The Effect of Roll Slide Mobilization and Traction Manual on Knee

Pain Scale Intensity Patients with Osteoarthritis

Tati Murni Karokaro, Isidorus Jehaman, Rahmad Gurusinga, Kardina Hayati, Siti Sarah Bintang, Sari

Desi Esta Ulina Sitepu, and Abdi Lestari Sitepu

Faculty of Nursing and Physiotherapy, Institut Kesehatan Medistra Lubuk Pakam, Indonesia

Keywords: Roll Slide Mobilization, Traction Manual, Knee pain Scale Intensity, Osteoarthritis patients.

Abstract: Osteoarthritis was a chronic joint disease that is characterized by abnormalities in the cartilage of the joints

and nearby bones. Cartilage (cartilage) is the part of the joint that lines the end of the bone, to facilitate the

movement of the joint. The occurrence of osteoarthritis is influenced by various risk factors such as age (aging

process), genetic, obesity, joint injury, anatomical anomaly, metabolic disease and inflammatory joint disease.

The objectives of this research is to determine the effect of roll slide and manual traction mobilization on the

intensity of the knee pain scale in patients with osteoarthritis. The method used a quasi-experimental one

group pre and post test, with a sample of 22 respondents. Pain scale measurement using VAS, using paired t-

test analysis. The results of the test showed that there was an influence of the provision of Slide Slide and

Manual Traction Mobilization to decrease the intensity of the knee pain scale with the results of paired sample

t-test results obtained p-value <a (0,000 <0.05). The Conclusion there was the effect of providing roll slide

mobilization and manual traction on the intensity of the knee pain scale patients with osteoarthritis. The

researcher suggests to the next researcher add the number of samples and longer time so that the results

obtained are more optimal.

1. INTRODUCTION

Humans are living things, the characteristic of living

things is moving. Humans move to needs of life in

daily activities. The one that often experience

disturbances are the joints, especially the knee joints,

which have quite heavy movements and are mostly

used by humans in carrying out activities and meeting

their daily needs. Impaired motion and function in

humans will result in pain or decreased functional

ability, so that it can limited physical activity and

sufferers depending on the help of others. Many

factors or caused that can cause these disorders, one

of which is Osteoarthritis where degenerative joint

disease occurs in the knee joints caused by various

factors (Triyono, 2018).

Osteoarthritis (OA) is the most common joint

disorder and the leading cause of disability in elders.

In 2015, the World Health Organization estimated

that 18.0% of women and 9.6% of men 60 years of

age or over suffer from symptomatic OA. Among

people with symptomatic OA, 80% have some

limitation in mobility and 25% are unable to perform

their major daily activities (Zhang and Niu, 2016).

Indonesia is sufferers of osteoarthritis are 5% at the

age of <40 years, at the age of 40-60 years reaching

30%, and 65% at the age of> 61 years. For knee

osteoarthritis the prevalence in Indonesia is also quite

high, reaching 15.5% men and 12.7% women of all

osteoarthritis sufferers (Adhiputra, Putra 2017).

Based on data from RISKESDAS 2018, the

prevalence of joint disease in Indonesia is around

7.3% and osteoarthritis (OA) or arthritis is a common

joint disease. Although it often occurs with age, or

known as degenerative disease, joint disease has

occurred in people in the age range of 15-24 years

(prevalence rate around 1.3%), the prevalence rate

continues to increase in the age range of 24-35 years

(3, 1%) and the age range is 35-44 years (6.3%).

Osteoarthritis is a non-inflammatory joint

disorder that affects old, chronic, and slow

progressive joints that eventually causes joint and

disability failure. These degenerative and progressive

joint diseases occur in about 250 million people

worldwide, 27 million people in the United States 3,

4 Elderly (around 35% of patients over 65 years old)

are women, while African-American populations are

at the highest risk of developing OA.5,6, and in India

there are more than 10 million cases annually and 60

Karokaro, T., Jehaman, I., Gurusinga, R., Hayati, K., Bintang, S., Sitepu, S. and Sitepu, A.

The Effect of Roll Slide Mobilization and Traction Manual on Knee Pain Scale Intensity Patients with Osteoarthritis.

DOI: 10.5220/0009467801490156

In Proceedings of the International Conference on Health Informatics and Medical Application Technology (ICHIMAT 2019), pages 149-156

ISBN: 978-989-758-460-2

149

million cases and will be at ranked 3rd in the world in

2025. Pain also originates from bone due to

stimulation of the periosteum because osteophytes are

recipients of nociceptive pain. There are 3 places that

distinguish pain, namely: 1. Sinovum, occurs due to

inflammatory reactions that arise due to the crest in

joint fluid, 2 Damage to the soft tissue can be

ligament tears, joint capsules and meniscus damage.

The process of Osteoarthritis is different for each

person that we can see like in Figure 1 (Kumar, &

Gupta 2017, Khon 2016).

Figure 1: The Process of Osteoarthritis

The cause of osteoarthritis in every daily activity

can be an emphasis on the joint area, especially the

joints that become the weight of the body such as

ankles, knees, and pelvis, degenerative changes that

initiate primary osteoarthritis, while age, obesity,

trauma, and other causes are factors that cause

secondary osteoarthritis (Ganu, Merchant, 2018).

The results of research conducted by Pandya,

Sheth, 2017 found that manual traction is effective for

reducing pain and can increase functional activity and

a decrease in pain in osteoarthritis of the Knee Joint

That the roll-slide is used to mobilize the joints if

there is limited space for joint motion due to the

shortening of capsuleligamentair and can reduce Pain

and can maintain joint ROM, (Pandya, Sheth, 2017).

Measurement of pain response felt by patients can

be measured using the Visual Analog Scale (VAS) is

a measure of pain intensity that is considered the most

efficient that has been used in research and clinical

settings. VAS is generally presented in the form of

horizontal lines. In its development, the VAS method

of presentation is given the numbers 0-10, "0" is no

pain and "10" shows very severe pain, that we can see

like in Figure 2 (Klimek, Bergmann, Biedermann, et

all, 2017).

Figure 2: Visual Analog Scale (VAS)

Manual Traction is a technique used to treat joint

dysfunction such as pain, stiffness, reversible joint

hypomobility. Traction is a passive motion that can

be done at a slow speed. This traction can stimulate

biological activity by flowing synovial fluid that can

carry nutrients in the avascular portion of the joint

cartilage on the joint surface and fibro cartilage in the

joints (Pandya, Sheth, 2017).

Roll slide mobilization in the knee joint is one

form of mobilization in the form of passive motion in

the knee joint that is adapted from physiological

movements that occur when flexion and extension are

in accordance with osteokinematics of the knee joint

and intra articular elements have rotational,

translational and spin motion. Roll slide mobilization

is used to mobilize the joints if there are mechanical

limitations or shortening of the capsuloligament and

can maintain joint ROM while minimizing pain.

Dosage and use: a) Degree I: Roll slides with small

amplitudes are applied parallel to the surface of the

joint and carried out at the beginning of the degree of

movement. Used to reduce pain b) Degree II: Bone

moves parallel to the surface of the joint until slack

and tissue around the joint tighten. Used to reduce

pain c) Degree III: Bone moves parallel to the joint

surface with a large enough amplitude that we can see

like in Figure 3 (K. Hanoch & P. Elavaration in 2016).

Figure 3: Roll Slide Mobilization and Manual Traction.

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Pain is an unpleasant subjective and emotional

sensory obtained related to actual or potential tissue

damage or describes the condition of the damage.

Pain stimulation received by nociceptors on the skin

can be high or low intensity such as stretching and

temperature as well as by tissue lesions. Necrotic cells

release K + and intracellular proteins. Increased

extracellular K + levels will cause depolarization of

nociceptors, whereas proteins in some circumstances

will infiltrate microorganisms, causing

inflammation/inflammation. As a result, pain

mediators are released such as leukotrienes,

prostaglandin E2, and histamine which will stimulate

nociceptors so that dangerous and harmless stimuli

can cause pain (hyperalgesia or allodynia).

addition, the lesion also activates blood clotting

factors so bradykinin and serotonin will be stimulated

and stimulate nociceptors. If there is occlusion of

blood vessels there will be ischemia which will cause

accumulation of extracellular K + and H + which then

activates nociceptors. Histamine, bradykinin, and

prostaglandin E2 have a vasodilator effect and

increase vascular permeability. This causes local

edema, increased tissue pressure and also occurs

nosisepto stimulation. When nociceptors are

stimulated, they release the peptide substance P (SP)

and the peptide-related calcitonin gene (CGRP),

which will stimulate the inflammatory process and

also produce vasodilation and increase vascular

permeability. Vasoconstriction (by serotonin),

followed by vasodilation, may also be responsible for

migraine attacks. This nociceptive impulse causes

pain that we can see like in Figure 4 (Ardinata, D,

2017, and Zhang and Niu, 2016).

Figure 4: Physiology of Pain

Based on preliminary surveys at Grandmed Lubuk

Pakam Hospital, the number of physiotherapy

patients in 2018 was 7857 patients in poly

physiotherapy at grandmed hospitals, whereas

specifically in osteoarthritis sufferers in January to

December 2018 there were 960 people. The average

number of patients per month is 80 patients per

month.

2 RESEARCH METHODS

The location of this research was carried out at the

Grandmed Lubuk Pakam Hospital, this research was

conducted with a Quasi-experimental with one group

pretest-posttest design model (Sugiyono, 2017). The

purpose of this study was to determine the effect of

roll slide mobilization and manual traction on the

intensity of the knee pain scale in osteoarthritis

sufferers. The samples in this study was taken 22

The Effect of Roll Slide Mobilization and Traction Manual on Knee Pain Scale Intensity Patients with Osteoarthritis

151

people with inclusion criteria: patients who

experience knee osteoarthritis pain who visited poly

physiotherapy at Grandmed Lubuk Pakam Hospital,

Age 40 to 65 years, male and female sex, and

exclusion criteria were: Patients with

osteoarthritisknee due to other causes or not due to

nerve disorders such as bone TB pain or malignancy

in other cases of knee osteoarthritis, knee

osteoarthritis patients who get other treatments and

patients who receive pharmacological therapy in pain

management. The data collection techniques were

carried out using purposive sampling technique

which was done by entering every patient who met

the inclusion and exclusion criteria. The instrument

used was an observation sheet. Measurement of pain

scale is done by VAS which is divided into 3

assessments given numbers 0-10, "0" category of no

pain, 1-3 categories of mild pain, 4-6 categories of

moderate pain, 7-9 categories of aches and "10

"Shows extreme pain. The implementation procedure

can be seen in the figure 5 below:

Figure 5: Examine Procedure

Before the intervention is carried out, the pain

scale is measured first to ensure the pain value felt by

the sample, after the pain scale is obtained from the

sample, then it is continued with 3 times a week of

roll slide and manual traction interventions.

Measurements were taken again after the intervention

was given whether there was a decrease in pain scale

or not, then data were analyzed using paired sample

t-test.

3 THE RESULTS AND

DISCUSSION

Based on Table 1, the scale of knee pain scale before

Roll Slide and Manual Traction Mobilization

intervention in Patients with Knee Osteoarthritis

found that the dominant knee pain scale is moderate

pain by 16 respondents (72.7%), mild pain by 5

respondents (22.7%), while severe pain 1 respondent

(4.5%).

Table 1: Distribution of Knee Pain Scale values

before Roll Slide Mobilization and Manual Traction

interventions on Osteoarthritis Sufferers.

Pain Scale n %

Mild Pain 5 22,7%

Middle Pain 16 72,7%

Heav

Pain 1 4,5%

Total 22 100%

Based on Table 2, the Knee Pain Scale value after

Roll Slide Mobilization and Manual Traction

intervention in Knee Osteoarthritis Patients shows

that the dominant pain scale is mild pain as much as

9 respondents (40.9%), moderate pain is 8

respondents (36.4%), whereas pain slightly 5

respondents (22.7%).

The Average of Knee Pain Scale before giving

intervention in patients with Osteoarthritis, it is mean

value of the knee pain scale prior to the intervention

of Roll Slide Mobilization and Manual Traction in

Patients with Knee Osteoarthritis found the average

pain value is 2.82 with a standard deviation of 0.501

Table 2: The Distribution of Knee Pain Scale values

after Roll Slide Mobilization and Manual Traction

interventions on Osteoarthritis Sufferers.

Pain Scale n %

Little Pain

5 22,7%

Mild Pain

9 40,9%

Middle Pain

8 36,4%

Total 22 100%

The average Knee Pain Scale before giving

intervention in patients with Osteoarthritis, it is mean

value of the knee pain scale after Roll Slide and

Manual Traction Mobilization intervention in Knee

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Osteoarthritis Patients showed an average value of

2.14 with a standard deviation of 0.774.

The average Knee Pain Scale after Roll Slide

Mobilization and Manual Traction Intervention in

Patients with Osteoarthritis, the value of difference

intensity of the knee pain scale before and after the

intervention of Roll Slide Mobilization and Manual

Traction in Patients with Osteoarthritis Knee obtained

is 0.682 with a standard deviation of 0.568 and p-

Value 0,000 which means that there is an effect of

giving Roll Slide Mobilization and Manual Traction

in Patients with Osteoarthritis.

Difference in Pain Scale Intensity Before and

After the Intervention of Roll Slide Mobilization and

Manual Traction in People with Osteoarthritis, the

value of the difference in the intensity of the pain

scale before and after the administration of Roll Slide

Mobilization and Manual Traction in Patients with

Osteoarthritis in the Knee obtained a Mean value of

0.682 with a standard deviation of 0.568 and 0,000,

which means there is an effect of giving Roll Slide

Mobilization and Manual Traction in Osteoarthritis

Sufferers.

4 DISCUSSION

4.1 Average Pain Scale before

Administration of Roll Slide

Mobilization and Manual Traction

in Osteoarthritis Sufferer

The results of research conducted on 22 people on the

measurement of the VAS value before the

administration of Roll Slide Mobilization and Manual

Traction techniques that have mild pain values of 5

people (22.7%), moderate pain of 16 people (72.7%),

and annoying pain 1 people (4.5%). Osteoarthritis is

a chronic joint disease that is characterized by

abnormalities in the cartilage of the joints and nearby

bones. Cartilage will result in bones rubbing against

each other, resulting in symptoms of stiffness, pain

and restriction on the endi movement means that

osteoarthritis is a degenerative joint disease

associated with joint cartilage damage. Osteoarthritis

is chronic, slow progressive and is characterized by

changes in susceptible joints and the formation of

new bone on the joint surface. Osteoarthritis often

affects joints that support weight such as vertebre,

pelvis, knees, and ankles. The occurrence of

osteoarthritis is influenced by various risk factors

such as age (aging process), genetic, obesity, joint

injury, anatomical anomaly, metabolic disease and

joint inflammation, osteoarthritis is influenced by

various risk factors such as age (aging process),

genetic, obesity, injury joints, anatomical anomalies,

metabolic diseases and diseases of joint inflammation

(Endang, 2016, Ismaningsih, 2018 & Bove, Smith,

Bise, 2018).

Other studies that are in line with this research

were conducted in India in 2016 where the p value

was less than 0.01 which showed that the average

pain score at the level before and after the treatment

was not the same, this can occur because of manual

cervical traction techniques with heating pads

superficial TENS was found to be the best and

effective way to relieve pain and restore the active

function of patients in daily life with a significant

increase in symptoms that bring good patient results.

(Khan, Yasmeen, Ishaque, 2016 and Pandya, Sheth,

2017, Anwer, Alghadir, Zafar, 2018).

4.2 Average Pain Scale after

Administration of Roll Slide

Mobilization and Manual Traction

in Osteoarthritis Sufferers

The results of research conducted was 22 peoople on

the measurement of VAS values after the

administration of Roll Slide Mobilization and Manual

Traction techniques that have a slight pain value of 5

people (22.7%), mild pain 9 people (40.9%) and

moderate pain 8 people (36.4%). Roll Slide

Mobilization Technique is one form of mobilization

exercise in the form of passive motion in the knee

joint that is adapted from physiological motion that

occurs arthrokinematic motion where in the tibia

there is a roll toward the dorsal and the slide towards

the dorsal as well so as to obtain stretching of the

ligamenter capsule ligamenter which does not occur

excessive stretching on one part given the exercise.

This exercise is expected to stimulate biological

activity by flowing synovial fluid that carries

nutrients to the avascular part of the joint cartilage on

the joint surface and fibrocertilago joints. Repeated

movements in the slide roll mobilization will increase

microcirculation and more liquid will come out so

that the water content and matrix in the tissue

increases and the tissue is more elastic. manual

traction techniques that are carried out repeatedly in

the movement of traction will improve the micro-

circulation and fluid that is released a lot so that the

water and matrix content in the tissue can increase

and the tissue becomes more elastic. In addition, the

traction motion elements are almost the same as the

physiological movements of the knee joint in flexion

movements so as to increase and maintain the

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153

elasticity of the capsules, ligaments, and muscles, any

mechanical dysfunction needs to be corrected through

mechanical means. Therefore manual therapy in the

form of traction tends to shift the joints at the level of

the articular surface. The combination of mechanical

and sports traction for patients with cervical

radiculopathy improves function and reduces pain

(Bukhari, Rehamn, Ahmad, Naeem 2016).

The results of the research related to the above

study were conducted at the Meerut LLRM campus

in 2018 where the assessment was conducted on day

-1 of the intervention and was reassessed after 15 days

of intervention. Group A VAS scores showed an

overall percentage of 18%, group B experienced an

overall percentage decrease of 32%. ROM scores of

group A decreased by an overall percentage of 30%

group B decreased by 34% overall, where the results

showed that mechanical cervical traction and manual

traction with nerve mobilization

techniques were

almost equally efficient in reducing pain and

increasing range of motion, this can be occur due to

neck span movements and decreased level of

neck

disability in two therapeutic interventions namely

intermittent

cervical traction combined with neck

strengthening exercises in nerve mobilization

combined with neck strengthening exercises that we

can see like in Figure 6 (Xu, Chen, Wang, 2017 and

Sarfaraj & Deepali, 2018).

Figure 6: Manual Therapy Technique for the Slide Slide

Method on the Knee Joint

4.3 The Effect of Difference in Pain

Scale before and after

Administration of Roll Slide

Mobilization and Manual Traction

in Osteoarthritis Sufferers

The results of the study prior to the administration of

Roll Slide Mobilization and Traction Manual

revealed the average value of the pain scale before

2.82 with SD = 0.501 while after the administration

of Roll Slide Mobilization and Traction Manual it

was known the average value of the pain scale was

2.14 with SD = .774 while the results of the study of

the difference in pain scale before and after the

administration of Roll Slide Mobilization and

Traction Manual amounted to 0.682 with SD = 0.568.

The statistical test results obtained p-value <α (0,000

<0.05), it can be concluded there is an influence

before and after the administration of roll slide and

manual traction mobilization in knee osteoarthritis

sufferers. The results of this study are in accordance

with research conducted by Pandya, Sheth (2017) on

the "Effect of Mechanical Traction on Pain And

FunctionIn Subjects With Osteoarthritis Knee" given

to osteoarathrits patients with a frequency of twice a

week in osteoarthritis patients the healing phase can

reduce pain in knee.

In line with research conducted in India in 2015

that there was a significant increase in the range of

motion of subjects treated with manual therapy (P

value for all cervical spine movements <0.005). This

can occur because intermittent traction increases

circulation to tissues and reduces swelling thereby

helping to reduce inflammatory reactions from nerve

roots. Therapy is performed with the first 2 stages,

namely to form stretches that extend all vertically

oriented neck soft tissue, and the second to reduce the

strength of heavy bearing compression on the surface

of the joints, intervertebral discs and intervertebral

foramina of the cervical spine. In manual therapy,

direct tensile force is applied at the level of the

affected spine. When traction separates the spinous

processes, the size of the intervertebral foramina

increases thereby reducing compressed nerve roots to

provide faster assistance in radiation and also increase

intervertebral motion at these levels. Thus manual

mulligan traction can be considered the treatment of

choice for cervical spondylosis with or without

radiculopathy. Roll Slide and Manual Traction

Mobilization Measures with the determined intensity,

frequency and time are very effective for

osteoarthritis sufferers who experience knee pain,

because this intervention can stimulate biological

activity by flowing synovial fluid that carries

nutrients to the avascular part of the joint cartilage on

the joint surface and joint fibrocystilage so that pain

is reduced (Bosmia & Kotwal, 2015, Xu, Chen,

Wang, 2017).

Research conducted in Australia in 2016 showed that

toe distance significantly increased with one nerve

mobilization session (p <0.01) or static stretching (p

<0.01). The effects of static stretching interventions

on toe touch are consistent, which report similar

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154

changes in the sit and range test, an alternative that is

highly correlated with the finger touch test. The

results of this study indicate that mobilization of the

nerves is also an effective method for increasing toe

touch distance. (Curtis, Retchford, Khalaf & Jeline

2016

5 CONCLUSIONS

 Knee pain scale prior to intervention Slide Slide

and Manual Traction Mobilization on Patients

with Knee Osteoarthritis found the average pain

value is 2.82 with a standard deviation of 0.501

 The scale of knee pain after the intervention of

Roll Slide Mobilization and Manual Traction on

Patients with Knee Osteoarthritis found an

average

value of 2.14 with a standard deviation

of 0.774.

 Difference intensity of the knee pain scale

before and after the intervention of

Roll Slide

Mobilization and Manual Traction in Patients

with Osteoarthritis Knee obtained is 0.682 with

a standard deviation of 0.568 and p-Value 0,000

which means there is an influence on the

provision of Roll Slide Mobilization and

Manual Traction in Osteoarthritis Sufferers

ACKNOWLEDGEMENTS

Thank you for the:

 To all patients who were willing to be

respondents in this research

 The Managing Director of the GRANDMED

Lubuk Pakam Hospital who has given

permission for the researcher to be completed

properly

 The Rector of Health Institute MEDISTRA

Lubuk who has given permission and support

conducting this research.

REFERENCES

Ardinata, D. (2017). Multidimensional nyeri. Jurnal

Keperawatan Rufaidah Sumatera Utara.

Curtis, Retchford, Khalaf & Jeline. 2016. Acute effects of

neural mobilization and static hamstring stretching on

multi-joint flexibility in a group of young adults.

Journal of Novel Physiother.

Chen, Zhan, Marszalek, 2018. Manual therapy for knee

osteoarthritis pain: a systematic review and meta-

analysis. Elsevier Inc. Volume 26

French, Brennan, White, et all, 2017. Manual therapy for

osteoarthritis of the hip or knee – A systematic review.

Journals & Books. Volume 16, Issue 2

Hameed, Waqas, Akhtar at al., 2017. Effect of Manual

Therapy on Knee Osteoarthritis (OA) Pain, A

Randomized Control Trial. International Journal of

Research Studies in Medical and Health Sciences

Ismaningsih, Selviani, I. (2018). Muskuler taping dan

strengthening exercise untuk meningkatkan kapasitas

fungsional. Pekan Baru: Jurnal Ilmiah Fisioterapi

(JIF).

Klimek, Bergmann, Biedermann, et all, 2017. Visual

analogue scales (VAS): Measuring instruments for the

documentation of symptoms and therapy monitoring in

cases of allergi crhinitis in every day health care

Kisner, C and Colby, LA, 2017. Therapeutic exercise

foundations and techniques (therapeudic exercise:

foundations and techniques). 7th Edition, Kindle

Edition. F.A. Davis Company, Philadelphia.

K. Hanoch & P. Elavarasi, 2016. Department of oral

medicine and radiology, SD Dental College & Hospital,

Parbhani, Maharashtra, India, Department of Oral

Medicine and Radiology, Dayananda Sagar Dental

College and Hospital, Bengaluru, Karnataka, India

Journal of Advanced Clinical & Research Insights

(2016)

Khan, Yasmeen, Ishaque, et all, 2016. Effectiveness of

manual traction and other physiotherapy treatment in

the management of painful cervical radiculopathy.

International Journal of Physiotherapy. Vol 3(3), 286-

290, June (2016). ISSN: 2348 – 8336

Kohn BA, Sassoon MD, Fernando MD, (2016). Kellgren-

lawrence classification of osteoarthritis. Clinical

Orthopaedics and Related Research. journal Volume

474, No 8.

Kumar, A., Goel, S., Gupta, R. & Gupta, B.M. (2017).

Osteoarthritis research in India: Ascientometric

assessment of publications output during 2007-16.

International Journal of Information Dissemination and

Technology, 7(3), 157-161.

RISKESDAS. (2018). Laporan Hasil Riset Kesehatan

Dasar (Rikesdas) Nasional. Jakarta.

Sarfaraj MD & Deepali. (2018). Effectiveness of manual

cervical traction and mechanical cervical traction with

neural mobilization in cervical radiculopathy.

International Journal of Advance Research and

Development. Volume 3, Issue 5.

Sugiyono. (2017). Metode penelitian kuantitatif, kualitatif,

dan R&D. Bandung: Alfabeta, CV.

World Health Organization (2016). Action plan for the

prevention and control of noncommunicable diseases in

the WHO European Region.

Abdel-aziem, Soliman, Mosaad, et all. 2018. Effect of a

physiotherapy rehabilitation program on knee

osteoarthritis in patients with different pain intensities.

The Journal of Physical Therapy Science. Vol. 30, No.

The Effect of Roll Slide Mobilization and Traction Manual on Knee Pain Scale Intensity Patients with Osteoarthritis

155

Ganu, Merchant, 2018. Effect of retrowalking on pain,

functional disability and functional mobility in patients

with chronic knee osteoarthritis. International Journal

of Health Sciences & Research. Vol.8; Issue: 11.

Anwer, Alghadir, Zafar, 2018. Effects of orthopaedic

manual therapy in knee osteoarthritis: a systematic

review and meta-analysis. Volume 104, Issue 3,

Pages 264–276.

Xu, Chen, Wang, 2017. The effectiveness of manual

therapy for relieving pain, stiffness, and dysfunction in

knee osteoarthritis: A Systematic Review and Meta-

Analysis.

Bove, Smith, Bise, 2018. Exercise, manual therapy, and

booster sessions in knee osteoarthritis: cost-

effectiveness analysis from a multicenter randomized

controlled trial. Vol. 98 Number 1.

Pandya, Sheth, 2017. Effect of mechanical traction on pain

and functionin subjects with osteoarthritis knee.

International Journal of Physiotherapy and Research,

Int J Physiother. Vol 5 (4): 2198-02.

Zhang and Niu, 2016. Shifting gears in osteoarthritis

research towards symptomatic osteoarthritis. Arthritis

Rheumato. HHS Public Access. Boston.

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

156