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Irawan, Tannia Rizkyka, Muhayani, Gustin Fat’aah (2024) The Effect of TENS and Ultrasound

Diathermy on Osteoarthritis Patients in Physical Medicine and Rehabilitation Unit of Patut Patuh

Patju Hospital, West Nusa Tenggara, (06) 10,

E-ISSN:

2684-883X

THE EFFECT OF TENS AND ULTRASOUND DIATHERMY ON

OSTEOARTHRITIS PATIENTS IN PHYSICAL MEDICINE AND

REHABILITATION UNIT OF PATUT PATUH PATJU HOSPITAL, WEST NUSA

TENGGARA

Irawan, Tannia Rizkyka, Muhayani, Gustin Fat’aah

Patut Patuh Patju General Hospital, Indonesia

Email: [email protected]

Abstract

Osteoarthritis is generally recognized as a common musculoskeletal condition in Indonesia,

characterized by the degeneration of joint cartilage and narrowing of the joint space. The form

of therapy that can be given to knee OA patients is a combination of TENS therapy and

ultrasound diathermy (USD). WOMAC is an index used to measure osteoarthritis patiens

based on pain, stiffness, and physical function. Patut Patuh Patju General Hospital is the only

hospital in West Lombok district where physical medicine and medical rehabilitation have

recently been introduced. This research aims to determine the effects of administering TENS

and ultra sound diathermy on OA patients in the physical medicine and rehabilitation unit of

Patut Patuh Patju Hospital, a newly established district hospital in NTB, which has been

operational for the past year. This type of research uses a pre-experimental design with a one

group pretest-posttest method. Sampling was taken using a purposive sampling technique

with a total sample of 30. The research population was knee osteoartritis patients undergoing

physiotherapy treatment at the Medical Rehabilitation Unit of Patut Patuh Patju General

Hospital. Data was collected using the WOMAC questionnaire before and after 6 until 8 times

therapy. The distribution of research data was analyzed using the Shapiro-Wilk test. If the

data distribution is normal, it is analyzed using the paired t-test, whereas if it is not normal, it

is analyzed using the Wilcoxon test. The combination of TENS therapy and ultra sound

diathermy results in improvement of WOMAC scores in knee osteoarthritis patients with p-

value = 0.000 (p < 0.05).

Keywords: Osteoarthritis, TENS, Ultra-sound diathermy, WOMAC.

INTRODUCTION

Osteoarthritis (OA) is a degenerative joint disorder that leads to joint dysfunction

characterized by pain and limited range of motion, which in turn reduces physical activity and

diminishes quality of life. This condition significantly contributes to the global burden of

disease. Early diagnosis of knee OA is crucial for implementing effective treatments before

the condition progresses to severe, irreversible stages (Allen, Thoma, & Golightly, 2022;

Kanamoto et al., 2020) (TERZİ & ALTIN, 2017).

Consequently, there has been a growing global focus on defining early OA and

developing new treatment strategies (Allen et al., 2022; Kanamoto et al., 2020). The

prevalence of OA can vary widely depending on factors such as age, sex, and geographical

JOURNAL SYNTAX IDEA

p–ISSN: 2723-4339 e-ISSN: 2548-1398

Vol. 6, No. 10, Oktober 2024

Irawan, Tannia Rizkyka, Muhayani, Gustin Fat’aah

6176 Syntax Idea, Vol. 6, No. 10, Oktober 2024

location within a country (Allen et al., 2022; Kanamoto et al., 2020). The number of OA cases

in 2019 increased by 153.12% in males and 143.36% in females compared to 1990. This

represents more than a doubling of OA cases in both sexes over the same period. The rising

incidence of OA in Indonesia mirrors global trends but at a higher rate, with a 147.44%

increase in Indonesia compared to a 113.25% global increase from 1990 to 2019 (Jiang,

2022).

The pathogenesis of worsening osteoarthritis is complex and involves several factors,

with key elements including chondrocyte regulation within the extracellular matrix, genetic

influences, local mechanical factors, and inflammation. Joint degeneration leading to the

clinical syndrome of osteoarthritis most commonly occurs in the knee, hip, hands, feet, and

spine (Butarbutar, Basuki, Sungono, Riantho, & Fidiasrianto, 2024).

Of the 344 million people living with osteoarthritis, a significant proportion experience

moderate to severe severity levels requiring rehabilitation. With an aging population and

rising rates of obesity and injuries, the prevalence of osteoarthritis is expected to continue

increasing globally (Butarbutar et al., 2024; Holden et al., 2023).

Prevalence of Joint Diseases Based on RISKESDAS 2018, West Nusa Tenggara

Province, generally NTB province has a prevalence of 5.03%, with West Lombok at 6.42%.

The majority are females (62%), with the highest prevalence observed among farmers and

fishermen at 7-7.4% (Holden et al., 2023).

Damage to the structure of the knee and its manifestations causes a person with

knee osteoarthritis to experience difficulty in carrying out daily activities, which may have an

impact on their quality of life (Holden et al., 2023).

The Western Ontario and McMaster Osteoarthritis Index (WOMAC) is a widely used

disease-specific questionnaire designed for patients with knee and hip arthritis. It was

originally developed to assess clinically significant, patient-relevant changes in health status

and to evaluate therapeutic outcomes following interventions (Laporan Nasional Riskesdas

2018, 2020).

Based on the considerations and the absence of prior research on osteoarthritis in NTB

in general and specifically in Lombok Barat, the author intends to conduct a study about the

physical medicine and rehabilitation approach on osteoarthritis. This research also aims to

assess the The Effect of TENS and Ultrasound Diathermy on Osteoarthritis Patients in

Physical Medicine and Rehabilitation Unit of Patut Patuh Patju Hospital, West Nusa

Tenggara.

RESEARCH METHOD

This type of research uses a pre-experimental design with a one group pretest-posttest

method (Seltman, 2012). Sampling was taken using a purposive sampling technique with a

total sample of 30. The research population was knee osteoartritis patients undergoing

physiotherapy treatment at the Medical Rehabilitation Unit of Patut Patuh Patju General

Hospital (Leardi, 2009). Data was collected using the WOMAC questionnaire before, after 6

until 8 times therapy.

Inclusion Criteria

1. Patients with knee osteoarthritis (OA) in the Medical Rehabilitation Clinic confirmed by

Orthopedic Specialist and Physical Medicine and Rehabilitation Specialist.

2. Respondents who have undergone therapy ≤ 3 times.

3. Have OA grade 1, 2, or 3 based on radiological examination using the Kellgren-Lawrence

classification system.

The Effect of TENS and Ultrasound Diathermy on Osteoarthritis Patients in Physical

Medicine and Rehabilitation Unit of Patut Patuh Patju Hospital, West Nusa Tenggara

Syntax Idea, Vol. 6, No. 19, Oktober 2024 6177

4. Respondents willing to participate and have signed the consent form.

Exclusion Criteria

1. Received physiotherapy treatment within the last 1 month prior to the study (washout

period).

2. History of intra-articular injection therapy or total knee arthroplasty.

3. Have neurological disorders such as paralysis or stroke.

RESULT AND DISCUSSION

Table 1 Paired Samples Statistics

Mean

Std. Deviation

Std. Error Mean

Pair 1

Before

47.5667

2.31462

.42259

After

23.6333

4.06400

.74198

On the table above, the observed difference shows a decrease in the mean WOMAC

score from 47.5 before treatment to 23.63 after treatment. The significance value of 0.000 <

0.05 indicate that the null hypothesis (Ho) is rejected.

ANOVA was used to determine whether there were significant differences among the

three treatments, followed by post hoc tests to identify which treatment had the most impact

on WOMAC. The significance value of 0.000 < 0.05 indicates that there are differences

among the three treatments. Subsequent post hoc tests were performed to determine which

treatment had the most influence after treatment.

Figure 2. Diagram Pre-and Post-Treatment

From the table above, it is evident that there is a difference in the mean data between

pre- and post-treatment. Based on the data obtained before and after treatment, it is apparent

that improvement in physical activity is one of the factors where the majority of patients

experienced changes, as reflected in the improvement of WOMAC scores after treatment

(Wu, Zhu, Chen, & Zhang, 2022).

Based on the data analysis using the Wilcoxon test on the difference in WOMAC scores

before (T1) and after 6-8 therapy sessions (T2), it can be concluded that there is an effect of

the combination therapy of TENS and diathermy on improving WOMAC scores in knee

osteoarthritis patients after 6-8 therapy sessions.

Irawan, Tannia Rizkyka, Muhayani, Gustin Fat’aah

6178 Syntax Idea, Vol. 6, No. 10, Oktober 2024

Table 2 Characteristic samples.

Sex

Male

Female

Age

30-40

41-50

41-60

61-70

BMI

Underweight

Normal

Overweight

Obese I

Obese II

Occupation

Housewives

Market seller

Retired

Farmer

Kallgren-lawrence

III

Based on the sample characteristics, all respondents were female (100%), with the

largest age group being 41-60 years old (43%). Overweight BMI accounted for 46%, and the

most common occupations were housewives and farmers at 30%. The majority of respondents

had severe OA based on radiological findings, with 53% classified as grade 3 or higher (Ha,

Lee, Hong, & Lee, 2021).

Transcutaneous Electrical Nerve Stimulation (TENS) is one of the alternative therapies

used to alleviate chronic pain in osteoarthritis. Electric current generated by this device

stimulates nerves through the skin. Antidromic TENS stimulation can block the transmission

of stimuli from nociceptors to the spinal cord. TENS also activates the autonomic nervous

system, triggering vasomotor responses that subsequently alter tissue chemistry to reduce pain

(Shalhoub et al., 2022).

Diathermy is also widely used in managing various musculoskeletal issues, including

osteoarthritis. It raises tissue temperature, which can induce vasodilation, increase cellular

activity, raise pain thresholds, and reduce muscle spasms (Shalhoub et al., 2022).

The physical medicine and rehabilitation service in West Lombok was established in

2022 and has received positive reception from residents in the region. The introduction of

TENS and ultrasound diathermy is a new experience for some osteoarthritis (OA) patients in

West Lombok. The use of TENS and diathermy is commonly employed to alleviate pain and

stiffness in OA patients, as evidenced by research conducted by Shimoura et al., 2020, they

conducted a Randomized Control Trial involving 50 patients with mild osteoarthritis

(Kallgren-Lawrence grade 0 or 1) in Japan. They observed improvements in VAS scores,

Time Up and Go test, and 6-minute walk test (6MWT) in the group receiving TENS

compared to the placebo group (Ab Rahman, Narhari, Sharifudin, & Shokri, 2020)

The Effect of TENS and Ultrasound Diathermy on Osteoarthritis Patients in Physical

Medicine and Rehabilitation Unit of Patut Patuh Patju Hospital, West Nusa Tenggara

Syntax Idea, Vol. 6, No. 19, Oktober 2024 6179

Wu et al, 2021, conducted a systematic review and meta-analysis on twenty-nine studies

on MEDLINE, PubMed, and Cochrane. They found (1398 people, age range 54-85, 74% are

female) and coclude that TENS could significantly relieve pain, decrease dysfunction and

improve walking ability in people with Knee OA, but it is not effective for stiffness (Mintarjo,

Poerwanto, & Tedyanto, 2023)

Sin Ho et al., 2021 conducted a study to investigate selective region high-frequency

diathermy on pain, function, balance and gait in older patients with degenerative knee

osteoarthritis (DKO) (Iijima et al., 2020). The results of this study suggest that selective

region high-frequency diathermy at trigger points with therapeutic exercises is an an effective

intervention to decrease pain, improve knee function, balance and gait in patients with DKO.

The selective region high-frequency diathermy with therapeutic exercises may be feasible and

provide potential benefits for rehabilitation of DKO (Iijima et al., 2020).

Therefore, the combination therapy of TENS and diathermy can improve WOMAC

scores in patients with knee osteoarthritis. WOMAC scores encompass pain, stiffness, and

functional activity components. A lower WOMAC score indicates a reduction in the

complaints experienced by the patient due to osteoarthritis.

CONCLUSION

It is concluded that there is a significant difference in the mean WOMAC scores before

and after therapy, or there is a significant treatment effect on WOMAC scores. When

compared between groups, the factor of physical activity is the aspect where patients

experienced more improvement compared to other WOMAC points

BIBLIOGRAFI

Ab Rahman, S., Narhari, P., Sharifudin, M. A., & Shokri, A. A. (2020). Western Ontario and

McMaster Universities (WOMAC) Osteoarthritis Index as an assessment tool to indicate

total knee arthroplasty in patients with primary knee osteoarthritis. IIUM Medical

Journal Malaysia, 19(3).

Allen, K. D., Thoma, L. M., & Golightly, Y. M. (2022). Epidemiology of osteoarthritis.

Osteoarthritis and Cartilage, 30(2), 184–195.

Butarbutar, John C. P., Basuki, Pamela, Sungono, Veli, Riantho, Albert, & Fidiasrianto,

Kevin. (2024). Burden of osteoarthritis in Indonesia: A Global Burden of Disease (GBD)

study 2019. Narra J, 4(2), e884–e884.

Ha, Sin Ho, Lee, Dong Geon, Hong, Soung Kyun, & Lee, Gyu Chang. (2021). Potential

benefits of a selective region high-frequency diathermy with therapeutic exercises on

older persons with degenerative knee osteoarthritis: A case report. Physical Therapy

Rehabilitation Science, 10(4), 387–397.

Holden, M. A., Nicolson, P. J. A., Thomas, M. J., Corp, N., Hinman, R. S., & Bennell, K. L.

(2023). Osteoarthritis year in review 2022: rehabilitation. Osteoarthritis and Cartilage,

31(2), 177–186. https://doi.org/https://doi.org/10.1016/j.joca.2022.10.004

Iijima, Hirotaka, Eguchi, Ryo, Shimoura, Kanako, Yamada, Keisuke, Aoyama, Tomoki, &

Takahashi, Masaki. (2020). Transcutaneous electrical nerve stimulation improves stair

climbing capacity in people with knee osteoarthritis. Scientific Reports, 10(1), 7294.

Jiang, Y. (2022). Osteoarthritis year in review 2021: biology. Osteoarthritis and Cartilage,

30(2), 207–215.

Irawan, Tannia Rizkyka, Muhayani, Gustin Fat’aah

6180 Syntax Idea, Vol. 6, No. 10, Oktober 2024

Kanamoto, Takashi, Mae, Tatsuo, Yokoyama, Teruki, Tanaka, Hiroyuki, Ebina, Kosuke, &

Nakata, Ken. (2020). Significance and definition of early knee osteoarthritis. Annals of

Joint, 5.

Laporan Nasional Riskesdas 2018. (2020). Laporan Nasional Riskesdas 2018. Retrieved from

https://repository.badankebijakan.kemkes.go.id/id/eprint/3514/

Leardi, Riccardo. (2009). Experimental design in chemistry: A tutorial. Analytica Chimica

Acta, 652(1–2), 161–172.

Mintarjo, Jessica Amelinda, Poerwanto, Eka, & Tedyanto, Eric Hartono. (2023). Current non-

surgical management of knee osteoarthritis. Cureus, 15(6).

Seltman, Howard J. (2012). Experimental design and analysis. Carnegie Mellon University

Pittsburgh.

Shalhoub, Mojahed, Anaya, Mohammad, Deek, Soud, Zaben, Anwar H., Abdalla, Mazen A.,

Jaber, Mohammad M., Koni, Amer A., & Zyoud, Sa’ed H. (2022). The impact of pain on

quality of life in patients with osteoarthritis: a cross-sectional study from Palestine. BMC

Musculoskeletal Disorders, 23(1), 248.

TERZİ, Rabia, & ALTIN, Firuzan. (2017). Evaluation of Short-Wave Diathermy and

Ultrasound Treatments as Combined Physical Treatments for Knee Osteoarthritis.

Journal of Physical Medicine & Rehabilitation Sciences, 20(3).

Wu, Yu, Zhu, Feilong, Chen, Wei, & Zhang, Ming. (2022). Effects of transcutaneous

electrical nerve stimulation (TENS) in people with knee osteoarthritis: a systematic

review and meta-analysis. Clinical Rehabilitation, 36(4), 472–485.

Irawan, Tannia Rizkyka, Muhayani, Gustin Fat’aah (2024)

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