Tesis

Evidence Based Case Report. Pengaruh Latihan Penguatan Ekstremitas Atas Terhadap Nyeri Bahu pada Pasien Cedera Medula Spinalis Paraplegia yang Menggunakan Kursi Roda Manual = Evidence Based Case Report. The Effects of Upper Extremities Strengthening Exercise on Shoulder Pain in Spinal Cord Injury Paraplegic Patients Who were Manual Wheelchair Users.

Tesis ini disusun dengan metode evidence-based case report (EBCR) yang merupakan metode pelaporan sebuah masalah klinis dengan pendekatan berbasis bukti. Pasien laki-laki, 39 tahun, dengan cedera medulla spinalis paraplegia kronis pengguna kursi roda manual datang dengan keluhan nyeri pada kedua bahu VAS 4. Keluhan nyeri dirasakan dalam 4 bulan terakhir dan dirasakan terutama saat transfer dan mengayuh kursi roda. Pertanyaan klinis dari kasus ini yaitu apakah pemberian latihan penguatan otot-otot ekstremitas atas dapat mengurangi nyeri bahu dan meningkatkan kemampuan fungsional individu cedera medula spinalis paraplegia pengguna kursi roda manual dan wheeling mandiri dengan nyeri bahu. Pencarian literatur dilakukan pada pusat data Cochrane, Pubmed, Scopus, Science Direct, dan Sage Journals. Dari seleksi judul dan abstrak berdasarkan kriteria inklusi dan eksklusi dan pembacaan jurnal secara menyeluruh diperoleh tiga artikel yang sesuai dengan pertanyaan klinis. Dilakukan analisis ketiga artikel tersebut dengan menilai kualitasnya berdasarkan validitas, kepentingan dan aplikabilitasnya. Hasil analisis menunjukkan bahwa latihan penguatan otot-otot bahu dengan intensitas sedang pada pasien cedera medulla spinalis paraplegia pengguna kursi roda manual selama 8 hingga 12 minggu berujung pada perbaikan bermakna nyeri bahu kronis yang dinilai dengan Visual Analog Pain Scale (VAS) dan Wheelchair User’s Shoulder Pain Index (WUSPI). Hasil analisis subgrup juga menunjukkan perbaikan bermakna kemampuan fungsional sendi bahu yang dinilai dengan Physical Examination of the Shoulder Scale (PESS), the 36-item Short Form Health Survey (SF-36), the subjective quality of life scale (SQoL), dan Patient Global Impression of Change Scale. Kesimpulan penelitian ini adalah latihan penguatan ekstremitas atas pada pasien cedera medula spinalis paraplegia yang menggunakan kursi roda manual dengan nyeri bahu memiliki manfaat positif dalam penurunan nyeri bahu dan perbaikan kemampuan fungsional sendi bahu dalam aktivitas sehari-hari.
Kata kunci: Cedera Medulla Spinalis, Paraplegia, Nyeri Bahu, Latihan Penguatan, Fungsional Bahu.


This was an evidence-based case report (EBCR) designed to figure out the effects of upper extremities strengthening exercise towards shoulder pain experienced by spinal cord injury paraplegic patients who were manual wheelchair users. EBCR referred to a clinical case report with evidence-based approach method. A 39 year old paraplegic male patient came to the outpatient clinic with complaints of bilateral shoulder pain, VAS 4, in the past 4 months, especially felt during transfer and wheeling propulsion. This raised a clinical question whether upper extremities strengthening exercise would be able to reduce pain and improve shoulder function in paraplegic patients who were manual wheelchair users. Literature search in accordance with the clinical question was conducted on Cochrane, Pubmed, Scopus, Science Direct, and Sage Journals databases. Selection of titles and abstracts based on inclusion and exclusion criteria, multiple screening and thorough reading of the journal articles resulted in three suitable articles. Analysis was carried out on these articles by assessing their quality based on their validity, importance and applicability. The result of our analysis showed that shoulder strengthening exercises in moderate intensity performed in duration of 8 to 12 weeks demonstrated significant improvement in pain reduction assessed with Visual Analog Pain Scale (VAS), and Wheelchair User’s Shoulder Pain Index (WUSPI). Subgroup analysis showed significant improvement in shoulder function with improvement in Physical Examination of the Shoulder Scale (PESS), the 36item Short Form Health Survey (SF-36), the subjective quality of life scale (SQoL), and Patient Global Impression of Change Scale. In summary, shoulder strengthening exercises have been demonstrated to improve shoulder pain dan function significantly in spinal cord injury paraplegic patients who used manual wheelchair for mobility on daily basis.
Keywords: Spinal Cord Injury, Paraplegic, Shoulder Pain, Strengthening Exercise, Shoulder Function.