Tesis

Peran Latihan Pernapasan dalam Tatalaksana Pasien Rawat Inap COVID-19 Nonkritis di RSUP Persahabatan = The Role of Breathing Exercises in Management of Noncritical COVID-19 Patients Treated at Persahabatan Hospital, Jakarta, Indonesia.

Latar Belakang dan Tujuan : Kerusakan parenkim paru akibat Coronavirus disease 2019 (COVID-19) mengakibatkan gangguan pertukaran udara di alveolus dan penurunan fungsi ventilasi pulmoner. Terapi fisis dada dan latihan pernapasan merupakan salah satu terapi suportif yang direkomendasikan untuk memperbaiki status respirasi pasien dengan meningkatkan bersihan jalan napas dan pertukaran gas, mengurangi kerja pernapasan, mempercepat pemulihan, serta meningkatkan kualitas hidup pasien. Penelitian ini dilakukan untuk mengetahui pengaruh latihan pernapasan terhadap perubahan sesak napas pada pasien COVID-19 nonkritis yang dirawat di Rumah Sakit Umum Pusat (RSUP) Persahabatan. Metode : Penelitian ini merupakan single blind randomized control-group dengan desain pretest-posttest yang dilakukan bulan Juli-Oktober 2020 secara consecutive sampling pada pasien COVID-19 nonkritis yang dirawat di RSUP Persahabatan. Penentuan kelompok kontrol dan intervensi dilakukan secara acak dengan block randomization. Kelompok intervensi diberikan latihan pernapasan dengan porsi latihan terukur sedangkan kelompok kontrol diberikan latihan pernapasan tanpa porsi latihan terukur selama 4 minggu. Latihan pasca rawat inap dipantau tim peneliti melalui telemedicine dan subjek penelitian diminta untuk datang kontrol pada akhir minggu ke-4 untuk dievaluasi. Parameter yang dinilai sebelum dan sesudah pemberian latihan pernapasan pada kedua kelompok perlakuan yaitu saturasi oksigen perifer (SpO2), ekspansi dinding dada, dan skala Borg. Hasil : Subjek penelitian yang memenuhi kriteria inklusi sebanyak 28 orang dengan karakteristik dasar yaitu paling banyak derajat sedang (67,9%), laki-laki (67,9%), kelompok usia ≤ 60 tahun (85,7%), status gizi lebih (57,1%), komorbid hipertensi (35,71%) dan diabetes mellitus (DM) tipe 2 (32,14%), tidak menggunakan alat oksigenasi tambahan (71,4%), ada riwayat merokok dengan indeks Brinkman (IB) ringan (42,9%). Terdapat perbedaan SpO2 yang bermakna pada subjek penelitian yang tidak menggunakan alat oksigenasi (p < 0,05), perbedaan ekspansi dinding dada yang tidak bermakna (p > 0,05), dan perbedaan skala Borg yang bermakna (p < 0,05) sebelum dan sesudah pemberian latihan antara kelompok intervensi dan kelompok kontrol. Kesimpulan : Pada penelitian ini didapatkan pemberian latihan pernapasan secara berkala selama 4 minggu dapat memperbaiki SpO2 dan skala Borg secara bermakna pada pasien COVID-19 nonkritis.
Kata kunci : COVID-19, latihan pernapasan, skala Borg, SpO2, ekspansi dinding dada


Background: Pulmonary parenchymal damage due to Coronavirus disease 2019 (COVID-19) causes alveolar gas exchange and pulmonary ventilation impairments. Chest physiotherapy and breathing exercises are recommended to increase respiratory function by improving airway clearance and gas exchange, reducing the work of breathing, accelerating recovery process and thus, improving patient’s quality of life. This study aimed to investigate the effect of breathing exercises to alleviate dyspnea in non-critical COVID-19 patients treated at Persahabatan Hospital, Jakarta, Indonesia. Methods: This single-blind randomized control-group pretest-posttest study was done through consecutive sampling of non-critical COVID-19 patients treated at the study site between July and October 2020. Experimental and control grouping were done using block randomization. Each group received guided breathing exercises during hospitalization with exercise length and duration predetermined for experimental group and were self-regulatory for control group. Breathing exercise was continued after discharged with total duration of four weeks. Postdischarged exercise was monitored by telemedicine and subjects were only required to come to the hospital for final assessment. Data on peripheral oxygen saturation (SpO2), chest wall expansion, and Borg scale were collected at baseline and at the end of the fourth week. Analysis of Variance (ANOVA) repeated measurement was applied to compare the outcome. Results: In this study, 28 COVID-19 patients met the inclusion criteria, predominantly moderate cases (67.9%), males (67.9%), ≤ 60 years old (85.7%), and those with body mass index above normal (57.1%), hypertension (35.71%), type 2 diabetes (35.71%), not receiving supplemental oxygen (71.4%), and smoking history with mild Brinkman index (42.9%). There were significant differences in SpO2 of subjects without supplemental oxygen and Borg scale (p < 0.05), yet insignificant difference in chest wall expansion measurement (p > 0.05) between both groups before and after exercise period. Conclusions: There were significant improvements in SpO2 and Borg scale over the course of four weeks breathing exercises in non-critical COVID-19 patients treated in the study site.
Keywords : Borg scale, breathing exercises, chest physiotherapy, chest wall expansion, COVID-19, SpO2