: Care and Management in Adults. NICE
Clin Guidel No 177. 2014 Feb;137–49. Diunduh dari:
http://www.ncbi.nlm.nih.gov/pubmed/25340227
Nasiri, A., & Mahmodi, M. A. (2018). Aromatherapy massage with lavender essential oil and the
prevention of disability in ADL in patients with osteoarthritis of the knee: A randomized
controlled clinical trial. Complementary Therapies in Clinical Practice, 30, 116-1
Purnomo, N. T. (2013). Pengaruh Circulo Massage dan Swedia Massage Terhadap Penurunan
Kadar Asam Laktat Darah Pada Latihan Anaerob. Journal of Physical Education and Sports,
2(1).
Price Sylvia A, Wilson Lorraine M. Patofisiologi: Konsep Klinis. Proses-Proses Penyakit.
Jakarta: EGC; 201
Saputra, E. V. (2017). RESPONS AKUT SHIATSU DAN REFLEKSI TERHADAP KADAR
GLUKOSA DARAH PENDERITA DIABETES MELITUS TIPE DUA
Yusdiana, M., & Prasetyo, E. B. (2015). Penatalaksanaan Fisioterapi pada Kondisi Osteoarthritis
Knee Dekstra dengan Modalitas Ultrasound dan Terapi Latihan di RSUD Prof. Dr.
Margono Soekarjo. Pena Jurnal Ilmu Pengetahuan Dan Teknologi, 23(1).
Original Article
The Effect of
Aromatherapy Massage
on Knee Pain and
Functional Status in
Participants with
Osteoarthritis
--- Dilek Efe Arslan, PhD, RN,*
urkan, PhD, RN,†
Sevinç Kutlut€
and Murat Korkmaz, PhD, RN‡

- ABSTRACT:
This study was conducted to evaluate the effect of aromatherapy
massage on knee pain and functional status in subjects with osteoar-
thritis. The study was designed as a non-randomized interventional
study. The study was carried out on patients who referred to the
outpatient clinics of the Department of Orthopedics, Physiotherapy
and Rehabilitation at Bozok University Research and Application
Hospital, and were diagnosed with osteoarthritis. A total number of 95
patients were included in the study, and of those, 33 were allocated to
aromatherapy massage group, 30 were allocated to conventional
massage group, and 32 were allocated to the control group. The study
From the *Department of Medical data were collected using the Patient Identification Form, visual
Nursing, University of Bozok, School analogue scale, the Western Ontario and McMaster University Osteo-
of Health, Yozgat, Turkey;
† arthritis Index. Repeated measures analysis of variance test was used
Department of Medical Nursing,
University of Gazi, Ankara, Turkey; to analyze the outcomes in the aromatherapy, conventional massage

University of Bozok, Yozgat, Turkey. and control groups, according to the weeks of follow-up. Bonferroni
test was used for further analysis. Baseline mean visual analogue scale
Address correspondence to Dilek Efe
Arslan, PhD, RN, Department of score and the Western Ontario and McMaster University Osteoarthritis
Medical Nursing, University of Bozok, Index were not significantly different between the groups (p > .05).
School of Health, 66200 Yozgat, Visual analogue scale (rest-activity) scores and the scores in the
Turkey. E-mail: dilekefe_@hotmail.
com
Western Ontario and McMaster University Osteoarthritis Index in the
aromatherapy massage group were lower, and the difference
Received December 8, 2016; compared to the control group was statistically significant (p < .001).
Revised October 27, 2017;
Aromatherapy massage performed in patients with osteoarthritis
Accepted December 20, 2017.
reduced knee pain scores, decreased morning stiffness, and improved
1524-9042/$36.00 physical functioning status. Thus, as long as specific training is pro-
Ó 2017 by the American Society for vided for aromatherapy massage, aromatherapy can be recommended
Pain Management Nursing
https://doi.org/10.1016/ for routine use in physical therapy units, hospitals and homes.
j.pmn.2017.12.001 Ó 2017 by the American Society for Pain Management Nursing

Pain Management Nursing, Vol -, No - (--), 2018: pp 1-11


2 Efe Arslan, Kutlut€
urkan, and Korkmaz

Pain is the most important symptom of osteoarthritis system, alleviating inflammation, and increasing sleep
(OA). Previous studies have reported that patients quality and quality of life of the patients (Fontaine,
with OA experience various levels of pain (Kiper & 2005; Gok Metin & Ozdemir, 2016). Aromatherapy
Kılıç Akça, 2012; Do gan, Goris, & Demir, 2016; massage can also be performed for joint diseases
Panah, Baharlouie, Rezaeian, & Hawker, 2016). such as knee OA (Yip & Tam, 2008). Components of
Do gan et al. (2016) have reported the percentage of the essential oils used during aromatherapy massage
osteoarthritis patients experiencing pain as 78.5%. access the circulatory system through the lymph and
Pain in osteoarthritis is induced by osteophytes irri- blood vessels in the epidermis and act to relieve pain
tating the periosteum, pressure in the subchondral and improve physical function (Başaran, 2009;
bone, capsule distension, bursitis, tenosynovitis, cen- Buckle, 1998; Gok Metin & Ozdemir, 2016; Ozata, €
tral neurogenic changes, and muscle spasms around 2009; Taşçı & Başer, 2015). It has been stated that
the affected joint (Karadakovan & Arslan, 2009; Ling certain components with analgesic characteristics in
& Rudolph, 2007). essential oils reduce pain in patients by influencing
Patients with knee osteoarthritis experience joint the release of neurotransmitters such as dopamine,
stiffness in the morning when they wake up and/or af- endorphin, noradrenaline, and serotonin (Başaran,
ter immobilization for a certain period. The stiffness 2009; G€ ul & Eti Aslan, 2012; Taşçı & Başer, 2015).
often lasts for less than 30 minutes, but the pain and Various studies have emphasized that eucalyptus
stiffness result in decreased physical function oil, lavender oil, and ginger oil can be applied during
(Karadakovan & Arslan, 2009). G€ um€ u ş and U€ nsal, massage therapy to control pain and improve the phys-
(2014) reported that shopping (32%) and getting into ical function of patients with joint diseases (Barbar,
transportation vehicles (28.5%) were the major daily 2015; Kim, Nam, & Paik, 2005; Varghese, Rajeswari,
activities during which individuals with OA felt depen- Gayathri-Priya, & Kalpana, 2014; Yip & Tam, 2008).
dent. Pain, stiffness, decreased physical function, sleep In OA, ginger oil is preferred for its effect of
disturbances, anxiety, and depression experienced by improving joint function, lavender oil for its effect of
patients with knee OA decrease the quality of life decreasing pain, and eucalyptus oil for its effect of
(Hafez, Alenazi, Kachanathu, Alromi, & Mohamed, locally decreasing pain through the neural networks
2014). Such problems must be addressed through up- (Huang, Fang, & Fang, 2014; Ozata, € 2009; Taşçı &
to-date treatment approaches and care practices Başer 2015; White 2007). Kim et al. (2005) evaluated
(Atalay-G€ um€u ş, Alkan, & Aytekin, 2013; G€ uler Uysal 40 patients with arthritis and reported decreased
& Başaran, 2009; Karadakovan & Arslan, 2009). pain and depression levels in the aromatherapy mas-
Current guidelines for the treatment of knee OA sage group. Hwang et al. (Hwang, Lee, & Kim, 2011)
recommend the concomitant use of pharmacologic dripped 2-3 drops of lavender oil on a warmed towel
and nonpharmacologic methods. Nonopioids (acet- and applied it as a compress on the knees of the pa-
aminophen [paracetamol] combinations), nonsteroidal tients. They reported a decrease in knee pain and an
anti-inflammatory drugs, and opioids are among the increase in joint flexibility (using a visual analog scale
available pharmacologic options. However, patients [VAS]) in the experimental group (n ¼ 21) compared
often experience gastrointestinal problems, sleep dis- with the control group (n ¼ 24) (p < .001). Varghese
turbances, sexual dysfunction, and depression associ- et al. (2014) found that aromatherapy massage with
ated with the use of multiple drugs for a long period. eucalyptus oil in female patients (n ¼ 60) decreased
They therefore use their medications irregularly and joint pain and increased quality of life. In a qualitative
resort to nonpharmacologic therapies to cope with study performed by Therkleson (2010) on 10 individ-
their symptoms (Basedow, Runciman, March, & uals with OA, ginger oil compresses increased joint
Esteman, 2014; Blagojevic, Jinks, Jeffery, & Jordan, stimulation, decreased pain, and allowed flexibility of
2010; Hafez et al., 2014; Swift 2012). joint movements.
Aromatherapy massage is a nonpharmacologic Previous studies on individuals with knee OA have
method used for symptom control. Its main aim is only evaluated the effectiveness of aromatherapy mas-
not to cure the disease but to control the symptoms sage compared with a control group. We were unable
emerging as a result of the disease (Başaran, 2009; to find any study that compared the effect of conven-
Buckle, 2001; Lindquist, Snyder, & Tracy, 2014; tional massage using olive oil with that of aroma-

Ozdemir €
& Oztunç, 2013). The use of aromatherapy therapy massage using lavender, eucalyptus, or ginger
massage in nursing practice is important to improve oils in patients with knee OA. In addition, previous
overall health and accelerate recovery. Aromatherapy studies had small sample sizes and were based on
massage is preferred in many areas because of its pre- and post-test assessments (Hwang et al., 2011;
efficacy in relieving pain, strengthening the immune Kim et al., 2005; Therkleson, 2010; Varghese et al.,
Aromatherapy Massage for Knee Pain in Osteoarthritis 3

2014). There is also no study with regular weekly those with wounds at the application site, (3) previ-
follow-ups to evaluate the effectiveness of these inter- ously diagnosed vascular disease, (4) joint inflamma-
ventions. The aim of the present study was to evaluate tion, (5) surgery within the last 3 months. Criteria for
the effects of aromatherapy massage using a mixture of withdrawal from the study included the following:
lavender, eucalyptus, and ginger oils on knee pain and (1) placement in a physical therapy program, (2) un-
functional status in patients with osteoarthritis. willingness to continue participation in the study at
any time point, and (3) inability to be contacted for
Ethical Considerations follow-up phone calls.
Ethics Committee approval to conduct the study was Power analysis and sample size (NCSS-PASS,
obtained from the Turgut Ozal University Faculty of https://www.ncss.com/) software were used to calcu-
Medicine Clinical Trials Ethics Committee (dated late the required sample size for this study. Yip and
October 8, 2015 and numbered 99950669/156). The Tam (2008) reported a change of 1.8 points in the
study was initiated after obtaining the written approval pain subscale of the Western Ontario and McMaster
of the study centers and informed consent of the par- University Osteoarthritis Index (WOMAC) in the inter-
ticipants after providing information about the objec- vention group. Arithmetic mean and standard devia-
tives of the research while paying attention to the tion (a ¼ .05 and strength ¼ 90) were used to
willingness and voluntariness of the participants. estimate the sample size of study, and 30 participants
were required per group to provide sufficient power.
Thirty-five participants were allocated into each group,
METHODS taking into account possible dropouts from the study.
Hypotheses of the research were as follows:
H1-1: Aromatherapy massage reduces knee pain in Data Collection
patients with osteoarthritis. Patients with osteoarthritis who had presented to the
H1-2: Aromatherapy massage reduces stiffness in outpatient clinics of the orthopedics and physio-
patients with osteoarthritis. therapy and rehabilitation unit were referred by the
H1-3: Aromatherapy massage fosters functional physicians. All participants were evaluated for their
condition in patients with osteoarthritis. eligibility to participate in the study. The first partici-
H1-4: Classical massage reduces knee pain in pa- pants were allocated to the aromatherapy massage
tients with osteoarthritis. group and subsequent participants were allocated
H1-5: Classical massage reduces stiffness in pa- either to the conventional massage or control group
tients with osteoarthritis. depending on the match criteria (age, gender, VAS ac-
H1-6: Classical massage fosters functional condi- tivity score, analgesic use). Total WOMAC scores for
tion in patients with osteoarthritis. both knees of individuals with osteoarthritis were
taken into consideration. The same procedure was per-
Design and Sample formed on both knees.
A nonrandomized clinical trial was conducted on two The affected knees were evaluated using the WO-
interventional groups and one control group. The MAC osteoarthritis index and VAS. Pain intensity values
study group consisted of individuals who were of the participants both during activity (performing
referred with a diagnosis of knee osteoarthritis to the daily routine tasks) and at rest were evaluated using
outpatient clinics of the Department of Orthopedics, VAS at baseline, week 1, week 2, and week 3. Pain, stiff-
Physiotherapy and Rehabilitation at Bozok University ness, and physical function were evaluated using the
Research and Application Hospital, located in a middle WOMAC osteoarthritis index at baseline, week 1,
Anatolian city center. week 2, and week 3. VAS and WOMAC osteoarthritis in-
Inclusion criteria were as follows: (1) VAS pain dexes were used to evaluate the participants in the
score (activity) between 3-10 points, (2) age 35 years aromatherapy and conventional massage groups at
and older, (3) a diagnosis of knee OA made by the baseline and during sessions 3, 6, and 9 through face-
physician according to the criteria of the American Col- to-face interviews. In the control group, the VAS and
lege of Rheumatology, (4) not participating in a phys- WOMAC osteoarthritis indexes were administered
ical therapy program during the study, (5) absence of through face-to-face interviews at baseline, and subse-
a known psychiatric disease, (6) absence of visual or quent assessments were made over phone calls at
hearing impairment, (7) able to provide verbal and week 1, week 2, and week 3. Routine treatment of
written consent for participation in the study. the participants in the aromatherapy, conventional
Exclusion criteria were as follows: (1) diagnosis of massage, and control groups were not changed over
any type of cancer, (2) sensitivity to essential oils or the entire study period (Fig. 1).
4 Efe Arslan, Kutlut€
urkan, and Korkmaz

Individuals with Osteoarthris (n=105)

Inial Interview with the Individuals Meeng Study Criteria (n=105)


Obtaining informed consents
Compleng Paent Idenficaon Form
Compleng WOMAC Osteoarthris Index-VAS (acvity-rest)

Allocaon of paents into aromatherapy massage group, convenonal massage


group, and the control group according to the matching criteria (age, gender, VAS
acvity score, use of analgesics)

Aromatherapy massage group (n=35) Convenonal massage group (n=35) Control group (n=35)

• Aromatherapy massage using Convenonal massage with olive Roune treatment and care is
sweet almond oil, apricot oil three mes per week connued, no addional
kernel oil, lavender oil, intervenons are performed
eucalyptus oil, and ginger oil Administraon of the assessment
Administraon of the
three sessions per week forms through face-to-face
assessment forms through
• Administraon of the interviews at sessions 1, 3, 6 and 9
face-to-face interview in the
assessment forms through
inial encounter, than through
face-to-face interviews at
phone contacts
sessions 1, 3, 6 and 9

2 subjects did not regularly aend 3 subjects were


sessions inaccessible via phone
2 subjects withdrew on their own 2 subjects withdrew on their own
wish wish
1 subject moved to another city

Aromatherapy massage group (n=33) Convenonal massage group (n=30) Control group (n=32)

ANALYSIS

FIGURE 1. - Description of the study sample. WOMAC, The Western Ontario and McMaster University Osteoarthritis Index;
VAS, visual analog scale.

Instruments Visual Analog Scale. The VAS was developed by


Participant Description Form. The participant Price et al. in 1983 and is a valid and reliable tool for
description form is an eight-item form prepared by determining pain intensity. This easy-to-apply scale is
the investigator in line with the relevant literature to used to evaluate the intensity of pain with the patient
determine sociodemographic characteristics such as rating the highest level of pain perceived on a 10-
age, gender, educational status, body mass index, exer- centimeter scale with 10 evenly spaced markers
cise status, and other factors such as duration of dis- from 0 (no pain) to 10 (most severe pain) points.
ease, pain duration and type, factors aggravating and The pain decreases toward the left and increases to-
relieving pain, and medication use (Yıldırım, Ulusoy, ward the right in the horizontal VAS scale (Gallagher,
& Bodur, 2010; Yip & Tam, 2008). Liebman, & Bijur, 2001). Our participants were asked
Aromatherapy Massage for Knee Pain in Osteoarthritis 5

TABLE 1.
Distribution of the Participants According to Descriptive Characteristics (N ¼ 105)

Groups

Aromatherapy Conventional
Massage Group, Massage Group, Control Group,
Characteristics n (%) n (%) n (%) Test p

Sex
Female 28 (84.8) 26 (86.7) 29 (87.4) * *
Male 5 (15.2) 4 (13.3) 3 (12.6)
Age
35-64 yr 24 (72.7) 17 (56.7) 20 (62.5) c2 ¼ 1.825 .401
$65 yr 9 (27.3) 13 (43.3) 12 (37.5)
Educational Status
Literatea 14 (42.4) 12 (40.0) 19 (59.4) c2 ¼ 2.827 .243
Primary school and higherb 19 (57.6) 18 (60.0) 13 (40.6)

X  SS X  SS X  SS
(Min-Max) (Min-Max) (Min-Max)

Mean age 58.1  10.7 .299 61.6  8.0 F ¼ 1.017 .366


(36-77) (48-77)
Mean body mass index 31.6  5.1 33.6  5.0 32.1  6.1 F ¼ 1.149 .321
(22.2–42.3) (19.8–43.0) (24.9  53.3)
Mean duration of disease (years) 5.6  4.5 7.4  6.3 5.7  4.4 F ¼ 1.222
(1.0–15.0) (1.0–20.0) (1.0  16.0)
a
The datas of people who was literate and non-literate were united.
b
Group includes people in primary school, junior high school and high school group.
*The numbers in the cell are less five. So test was failed.

to place a mark on the line at a point that corre- Aromatherapy Massage


sponded to the level of pain intensity they recently Preliminary Procedures. We prepared a quiet
perceived. room where the patient could lie down comfortably
WOMAC Osteoarthritis Index. The WOMAC index for the procedure. The patient needs to be able to lie
is composed of 24 items and 3 subdimensions (pain, down comfortably without any anxiety and the person
stiffness, and physical function). The participants are performing the massage needs to have warm hands for
asked to rate pain (5 questions), stiffness (2 questions), both the aromatherapy massage and conventional
and difficulties encountered in physical functioning massage.
(17 questions) during the day (24 hours). The index The oils we used were prepared by taking the aro-
is a 5-point Likert-type scale, where 0 is none, 1 mild, matherapist’s opinions and the current literature into
2 moderate, 3 severe, and 4 very severe. Pain scores account. We had the oils analyzed for color, odor, pH
range from 0–20 points, stiffness scores from 0–8 level, and bacterial content to make sure they were
points, and difficulties in physical function scores appropriate for use on the body, that the odor of the
from 0–68 points. Higher scores indicate increased aromatherapy oils would stimulate positive emotions
pain and stiffness, impairment in physical functioning, in the participant, and that no organic content was pre-
and higher levels of physical limitation (Aungst, sent, and also to prevent the development of allergic
Aeschlimann, Steiner, & Stucki, 2001). reactions. The oil for the aromatherapy massage group
This validated and reliable tool is widely used to included 2 milliliters lavender, 2 milliliters eucalyptus,
assess patients with hip and knee osteoarthritis. Cron- and 1 milliliters ginger oil in 50 milliliters of
bach’s a values for the WOMAC pain, stiffness, and sweet almond oil and 50 milliliters of apricot kernel
physical function subdimensions in our study were €
oil. (In-Ryoung, 2006; Kim et al., 2005; Ozata, 2009;
.76, .94, and .93 before treatment, respectively, and Shaw, Annett, & Doherty, 2007; Taşçı & Başer, 2015;
the same values after intervention were .94, .95, and Varghese et al., 2014; Yip & Tam, 2008). In line with
.90, respectively. expert opinions and literature data, massage therapy
6 Efe Arslan, Kutlut€
urkan, and Korkmaz

TABLE 2.
Comparison of VAS Scores of Participants According to Weeks of Follow-Up (N ¼ 105)

Follow-Up Weeks

Baselinea Week 1b Week 2c Week 3d Significant


VAS Severity X ± SD X ± SD X ± SD X ± SD Teste p Difference

VAS Rest
Aromatherapy Massage 4.6  1.6 3.4  1.5 2.7  1.5 1.4  1.1 50.467 .001* *a-b, *a-c, *a-d.
Group1 (2.0-9.0) (1.0-7.0) (0.0-6.0) (0.0-4.0) *b-d. *c-d
Conventional Massage 4.9  1.6 4.1  1.7 3.7  1.6 3.4  1.6 12.922 .001* *a-b, *a-c, *a-d
Group2 (3.0-8.0) (1.0-8.0) (1.0-7.0) (0.0-6.0)
Control group3 5.1  2.6 5.2  2.7 5.1  2.6 5.2  2.5 .135 .939 —
(2.0-10.0) (2.0-10.0) (1.0-10.0) (2.0-10.0)
Testf .474 6.746 12.654 33.883
p .624 .002 .000 .000
 
Difference — 1-3 1-3.  1-2.  2.3 
1-3  1-2.  2.3
VAS Activity
Aromatherapy Massage 8.9  1.2 6.3  1.9 5.1  1.1 3.8  1.2 135.106 .001* *a-b,*a-c,*a-d
Group1 (5.0-10.0) (2.0-9.0) (0.0-6.0) (2.0-7.0) *b-c, *b-d, *c-d
Conventional Massage 8.5  1.5 7.5  1.4 6.3  2.0 5.9  2.1 23.996 .001* *a-b,*a-c,*a-d,
Group2 (3.0-10.0) (5.0-10.0) (1.0-10.0) (0.0-9.0) *b-c,*b-d
Control Group3 8.1  2.0 7.7  1.6 7.3  1.7 7.8  1.7 3.221 .082 —
(4.0-10.0) (4.0-10.0) (4.0-10.0) (3.0-10.0)
Testf 1.842 6.546 15.023 45.910
p .164 .002 .001 .001

Difference — 1-3.  1-2 
1-3.  1-2 
1-3.  1-2.  2-3
VA, visual analog scale; SD, standard deviation; ANOVA, analysis of variance.
a
baseline.
b
first week.
c
second week.
d
Third week.
e
ANOVA was used for repeated measurements.
f
One-way ANOVA was used.

Comparison of groups.
*Comparison of weeks.
1
Aromatherapy massage.
2
Conventional massage.
3
Control group.

was performed nine times, each session lasting minute for the oil to be absorbed through the
30 minutes, to the legs of the participants in the skin. (4) We then used 1 milliliter of oil for the
aromatherapy and conventional massage groups knee and used the effleurage technique to apply
(15 minutes for each knee). it, followed by one-hand ‘‘patting’’ of the knee for
2–3 minutes. (5) Using another 1 milliliter of oil,
Steps of Aromatherapy Massage we used the petrissage technique to apply it to
The massage was performed using the following the knee with two hands followed by one hand
steps after informing the participants and obtaining kneading (grasping the muscles with your palm
consent for the procedure (Shaw et al. 2007; Taşçı and fingers and kneading them by twisting and
& Başer, 2015; Tel, 2010; Tuna, 2004; Varghese et without sliding forth) of the knee for 2–3 minutes.
al., 2014; Yip & Tam, 2008): (1) The participant (6) Using another 1 milliliter of oil, a friction
was placed in the semi-Fowler’s position. (2) The technique with the palms and then with four
practitioner’s hands were rubbed together 10–15 fingers and the thumb was used to apply it to
times to warm the hands. (3) The amount of oil the knee with deep friction and ‘‘circular move-
used for each technique was 20 drops— ments/circular rubbing’’ of the knee for 4-5 minutes.
1 milliliter. The oil was first applied to the hands (7) Using another 1 milliliter of oil, the effleurage
to make them slippery. We then waited for a technique with both hands was employed to apply
Aromatherapy Massage for Knee Pain in Osteoarthritis 7

TABLE 3.
Comparison of Mean WOMAC Scores of the Participants According to the Weeks of Follow-Up (N ¼ 105)

Follow-Up Weeks

Baselinea Week 1b Week 2c Week 3d Significant


WOMAC X ± SD X ± SD X ± SD X ± SD Teste p Difference

WOMAC Pain
Aromatherapy Massage 16.0  2.8 12.8  3.2 10.6  3.0 8.3  3.3 107.982 .001* *a-b,*a-c,*a-d.
Group1 (11.0-20.0) (6.0-17.0) (5.0-15.0) (2.0-14.0) *b-c.*b-d.*c-d
Conventional Massage 15.4  2.2 14.0  2.5 13.2  3.0 12.4  3.3 16.943 .001* *a-b,*a-c
Group2 (12.0-20.0) (9.0-19.0) (4.0-19.0) (4.0-19.0) *a-d.*b-d
Control group3 16.0  3.2 15.7  3.0 15.2  3.3 15.9  3.0 1.798 .153 —
(8.0-20.0) (8.0-20.0) (8.0-20.0) (8.0-20.0)
Testf .491 7.749 18.055 45.586
p .614 .001  .001  .001
 
Difference - 1-3 1-2. 1-3.  2-3 
1-2. 1-3.  2-3
WOMAC Stiffness
Aromatherapy Massage 5.3  1.3 4.7  1.3 4.2  1.5 3.3  1.4 23.126 .001* *a-c.*a-d.
Group1 (2.0-8.0) (2.0-6.0) (0.0-6.0) (0.0-6.0) *b-d.*c-d
Conventional Massage 5.7  1.3 5.4  1.3 5.3  1.3 5.3  1.6 2.337 .079 —
Group2 (4.0-8.0) (2.0-8.0) (3.0-8.0) (0.0-8.0)
Control group3 5.6  1.6 5.3  1.6 5.3  1.5 5.6  1.5 1.354 .262 —
(2.0-8.0) (2.0-8.0) (2.0-8.0) (2.0-8.0)
Test .572 2.281 7.161 21.733
p .566 .108 .001 .001

Difference — — 1-2.  1-3 
1-2.  1-3
WOMAC Physical Function
Aromatherapy Massage 52.5  7.7 45.7  8.1 40.8  9.0 33.6  10.7 76.494 .001* *a.b.*a-c.*a-d.
Group1 (40.0-64.0) (28.0-57.0) (13.0-59.0) (10.0-57.0) *b-c.*b-d.*c-d
Conventional Massage 52.6  7.8 50.1  9.0 48.6  8.7 47.0  10.0 13.018 .001* *a-b.*a-c.*a-d.
Group2 (39.0-66.0) (31.0-66.0) (37.0-66.0) (25.0-66.0) *b-d
Control group3 54.1  7.9 55.3  8.7 54.3  8.6 55.4  8.5 1.652 .183 —
(33.0-67.0) (34.0-67.0) (34.0-68.0) (34.0-68.0)
Testf .430 10.325 19.147 41.004
p .652 .001 .001 .001
 
Difference — 1-3 1-2.  1-3.  2-3 
1-2.  1-3.  2-3
WOMAC, The Western Ontario and McMaster University Osteoarthritis Index; SD, standard deviation; ANOVA, analysis of variance.
a
baseline.
b
first week.
c
second week.
d
Third week.
e
ANOVA was used for repeated measurements.
f
One-way ANOVA was used.

Comparison of groups.
1
Aromatherapy massage.
2
Conventional massage.
3
Control group.

it to the knees followed by one-hand ‘‘patting’’ Conventional Massage Intervention


of the knee for 1 minute. These steps were Olive oil was used for the conventional massage group.
then repeated for the other affected knee joint, The preliminary procedures, massage technique, appli-
5-10 minutes after the initial massage therapy. cation steps and session content, frequency, and dura-
(8) The materials used were removed at the end tion were the same in the conventional massage group.
of the procedure. (9) The next visit was scheduled
with the participant and the patient was
discharged from the unit (Shaw et al. 2007; Taşçı Data Analysis
& Başer, 2015; Tel, 2010; Tuna, 2004; Varghese The Statistical Package for Social Sciences (SPSS)
et al., 2014; Yip & Tam, 2008). Version 21 (IBM Corp., Armonk, NY) was used for
8 Efe Arslan, Kutlut€
urkan, and Korkmaz

6
5.7
5.6 5.6
5.3 5.4
5.3 5.3 5.3
5
4.7
4.2
FIGURE 2. - Visual analog scale. WOMAC, The Western 4 Aromatherapy massage
group
Ontario and McMaster University Osteoarthritis Index. 3
3.3
Conventional massage group

2 Control group
statistical analysis. Repeated-measures analysis of vari- 1
ance was used to evaluate participants in the aroma-
0
therapy, conventional massage, and control groups 1 2 3 4
according to the follow-up weeks. The Bonferroni
test was used for further analysis, and one-way analysis FIGURE 4. - Comparison of the mean WOMAC-Stiffness
of variance was used to determine the difference be- scores of the participants according to the weeks of
tween the groups. The level of statistical significance follow-up. WOMAC, The Western Ontario and McMaster
University Osteoarthritis Index.
was set at p < .05 within a 95% confidence interval

(Nahcivan, 2014; Ozdamar, 2013).
32.1  6.1 kilograms per square meter. The mean dura-
tion of disease was 5.7  4.4 years.
RESULTS There was no statistically significant difference
between the aromatherapy massage, conventional
Demographic Characteristics of the massage and control groups with respect to descrip-
Participants tive characteristics of the participants. The individuals
Regarding the participants in the aromatherapy mas- in all three groups had similar characteristics
sage group, 72.7% were in the 35-64 years age (Table 1).
group (the mean age was 58.1  10.7 years),
84.8% were female, and 57.6% were primary school
graduates or had higher education. Mean body mass Intervention Effects
index (BMI) was 31.6  5.1 kilograms per square We found no significant difference between the pretest
meter. The mean duration of disease was VAS and WOMAC scores of the aromatherapy, classic
5.6  4.5 years. massage, and control group participants (p > .05).
Regarding the participants in the conventional The individuals in all three groups can be seen to
massage group, 56.7% were in the 35-64 years age have similar characteristics (Tables 2 and 3).
group (the mean age was 60.8  11.6 years), 86.7% There were significant differences between the
were female, 60% were primary school graduates or mean VAS scores (rest-activity) of the participants in
had higher education, and the mean BMI was the aromatherapy and conventional massage groups
33.6  5.0 kilograms per square meter. The mean dura- according to follow-up weeks (at sessions 3, 6, and
tion of disease was 7.4  6.3 years. 9). The decrease in pain scores in the aromatherapy
Regarding the participants in the control group, and conventional massage groups started in the first
62.5% were in the 35–64 years age group (the mean week of therapy and continued in the following
age was 61.6  8.0 years), 87.4% were females, weeks. This decrease was even more remarkable in
59.4% were literate and the mean BMI was the aromatherapy massage group compared with the

60
18 55.3 55.4
54.1
52.6
52.5 54.3
16 16 15.7 15.9 50 50.1 48.6
15.4 15.2 47
14 45.7
14
12.8 13.2 40 40.8 Aromatherapy massage
12 12.4 Aromatherapy massage
group group
10.6 33.6
10
Conventional massage
30 Conventional massage group
8 8.3
group
6 20 Control group
Control group
4
10
2
0 0
1 2 3 4 1 2 3 4

FIGURE 3. - Comparison of the mean WOMAC-Pain scores FIGURE 5. - Comparison of the mean WOMAC–Physical
of the participants according to the weeks of follow-up. Function scores of the participants according to the weeks
WOMAC, The Western Ontario and McMaster University of follow-up. WOMAC, The Western Ontario and McMaster
Osteoarthritis Index. University Osteoarthritis Index.
Aromatherapy Massage for Knee Pain in Osteoarthritis 9

conventional massage group (aromatherapy massage Aromatherapy massage decreased joint stiffness in
group, p < .001; conventional massage group, our study, whereas conventional massage had no ef-
p < .001; control group, p > .05; Table 2, Fig. 2). fect. In a qualitative study performed by Therkleson
There were highly significant differences between (2010) on participants with OA (n ¼ 10), ginger oil
WOMAC pain, WOMAC stiffness, and WOMAC phys- compresses increased range of joint motion in addition
ical function scores of the participants in the aroma- to providing warming, stimulatory, and analgesic ef-
therapy, conventional massage, and the control fects. Therkleson and Sherwood (2004) evaluated
groups according to the week of follow-up ginger compressed on the kidney region in partici-
(p < .001). WOMAC pain and stiffness scores, and pants with OA and reported a warming sensation and
physical function scores were more significantly body relaxation. In line with the literature, the present
decreased in the aromatherapy massage group study found that aromatherapy massage significantly
compared with the conventional massage and control reduced WOMAC stiffness scores when compared
groups. We also found that the WOMAC pain scores with the other groups. As already known, massage re-
decreased together with an improvement in physical lieves pain by increasing tissue oxygenation and endor-
functioning status in the conventional massage group, phin release. We believe the aromatherapy oils, rather
but there was no decrease in the stiffness scores than the massage therapy itself, affected the outcomes
(p < .001). (Table 3; Figs. 3, 4, and 5). in terms of reducing stiffness. Ginger oil, one of these
aromatherapy oils, enters the circulation through vaso-
dilation at the relevant body area and then stimulates
DISCUSSION tissues and reduces stiffness (Ryan, Heckler, &
Roscoe, 2012; Steflitsch & Steflitsch, 2008;
We found a significantly more prominent decrease in Therkleson, 2010).
the pain scores of the participants in the aromatherapy Participants with knee OA have reduced level of
group than those in the conventional massage group in physical functioning because of pain, stiffness, and
this study. Such a significant decrease in the aroma- structural changes in the joints (Doral et al., 2007
therapy massage group may be a result of the aroma- Karadakovan & Arslan, 2009; ). The aromatherapy
therapy oils used during the massage therapy, which massage and conventional massage used in the
possibly increased the effectiveness of the massage, present study improved physical functioning in
together with favorable effects of the massage itself participants with osteoarthritis (p < .001). Won and
on circulation. Lavender oil, one of the commonly Chae (2011) reported from their study on knee OA
used aromatic oils, is able to slow down nerve im- patients who received aromatherapy massage twice
pulses thanks to the linalool found in lavender. This a week for four weeks that the study group had
mechanism results in decreased muscle tension, lower significant decreased pain compared with the control
pain perception, and less anxiety (Başaran, 2009; group (p < .001). In a quasiexperimental study, Inja
Buckle, 2001; Steflitsch & Steflitsch, 2008). and Kyung (2009) evaluated pain and fatigue in
Eucalyptus oil is effective in decreasing joint, muscle, participants with knee osteoarthritis and reported
and bone pain in patients with arthritis and that aromatherapy massage decreased pain and
rheumatic disorders (Barbar, 2015; Başaran, 2009; fatigue and improved functioning in daily activities.

Ozata, 2009). In a semiexperimental study conducted In a study carried out by Yip and Tam (2008) on
by Kim et al. (2005) using lavender oil, eucalyptus participants with knee osteoarthritis, aromatherapy
oil, marjoram oil, rosemary oil, and peppermint oil in massage performed for 3 weeks reduced pain and
patients with arthritis, pain scores were found to be improved functional status; however, there was no
lower in the aromatherapy group compared with the significant difference between the experimental
control group. Hwang et al. (2011) applied 2-3 drops group and the control group (p > .05). With the use
of lavender oil on warmed towel compresses and of aromatherapy massage, participants with OA
then applied these to the knees of their patients. experienced less difficulty in daily activities such as
They reported decreased knee pain scores (VAS) in walking up and down the stairs, going shopping,
the experimental group compared with the control and putting on socks, and these results are consistent
group (p < .001). The decreases noted in the pain with the results of the other studies.
scores of participants in the aromatherapy and conven-
tional massage groups in the present study are compa-
rable to those reported in the literature. Limitations
Stiffness occurs as a result of immobility and can This study had some limitations. First, the study sample
be relieved with mobilization of the individual. consisted only of patients diagnosed with knee
10 Efe Arslan, Kutlut€
urkan, and Korkmaz

osteoarthritis from the orthopedics, physical therapy, treatment modalities are useful for nurses who
and rehabilitation outpatient clinics of a single university can perform aromatherapy massage for symptom
hospital located in a middle Anatolian city center. management in OA. However, training the practitioners
Second, all data pertaining to the aromatherapy massage, and ensuring they are adequately experienced in
conventional massage, and control groups were collected aromatherapy massage are critical to achieve successful
by the investigator. We assumed that the participants results. It is recommended that randomized controlled,
used the medication recommended by the physician. double-blind studies be conducted to support the
Once a person develops chronic knee osteoar- evidence obtained in this study. The present study is
thritis, this condition becomes a lifelong disease. important because it aimed to determine the efficacy
Future research involving a time frame of 6 months of aromatherapy massage using lavender, eucalyptus,
or longer is therefore recommended to determine and ginger oils to develop a method for home use by
long-term effectiveness of the intervention. individuals with OA and to alleviate the most common
symptoms such as pain, stiffness, and decreased
physical function. Aromatherapy massage can be
CONCLUSIONS AND IMPLICATIONS
performed at centers admitting osteoarthritis patients.
FOR NURSING The research suggests that developing evidence-based
Aromatherapy massage is superior to conventional procedures in nursing practices would contribute
massage in terms of reducing pain and stiffness and to improving and standardizing the outcomes of
improving physical functioning. These complementary clinical care.

REFERENCES
Atalay-G€um€ u ş, S., Alkan, B. M., & Aytekin, M. M. (2013). severity measured on a visual analog scale. Annals of Emer-
Osteoartritte g€ uncel yaklaşım. Ankara Medical Journal, gency Medicine, 38(6), 633–638.
13(1), 26–32. Gok Metin, Z., & Ozdemir, L. (2016). The effects of
Aungst, F., Aeschlimann, A., Steiner, W., & Stucki, G. aromatherapy massage and reflexology on pain and fatigue in
(2001). Responsiveness of the WOMAC osteoarthritis index patients with rheumatoid arthritis: A randomized controlled
as compared with the SF-36 in patients with osteoarthritis of trial. Pain Management Nursing, 17(2), 140–149.
the legs undergoing a comprehensive rehabilitation inter- G€um€ € nsal, A. (2014). Osteoartritli bireylerin
u ş, K., & U
vention. Annals of Rheumatic Diseases, 60(9), 834–840. g€unl€uk yaşam aktivitelerinin de gerlendirilmesi. T€ urk Osteo-
Barbar, A. (2015). Essential oils used in aromatherapy: A poroz Dergisi, 20(3), 117–124.
systemic review. Asian Pacific Journal of Tropical G€ul, A., & Eti Aslan, F. (2012). A grı Kontrol€
une Kanıt Te-
Biomedicine, 5(8), 601–611. melli Yaklaşım; Masaj ve Aromaterapi. Turkiye Klinikleri J
Basedow, M., Runciman, W. B., March, L., & Esteman, A. Nurs Sci, 4(1), 30–36.
(2014). Australians with osteoarthritis; the use of and beliefs G€uler Uysal, F., & Başaran, S. (2009). Diz osteoartriti. The
about complementary and alternative medicines. Comple- Turkish Journal of Physical Medicine and Rehabilitation,
mentary Therapies in Clinical Practice, 20(4), 237–242. 55(Suppl 1), 1–7.
Başaran, A. (2009). Dogal aromaterap€ otik bitkiler ve Hafez, A. R., Alenazi, A. M., Kachanathu, S. J., Alromi, M. A.,
uçucu yaglar. T€
urkiye Klinikleri Journal of Medical Sci- & Mohamed, E. S. (2014). Knee osteoarthritis: A review of
ences, 29(5 Suppl 1), 86–94. literature. Physical Medicine and Rehabilitation Interna-
Blagojevic, M., Jinks, C., Jeffery, A., & Jordan, K. P. (2010). tional, 1(5), 1–8.
Risk factors for onset of osteoarthritis of the knee in older Huang, S., Fang, L., & Fang, S. (2014). The effectiveness of
adults: A systematic review and meta-analysis. Osteoarthritis aromatherapy with lavender essential oil in relieving post
and Cartilage, 18(1), 24–33. arthroscopy pain. Journal of Medical Research,
Buckle, J. (2001). The role of aromatherapy in nursing 2014(2014), 1–9.
care. Holistic Nursing Care, 36(1), 57–72. Hwang, J. H., Lee, S. O., & Kim, Y. K. (2011). Effects of
Buckle, J. (1998). Alternative/complementary therapies. thermotherapy combined with aromatherapy on pain, flex-
Critical Care Nurse, 18, 54–61. ibility, sleep, and depression in elderly women with osteo-
Dogan, N., Goris, S., & Demir, H. (2016). Osteoartritli bi- arthritis. Journal Muscle Joint Health, 18(2), 192–202.
reylerin agrı ve o€z etkililik d€uzeyleri. Agri, 28(1), 25–31. Inja, K., & Kyung, K. (2009). Effect of aroma massage on
Doral, M. N., D€ onmez, G., Atay, O.€ A., Bozkurt, M., pain, activities of daily living and fatigue in patients with
Leblecioglu, G., U € z€
umcigil, A., & Aydog, T. (2007). Dejener- knee osteoarthritis. Journal Muscle Joint Health, 16(2),
atif eklem hastalıkları. TOTBI_ D (T€ urk Ortopedi ve Travma- 145–153.
toloji Birligi Dernegi) Dergisi, 6(1-2), 56–65. In-Ryoung, C. (2006). Effects of Aromatherapy massage on
Fontaine, L. (2005). Complementary & alternative pain, physical function, sleep disturbance and depression in
therapies for nursing practice. In: Aromatherapy, (2nd elderly women with osteoarthritis. Korean Journal Women
ed.) (pp. 143–156) Upper Saddle River, NJ: Pearson Health Nursing, 12(2), 168–176.
Prentice Hall. Karadakovan, A., & Arslan, F. E. (2009). Dahili ve Cerrahi
Gallagher, E. J., Liebman, M., & Bijur, P. E. (2001). Pro- Hastalıklarda Bakım (pp. 1366–1372). Adana: Nobel
spective validation of clinically important changes in pain Kitapevi.
Aromatherapy Massage for Knee Pain in Osteoarthritis 11

Kim, M. J., Nam, E. S., & Paik, S. I. (2005). The effect of Swift, A. (2012). Osteoarthritis 1: Physiology, risk factors
aromatherapy on pain, depression and life satisfaction of and causes of pain. Nursing Times, 108(7), 12–15.
arthritis patients. Taehan Kanho Hakhoe Chi, 35(1), 186– Taşçı, S., & Başer, M. (2015). Kanıta Dayalı Rehberleriyle
194. Tamamlayıcı ve Destekleyici Uygulamalar (pp. 39–97).
Kiper, S., & Kılıç Akça, N. (2012). Osteoartritli bireylerin Ankara: Akademisyen Kitapevi.
a €
grı durumlarının degerlendirilmesi. Bozok Universitesi Tıp Tel, H. (2010). A grı, A
grıya Y€
onelik Uygulamalar ve Hasta
Dergisi, 2(2), 29–38. Bakımı. In N. Sabuncu, & F. Akça Ay (Eds.), Klinik Beceriler
Lindquist, R., Snyder, M., & Tracy, M. F. (2014). Comple- Saglı
gın De gerlendirilmesi Hasta Bakım ve Takibi (pp.
mentary & Alternative Therapies in Nursing, (7th ed.) (pp. 652–676). I_stanbul: Nobel Tıp Kitabevi.
323–343) New York: Springer. Therkleson, T. (2010). Ginger compress therapy for adults
Ling, S. M., & Rudolph, K. (2007). Osteoartrit. In A. Dinç with osteoarthritis. Journal Advanced Nursing, 66(10),
(Ed.), Romatizmal Hastalıklarda Klinik Tedavi, (3rd ed) 2225–2233.
(pp. 127–132). Ankara: Ozg€ € un Ofset. Therkleson, T., & Sherwood, P. (2004). Patients’ experi-
Nahcivan, N. (2014). Nicel Araştırma Tasarımları. In ence of the external therapeutic application of ginger by
S. Erdogan, N. Nahcivan, & M. N. Esin (Eds.), Hemşirelikte anthroposophically trained nurses. The Indo-Pacific Journal
Araştırma S€ ureç, Uygulama ve Kritik (pp. 87–128). of Phenomenology, 4(1), 1–11.
I_stanbul: Dokuz Nobel Tıp Kitapevi. Tuna, N. (2004). A’dan Z’ye masaj (pp. 375–382). Nobel

Ozata, N. (2009). Fitoterapi ve Aromaterapi (pp. 116– Tıp Kitabevleri, Sarı H. (2004). Masaj. Tıbbi Rehabilitasyon.
164). I_stanbul: Dogan Kitap. Nobel Tıp Kitabevleri.

Ozdamar, K. (2013). Paket Programlar ile I_ statistiksel Varghese, S., Rajeswari, S., Gayathri-Priya, N., & Kalpana.
Veri Analizi. Ankara: Nisan Kitabevi. (2014). Effectiveness of aromatherapy on joint pain and qual-

Ozdemir, €
H., & Oztunç, G. (2013). Hemşirelik uygulama- ity of life among the women with menopause at selected vil-
larında aromaterapi. T€ urkiye Klinikleri Journal of Nursing lages of thiruvallur district. Journal of Science, 4(9), 575–582.
Science, 5(2), 98–104. White, B. (2007). Ginger: An overview. American Family
Panah, S. H., Baharlouie, H., Rezaeian, Z. S., & Hawker, G. Physician, 75(11), 1689–1691.
(2016). Cross-cultural adaptation and validation of the Per- Won, S., & Chae, Y. (2011). The effects of aromatherapy
sian version of the intermittent and constant osteoarthritis massage on pain, sleep, and stride length in the elderly with
pain measure for the knee. Iranian Journal of Nursing and knee osteoarthritis. Journal of Korean Biological Nursing
Midwifery Research, 21(4), 417–423. Science, 13(2), 142–148.
Ryan, J. L., Heckler, C. E., & Roscoe, J. A. (2012). Ginger Yıldırım, N., Ulusoy, M. F., & Bodur, H. (2010). The effect of
reduces acute chemotherapy induced nausea: A URCC heat application on pain, stiffness, physical function and
CCOP study of 576 patients. Support Care Cancer, 20(7), quality of life in patients with knee osteoarthritis. Journal of
1479–1489. Clinical Nursing, 19(7-8), 1113–1120.
Shaw, D., Annett, J. M., & Doherty, B. (2007). Anxiolytic Yip, Y. B., & Tam, A. C. Y. (2008). An experimental study
effects of lavender oil inhalation on open-field behaviour in on the effectiveness of massage with aromatic ginger and
rats. Phytomedicine, 14(9), 613–620. orange essential oil for moderate-to-severe knee pain among
Steflitsch, W., & Steflitsch, M. (2008). Clinical aroma- the elderly in Hong Kong. Complementary Therapies in
therapy. Journal of Men’s Health, 5(1), 74–85. Medicine, 16(3), 131–138.
Complementary Therapies in Clinical Practice 30 (2018) 116e121

Contents lists available at ScienceDirect

Complementary Therapies in Clinical Practice


journal homepage: www.elsevier.com/locate/ctcp

Aromatherapy massage with lavender essential oil and the prevention


of disability in ADL in patients with osteoarthritis of the knee: A
randomized controlled clinical trial
Ahmad Nasiri a, Mohammad Azim Mahmodi b, *
a
Health Qualitative Research Center, Birjand University of Medical Sciences, Birjand, Iran
b
MSc of Nursing, School of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand, Iran

a r t i c l e i n f o a b s t r a c t

Article history: Background: Knee osteoarthritis is considered as one of the most prevalent musculoskeletal disorders
Received 23 October 2017 which leads to joint degeneration and consequently disability in activities of daily living. This study
Received in revised form aimed to evaluate the effects of aromatherapy massage with lavender essence on activities of daily living
15 November 2017
of patients with knee osteoarthritis.
Accepted 10 December 2017
Methods: This is a single-blinded, randomized clinical trial. A total of 90 patients with osteoarthritis of
the knee referring to the outpatient rheumatology clinics affiliated to Birjand University of Medical
Keywords:
Sciences were selected via convenience sampling method. The participants were randomly assigned into
Osteoarthritis
Aromatherapy massage
three groups: intervention group (aromatherapy massage with lavender essential oil), placebo group
Essential oil (massage with almond oil) and control group (without massage). The activities of daily living of patients
Lavender was evaluated according to the Western Ontario and McMaster Universities Osteoarthritis index
Activities of daily living (WOMAC) at baseline, immediately after the intervention, 1 week, and 4 weeks after the intervention.
Data were analyzed using SPSS statistical software version 16.
Results: The activities of daily living of patients were significantly improved immediately and 1 week
after the intervention in the intervention group compared with their initial status (p < .001) and that of
the control group (p < .001 and p ¼ .03 respectively). However, 4 weeks after the intervention, there was
no significant difference between the groups according to the Western Ontario and McMaster Univer-
sities Osteoarthritis index (p ¼ .95).
Conclusion: Aromatherapy massage with lavender essential oil may reduce the incidence of activities of
daily living disability in patients with osteoarthritis of the knee. However, further studies are required to
confirm findings of this study.
© 2017 Published by Elsevier Ltd.

1. Introduction OA rises remarkably from 4% in the 18e24 years age group to 85% in
the 75e79 years age group [4,5]. Approximately 27 million Amer-
Osteoarthritis (OA), also known as degenerative arthritis or icans have OA and its prevalence will increase to 70 million in the
osteoarthrosis is the most common musculoskeletal disorder that coming decades [6,7]. According to WHO-ILAR COPCORD study,
leads to disability in activities of daily living (ADL), particularly in Iranians are the community most involved with knee OA among
the elderly [1]. It is already one of the ten most disabling diseases in different nationalities. The prevalence of knee OA in rural com-
developed countries as reported by the WHO [2]. OA can affect any munities in Iran, according to the same study, is about 19.3% [8].
joint, but the knees are among the most vulnerable [3]. Common One of the main goals of the management of patients with OA is
risk factors for developing OA include obesity, age increase, race, to minimize disability in ADL. Treatment strategies for OA include
previous joint injury, hormonal problems, overuse of the joint, and pharmacological and non-pharmacological treatments as well as
job. A major risk factor reported is age such that the prevalence of surgical interventions as the last expedient. Pharmacological
treatments have side-effects [9e11] and surgical interventions are
of high economic costs [12]. In this line, complementary therapies
* Corresponding author. have taken a step forward towards self-sufficiency and have
E-mail address: mahmodi_ems@bums.ac.ir (M.A. Mahmodi).

https://doi.org/10.1016/j.ctcp.2017.12.012
1744-3881/© 2017 Published by Elsevier Ltd.
A. Nasiri, M.A. Mahmodi / Complementary Therapies in Clinical Practice 30 (2018) 116e121 117

attracted the attention of researchers as they both promote health that clinically determines the changes in the health status of pa-
and reduce complications and costs. One of the complementary tients with knee OA [21e23]. Moreover, Golhasani et al. (2014)
therapies is aromatherapy massage, which uses the essential oil assessed internal consistency of the Persian version of the WOMAC
(EO) extracted from various herbs for their medical properties. index in an Iranian population of patients with knee OA. Their re-
Aromatherapy massage is the most extensively used complemen- sults indicated that the Persian WOMAC index is a valid and reliable
tary therapy [13]. patient-reported clinical instrument for knee OA. This question-
One of the EOs used in aromatherapy is lavender (scientific naire measures five items for pain (score range 0e20), two for
name Lavandula angustifolia) which is well known as a powerful stiffness (score range 0e8), and 17 for functional limitation (score
aromatic and medicinal herb. Lavender is used in complementary range 0e68) [24].
therapy across the world for its anti-inflammatory and analgesic Complementary information was collected using a demographic
effects [14]. Yip and Tse found that lavender oil in complementary characteristics form. The form included items on participants' age,
therapy enhanced the physical functionality among adults with weight, height, BMI, residence, education, occupation, and gender.
sub-acute non-specific neck pain and adults with sub-acute non- In this study, the data collector was blinded to allocations. The data
specific low back pain [15,16]. were collected at four time points. The first point of time was before
Numerous studies have reported that aromatherapy massage is intervention when WOMAC index and the demographic charac-
a helpful non-pharmacological approach in complementary ther- teristics form were administered to the participants in the rheu-
apy for patients with knee OA [17e20]. These studies were con- matology clinic. The other points were immediately after the three-
ducted with various compounds of EOs in certain countries on week intervention, 1 week, and 4 weeks after the intervention
different age groups and genders. Therefore, because of the high when the data collector made calls to obtain participants' WOMAC
prevalence of knee OA, especially in older people, and complica- index scores.
tions of pharmacological and surgical treatments in these patients,
as well as safety, convenience, non-invasiveness and cost- 2.3. Ethics considerations
effectiveness of complementary therapies, the present study
aimed to determine the effects of aromatherapy massage with The study protocol was approved by the Ethics Committee of
lavender EO as an intervention for improving ADL in patients with Birjand University of Medical Sciences. The study is also registered
knee OA. in the Iranian Registry of Clinical Trials with the registration
number: IRCT2015041921839N1. At first, one of the researchers
2. Materials and methods described the objectives of and procedures of the study to the
participants. Then, written informed consent was signed by the
2.1. Sample and sampling method participants. All of them were informed that they would be free to
withdraw from the study at any time.
This single-blinded, randomized clinical trial was conducted
from April 2015 to January 2016. The participants consisted of pa- 2.4. Procedure
tients with knee OA, who referred to the outpatient rheumatology
clinics of hospitals affiliated to Birjand University of Medical Sci- At first, the researcher reviewed aromatherapy massage theo-
ences, (Southern Khorasan province, Iran). Inclusion criteria retically in line with a technique from a basic aromatherapy text-
included knee OA as confirmed by a rheumatologist, age from 18 to book [25], attended a training course in massage protocols, and
65 years, knee pain level4 on a visual analogue scale, willingness went through practical training from a specialist in traditional
to participate in the study, ability to communicate and answer medicine. Afterwards, effleurage massage, which is a gliding or
questions, no history of OA in the hands and other areas, no history sliding movement over the skin [26,27], was privately taught by the
of allergy or sensitivity to herbal ingredients, no symptoms of acute researcher to each and every one of the participants at the time of
infection in the knee joint, no olfactory impairment, no history of sampling. The training was considered completed when the par-
asthma, and no history of knee surgery. Exclusion criteria were set ticipants could apply effleurage massage in a correct manner.
as follows: intra-articular steroid injections, knee surgery, physio- Consequently, they were already familiar with the effleurage
therapy prescribed for knee pain, admittance to hospital, allergic massage technique and had reviewed it a few times using written
reaction to lavender, and unwillingness to continue participation. paper instructions before the intervention initiated. Next, a bottle
The sample size was calculated by regarding a confidence in- was given to each participant containing 50 cc of lavender EO 3%
terval of 95% and a power of 90%. According to Yip's study [18], the (3 cc lavender EO was mixed with 97 cc sweet almond oil) accom-
sample size was determined to be 22 participants in each group. To panied by an illustrated pamphlet and a weekly massage timetable
compensate for a probable 20% dropout rate and enhance mea- (to record the days of doing intervention and also to record the start
surement precision, we recruited 30 patients in each group. The and ending time of each intervention session) in the aromatherapy
participants were selected using convenience sampling method massage group.
and were randomly allocated into one of three groups of aroma- The placebo group received a bottle holding 50 cc of merely
therapy massage (N ¼ 30), placebo (N ¼ 30), or control (N ¼ 30). To sweet almond oil together with the same pamphlet and timetable.
do this, as many cards were prepared as were the participants. The The aromatherapy massage group massaged their knees for 20 min
names of treatment methods were written on the cards, and the with 5 ml of lavender EO, which was diluted in sweet almond oil at
cards were put in a bag. At the referral of participants, they were a final concentration of 3% using the same type of syringe in each
requested to take one card from the bag, and thus, the treatment session. Concentration of EO used in this study was determined
type for each participant was specified. according to the literature review [28e30] and in consultation with
the herbal medicine specialist. The self-massage was conducted in a
2.2. Measurement instruments convenient room and at a fixed-time of the day with the patient
sitting in a chair.
The data in this study was collected using a demographic Whereas the control group received no massage during the
characteristics form and the Persian version of the WOMAC OA study, the placebo group applied the same intervention as that of
Index. WOMAC OA Index is a valid, reliable and very accurate index the aromatherapy massage group except that they used
118 A. Nasiri, M.A. Mahmodi / Complementary Therapies in Clinical Practice 30 (2018) 116e121

sweet almond oil only. Sweet almond oil was used because there is were removed from the study because they had exclusion criteria.
no proved respiratory effect but a frequent application of this oil as Fig. 1 displays the processes of enrollment, randomization, dropout
a placebo in previous studies [28,31,32]. Both aromatherapy mas- of the participants, and analyses.
sage and placebo groups performed self-massage nine times within Characteristics of the three groups of the study are summarized
3 weeks on the affected knee using the specific oils of their group. in Table 1. The results indicated that there was no significant dif-
This duration of intervention was based on similar studies con- ference between the three groups as for demographic characteris-
ducted in this area [16e18]. tics such as age, education, gender, occupation, duration of disease,
Additionally, the researcher reminded timely interventions to residence, and BMI. The repeated measurement ANOVA indicated
the participants via phone calls. During follow-up, the researcher that the patients' ADL were significantly improved immediately, 1
made phone calls on a weekly basis to review the application of the week, and 4 weeks after the intervention across the three groups
oils by participants. All the participants received similar conven- (Table 2). One-way ANOVA revealed that the mean score of pa-
tional drugs, such as NSAIDs, acetaminophen, etc. which were tients' ADL was not significantly different between the three groups
administered by the rheumatologist. The lavender EO and before intervention. Nonetheless, there were significant differences
sweet almond oil were produced by a reputable pharmaceutical between the three groups immediately and 1 week after the
company in Iran. At the same time, prepared products were kept intervention. However, the differences did not sustain 4 weeks after
throughout the study period in a place away from sunlight and on the intervention (Table 2).
the recommended temperature by the producing company. Tukey's post-hoc test showed that the mean score of patients'
ADL immediately after the intervention and 1 week after the
2.5. Data analysis intervention in the aromatherapy massage group had a significant
difference compared with control group (P ¼ .001 and P ¼ .03
The Kolmogorov-Smirnov test was performed to ensure normal respectively).
distribution of the data to find that the data were normally There was no correlation between the mean score of patients'
distributed. Hence, parametric statistics were used. The repeated ADL and the variables of age, gender, education level, occupation,
measure ANOVA was used to compare the mean scores of variables and residence.
before and at the three follow-up points in each group. Addition-
ally, one-way ANOVA and Tukey's post hoc test were applied to 4. Discussion
compare the groups. The level of significance was set at p < .05 for
all the tests. The results were analyzed using SPSS software (version Our findings using within group comparison showed that ability
16). to perform ADL was significantly improved in all three groups. This
can be attributed to the fact that all the participants continued
3. Results similar conventional drugs prescribed by the rheumatologist.
Patients' ADL after intervention were significantly improved in
A total number of 90 patients participated in the study. From the aromatherapy massage group compared with the
among them, 27 completed the study in the intervention, 27 in the sweet almond oil massage and the control groups.
placebo, and 26 patients in the control groups. Ten participants This finding is consistent with that of Choi's study (2006), which

Fig. 1. CONSORT diagram of the study.


A. Nasiri, M.A. Mahmodi / Complementary Therapies in Clinical Practice 30 (2018) 116e121 119

Table 1
Comparison of demographic characteristics between the three study groups.

demographic data Group


(Mean ± SD)
Aromatherapy massage group (N ¼ 27) Placebo massage group (N ¼ 27) Control group (N ¼ 26) Pvaluea

Age (years) 55.88 ± 6.36 57.33 ± 4.85 56.84 ± 6.41 0.66


Height (m) 1.62 ± .05 1.64 ± .05 1.63 ± .05 0.45
Weight (kg) 70.88 ± 5.30 69.74 ± 5.02 71.53 ± 7.01 0.52
BMI (kg/m2) 26.99 ± 2.02 25.93 ± 1.94 26.91 ± 2.18 0.11
Duration of disease (years) 3.79 ± 2.05 3.59 ± 1.55 3.61 ± 1.62 0.89

frequency (%) frequency (%) frequency (%) Pvalueb

Gender
Female 21 (77.8%) 19 (70.4%) 19 (73.1%) 0.82
Male 6 (22.2%) 8 (29.6%) 7 (26.9%)
Residence
Urban 8 (29.6%) 9 (33.3%) 11 (42.3%) 0.61
Rural 19 (70.4%) 18 (66.7%) 15 (57.7%)
Education
No education 6 (22.2%) 7 (25.9%) 5 (19.2%) 0.54
Primary school 15 (55.6%) 13 (48.1%) 10 (38.5%)
Diploma and higher 6 (22.2%) 7 (25.9%) 11 (42.3%)
Occupation
Housewife 13 (48.1%) 8 (29.6%) 9 (34.6%) 0.82
Retired 4 (14.8%) 6 (22.2%) 5 (19.2%)
Employee 5 (18.5%) 6 (22.2%) 4 (15.4%)
Other 5 (18.5%) 7 (25.9%) 8 (30.8%)
a
Pvalue is calculated by one-way ANOVA test for between group comparison.
b
Pvalue is calculated by Chi-square test for between group comparison.

Table 2
Comparison of mean scores of patients' ADL before treatment and the three follow-ups within the groups and between groups.

Group Baseline Immediately after intervention 1 week after intervention 4 weeks after intervention Pvaluea

intervention group (N ¼ 27) 34.96 ± 6.69 24.22 ± 8.03 27.51 ± 8.75 33.11 ± 6.48 <0.001
placebo group)N ¼ 27 ( 33.74 ± 7.32 27.81 ± 6.93 31.37 ± 7.18 32.51 ± 7.26 <0.001
control group)N ¼ 26 ( 34.38 ± 6.72 32.88 ± 6.58 32.80 ± 6.44 32.84 ± 6.30 0.01

Pvalueb 0.81 <0.001 0.03 0.95


a
Pvalue is calculated by repeated measure ANOVA test for within group comparison.
b
Pvalue is calculated by one way ANOVA test for between group comparison.

investigated the effectiveness of aromatherapy massage on physical who performed it reported greater improvement in ADL than those
function in elderly women with OA. In his study, the patients were in the placebo and control groups. Kim and Kim (2009) investigated
divided into three groups: oil group with non-aromatic oil the effects of aroma massage on ADL in patients with knee OA.
(sweet almond oil); aromatherapy massage group with EOs of sage, Patients were divided into two groups e one group with aroma
lavender, marjoram, and ginger; and a control group. The partici- massage using lavender, chamomile, and ginger oil and the other
pants received aroma massage nine sessions during three weeks. A with non-aromatic massage oil. They were encouraged to use self-
statistically significant difference was found between the three massage at least two times a day for 2 weeks. Similar to our results,
groups in terms of physical function scores before and after the after 2 weeks, there was a statistically significant improvement in
intervention [17]. ADL in the aroma massage group [19].
In another study, Won and Chae (2011) assessed the effects of A few basic mechanisms are offered to explain the purported
aromatherapy massage in the elderly with knee osteoarthritis. In effects. One is the influence of aroma on the brain, especially the
that study, the participants were assigned randomly into an inter- limbic system through the olfactory system. The limbic system
vention group (n ¼ 21) the participants of which had aromatherapy controls emotions and influences the nervous system and hor-
massage (with a cream containing peppermint, eucalyptus, rose- mones. Based on the type of aroma, nerve cells release various
mary) on lower legs for 20 min twice a week for four weeks as well neurotransmitters consisting of enkephalins, endorphins,
as a control group (n ¼ 21). The results showed that the experi- noradrenaline and serotonin [13,34]. Another explanation refers to
mental group's stride length increased significantly more than the direct pharmacological effects of EOs. The effect of lavender is
those of the control group (p ¼ .009). This is also consistent with possibly because of lynalyl acetate and linalool, which can effec-
our findings [20]. tively decrease pain and inflammation and prevent muscle spasms
In a randomized controlled trial, Atkins et al. (2012) enquired and reduce tensions, leading thus to improved ADL [35,36]. After
into the effects of self-massage in management of knee osteoar- topical application, the EOs get absorbed into the blood and exert
thritis symptoms. Symptoms were measured using the WOMAC. effects through the blood stream [37]. Moreover, these results may
The experimental group used self-massage therapy for 20 min, be attributed to the effects of massage such as increased oxygen-
twice weekly during thirteen sessions. The results demonstrated ation and nutrients to cells and tissue, release of endorphins,
that self-massage can improve ADL in knee OA patients, which is physical and mental relaxation following massage, and improved
consistent with the findings of our research [33]. feeling of well-being, calmness and a sense of receiving good care
Self-aromatherapy massage was used in this study. Participants for patients [38].
120 A. Nasiri, M.A. Mahmodi / Complementary Therapies in Clinical Practice 30 (2018) 116e121

This enquiry also indicated that improvement in ADL one week https://doi.org/10.1016/j.ctcp.2017.12.012.
after the intervention was significantly more in the lavender EO
massage group than the controls. Findings obtained are in line with References
those of Yip and Tam's study (2008) which was conducted on
elderly people with knee pain. In their study, 59 people were [1] C.-L. Shen, B.J. Smith, D.-F. Lo, M.-C. Chyu, D.M. Dunn, C.-H. Chen, et al., Dietary
polyphenols and mechanisms of osteoarthritis, J. Nutr. Biochem. 23 (11)
randomly allocated into one of three groups of control (no inter- (2012) 1367e1377.
vention), placebo (olive oil massage), and intervention (aroma- [2] W. Zhang, R. Moskowitz, G. Nuki, S. Abramson, R. Altman, N. Arden, et al.,
therapy massage with EOs of orange and ginger with a solution of OARSI recommendations for the management of hip and knee osteoarthritis,
Part II: OARSI evidence-based, expert consensus guidelines, Osteoar. Cartil. 16
1%). The intervention continued for 6 sessions across 3 weeks. The (2) (2008) 137e162.
WOMAC index was used to assess physical functioning before the [3] A.D. Woolf, B. Pfleger, Burden of major musculoskeletal conditions, Bull.
intervention, 1 week, and 4 weeks after initiation of the study. They World Health Organ. 81 (9) (2003) 646e656.
[4] A. Yegane, A. Mottaghi, J. Moghimi, Correlation of quantified MRI, physical
found that the improvement of physical function was significant
exam and knee radiography in patients with knee osteoarthritis, Tehran Univ.
only in the final phase, i.e., one week after the intervention had Med. Sci. 69 (3) (2011).
finished [18]. [5] L. Loew, L. Brosseau, G.A. Wells, P. Tugwell, G.P. Kenny, R. Reid, et al., Ottawa
Finally, the current study found no significant difference be- panel evidence-based clinical practice guidelines for aerobic walking pro-
grams in the management of osteoarthritis, Arch. Phys. Med. Rehabil. 93 (7)
tween the groups in terms of ADL scores four weeks after the (2012) 1269e1285.
intervention had finished. This can be due to the fact that the effects [6] M.D. Van Manen, J. Nace, M.A. Mont, Management of primary knee osteoar-
of EOs could have faded away in the course of time. Nevertheless, thritis and indications for total knee arthroplasty for general practitioners,
J. Am. Osteopath. Assoc. 112 (11) (2012) 709e715.
no similar study could be found in this regard. [7] D.C. Turk, M.J. Cohen (Eds.), Sleep as a Marker in the Effective Management of
A clinical implication of the present study is that this comple- Chronic Osteoarthritis Pain with Opioid Analgesics. Seminars in Arthritis and
mentary therapy is useful to healthcare providers who can learn, Rheumatism, Elsevier, 2010.
[8] S.A. Haq, F. Davatchi, Osteoarthritis of the knees in the COPCORD world, Int. J.
apply, or recommend aromatherapy massage techniques as a Rehum. Dis. 14 (2) (2011) 122e129.
component of care for symptoms management to OA patients. As a [9] A. Soltanian, S. Faghihzadeh, D. Mehdibarzi, A. Gerami, M. Nasery, J. Cheng,
non-invasive and accessible method, aromatherapy massage has Assessment of marhame-mafasel pomade effect on knee osteoarthritis with
non-compliance, J. Res. Health Sci. 9 (2) (2009) 19e24.
therefore the potential to attract further attention in both patient [10] Topical analgesics in the management of acute and chronic pain, in:
care settings such as clinics, wards, etc. and in future research en- C.E. Argoff (Ed.), Mayo Clinic Proceedings, Elsevier, 2013.
deavors. We admit that this clinical trial has limitations. One lim- [11] S.P. Stanos, Topical agents for the management of musculoskeletal pain, J. Pain
Symptom Manag. 33 (3) (2007) 342e355.
itation refers to the inappropriate proportion of the included
[12] H.-C. Kim, Nonsurgical treatment of osteoarthritis, J. Korean Med. Assoc. 49 (5)
patients. In fact, about 26.2% of the patients were male which can (2006) 457e463.
limit the generalizability of our findings for male patients with knee [13] G. Kyle, Evaluating the effectiveness of aromatherapy in reducing levels of
OA. Moreover, double blinding was impossible because of the smell anxiety in palliative care patients: results of a pilot study, Compl. Ther. Clin.
Pract. 12 (2) (2006) 148e155.
of lavender. Finally, inaccessibility to an aroma therapist or massage [14] D. Djenane, M. Aïder, J. Yangüela, L. Idir, D. Go mez, P. Roncale
s, Antioxidant
therapist was another limitation. These limitations should be and antibacterial effects of Lavandula and Mentha essential oils in minced
regarded for in future studies, and further research is required beef inoculated with E. coli O157: H7 and S. aureus during storage at abuse
refrigeration temperature, Meat Sci. 92 (4) (2012) 667e674.
before firmer conclusions can be proposed. [15] Y. Yip, S. Tse, The effectiveness of relaxation acupoint stimulation and
acupressure with aromatic lavender essential oil for non-specific low back
5. Conclusion pain in Hong Kong: a randomised controlled trial, Compl. Ther. Med. 12 (1)
(2004) 28e37.
[16] Y. Yip, S.H.-M. Tse, An experimental study on the effectiveness of acupressure
The study results suggest that lavender aromatherapy massage with aromatic lavender essential oil for sub-acute, non-specific neck pain in
could have positive effects on prevention of disability in ADL in Hong Kong, Compl. Ther. Clin. Pract. 12 (1) (2006) 18e26.
[17] I.R. Choi, Effects of aromatherapy massage on pain, physical function, sleep
patients with knee OA although temporarily. Given the high prev-
disturbance and depression in elderly women with osteoarthritis, Korean J.
alence of OA, this technique can be suggested because of its safety, Women Health Nurs. 12 (2) (2006) 168e176.
accessibility, and cost-effectiveness. Moreover, in light of the limi- [18] Y.B. Yip, A.C.Y. Tam, An experimental study on the effectiveness of massage
with aromatic ginger and orange essential oil for moderate-to-severe knee
tations in this study and scantiness of similar studies, performing
pain among the elderly in Hong Kong, Compl. Ther. Med. 16 (3) (2008)
further studies in other countries and on other musculoskeletal 131e138.
disorders can be an interesting topic. Lastly, it is suggested that [19] I.-J. Kim, E.-K. Kim, Effects of aroma massage on pain, activities of daily living
future studies investigate the effects of different doses, concen- and fatigue in patients with knee osteoarthritis, J. Muscle Jt. Health 16 (2)
(2009) 145e153.
trations and administration routes of lavender EO with various [20] S.-J. Won, Y.-R. Chae, The effects of aromatherapy massage on pain, sleep, and
types of research designs and also with psychological measures for stride length in the elderly with knee osteoarthritis, J. Korean Biol. Nurs. Sci.
further confirmation/rejection of our results. 13 (2) (2011) 142e148.
[21] N. Bellamy, W. Kean, W. Buchanan, E. Gerecz-Simon, J. Campbell, Double blind
randomized controlled trial of sodium meclofenamate (Meclomen) and
Conflicts of interest diclofenac sodium (Voltaren): post validation reapplication of the WOMAC
Osteoarthritis Index, J. Rheumatol. 19 (1) (1992) 153e159.
[22] G. Hawker, C. Melfi, J.E. Paul, R. Green, C. Bombardier, Comparison of a generic
The authors have no conflict of interest to declare. (SF-36) and a disease specific (WOMAC) instrument in the measurement of
outcomes after knee replacement surgery, J. Rheumatol. 22 (6) (1995)
Acknowledgments 1193e1196.
[23] G. Stucki, O. Sangha, S. Stucki, B.A. Michel, A. Tyndall, W. Dick, et al., Com-
parison of the WOMAC (Western Ontario and McMaster Universities) osteo-
The source of data used in this paper was from a thesis for a arthritis index and a self-report format of the self-administered
Master's degree in nursing and financial support was provided by LequesneeAlgofunctional index in patients with knee and hip osteoarthritis,
Osteoar. Cartil. 6 (2) (1998) 79e86.
Birjand University of Medical Sciences. The authors also would like
[24] M.H. Ebrahimzadeh, H. Makhmalbaf, A. Birjandinejad, H.A. Hoseini,
to thank the patients of this study for their kind participation. S.M. Mazloumi, The Western Ontario and McMaster Universities osteoarthritis
index (WOMAC) in Persian speaking patients with knee osteoarthritis, Arch.
Appendix A. Supplementary data Bone Jt. Surg. 2 (1) (2014) 57e62.
[25] S. Price, L. Price, Aromatherapy for Health Professionals, Elsevier Health Sci-
ences, 2007.
Supplementary data related to this article can be found at [26] V.S. Cowen, L. Burkett, J. Bredimus, D.R. Evans, S. Lamey, T. Neuhauser, et al.,
A. Nasiri, M.A. Mahmodi / Complementary Therapies in Clinical Practice 30 (2018) 116e121 121

A comparative study of Thai massage and Swedish massage relative to (4) (2008) 493e502.
physiological and psychological measures, J. Bodyw. Mov. Ther. 10 (4) (2006) [32] G.T. Lewith, A.D. Godfrey, P. Prescott, A single-blinded, randomized pilot study
266e275. evaluating the aroma of Lavandula augustifolia as a treatment for mild
[27] S. Netchanok, M. Wendy, C. Marie, The effectiveness of Swedish massage and insomnia, J. Alternative Compl. Med. 11 (4) (2005) 631e637.
traditional Thai massage in treating chronic low back pain: a review of the [33] T. Atkins, V. Dorothea, A. David, The effects of self-massage on osteoarthritis of
literature, Compl. Ther. Clin. Pract. 18 (4) (2012) 227e234. the knee: a randomized, controlled trial, Int. J. Ther. Massage Bodywork Res.
[28] Y.-J. Kim, M.S. Lee, Y.S. Yang, M.-H. Hur, Self-aromatherapy massage of the Edu. Pract. 6 (1) (2012) 4e14.
abdomen for the reduction of menstrual pain and anxiety during menstrua- [34] P.H. Koulivand, M. Khaleghi Ghadiri, A. Gorji, Lavender and the nervous sys-
tion in nurses: a placebo-controlled clinical trial, Eur. J. Integr. Med. 3 (3) tem, Evid. Based Complement. Alternat. Med. 2013 (2013).
(2011) e165ee168. [35] M. Sko €ld, L. Hagvall, A.T. Karlberg, Autoxidation of linalyl acetate, the main
[29] F. Darsareh, S. Taavoni, S. Joolaee, H. Haghani, Effect of aromatherapy massage component of lavender oil, creates potent contact allergens, Contact Derma-
on menopausal symptoms: a randomized placebo-controlled clinical trial, titis 58 (1) (2008) 9e14.
Menopause 19 (9) (2012) 995e999. [36] J. Tillett, D. Ames, The uses of aromatherapy in women's health, J. Perinat.
[30] M.-S. Ju, S. Lee, I. Bae, M.-H. Hur, K. Seong, M.S. Lee, Effects of aroma massage Neonatal Nurs. 24 (3) (2010) 238e245.
on home blood pressure, ambulatory blood pressure, and sleep quality in [37] Hyldgaard M, Mygind T, Meyer RL. Essential oils in food preservation: mode of
middle-aged women with hypertension, Evid. Based Complement. Alternat. action, synergies, and interactions with food matrix components. 2012.
Med. 2013 (2013). [38] K. Kolcaba, T. Dowd, R. Steiner, A. Mitzel, Efficacy of hand massage for
[31] S.Y. Chang, Effects of aroma hand massage on pain, state anxiety and enhancing the comfort of hospice patients, J. Hospice Palliat. Nurs. 6 (2) (2004)
depression in hospice patients with terminal cancer, J. Korean Acad. Nurs. 38 91e102.
PENATALAKSANAAN FISIOTERAPI
PADA KONDISI OSTEOARTHRITIS KNEE DEKSTRA
DENGAN MODALITAS ULTRASOUND DAN TERAPI LATIHAN
DI RSUD Prof. Dr. MARGONO SOEKARJO
Merri Yusdiana, Eko Budi Prasetyo (Prodi DIII Fisioterapi FIK-UNIKAL)

ABSTRACT

Osteoarthritis is a common rheumatic disease and causes pain and inability to


perform daily activities. Osteoarthritis is caused by several factors such as: age,
obesity, physical activity, sex, hormonal, and idiopathic causes damage to the
cartilage resulting in reduced mobility, pain and decreased muscle strength. Handlers
in this state first examined pain with VDS scale, examination of muscle strength
(MMT), examination of range of motion and functional activity. The modalities used
in this condition is Ultra Sound (US) and exercise therapy.
From the results obtained, it can be concluded that the use of ultrasound modalities
and therapeutic exercises can help reduce the problems that arise in the case of
osteoarthritis.
Key words: Osteoarthritis with VDS, MMT, LGS, ADL Index, ultrasound and
exercise therapy.

PENDAHULUAN fungsinya didalam keluarga dan


masyarakat.
Fisioterapi merupakan upaya
Osteoarthritis merupakan kelainan
pelayanan kesehatan profesional yang
sendi yang paling sering ditemukan
bertanggung jawab atas kapasitas fisik
dan menimbulkan ketidakmampuan
dan kemampuan fungsional bagi umat
atau yang disebut dengan disabilitas.
manusia yang bertujuan untuk
Ada beberapa faktor yang
meningkatkan derajat kesehatan secara
dapat mempengaruhi perkembangan
optimal dengan cara mengelola
penyakit osteoarthritis minimal ada
interaksi antara potensi alam dan
tiga faktor yang berpengaruh yaitu :
jaringan tubuh serta edukasi, agar
usia, faktor mekanik, faktor metabolik.
dapat menjalankan tugas dan
Peran fisioterapi pada kondisi
kewajibannya sesuai dengan peran dan
Osteoarthritis sangat ditentukan oleh
kondisi yang problemnya diidentifikasi

1
berdasarkan hasil–hasil kajian X : Keadaan pasien sebelum
fisioterapi yang meliputi: assessment, diberikan program fisioterapi
diagnosis, planning, intervention dan Y : Keadaan pasien setelah
evaluasi. Intervensi fisioterapi diberikan program fisioterapi
berupaaspek: pronative, preventive, Z : Program Fisioterapi
curative, rehabilitative dan Permasalahan yang timbul
maintenance dengan modalitas dasar sebelum pasien menjalani program
fisioterapi. terapi adalah pasien merasakan nyeri
METODE PENELITIAN gerak, keterbatasan lingkup grak sendi,
1. Pendekatan spasme otot quadriceps dan otot
Rancangan penelitian yang hamstring dan gangguan aktifitas
digunakan adalah studi kasus fungsional, kemudian pasien pergi
2. Desain Penelitian kefisioterapi untuk menjalani program
Penelitian ini dilakukan dengan terapi. Sebelumnya pasien menjalani
cara melakukan interview dan pemeriksaan fisioterapi yang berupa
observasional pada seseorang nyeri dengan VAS, kekuatan otot
pasien dengan kondisi dengan MMT, lingkup gerak sendi
osteoarthritis. dengan Goneometer, dan spasme
Desain penelitian digambarkan dengan dipalpasi. Setelah melakukan
sebagai berikut : pemeriksaan didapatkan permasalahan
kapasitas fisik dan kemampuan
fungsional, oleh fisioterapi pasien
diberikan modalitas terapi dengan
X Y
ultrasound dan terapi latihan. Dengan
pemberian tersebut diharapkan adanya
peningkatan pada kapasitas fisik dan
Z kemampuan fungsional.
Instrument Penelitian
Keterangan : 1. Nyeri diukur dengan VDS

2
VDS (Verbal Discriptive Scale Bertujuan untuk mengetahui
), dengan definisi : (1) tidak nyeri, (2) keadaan fisik pasien.
nyeri sangat ringan, (3) nyeri ringan, Pemeriksaan ini terdiri dari:
(4) nyeri tidak begitu berat, (5) nyeri vital sign, inspeksi, palpasi,
cukup berat, (6) nyeri berat, (7) nyeri pemeriksaan gerakan dasar,
hampir tak tertahankan. kemampuan fungsional dan
2. Lingkup Gerak Sendi (LGS) lingkungan aktifitas.
Yaitu suatu cara yang b. Interview
dilakukan oleh fisioterapi untuk Metode ini digunakan untuk
mengetahui besarnya lingkup gerak mengumpulkan data dengan
sendi yang bisa dilakukan pada suatu jalan Tanya jawab antara
sendi. Disini penulis menggunakan terapis dengan sumber data :
alat yaitu Goneometer untuk mengukur c. Observasi
LGS. Dilakukan untuk mengamati
perkembangan pasien sebelum
3. Spasme otot dengan palpasi terapi, selama terapi dan
Spasme otot dilakukan dengan sesudah diberikan terapi.
cara palpasi yaitu : dengan jalan Obyek yang dibahas
menekan dan memegang organ atau 1. Nyeri
bagian tubuh pasien untuk mengetahui Nyeri adalah pengalaman
kelenturan otot punggung, misal : sensorik dan emosional yang tidak
terasa kaku, tegang atau lunak. Untuk nyaman, yang berkaitan dengan
kriteria penilaian sebagai berikut : kerusakan jaringan atau berpotensi
Nilai 0 : tidak spasme merusak jaringan atau menyatakan
Nilai 1 : spasme ringan kerusakan tersebut.
Nilai 2 : spasme sedang 2. Spasme Otot
Nilai 3 : spasme berat Spasme otot terjadi oleh
Prosedur Pengambilan Data karena proteksi oleh adanya nyeri.
a. Pemeriksaan fisik Reaksi proteksi lain adalah
penderita berusaha menghindari

3
gerakan yang menyebabkan nyeri dalam melakukan aktivitas spesifik
apabila dibiarkan terus menerus dalam hubungan nya dengan
menyebabkan kekakuan sendi, rutinitas kehidupan sehari-hari
pemendekan otot , atrofi otot dan ataupun waktu senggangnya yang
gangguan fungsi pada lutut kanan. terintegrasi dengan lingkungan
Skala penilaiannya adalah aktivitasnya (Mardiman, Sri,
nilai 0 : tidak ada spasme, nilai 1 : 1994).
spasme sedang, nilai 2: spasme HASIL DAN PEMBAHASAN
berat. 1. Nyeri
3. Lingkup Gerak sendi (LGS) Mekanisme terjadinya nyeri
Pemeriksaan lingkup gerak adalah dimulai rangsangan nyeri
sendi gerak sendi adalah suatu cara diterima oleh cociceptors,
pengukuran yang bisa dilakukan diteruskan ketanduk belakang
suatu sendi. Sedangkan tujuan dari medulla spinalis melalui serabut
pada pengukuran LGS adalah 1) afferent sensorik. Oleh serabut
Untuk mengetahui besarnya LGS afferent, rangsangan nyeri
yang ada pada suatu sendi, 2) disampaikan ketanduk belakang
Membantu diagnose dan medulla spinals tepatnya pada
menentukan fungsi sendi penderita, lamina II, III, V, selanjutnya
3) Untuk evaluasi terhadap rangsangan menyebar ke tractus
penderita sebelum dan sesudah anterolateralis dan meneruskan
terapi 4) Untuk meningkatkan venterolateralis dan meneruskan
motivasi dan semangat penderita ventropostero lateralis dan ventro
dalam menjalani program terapi, 5) medialis dari thalamus yang
Untuk dokumentasi dapat akhirnya ke korteck cerebri.
digunakan untuk keperluan riset. Cabang-cabang collateral menuju
4. Fungsional Aktivitas ke forma sioreti cularis sistem
Pemeriksaan fungsional limbic dan hypothalamus
adalah suatu proses untuk (Nugraha, 2001).
mengetahui kemampuan pasien Tabel 1 evaluasi nyeri T!-T6

4
Jenis T1 T2 T3 T4 T5 T6 3. Lingkup Gerak Sendi
nyeri
Diam 1 1 1 1 1 1 Lingkup gerak sendi
Tekan 1 1 1 1 1 1
Gerak 4 4 4 3 3 3 merupakan jarak yan ditempuh
sendi saat bergerak(Kisner, 1996).
2. Spasme Otot Penurunan LGS disebabkan reaksi
Tabel 2 evaluasi nilai spasme otot proteksi, yaitu penderita berusaha
Keluhan T1 T2 T3 T4 T5 T6 menghindari gerakan yang
Spasme 2 2 2 1 1 1
menyebabkan nyeri. Bila diabaikan
Spasme otot muncul akibat terus menerus akan mengakibatkan
adanya efek defend mechanisme penurunan kekuatan sendi lutut dan
daritubuh itu sendiri atau bagian terjadi gangguan fungsional. Untuk
tubuh tertentu dan biasanaya memeriksa lingkup gerak sendi
bersifat local. Reaksi lain adalah menggunakan goneometer, yang
penderita berusaha menghindari pada dasarnya berupa unsur
gerakan yang menyebabkan nyeri. dengan buah tungkai panjang, satu
Apbila dibiarkan terus menerus merupakan tungkai statis dan yang
akan mengakibatkan kekakuan satunya bergerak ( Kisner, 1996).
sendi dan gangguan fungsional, Table 3 evaluasi lingkup gerak
untuk mengetahui spasme otot sendi
dapat dilakukan dengan cara GERAK AKTIF T1 T2 T3 T4 T5 T6

palpasi, yaitu dengan cara meraba, Knee dekstra S = 0° S = 0°S = 0°S = 0°S = 0°S = 0°
- 0 - - 0 -- 0 -- 0 -- 0 -- 0 -
menekan, memegang organ atau 120° 120° 120° 125° 125° 125°

bagian tubuh pasien, misal : terasa Knee sinistra S = 0°S = 0°S = 0°S = 0°S = 0°S = 0°
- 0 -- 0 -- 0 -- 0 -- 0 -- 0 -
kaku atau lunak. 130° 130° 130° 130° 130° 130°

Dari hasil evaluasi diatas dapat GERAK PASIF T1 T2 T3 T4 T5 T6

dilihat terjadi penurunan derajat Knee dekstra S = 0°S = 0° S = S = 0°S = 0°S = 0°


- 0 -- 0 - 0° - 0 - 0 -- 0 -- 0 -
spasme atau kekakuan otot dari 120° 120° - 130° 130° 130°
120°
penurunan spasme atau kekakuan
Knee sinistra S = 0°S = 0°S = 0°S = 0°S = 0°S = 0°
otot dari nilai 2 menjadi 1. - 0 -- 0 -- 0 -- 0 -- 0 -- 0 -
140° 140° 140° 140° 140° 140°

5
Tabel 4 evaluasi fungsional aktifitas
4. Fungsional Aktivitas Aktifitas T1 T2 T3 T4 T5 T6
Transfer dari lantai kekursi 1 1 1 1 1 1
kemampuan fungsional adalah Transfer dari kursi ke bed 2 2 2 2 2 2
Berjalan dalam ruangan 2 2 2 2 2 2
kemampuan dari pasien untuk Berjalan diluar 2 2 2 2 2 2
Naik tangga atau trap 2 2 2 2 2 2
melakukan aktivitas sehari- Turun tangga atau trap 2 2 2 2 2 2
Berpakaian 1 1 1 1 1 1
Mencuci 1 1 1 1 1 1
harinya. Terganggunya aktifitas Mandi 1 1 1 1 1 1
Menggunakan toilet 2 2 2 2 2 2
fugsional oleh karena adanya rasa Control bowel dan blader 1 1 1 1 1 1
Berhias 1 1 1 1 1 1
nyeri sehingga pasien membatasi Menyikat gigi 1 1 1 1 1 1
Menyiapkanminuman teh 1 1 1 1 1 1
aktivitas yang menimbulkan nyeri. Menggunakan kran 1 1 1 1 1 1
Makan 1 1 1 1 1 1
Untuk mengetahui kemampuan
KESIMPULAN
fungsional dari pasien digunakan
indek ADL. Gangguan pada Dari keterangan diatas dapat
kemampuan fungsional pasien diambil kesimpulan bahwa
yaitu pasien mengalami kesulitan osteoarthritis dapat mengakibatkan
pada saat menekuk lutut secara munculnya berbagai permasalahan-
maksimal. Aktivitas sehari-hari permasalaha fisioterapi yaitu (1)
pasien mengalami kesulitan saat adanya nyeri gerak (2) menurunnya
jongkok, saat BAB dengan toilet kekuatan otot (3) keterbatasan gerak
jongkok, saat sholat tepatnya pada lutut terutamauntuk gerakan feksi (4)
gerakan rukuk. Dari tabel dibawah gangguan aktivitas fungsional,
dapat diketahui bahwa ada modalitas fisioterapi yang digunakan
peningkatan aktivitas fungsional untuk mengatasi permasalah-
yang dilakukan oleh pasien selama permasalahan tersebut adalah
menjalani terapi dengan skala ultrasound dan terapi latihan.Setelah
penilaian dilakukan tindakan fisioterapi
Nilai 1= dapat melakukan tanpa sebanyak 6x terapi dengan
bantuan. menggunakan modalitas. Ultrasound
Nilai 2= dapat melakukan dengan dan terapi latihan terjadi perubahan
bantuan atau dengan hasil :Nyeri gerak mulai
Nilai 3= tidak dapat melakukan.

6
berkurang dari T1=4 menjadi 3 setelah TITAFI XV, Semarang 2-4
6 kali terapi. Oktober 2000.
Adanya peningkatan kekuatan otot
Prasetya H (2002) Rematologi,
quadriceps T1=4 menjadi setelah 6
Akademi Fisioterapi Depkes RI.
kali terapi Peningkatan LGS pada knne
Surakarta
dekstra aktif T1 S = 0° - 0 - 120°
Prof.Dr.Soekidjo Noto
menjadi S = 0° - 0 - 125°.pada knee
atmojo,S.K.M.M.Com.H
dekstra pasif S = 0° - 0 - 125° menjadi
(2010) Promosi Kesehatan
S = 0° - 0 – 130°.Data-data tersebut
Teori dan Aplikasi Edisi revisi
menunjukan adanya perkembangan
2010.
pasien kearah perbaikan.
Syaifuddin, AMK (2006).Anatomi
DAFTAR PUSTAKA Fisiologi untuk mahasiswa
Kisner,Carolyn dan Colby, Lynn; kepe rawatan.Edisi 3.
Therapeutic Excercise Jakarta.
Foundation And Techniques;
Third Edition;F.A. Davis
Company; Philadelphia, 1996.

Mardiman Sri, Ed; Dokumentasi


Persiapan Praktek Professional
Fisioterapi; Akademi
Fisioterapi Surakarta, Depkes
RI, Surakarta, 1994.

Nugroho Slamet; Terapi Listrik Untuk


Modulasi Nyeri; IFI Cabang
Semarang; Semarang, 2002.

Parjoto, Slamet. Assesment Fisioterapi


pada Osteoartritis Sendi Lutut.
Dalam Pertemuan Rutin