EVIDENCE BASED MIDWIFERY

CRITICAL APPRASIAL
Disusun untuk memenuhi tugas mata kuliah Manajemen Pelayanan Asuhan Kebidanan
Profesional dan Evidance Based Midwifery
Dosen Pengampu : Henik Istikhomah, SST.,M.Keb

Disusun Oleh :

1. Kusumaning Ayu Sefiany (P27224023343)

2. Zenith Elisa Kurniawati (P27224023379)

KEMENTERIAN KESEHATAN REPUBLIK INDONESIA

POLTEKKES KEMENKES SURAKARTA
JURUSAN KEBIDANAN
TAHUN 2024
 CRITICAL APPRASIAL
ABDOMINAL STRETCHING AS A THERAPY
FOR
DYSMENORRHEA

A. Strategi Pelacakan
1. Metode pencarian literatur
Database yang digunakan: Macedonian Journal of Medical Sciences
https://doi.org/10.3889/oamjms.2021.6711
2. Kata kunci
PICO ELEMENT KEYWORST SEARCH TERMS SEARCH
STRATEGIES
P (Patient or Menstrual cramps; Menstrual cramps, Menstrual cramps OR
Population) Abdominal stretching Abdominal Abdominal stretching
exercise; stretching, exercise OR
Dysmenorrhea Dysmenorrhea Dysmenorrhea
I (Intervention) Abdominal stretching exercise exercise
C (Comparison) Not Abdominal
stretching exercise
O (Outcome) Effect of abdominal Dysmenorrhea Dysmenorrhea
exercises on
dysmenorrhea

3. Jumlah literatur yang di

dapatkan 114
4. Proses seleksi literatur
Dengan memilih jurnal sesuai dengan tema dan kemampuan penelaah
untuk melakukan critical appraisal.
5. Judul jurnal
Abdominal Stretching as a Therapy for Dysmenorrhea
6. Peneliti
Sri Rejeki, Fariz Yulian Pratama, Ernawati Ernawati, Arief Yanto, Edy
Soesanto, Satriya Pranata
 7. Tahun terbit
2021
B. Apakah Hasil Penelitian Valid
1. Apakah pasien pada penelitian di randomisasi?
ya, penelitian bersifat random. Hal ini dijelaskan pada bagian sampel

2. Apakah semua pasien yang masuk dalam kelompok control dan

eksperimen dicatat dengan benar dan dikaitkan dengan kesimpulan?
Ya, semua pasien yang masuk dalam kelompok kontrol maupun kelompok
eksperimen dicatat karakteristiknya dari awal penelitian. Hal ini dibuktikan
dengan, Subjek yang di ambil di masukkan dalam kelompok kontrol 65 dan
eksperimen 65. Kedua kelompok diberikan pre-test dan post-test. Dalam desain
penelitian ini, intensitas nyeri sebelum dan sesudah perlakuan pada kelompok
intervensi diukur. Itu diukur menggunakan Skala Penilaian Numerik. Hasil
observasi intensitas nyeri kelompok intervensi kemudian dibandingkan dengan
hasil observasi kelompok kontrol.

3. Apakah follow-up kepada pasien cukup panjang dan lengkap?

Ya, paisen di follow up dengan jelas. Pasien melakukan perenggangan otot
perut selama 10-15 menit untuk meningkatkan kekuatan, daya tahan,
fleksibilitas otot, menghilangkan nyeri, dan menurunkan kontraksi sehingga
 mengurangi nyeri haid (dismenore). Tujuan dari peregangan otot adalah untuk
meningkatkan oksigenasi (proses seluler mentransfer oksigen dan karbohidrat)
dan merangsang aliran drainase getah bening, sehingga dapat meningkatkan
fleksibilitas otot dan mempertahankan fungsi dengan baik, sekaligus
memperbaiki elastisitas dan fleksibilitas jaringan tubuh untuk mengurangi
kram otot.

4. Apakah pasien dianalisis di dalam grup dimana mereka dirandomisasi?

Iya, dengan jumlah 65 responden sebagai kelompok kontrol dan 65 responden
sebagai kelompok intervensi.

5. Apakah pasien, klinisi dan peneliti blind terhadap terapi?

Tidak, penelitian ini tidak duble blind dimana peneliti dan responden
mengetahui terapi yang akan diterapkan.
 6. Apakah grup pasien diperlakukan sama, selain dari terapi yang diberikan?
Iya, Hal ini juga didukung oleh penelitian bahwa olahraga efektif untuk
mengurangi nyeri akibat dismenore.

7. Apakah karakteristik grup pasien sama pada awal penelitian?

Ya, karakteriktik grup pasien sama pada awal penelitian. Sampel yang di ambil
remaja usia 15-17 tahun. Dengan 65 responden sebagai kelompok kontrol dan
65 responden sebagai kelompok eksperimen.

C. Apa Hasil Dari Penelitian Tersebut

1. Seberapa penting hasil penelitian
Siswa perempuan yang menderita dismenore cenderung mengalami gangguan
belajar, karena rasa sakit tersebut mengharuskan mereka untuk tidak masuk
sekolah dan mempengaruhi konsentrasi belajar mereka. Dari fenomena diatas
maka peneliti tertarik untuk melakukan penelitian tindakan dengan manajemen
nyeri non farmakologi dengan menggunakan latihan peregangan perut.
 2. Seberapa tepat estimasi dari efek terapi
Keluaran
Senam Skor
Total
Perut Oswestry Skor VAS
LBDQ (mm)
Eksperimen 4,58 1,46 6,04
Control 4,48 3,47 7,95
Total 9,06 4,93

Experiment
Even Rate a/100 0,24
(EER)
Control
Even Rate c/100 0,43
(CER)
Kemampuan keberhasilan
perengganagan perut remaja terhadap
Relative
EER/CER 0,55 dismenorea 0,55 kali dibandingkan
Risk (RR)
dengan remaja yang tidak melakukan
perenggangan perut.
Relative
Dengan melakukan perenggangan
Risk (EER-
0,45 perut pada remaja akan mengurangi
Increase CER)/CER
dismenore sebesar 0,45
(RRI)
Absolut
Insiden nyeri dismenore pada remaja
Risk
EER-CER -0,19 akan menurun -0,19 jika remaja
Increase
melakukan perenggangan perut
(ARI)
Setiap remaja yang melakukan
Number perenggangan perut akan tampak 1
Need to insiden penurunan dismenore atau
1/ARI -1,11
Treat kita perlu melakukan perenggangan
(NNT) perut kepada remaja untuk mencegah
1 kejadian dismenore

D. Apakah Hasil Penelitian yang Valid dan Penting Tersebut Applicable (Dapat
Diterapkan) Dalam Praktek Sehati-hari?
1. Apakah hasilnya dapat diterapkan kepada pasien kita?
Ya, hasil penelitian dapat diterapkan pada pasien kita. Olah raga merupakan
salah satu tindakan non farmakologis manajemen nyeri yang dianggap aman,
karena hanya menggunakan fisiologi. Signifikansi kebiasaan olah raga
terhadap dismenore dimana gejala psikologis dan fisik dari dismenore primer
 mengalami penurunan. Olahraga teratur memicu pelepasan endorfin. semakin
banyak latihan, semakin tinggi kadar endorfin yang dilepaskan.

2. Apakah karakteristik pasien kita sangat berbeda dibandingkan pasien

pada penelitian sehingga hasilnya tidak dapat diterapkan?
Tidak, karakteristik pasien sama dengan penelitian yaitu remaja usia 15-17
tahun sehingga hasilnya dapat diterapkan.

3. Apakah hasilnya mungkin dikerjakan di tempat kerja kita?

Iya, hasil penelitian ini dapat diterapkan di tempat kerja kita dan diterapkan
pada remaja atau wanita yang mengalami dismenore.
4. Apakah value dalam preferensi terapi ini?
Terdapat pengaruh yang signifikan peregangan perut terhadap intensitas nyeri
dismenore pada remaja putri. Rerata intensitas dismenore pada remaja putri
sebelum dilakukan penerapan peregangan perut adalah 4,58 dan menurun
menjadi 1,46 setelah penerapan peregangan perut. Informasi tersebut dapat
digunakan untuk menangani remaja putri penderita dismenore dengan
menggunakan teknik non farmakologi.

5. Apakah kita dan pasien kita mempunyai penilaian yang jelas dan tepat
akan value dan preferensi pasien kita?
 Iya, berdasarkan penelitian ini menunjukkan intensitas nyeri setelah dilakukan
tindakan abdominal peregangan sebesar 1,46 dengan rerata intensitas nyeri
sebelum dilakukan tindakan sebesar 4,58. intensitas nyeri rata-rata pada
kelompok kontrol adalah 4.48. Dengan demikian dapat disimpulkan bahwa
terdapat pengaruh yang signifikan peregangan otot perut terhadap penurunan
intensitas nyeri pada remaja putri penderita dismenore.

6. Apakah value dan preverensi pasien kita dipenuhi dengan terapi yang akan
kita berikan?
Iya, dapat dilakukan oleh remaja dan wanita yang dismenore
7. Apakah kemungkinan benefit dan harm dari terapi tersebut?
a. Benefit
1) Mengurangi nyeri saat haid
2) Meningkatkan kekuatan otot, daya tahan tubuh, dan kelenturan otot
b. Harm
Tidak ada efek samping yang terlalu berisiko dari pemberian
perenggangan perut
Scientific Foundation SPIROSKI, Skopje, Republic of Macedonia
Open Access Macedonian Journal of Medical Sciences. 2021 Oct 28; 9(G):180-183. https://doi.org/10.3889/oamjms.2021.6711
eISSN: 1857-9655
Category: G - Nursing
Section: Nursing in Gynecology and Obstetrics

Abdominal Stretching as a Therapy for Dysmenorrhea

Sri Rejeki¹* , Fariz Yulian Pratama², Ernawati Ernawati1 , Arief Yanto1 , Edy Soesanto 1
, Satriya Pranata1,3
1
Department of Nursing, Faculty of Nursing, Universitas Muhammadiyah Semarang, Semarang, Indonesia; 2Department of
Nursing, Nurse Advisor and Practitioner Nursing Laboratory, Universitas Muhammadiyah Semarang, Semarang, Indonesia;
3
Department of Nursing, School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan

Abstract
Edited by: Rehan Mohamed Saleh BACKGROUND: Dysmenorrhea is pain during the menstrual period caused by uterine muscle cramps. The Dysmenorrhea
Citation: Rejeki S, Pratama F Y, Ernawati E, Yanto A,
Soesanto E, Pranata S. Abdominal Stretching as a
prevalence in Indonesia is categorized as high at 64.25%. The dysmenorrhea symptom could be very disruptive and even
Therapy for Dysmenorrhea. Open Access Maced J Med decrease women’s productivity. Related to this problem, abdominal stretching is one of the alternatives to reduce pain from
Sci. 2021 Oct 28; 9(G):180-183.
https://doi.org/10.3889/oamjms.2021.6711
dysmenorrhea.
Keywords: Menstrual cramps; Abdominal stretching
exercise; Dysmenorrhea
AIM: This research was aimed to find out the effect of abdominal stretching on the pain intensity of menstrual cramps.
*Correspondence: Sri Rejeki, Department of Nursing,
Faculty of Nursing, Universitas Muhammadiyah Semarang, METHODS: It was a quasi-experimental research with a pre-test post-test control group design. The sample was 130 female
Semarang, Indonesia. E-mail: srirejeki@unimus.ac.id adolescents that were taken by total sampling. The sample was divided into two groups, which were the intervention group
Received: 25-Jun-2021
Revised: 14-Oct-2021 and the control group.
Accepted: 18-Oct-2021
Copyright: © 2021 Sri Rejeki, Fariz Yulian Pratama, RESULTS: The research finding, with a 0.000 (p < 0.005) significance value was obtained by using the Wilcoxon test.
Ernawati Ernawati, Arief Yanto, Edy Soesanto, Satriya
Pranata CONCLUSION: It means abdominal stretching exercise is significantly effective to reduce pain intensity from menstrual
Funding: This research did not receive any financial
support
cramps (dysmenorrhea) in female adolescents. It is suggested to implement abdominal stretching as nursing care for
Competing Interests: The authors have declared that no menstrual cramps.
competing interests exist
Open Access: This is an open-access article distributed
under the terms of the Creative Commons Attribution-
NonCommercial 4.0 International License (CC BY-NC 4.0)

Introduction and 9.36% secondary dysmenorrhea [6]. Primary

dysmenorrhea commonly happens 1–2 years after the
menarche [3], [6]. Meanwhile, the common menarche age
Menstruation is periodical and cyclical uterine for Indonesian adolescents is 13–14 years old [7]. Based on
bleeding accompanied by endometrium desquamation the data, the dysmenorrhea experienced by female
which is also a sign that a woman is in her puberty period adolescents between 16 and 18 years old, or when they are
[1]. A woman first gets her period between 12 and 15 years in high school years [1].
old, depends on some factors such as health, nutrition
Primary dysmenorrhea and other systemic
status, and weight [2], [3]. Menstruation is a normal
symptoms are mainly caused by the high level of
physiological process and event in female adolescents [4].
prostaglandin. After the ovulation, as the response to
However, some of them might have a problem during
progesterone production, the fatty acid in the Phospholipid
their period. The most complained gynecological problem
cell membrane is increased. Then, arachidonic acid is
during menstruation may vary from the irregular
released and starts the prostaglandin cascade in the uterus.
menstrual cycle, menorrhagia, dysmenorrhea, and other
Prostaglandin (PGF-2) turns to hypertonic myometrium
related symptoms. Dysmenorrhea is mainly related to the
and vasoconstriction which leads to ischemia and pain [1].
previous ovulation with uterine muscle contraction and the
prostaglandin secretion which leads to uterine muscle The bad treatment of dysmenorrhea could cause
cramps [1], [5]. female activity disruption. The activity disruption could
happen in women, especially the active and dynamic
Dysmenorrhea is categorized into two, (1) primary adolescents in their growth and developmental period. The
dysmenorrhea related to the menstrual cramps without any severe pain during menstruation leads to activity
genital anatomy abnormality; (2) secondary dysmenorrhea intolerance, such as absence from work or school. It
is menstrual cramps with a particular anatomic disorder or decreases work output and affects learning achievement [8].
any pelvic pathology problem [6]. Dysmenorrhea prevalence For example, a female high school student who suffers from
in Indonesia is about 64.25% which consists of 54.89% dysmenorrhea could not fully concentrate on her study and
primary dysmenorrhea unfortunately must be

180 https://oamjms.eu/index.php/mjms/index
 Rejeki et al.

absent from school [4]. A study reports that primary
dysmenorrhea is proven to affect women’s life quality at
40–90%, where one out of 13 women with primary
dysmenorrhea is absent from work or school for 1–3
days every month [2], [4], [8].
According to the International Association for the
study of Pain, pain is the main reason for someone to seek
healthcare [9]. Someone with pain also feels the stress and
torture, so that he or she is driven to find relief. Pain is the
source of frustration either for patients or health workers
[10]. For some adolescents, primary dysmenorrhea is
particular torture they have to suffer every month [2]. It
drives them to find the perfect solution for the problem.
There are some solutions to relieve pain from menstrual
cramps, either pharmacological therapy or non-
pharmacological therapy [1]. Non- pharmacological pain
management is considered to be safer than pharmacological
therapy as it may have a side effect [11].
Pharmacology therapy usually uses pain- relief
medicine including analgesic (painkiller) from non-steroid
anti-inflammation drugs categories, such as paracetamol
or acetaminophen (sumagesic, panadol, etc.), mefenamic
acid (ponstelax, nichostan, etc), ibuprofen (ribunal, ostarin,
etc.), metamizole or methampyron (pyronal, novalgin, etc.),
and other pain- relief medicine [12]. Non-pharmacological
therapy could vary from warm compress, warm shower,
massage, exercise, enough sleep, hypnotherapy, distraction
such as listening to music, and relaxation in the form of
yoga and deep breathing technique [10]. Several studies
found that exercise could deal with dysmenorrhea [13].
Moreover, exercise is safer as it does no’t have any side
effects which may distract the physiological process of the
body [6], [13]. Physical exercise could trigger endorphin,
the natural opiate from the human body to increase the
feeling of well-being and reduce pain [9]. The increasing
endorphin level in the body could reduce pain from the
contraction. Exercise is proven to increase endorphin in the
blood 4–5 times higher. Therefore, the more exercise we do,
the higher the endorphin level in our blood [13].
Abdominal stretching exercise is an exercise to
reduce menstrual pain (dysmenorrhea). Abdominal
stretching exercise is a physical exercise that includes
abdominal muscle stretching for 10–15 min to improve
muscle strength, endurance, and flexibility [13]. It is
expected to be able in reducing pain from menstrual cramps
in female adolescents. It is also supported by study that
exercise is effective to decrease pain from dysmenorrhea
[2], [13], [14].
Based on the preliminary study done by the
researcher in October 2017 in Senior High School 3 Brebes,
192 out of all female ten grade students in Senior High
School 3 Brebes had dysmenorrhea experience. Female
students with dysmenorrhea tend to have study distraction,
as the pain requires them to be absent from school and
affect their learning concentration. From
the phenomena above, the researcher is interested to
conduct action research with non-pharmacological pain
management by using abdominal stretching exercises.
Methodology
It was a quasi-experimental study with a pre-test and
post-test control group design. 130 female students were
taken as a sample by using total sampling. The sample was
then divided into two groups using simple random sampling
with 65 respondents as the control group and 65
respondents as the intervention group. Both groups were
given pre-test and post-test.
In this research design, the pain intensity before
and after the treatment of the intervention group was
measured. It was measured using the Numeric Rating Scale.
The pain intensity observation result of the intervention
group was then compared with the observation result of the
control group.
Finding
Based on Table 1, it could be seen that the
respondents are mostly 16 years old with a minimum age at
15 and maximum age at 17.
Table 1: Respondent distribution based on age
Variable
Age
n
130
Min
15
Max
17
Mean
16
Deviation Std.
0.431
The Pain intensity before and after the abdominal
stretching exercise treatment In intervention group.
Based on Table 2 it was found that dysmenorrhea
pain intensity experienced by female adolescents before the
abdominal stretching exercises was 4.58 with a minimum
score at 2 and a maximum score at 8. meanwhile, after the
abdominal stretching exercise, it was found that the mean of the
pain intensity was 1.46 with the minimum score at 0 and
maximum score at 4.
Table 2: The distribution of the dysmenorrhea pain intensity
mean before and after the abdominal stretching treatment
Variable n Min Max Mean
Pain Intensity before the Abdominal Stretching Exercise 65 2 8 4.58
Pain Intensity after the Abdominal Stretching Exercise 65 0 4 1.46
65
The dysmenorrhea pain intensity before and after
in control group
Table 3: The distribution of dysmenorrhea pain intensity mean
in the control group
Variable n Min Max Mean
Pain Intensity before in control group 65 2 8 4.48
Pain Intensity before in control group 65 1 7 3.47
65

Open Access Maced J Med Sci. 2021 Oct 28; 9(G):180-183. 181
G - Nursing
Based on Table 3 it was found that the pain
intensity experienced by the control group was 4.48 with a
minimum score of 2 and a maximum score of 8.
The effect of abdominal stretching toward
dysmenorrhea pain intensity.
Based on Table 4, the finding of bivariate analysis
using the Wilcoxon test was p < 0.05 (0.000). it means that
there is a significant difference between pain intensity
before and after the abdominal stretching exercise for
female adolescents in Senior High School 3 Brebes.
Table 4: wilcoxon test result in intervention and control group
Variable n Mean Sig.
Pain intensity before
Pain intensity after
130 65.84
22.00
0.000
Discussion
Based on the research finding, the mean of
dysmenorrhea pain intensity before the implementation of
the abdominal stretching exercise was 4.58 with a
maximum score of 8 which shows severe or intolerable
pain. Dysmenorrhea caused by uterine muscle cramps starts
24 h before menstruation and can last for 24–36 h.
However, it usually happens in the first 24 h after the
bleeding. Dysmenorrhea is a normal condition for women
or female adolescents during their menstruation. However,
the pain might be unbearable. The bad treatment of
dysmenorrhea could disrupt daily activity as women may
feel weak, stress, depressed, collection of menstrual blood
in the pelvis, severe cramps accompanied by secretion of
menstrual clots from the uterus, pelvic cavity problem
which may lead to severe uterine contraction [3], [6], [8].
Dysmenorrhea is affected by physical and
psychological factors, such as stress and a high level of
prostaglandins [6]. The excessive prostaglandin release will
be diffused into endometrial tissue which leads to the
amplitude and frequency of uterine contraction. It may
also cause uterine ischemia, uterine tissue hypoxia,
endometrium disintegration, bleeding, and low abdominal
cramps [1]. Abdominal stretching to reduce dysmenorrhea
pain intensity [14].
In this research, it was found that some
respondents experienced level 8 pain. it means severe and
unbearable menstrual pain which makes the respondents
unable to do their normal activity either at work or school.
The Intolerable pain in respondents is caused by the
excessive production of adrenaline, estrogen, progesterone,
and prostaglandins hormones. estrogens could improve
excessive uterine contraction, meanwhile, progesterone
halts the contraction. excessive contraction may lead to
pain. Besides, the increase of adrenaline could stiffen
body muscle,
182
Nursing in Gynecology and Obstetrics
including uterine muscle which is painful during
menstruation [1], [4], [6], [9].
Based on this study, Table 4 shows the pain
intensity after the implementation of abdominal stretching
is at 1.46 with the mean of pain intensity before the
implementation of the treatment was
4.58. the mean pain intensity of the control group is
4.48. Therefore, It could be concluded that there is a
significant effect of abdominal stretching to reduce pain
intensity in female adolescents with dysmenorrhea.
Exercise is one of the non-pharmacological pain
management which is considered to be safe, as it only
employs physiology [13], [14]. The significance of exercise
habits toward dysmenorrhea in which the psychologist
and physical symptoms of primary dysmenorrhea are
decreased. Regular exercise triggers the secretion of
endorphins. the more exercises, the higher level of
endorphins released. endorphins are formed in the brain and
the spinal nervous system. the released endorphins are then
caught by the receptor in the hypothalamus and limbic
system to manage emotion. this hormone acts as a natural
sedative to give a sense of comfort and reduce pain [9],
[12], [13], [14]
Therefore, one of the exercises to reduce
menstrual pain is abdominal stretching exercise. the
implementation of abdominal stretching exercise during
menstruation could improve muscle strength, endurance,
muscle flexibility, pain relief, and reduce contraction to
reduce menstrual pain (dysmenorrhea) [14]. The aim of the
muscle stretching muscle is to improve oxygenation (the
cellular process of transferring oxygen and carbohydrate)
and stimulate the drainage flow of the lymph, as a result, it
could increase muscle flexibility and maintain the function
well, while fix the elasticity and flexibility of the body
tissue to reduce muscle cramps [1], [14].
It is in line with gate control theory which explains
about pain impulse is transmitted when the defense is
opened and halted when the defense is closed. the effort to
close the defense is a basis for pain relief therapy [9]. The
blockage could be done using relaxation techniques to
distract our attention. abdominal stretching is one of the
relaxation techniques to reduce pain by relaxing spasm
muscle contributed by the increase of prostaglandins level.
it can cause vasodilation of blood vessels and increase
blood flow to the spasm and ischemic area.
Conclusion
The mean of dysmenorrhea intensity in female
adolescents before the implementation of abdominal
stretching was 4.58 and was reduced to 1.46 after the
implementation of abdominal stretching. The
https://oamjms.eu/index.php/mjms/index

reduction of dysmenorrhea pain intensity mean after the
implementation of abdominal stretching was a minimum of
0 and a maximum of 2. There is a significant effect of
abdominal stretching toward dysmenorrhea pain intensity in
female adolescents as Wilcoxon test result showed p =
0.000. This information can be used to handle female
adolescents with dysmenorrhea by using a non-
pharmacological technique.
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