REVIEW JURNAL

Land-based versus water-based walking programs in elderly

women with knee osteoarthritis: preliminary results of a
randomized clinical trial

Disusun oleh:

1. Aning Sri A. Mey 2008114

2. Anita ulfah 2008115
3. Chrisna Ayu I 2008125
4. Diyah Setiyaningsih 2008129

PROGRAM STUDI PROFESI NERS

UNIVERSITAS KARYA HUSADA SEMARANG
2021
NO KOMPONEN ISI JURNAL
1. Identitas jurnal Brazilian Journal of Health and Biomedical Sciences – Juni 2019
2. Pengarang dan tahun Arthur N. Arrieiro, Vanessa A. Mendonça, Sueli F. Fonseca,
penelitian Jousielle M. Santos, Vanessa G. C.Ribeiro, Mateus R. Amorim,
Amanda A. O. Leopoldino, Ana C. R. Lacerda
3. Judul penelitian Program berjalan di tanah dan air pada wanita tua dengan
osteoarthritis lutut : hasil pendahuluan uji klinis acak

Land-based versus water-based walking programs in elderly

women with knee osteoarthritis: preliminary results of a
randomized clinical trial
4. Latar belakang Osteoarthritis (OA) merupakan kelainan degenerative kronik yang
sering menyerang sendi lutut menghasilkan gejala nyeri,
kekakuan, bengkak, kelemahan dan ketidakstabilan sendi.
Kejadian OA meningkat sesuai usia dan bertanggung jawab
terhadap tingginya kejadian kecacatan dan penyakit kronik lain
pada populasi usia tua
Pasien dengan kOA sering mengeluhkan nyeri dan masalah
aktivitas sehari0hari dan memiliki kesulitan aktivitas fisik dan
fungsi dibandingkan orang normal. Selain itu, nyeri dan gejala
lain dari OA memiliki efek kuat terhadap kualitas hidup.
Belum diketahui obat terhadap OA, dimana tujuan terapi
meminimalkan gejala penyakit. Terapi non farmakologis telah
diteliti untuk menangani OA. Latihan dalam air sudah digunakan
secara luas pada terapi kOA karena tubuh yang mengapung dalam
air mengurangi beban sendi terhadap berat badan.
Penelitian lain juga menunjukkan bahwa berjalan di tanah dengan
intensitas sedang mengurangi nyeri dan kecacatan pada pasien
dengan kOA tanpa efek samping terhadap gejala OA. Berdasarkan
kedua metode efektif tersebut beberapa penelitian
membandingkan intervensi latihan di tanah dan di air.

Osteoarthritis (OA) is a chronic degenerative disorder that

frequently affects the knee joint resulting in pain, stiffness,
swelling, weakness, and joint instability. Its prevalence increases
with age, and OA is responsible for a higher incidence of
disability than any other chronic disease in elderly populations
Patients with kOA frequently report pain and problems with daily
living activities and exercise, and have greater difficulty in
performing physical and functional activities compared to healthy
individuals. Furthermore, pain and other symptoms of OA may
have a profound effect on quality of life.
There is no known cure for OA, and the aim of treatment is to
minimize the disease symptoms. Nonpharmacological treatments
have been studied for the management of OA. Aquatic exercises
have been widely used as kOA treatments because the body’s
buoyancy in water reduces the weight that joints have to bear.
Studies have also shown that moderate-intensity aerobic walking
on land reduces pain and disability in subjects with knee OA with
no adverse effects on OA symptoms. Given that both of these
methods have been demonstrated to be effective, some studies
have compared aquatic to land-based exercise interventions
5. Tujuan Tujuan penelitian ini untuk mengetahui efek program latihan yang
terdiri dari berjalan menggunakan beban progresif terkontrol di
dalam air maupun di tanah, dalam hal nyeri, fungsi dan performa
fisik, serta kualitas hidup

The aim of this study was to investigate the effects of a training

program consisting of walking using a controlled progressive
workload in water compared with a similar program on land in
terms of pain, functional and physical performance, and quality of
life
6. Jenis penelitian Uji terkontrol acak

Randomized-controlled trial
7. Metode penelitian Penilaian sebelum dan sesudah tes

Pre dan post test assesment

8. Pengumpulan data Relawan dinilai oleh 1 orang penilai sesaat sebelum program
latihan dimulai dan setelah 12 minggu latihan aerobic di tanah dan
di dalam air. Pengukuran antropometri dan tes spesifik dilakukan
selama eksperimen

Volunteers were evaluated by an examiner immediately before the

training programs began and again after 12 weeks of land-based
or waterbased aerobic training. Anthropometric measures and
specific tests were performed during the experiment
9. Alat penelitian Pencatat waktu, monitor detak jantung

Timer, heart rate monitor

10. Analisa data Uji Shapiro-Wilk
11. Tehnik sampling Simple random sampling
12. populasi Wanita usia lebih dari 60 tahun dengan diagnosis OA pada salah
satu lutut
Women age over 60 years diagnosis of OA in at least one knee
13. sampel 16 orang
14. Lokasi penelitian Sesi latihan di tanah dilakukan di gymnasium, sesi latihan di
dalam air dilakukan di kolam hangat 30 m2 dengan kedalaman 1,2
meter

The land-based sessions were held in a gymnasium, while the

water-based sessions were conducted in a 30-square-meter
heated pool that was 1.20 meters deep
15. Analisa univariat dan Varibel dimasukkan ke dalam penilaian analisis variasi
bivariat dilanjutkan dengan perbandingan post hoc Tukey

Variables were submitted to measures analysis of variance

(ANOVA) followed by Tukey post hoc comparisons
16. Pengolahan data Pengukuran disamakan dengan menggunakan 2 perlakuan, latihan
di tanah dan di dalam air, dan juga pengukuran dilakukan pada 2
waktu yang berbeda, sebelum dan sesudah intervensi. Untuk
variabel dengan distribusi tidak normal, statistik yang digunakan
statistik ANOVA. Analisis nonparametric menggunakan piranti
lunak Statistical Analysis System (SAS Institute, Cary,
NC, USA). Pada penelitian ini angka signifikan ditetapkan P <
0.05
 Measurement was justified by the use of two treatments, land- and
water-based exercise, and measurements taken at two points in
time: before and after intervention. For the variables that were
not normally distributed, the statistic utilized was
the ANOVA. Nonparametric analyses were carried out
using Statistical Analysis System (SAS Institute, Cary,
NC, USA) software. In this study, the significance level was set at
P < 0.05
17. Hasil penelitian Karakteristik partisipan : Seluruh relawan menyelesaikan porsi
eksperimen dan tidak didapatkan perbedaan signifikan pada
karakteristik antropometri antara kedua kelompok penelitian
sebelum dan sesudah intervensi
Retensi dan ketaatan data : Seluruh relawan menyelesaikan semua
tugas eksperimen (angka ketaatan = 92%), menghadiri rata-rata 33
sesi dari total 36 sesi yang ditawarkan. Tidak terdapat perbedaan
signifikan antara subjek atau kelompok
Luaran : Nyeri yang dilaporkan sendiri, dinilai dengan WOMAC,
menunjukkan penurunan secara signifikan setelah 12 minggu
latihan dibandingkan sebelum memulai program intervensi, baik
kelompok latihan di tanah (41.82%) maupun di dalam air
(46.94%)
Fungsi fisik yang dilaporkan sendiri, juga dinilai oleh WOMAC,
menunjukkan peningkatan statistik setelah latihan dibandingkan
sebelum latihan baik pada kelompok latihan di tanah (43.48%)
maupun di dalam air (60.50%)

Participant characteristics : All 16 initial volunteers completed

the course of experiments, and no significant differences were
observed in anthropometric characteristics between the two study
groups before or after intervention
Data adherence and retention : All volunteers completed all the
experimental tasks (adherence rate = 92%), attending an average
of 33 sessions of a total of 36 offered. There were no significant
differences between subjects or between groups.
Outcome : Self-reported pain, assessed by WOMAC, showed a
significant reduction after 12 weeks of training compared to
before the beginning of the intervention program, both in the
land-based (41.82%) and waterbased groups (46.94%)
Self-reported physical function, also assessed by WOMAC,
showed a statistical improvement after training compared to
before training, both in the land-based (43.48%) and water-based
groups (60.50%)

Kekakuan yang dilaporkan sendiri tidak mengalami perbaikan

setelah latihan dibandingkan sebelum intervensi pada kedua
kelompok.
Performa fungsional, yang dievaluasi langsung oleh 6MWT dan
ST, membaik secara signifikan pada kedua kelompok, tanpa
adanya perbedaan diantara kedua kelompok.
Jarak berjalan selama 6MWT meningkat sebesar 15.38% setelah
12 minggu latihan pada kelompok latihan di tanah dan sebesar
11.23% pada kelompok latihan di dalam air. Waktu yang
dibutuhkan untuk naik dan turun 4 anak tangga pada latihan ST
 menurun sebesar 14.81% setelah intervensi pada kelompok latihan
di tanah dan sebesar 7.71% pada kelompok latihan di dalam air.

Self-reported stiffness did not improve after training compared to

before the intervention in either group
Functional performance, evaluated directly by the 6MWT and ST,
improved significantly in both groups, with no significant
difference between groups.
The distance walked during the 6MWT increased by
15.38% after 12 weeks of training in the land-based group and by
11.23% in the water-based group. The time required to walk up
and down four steps in the ST decreased by 14.81% after the
intervention in the land-based group and by 7.71% in the water-
based group.

Setelah penyelesaian tes progresif pada treadmill sampai letih,

performa fisik ditentukan oleh satuan VO2max dan AT. VO2max
meningkat signifikan pada kelompok latihan di tanah (7.04%) dan
kelompok latihan di dalam air (12.20%) setelah 12 minggu latihan
dibandingkan sebelum intervensi, dimana tidak ada perbedaan
signifikan
Selain itu, AT tercapai pada intensitas latihan yang lebih tinggi
karena konsumsi oksigen yang lebih tinggi pada kelompok latihan
di tanah (7.75%) dan kelompok latihan di dalam air (9.8%) tanpa
ada perbedaan signifikan antar kelompok
Kualitas hidup dinilai dengan SF-36, menunjukkan peningkatan 7
dari 9 domain pertanyaan, kecuali fungsi social dibandingkan
sebelum intervensi. Akan tetapi, tidak didapatkan perbedaan
signifikan antar kelompok pada semua domain

After completion of a progressive test on a treadmill

until fatigue, physical performance was determined in
terms of the VO2max and AT. The VO2max increased
significantly in the land-based (7.04%) and water-based groups
(12.20%) after 12 weeks of training compared with before
intervention, with no difference between groups.
Moreover, AT was reached at higher exercise intensity and,
therefore, at higher oxygen consumption after the intervention in
the land-based group (7.75%) and in the water-based group
(9.80%), with no difference between groups.
Quality of life, assessed by SF-36, showed improvement in 7 of 8
questionnaire domains, except social function, compared to
before the intervention. However, there was no significant
difference between groups in any domain
18. kesimpulan Berdasarkan tipe intervensi (tanah atau air), ketika seluruh subjek
berlatih dengan intensitas yang sama dengan jumlah latihan yang
sama pada setiap minggu, tidak ada metode latihan yang lebih
baik. Karena latihan berjalan di tanah sama efektifnya dibanding
latihan di dalam air, kami percaya bahwa latihan berjalan di tanah
adalah pilihan yang lebih murah untuk program kesehatan
masyarakat untuk penanganan pasien tua dengan kOA

Regardless of the type of intervention (land-based or water-

based), once all subjects exercised with the same intensity and
same amount of exercise during each week of training, neither
 mode was clearly superior to the other. Because land-based
walking training was as effective as waterbased walking training,
we believe that land-based walking training constitutes a more
cost-effective choice for public health programs for the treatment
of elderly patients with kOA.
19. saran Hasil penelitian ini harus dikonfirmasi pada sampel yang lebih
besar. Selain itu penelitian selanjutnya dibutuhkan untuk analisis
luaran klinis pada latihan berjalan di air atau di tanah pada pasien
dengan OA lutut

Therefore, the present results need to be confirmed in a larger

sample. So, further studies are needed to analyze clinical
outcomes for aquatic or terrestrial walking exercise in patients
with knee OA
20. Keunggulan isi jurnal Penilaian objektif dan subjektif dilakukan secara komprehensif
untuk menilai peran intervensi latihan terhadap luaran klinis OA
21. Kekurangan isi jurnal Sampel yang terlalu sedikit untuk sebuah penelitian
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