Tesis

Efektivitas Rehabilitasi Jantung Fase II Terhadap Performa Fisik Dinilai Dengan Short Physical Performance Battery Pada Pasien Gagal Jantung Kronik = Effectiveness of Phase II Cardiac Rehabilitation on Physical Performance Assessed by the Short Physical Performance Battery in Patients with Chronic Heart Failure.

Latar Belakang: Gagal jantung sering disertai penurunan performa fisik yang berdampak pada kapasitas fungsional dan kualitas hidup. Short Physical Performance Battery (SPPB) merupakan instrumen valid untuk menilai performa fisik lansia. Meskipun rehabilitasi jantung fase II direkomendasikan, bukti mengenai pengaruhnya terhadap performa fisik masih terbatas. Penelitian ini bertujuan menilai dampak rehabilitasi jantung fase II terhadap performa fisik pasien gagal jantung kronik menggunakan SPPB. Objektif: Untuk menilai perbedaan performa fisik yang diukur dengan SPPB pada pasien gagal jantung kronik sebelum dan sesudah menjalani program rehabilitasi jantung fase II. Metode: Penelitian ini menggunakan desain observasional analitik dengan metode one group pre-post test. Subjek adalah pasien gagal jantung kronik usia >60 tahun yang menjalani rehabilitasi jantung fase II selama 8 minggu di Instalasi Pelayanan Kardioserebrovaskular Terpadu RSUPN Dr. Cipto Mangunkusumo. Performa fisik dinilai menggunakan SPPB sebelum dan sesudah program rehabilitasi. Data dianalisis untuk mengetahui perbedaan skor SPPB pre dan post rehabilitasi. Hasil: Sebanyak 31 pasien gagal jantung kronik (usia rata-rata 64,9 tahun; 80,6% laki-laki) menyelesaikan program rehabilitasi jantung fase II selama 8 minggu. Skor total SPPB meningkat signifikan dari median 9 menjadi 11 (p < 0,001). Peningkatan bermakna juga terjadi pada kecepatan berjalan (p=0,002) dan kekuatan tungkai bawah yang dinilai dengan 5-times sit-to-stand (p < 0,001), sedangkan domain keseimbangan menunjukkan perbaikan kecil namun signifikan (p=0,025). Analisis lebih lanjut menunjukkan hanya riwayat penyakit jantung koroner (CAD) yang berhubungan dengan perubahan skor SPPB (p=0,042). Kesimpulan: Terdapat perbedaan yang signifinikan terhadap skor performa fisik yang dinilai dengan SPPB pada pasien gagal jantung kronik sebelum dan sesudah menjalani rehabilitasi jantung fase II.
Kata kunci: Gagal jantung; Rehabilitasi jantung fase II; Short Physical Performance Battery; Kapasitas fungsional; Kekuatan tungkai bawah


Background: Heart failure is frequently associated with a progressive decline in physical performance, adversely affecting patients' functional capacity and overall quality of life. The Short Physical Performance Battery (SPPB) is a reliable and validated tool for objectively evaluating physical function in older adults. While phase II cardiac rehabilitation is strongly recommended in clinical guidelines, evidence supporting its impact on physical performance in chronic heart failure remains limited. This study aims to investigate the effect of phase II cardiac rehabilitation on physical performance in patients with chronic heart failure, as measured by the SPPB. Objective: To evaluate the difference in physical performance, measured by the SPPB, in patients with chronic heart failure before and after completing a Phase II cardiac rehabilitation program. Methods: This observational analytic study used a one-group pre-post test design. Subjects were chronic heart failure patients aged >60 years who underwent an 8- week Phase II cardiac rehabilitation program at Instalasi Pelayanan Kardioserebrovaskular Terpadu, Dr. Cipto Mangunkusumo National General Hospital. Physical performance was assessed using the SPPB before and after the rehabilitation program. Data were analyzed to determine changes in SPPB scores pre- and post-rehabilitation. Results: A total of 31 chronic heart failure patients (mean age 64.9 years; 80.6% male) completed the 8-week Phase II cardiac rehabilitation program. The total SPPB score significantly improved from a median of 9 to 11 (p < 0.001). Significant improvements were also observed in gait speed (p=0.002) and lower limb strength assessed by the 5-times sit-to-stand test (p < 0.001), while the balance domain showed a small but significant improvement (p=0.025). Further analysis revealed that only a history of coronary artery disease (CAD) was significantly associated with changes in SPPB scores (p=0.042). Conclusion: Phase II cardiac rehabilitation significantly improved physical performance, as assessed by the SPPB, in patients with chronic heart failure.
Keywords: Chronic heart failure; Phase II cardiac rehabilitation; Short Physical Performance Battery; Functional capacity; Lower limb strength