The Difference between Transcutaneus Electrical Nerve Stimulation

and Oscillation Traction in Reducing Knee Osteoarthritis Pain

Isidorus Jehaman, Timbul Siahaan, Miftahul Zannah, Tati Murni Karokaro, Sabirin Berampu, Siti

Sarah Bintang, Redi Tantangan

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

e-mail: (dorusman1976, sabirinberampu, siahaantimbulfisio, tatikarokaro612sp, mfthlzannah, sarahbintang228,

renisirait1982, reditantangan) @gmail.com

Keywords: Transcutaneous Electric Nerve Stimulation Oscillation Traction, pain.

Abstract: Osteoarthritis is a chronic disease that affects quality of life and productivity of human body. The purpose of

study was to decide differences in administration of transcutaneous electric nerve stimulation with oscillation

traction on pain intensity in patients with knee osteoarthritis. This research method is a quasi-experimental

design with pre-test and post-test two groups. Respondents were 24 people consisting of two treatment groups

with each group totalling 12 people. Statistical test results obtained p-value <0.05 (0.001 <0.05) means that

there is an effect of giving transcutaneous electric nerve stimulation with oscillation traction to decrease pain

in patients with osteoarthritis of the knee. There are differences in transcutaneous electric nerve stimulation

with oscillation traction in reducing pain in patients with osteoarthritis of the knee where pain reduction with

TENS intervention falls by 16.7% and oscillation traction decreases by 50%.

1 INTRODUCTION

Degenerative disease is a chronic disease that affects

the quality of life and productivity of a person.

Degenerative diseases include cardiovascular

diseases (heart and blood vessels) including

hypertension, diabetes mellitus and cancer,

osteoarthritis. One of the many degenerative diseases

that have a high mortality rate and affects the life

force and productivity of a person is osteoarthritis

(Sue, 2019).

Osteoarthritis is a degenerative disease with a

fairly high mortality rate, and can affect the quality of

life and productivity of a person (Sue, 2019). Knee

osteoarthritis is a degenerative disease of the knee

joint caused by a variety of factors. A characteristic

feature of osteoarthritis is damage to the cartilage or

cartilage in the knee joint. This knee joint cartilage is

a slippery hard tissue that explain at the end of the

bones in knee joint. Cartilage in the joints serves as a

facilitator of movement in activities (Noor, 2016).

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 do their

major daily activities (Zhang and Niu, 2016). Data in

Indonesia according to Setiati, Marcellus, Alwi,

2017, people who suffer from osteoarthritis disorders

reached 5% affected at age <40 years, and 30% at age

40-60 years and 65% at age> 60 years.

According to Basic Health Research data

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%). Data from the hospital. Grandmed,

Lubuk Pakam showed cases of osteoarthritis has

increased from year to year. In 2017 a total of 4,407

people or 34% of the total 12,960 people while in

2018 a total of 5,472 people or 36.5% of the total

14,976 people visited, the Hospital Physiotherapy

Poly Grandmed Medistra, 2018.

Manual therapy will taken from the word manus

(hand) and therapy or treatment) so that it can be used

as therapy. Especially using hands. Manual therapy is

considered the structure and system in human body

such as bones, joints, soft tissue, circulation blood,

Jehaman, I., Siahaan, T., Zannah, M., Karokaro, T., Berampu, S., Tantangan, R. and Sarah Bintang, S.

The Difference between Transcutaneus Electrical Nerve Stimulation and Oscillation Traction in Reducing Knee Osteoarthritis Pain.

DOI: 10.5220/0009973204910498

In Proceedings of the International Conference on Health Informatics and Medical Application Technology (ICHIMAT 2019), pages 491-498

ISBN: 978-989-758-460-2

491

lymph and nerves. The main purpose of the therapy

manual is to help the body's natural recovery process.

The effects of manual physiological therapy include

smooth circulation blood, triggers endorphins

hormone and relaxes muscles. Accordingly. The

whole process can then, reducing perception through

the effect of excitatory inhibition pain (gate control),

muscle relaxation, improve joint motion, strength,

cordination, balance, reducing pain. Janis manual

therapy used is a traction method using mechanical

devices to remove spinal pressure, arms, legs and

neck.

The impact of pain on osteoarthritis was a

decrease quality of life expectancy such as the

reduced ability of motion of the patient in carrying out

daily activities (Price, 2014). The measuring

instrument used to measure pain intensity is the

Visual Analog Scale (VAS). VAS used very widely

in recent decades in studies related to pain with

reliable, valid and consistent results. VAS is an

instrument used to assess pain intensity using a 10 cm

line table with a reading of a scale of 0-10 cm with a

range meaning (Vaidehi, Kristian, Stephanie, et all,

2017).

To overcome the problem of pain in knee

osteoarthritis actions that are given in addition to

drugs but also given therapeutic measures with

Electroacupuncture (Lucas, Luci, Ricardo, 2018),

Exercise (Shim, Jung, Kim, 2016), Balance Exercise

(Ashtiani, Akbari, Mohammadi, et all, 2018). Other

methods that can given to overcome the problem of

pain in knee osteoarthritis are TENS and oscillation

traction (Veldman, Glatthorn, Visscher, 2019). TENS

is a modality that uses electrical energy that is useful

for stimulating the nervous system through the

surface of the skin which is proven effective for

stimulating various types of pain (Govil M,

Mukhopadhyay, Holwerda, et all, 2019). In this case

TENS has a sedative effect that stimulates the

Posterior Horn Cell (PHC) so that the pain that results

in disability will cut. The use of TENS in

osteoarthritis pain is primarily intended for

modulation of supraspinal and central levels, to

obtain the effectiveness of pain reduction with the

production endorphins, serotonin and enkepalin.

Traction is a technique used to treat joint

dysfunction such as stiffness, reversible joint

hypomobility and pain. Traction is a passive

movement that doing by physiotherapy at a slow pace

so that the patient can stop the movement. Giving

traction can stimulate biological activity by flowing

synovial fluid which can carry nutrients in the

vascular part of the joint cartilage on the joint surface

and joint fibrocartilage. Repeated movements in the

traction movement will improve microcirculation and

a lot of liquid will come out so that the water and

matrix moisture content in the tissue can increase and

the tissue becomes more elastic. In addition, the

traction element motion is almost the same as the

physiological motion of the knee joint in flexion

motion so that it can add and keep up elasticity of the

capsules, ligaments, and muscles (Negara, 2013).

Oscillation traction is a mobilization technique that

can cause synovial fluid movements and help deliver

nutrients to tissues that are avascular and fibro

cartilage and prevent pain and static degeneration

effects when the joints are swollen or painful and

limited. Therefore researchers want to prove whether

there is a difference between giving TENS and

oscillation traction in reducing pain in knee

osteoarthritis. The purpose of this study was to

determine the differences in the administer of

transcutaneous electric nerve stimulation with

oscillation traction on pain intensity in patients with

knee osteoarthritis

2 RESEARCH METHODS

This research was taken at the Grandmed Poly

Physiotherapy Hospital which is on Jl Raya Medan,

No.66, Lubuk Pakam. The research held on February

- July 2018. This type of research was a quasi-

experimental research design with pre-test and post-

test two groups. The research sample consisted of 24

people and divided into 2 groups: group I was given

TENS intervention and Group II was given oscillation

Traction intervention with a sample of 12 people

each.

The data had presented in tabular form after

editing, coding and tabulation, then the t-test closed

to confidence level of 95% (0.05). All statistical tests

were performed with the help of a computer using

SPSS 22 software. Research Implementation Flow

(Figure 1).

Pain measurement is performed use Verbal

Anolog Scale (VAS). VAS has been used in diverse

adult populations, including those suffering from

rheumatic diseases. VAS is an instrument used to

assessment pain intensity using a line 10 cm long

(Figure 2) with a scale reading of 0-10 cm with a

range of meanings: no pain (0.9 cm), mild pain (1-3

cm) moderate pain (3.1 -7 cm), and severe pain (7.1-

8.9 cm). Pain measurement can be done by the

respondent himself. Determination of the VAS score

is done by measuring the distance between the end of

the line on the painless line to the point indicated by

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

492

the patient, (Vaidehi, Kristian, Stephanie, et all,

2017).

Figure 1: Research Implementation Flow

Pain examination procedure with VAS:

 Explain to the patient about the purpose of the

measurement carried out.

 Explain to sufferers that right angle means no

pain, middle means moderate pain and left angle

means very painful (front VAS)

 Telling the patient to choose or move direction

the VAS arrow on the pain scale by the intensity

of pain felt when stationary/not moving (silent

pain)

 Pressing the patient's body area complained of

or other body areas related then told the patient

to select / move direct of the VAS arrow on the

pain scale by the intensity of pain felt when the

area is pressed (tenderness)

 Move the patient's body area complained of or

other body areas related then instruct the patient

to select or move direct the VAS arrow on the

pain scale by the intensity of pain felt when

moved by the examiner (motion pain)

 Take notes and then interpret the meaning of

pain expressed by the patient by comparing pain

gauges available at the back of the VAS Pain

measurement in this study was done before and

after TENS and oscillation traction treatments

Measurement data will be tested by Paired

Samplet-test and independent t-test. The flow of

this research will be seen in Figure 2.

Figure 2: Visual Analogue Scale

Physiotherapy intervention technology given

2.1 Transcutaneus Electrical Nerve

Stimulation

TENS method (Figure 3) used to reduce pain in knee

osteoarthritis was obtained through the gate control

theory (Sharvit, 2016). This theory explains sensation

of pain will be felt if the impulse / stimulation of pain

from the source of pain is successfully delivered by

small nerve fibers (S) to the pain center in the central

nervous system in the brain (Figure 4) through the

pain gate. Pain gates can be closed by inhibiting the

respective of C fibers by impulses on large nerve

fibers (L) through touch stimulation, pressure, touch,

or vibration (TENS stimulation) at the source of pain,

so that the pain impulses are not transmitted to the

spinal cord and to the brain and finally one does not

feel the sensation of pain (Figure 5).

Figure 3: Transcutaneus Electric Nerve Stimulation

Figure 4: Small Fiber Input (S) = Gate Open

The Difference between Transcutaneus Electrical Nerve Stimulation and Oscillation Traction in Reducing Knee Osteoarthritis Pain

493

The TENS application technique is performed by

placing electrodes / pad around the sensation of pain

in the knee (Figure 6a). This method was the easiest

and most often used, because this method directly

applied to the area of pain without regard to the

character and the most optimal location in relation to

the tissue that causes pain. Given frequency of 40-150

Hz and low intensity, current regulation between 10-

30 mA, short duration (above 50 microseconds), 30

minutes time.

Figure 5: Large Fiber Input (L) = Gate Closed

2.2 Oscillation Traction

Application of traction techniques form of oscillation,

stakato, or stretching continuously to increase

mobility and reduce pain. Procedures for conducting

therapy, position the patient face down, therapist

standing distal, fixation of the upper limbs of patients

with a band fixed to the bed, both hands holding the

tibia and fibula ankle, and perform traction towards

the distal (Figure 6b).

(a) (b)

Figure 6: TENS Application Method on the Knee (a),

Oscillation Traction Method in the Knee (b)

3 RESULTS AND DISCUSSION

3.1 Characteristics of Respondents

The data distribution of respondents based on the age

of majority aged 48-60 years amounted to 5 people or

88.3% in both the TENS group and the oscillation

traction group as in Table 1. This is consistent with

the existing theory that the aging process is very

influential in the process of knee osteoarthritis.

Elisabet, JC 2011) Whereas respondents based on

gender, the majority are female, amounting to 9

people or 75% of the total 12 respondents from the

two intervention groups.

This will thought to be related to the hormone

estrogen, where adult women have less calcium in

bone than in adult men and after menopause the

estrogen hormone disappears quickly, causing

women to lose calcium in bones faster than men of

equal age. The rapid disappearance of the hormone

estrogen causes an increase in osteoclast activity,

reduced osteoblastic activity in bone, reduced bone

matrix and reduced intake of calcium and bone

phosphate (Ebru , Ersin, Ozdıncler, et all, 2018). The

data confirms that with age a person is more at risk

for inflammation or calcification of the joints,

especially in the knee joints because the knee joint is

the most mobile joint and supports weight. Whereas

for the sexes that suffer the most osteoarthritis, they

are women, it is due to the monopouse process which

causes hormonal changes.

Table 1: Characteristic of Respondents.

Informati

Group TENS

Group

Oscillation

Traction

n % n %

Age

35-47 3 25 % 2 17%

48-60 9 75 % 10 83%

Total 12 100% 12 100%

Sex

Male 3

25 %

Female 9

75 %

Total 12 100% 12 100%

3.2 Pain Measurement Results before

and after Giving TENS and

Oscillation Traction

Pain measurement showed that the average VAS pain

scale felt by respondents before the TENS

intervention was 6 (moderate pain) and after the

TENS intervention, the average value was 5 (sweat

pain) or decreased by 16.7%. While the average VAS

pain scale before the oscillation traction intervention

was 6 (moderate pain) and after the intervention, the

average pain was a value of 3 (sweat pain) or

decreased by 50% (Table 2).

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

494

Table 2: VAS Pain Scale before and after intervention

TENS dan Oscillation Traction

VAS

Traksi Osilasi TENS

Befor

After

Before

After

1 6 4 1 5 4

2 7 5 2 6 5

3 6 3 3 7 6

4 7 4 4 6 5

5 6 2 5 7 6

6 4 2 6 5 4

7 5 2 7 6 5

8 6 3 8 5 4

9 5 2 9 7 6

10 7 3 10 6 5

11 6 3 11 6 5

12 7 3 12 6 5

VAS

Average

Value

72/12= 6 36/12= 3 72/6=6 60/12=5

3.3 The Differences in TENS and

Oscillation Traction in Reducing

Pain in Knee Osteoarthtritis

The results of data process used paired t-test, before

and after intervention in the oscillation traction group,

obtained a mean of 4,500 with p value = 0,000 <

(0,000 <0,05), it can be concluded that there is an

influence of oscillation traction administration on

pain reduction in sufferers of knee osteoarthtritis.

While giving TENS intervention obtained a mean of

1,500 and p-value < (0,001 <0.05), it can be

concluded that there is an effect of TENS

administration in reducing pain intensity in patients

with knee osteoarthritis.

3.4 The Difference between TENS and

Oscillation Traction

Based on the results of data processing that has been

done using the Independent t-test, then the TENS

intervention and oscillation traction obtained p-value

<(0.001 <0.05), it was concluded that the hypothesis

in the study accepted, namely: '' There is a difference

in the administration of TENS with traction

oscillation of pain intensity in patients with

osteoarthritis of the knee. in experimental animals

decreased during spinal transection, this indicates an

extrasegmental role in the event fibers and type C

fibers. Intake of small diameter fibers activates T cells

which will be felt as complaints of pain. If large-

diameter fibers were activated, this will also activate

T cells but at the same time the impulses will also

activate SG which has an impact on reducing the

intake of T cells from small-diameter fibers in other

words, the intake of large-diameter fiber impulses

will close the gate and inhibits the transmission of

pain impulses so that pain is felt to be reduced. (3)

Extra-segmental mechanism. TENS that induce

small-diameter afferent activity also produce

extrasegmental level analgesia through activation of

structures that form the path of desenderent inhibition

such as periaqueductal gray matter (PAG), Nucleus

Rape Magnus (NRM) and nucleus rape

gigantocellularis (NRG). Analgesia produced by

TENS stimulation of A- fibers and small-diameter

A- and A-The results of this study are consistent

with research conducted by Parjoto S (2012) that

TENS produces analgesia at the extrasegmental level

through structural activities that form the paths of

desenderent inhibition such as periaquedutal gray

(PAG), raohe magnus nucleus and raphegiganto

celluraris nucleus. The mechanism of pain reduction

with TENS according to Johnson M is (1) Peripheral

mechanism. Electrical stimulation applied to nerve

fibers will produce impulses that run in both

directions along the nerve axons concerned. In

sensory nerves, impulses that travel proximal were

called prodromic impulses, while impulses that travel

distally are known as antidromics. Antidromic

impulses will crash, reduce or eliminate afferent

impulses that come from damaged tissue or the source

of pain. (2) Segmental Mechanisms. Conventional

TENS produces analgesia mainly through the

segmental mechanism by activating A-ser fibers

which in turn inhibits nociceptive neurons in the

posterior horn of the spinal cord. This refers to the

gate control theory which states that the gates consist

of inhibitory international cells known as gelatinous

substances and T cells that relay information from a

higher center and both are located in the posterior

horn of the spinal cord. The level of T cell activity

was determined by the balance of intake from large

diameter A-The researchers' assumption is that the

stimulation of alternating electric currents with the

intensity, frequency and time that has been set the

stimulation of nosiceptor so that pain can be inhibited.

Barriers that are made in the form of electric current

stimulate innervation so that the spinal level this is

accordance with the gate control theory is very

instrumental in pain inhibition, for each person has a

different frequency of pain tolerance.

Oscillation traction interventions as they have

effects on pain relief in knee joint osteoarthritis.

Because the oscillation traction technique will

The Difference between Transcutaneus Electrical Nerve Stimulation and Oscillation Traction in Reducing Knee Osteoarthritis Pain

495

increase the joint surface movement which will

reduce the clamping of soft tissue, reduce

contractures, reduce muscle spasms so that blood

flow occurs smoothly, and there is a propioceptive

increase that affects the increased mobility of the

knee joint area which causes the effectiveness and

elasticity of the movement to increase, so that knee

was used again to increase functional degrees

(French, Brennan, White, et all, 2017). This is in line

with research according to Alkhawajah, Alsham.

(2019) with mobilization of traction by giving

traction to the tibiofemoral joints, the joint surfaces

move away, so that the distance between joints that

were narrowed in the condition of tibiofemoral joint

osteoarthritis can be widened so that pain due to

sensory nerve endings the pressure around the joints

can reduced, if the level of pressure decreases, the

level of irritation of the sensory nerves will decrease,

the impulse of the nociceptor nerve will decrease, and

pain can reduced.

Provision of traction can stimulate biological

activity by flowing synovial fluid which can carry

nutrients in the vascular part of the joint cartilage on

the joint surface and joint fibrocartilage. Repetitive

movements in the traction movement will improve

microcirculation and a lot of liquid will come out so

the water dam and matrix content in the tissue. Joint

distance that narrows with traction will widen the

distance between the joints so that the tissue

previously depressed by exist of osteophytes will

relax and will not irritate the surrounding tissue and

sensory nerve endings so that pressure will decrease

and pain can be reduced. With repetitive movements

that will improve local blood circulation of capsules,

ligaments, and also in the muscles, besides that it will

increase quantity of protein in the synovium fluid due

to the sedative effect there will be an increase in

circulation so that metabolism in the tissue increases,

irritation decreases and pain even reduced

Effects of oscillation traction, (1) Physical effects:

giving oscillation traction can stretch the joints so that

it stimulates biological activity in the joints by

moving synovial fluid. Synovial fluid activity can

increase the process of exchange of nutrients to the

surface of the joint cartilage and fibrocartilage so that

syinovial fluid increases. (2) neurological effects: can

stimulate joint receptors, namely mechanoreceptors

so that they inhibit stimulation of nociceptor stimuli

in the spinal cord via spinal level modulation. (3)

stretching effect: Can stretch painless

capsuloligament through the release of abnormal

collagen crosslink fibers so as to increase the scope of

joint and functional motion of the joints and keep up

tissue elasticity around the joints. (4) arthrokinematic

effect: stretch physiological movements of the joints.

(5) mechanical effects: traction with a small

amplitude on the joint surface causes synovial fluid

activity. Synovial fluid activity that delivers nutrients

to the cartilage and fibrocartilage, can reduce pain,

and increase the scope of joint motion, (Hameed,

Waqas, Akhtar at al, 2017). The researchers'

assumption is that by giving oscillation traction can

further inhibit or reduce pain, this is due to the process

of withdrawal and the creation of a joint space that

causes topping of impact due to cartilage damage to

the joints which causes the knee joints to become

loose and there is pressure on the bones against bones,

therefore we need interventions that can restore joint

space so that there is no friction between joints.

4 CONCLUSIONS

Based on the results of the statistical tests and the

discussion above, it can be concluded that

 Giving TENS affects the reduction of pain in

patients with osteoarthritis of the knee where the

average pain value using VAS before the action

is 6 (moderate pain) and after TENS

intervention, it becomes 5 (sweat pain) or

decreased by16.7%

 Giving oscillation traction affects the reduction

of pain in patients with osteoarthritis of the knee

where the average pain value using VAS before

the action is 6 (moderate pain) and after the

intervention, the average pain value becomes a

value of 3 (sweat pain) or falls by 50%.

 TENS and oscillation traction can be used as a

reference for making standard operating

procedures (sops) for managing osteoarthritis of

the knee. for the next researchers to use a larger

number of samples in order to obtain maximum

results.

ACKNOWLEDGEMENTS

Thank you sent to:

 To all patients who have agreed becomes

aresearch sample

 Director of the Grandmed Lubuk Pakam

Hospital who has given permission to carry out

this research

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

496

 Chancellor of the Medical Institute Medistra

Lubuk Pakam who has provided financial

support and facilities so that research can be

carried out properly and smoothly.

REFERENCES

Alkhawajah, Alsham. 2019. The effect of mobilization with

movement on pain and function in patients with knee

osteoarthritis: a randomized double-blind controlled

trial. BMC Musculoskeletal Disorders

Ashtiani, Akbari, Mohammadi, et all, 2018. The effect of

balance exercises on knee instability and pain intensity

in patients with knee osteoarthritis: a randomized

clinical trial. Journal of Research in Medical and

Dental Sciences.

Abdel-Aziem Soliman, Mosaad, Draz, 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.

Ayanniyi, Roseline, Adeniyi, 2017. Physiotherapy

management of knee osteoarthritis in nigeriad a survey

of self-reported treatment preferences. Elsevier

(Singapore) Pte Ltd. Hong

Cemile, Asuman, Özcan, at al, 2017. The effectiveness of

transcutaneous electrical nerve stimulation in knee

osteoarthritis with neuropathic pain component: A

Randomized Controlled Study. Turkish Journal of

osteoporosis published. Galenos Yayinevi. Turkish

Osteoporosis Society.

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

osteoarthritis pain: a systematic review and meta-

analysis. Elsevier Inc. Volume 26

Chen, Tsai, Wang, et all 2019. Can early rehabilitation after

osteoarthritis reduce knee and hip arthroplasty risk. A

national representative cohort study. Medicine:

Volume 98 - Issue 21 - p e15723.

Ebru , Ersin, Ozdıncler, et all, 2018. A comparison of two

manual physical therapy approaches and electrotherapy

modalities for patients with knee osteoarthritis: A

randomized three arm clinical trial. Journal

Physiotherapy Theory and Practice An International

Journal of Physical Therapy. Volume 34, 2018 - Issue

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

osteoarthritis of the hip or knee – A systematic review.

Journals & Books. Volume 16, Issue 2.

Gibson Wand, Meads, et all, 2019. Transcutaneous

Electrical Nerve Stimulation (TENS) for chronic pain -

anoverview of Cochrane Reviews. Journal of Pain

Research John Wiley. & Sons, Ltd.

Gil Sharvit, 2016. Expectancy effects of pain and disgust in

perceptual and moral decisions. University of

California, Berkeley.

Govil M, Mukhopadhyay, Holwerda, et all, 2019. Effects

of genotype on TENS effectiveness in controlling knee

pain in persons with mild to moderate osteoarthritis.

European journal of Pain Federation  EFIC.

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

Noor, 2016. Buku Ajar Gangguan Musculoscletal.

Yogyakarta. Salemba Empat.

Helmi, Z. N., 2012. Buku ajar gangguan musculoscletal.

Jakarta: Selemba Medika.

Hopkins, 2019. Pulse Electrical Stimulation for the Knee.

Johns Hopkins Health Care LLC

Johnson, Jones, 2016. Transcutaneous electrical nerve

stimulation: current status of evidence. Pain

Management. Future Medicine Ltd.

Juan, Rene, Yenisel, 2018, Knee osteoarthritis:

pathophysiology and current treatment modalities.

Journal of Pain Research.

Laporan Tahunan Poli Fisioterapi Rumah Sakit Grandmed

Lubuk Pakam Tahun 2018.

Lucas, Luci, Ricardo, 2018. Hip and knee strengthening is

more effective than knee strengthening alone for

reducing pain and improving activity in individuals

with patellofemoral pain: A Systematic Review with

Meta-Analysis. Journal of Orthopaedic & Sports

Physical Therapy. Volume 48.

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

Megha, Mohanty, Pattnaik, 2018. Effectiveness of

patellofemoral mobilisation, stretching and

strengthening on walking ability and stair climbing in

subjects with osteoarthritic knee - A Comparative

Study. Research Article EC ORTHOPAEDICS.

Qamar, Basharat, 2016. Manual therapy can be a potential

therapy in knee osteoarthritis.

RISKESDAS. (2018). Laporan Hasil Riset Kesehatan

Dasar (Rikesdas) Nasional. Jakarta.

Sato, Takamatsu, Samejima et all. The analgesic effect of

electrode placement area for Transcutaneous Electrical

Nerve Stimulation (TENS) in knee pain during exercise

- Comparison of two placements in the same

dermatome area. Journal of Electrophysical Agents

Setiati, Marcellus, Alwi, 2017. buku ajar ilmu penyakit

dalam Jilid: 1. Edisi: 6th. Penerbit: Jakarta Pusat.

Shai N G., 2017. Remote analgesic effects of conventional

transcutaneous electrical nerve stimulation: A

Scientific and Clinical Review with A Focus on

Chronic Pain. Journal of Pain Research. Journal of Pain

Research.

Shi, Yu, Wang, 2019. A comparison of the effects of

electroacupuncture vs transcutaneous electrical nerve

stimulation for pain control in knee osteoarthritis. Study

Protocol Systematic Review. Medicine.

Shim, Jung, Kim, 2016. Effects of Electroacupuncture for

Knee Osteoarthritis: A Systematic Review and Meta-

Analysis.

Shimoura, Iijima, Suzuki, et al, 2019. Immediate effects of

transcutaneous electrical nerve stimulation on pain and

physical performance in individuals with

The Difference between Transcutaneus Electrical Nerve Stimulation and Oscillation Traction in Reducing Knee Osteoarthritis Pain

497

preradiographic knee osteoarthritis: A Randomized

Controlled Trial. American Congress of Rehabilitation

Medicine. Elsevier Inc.

Sue, 2019. Keperawatan gerontik asuhan keperawatan pada

lansia. Andi Publisher .

Veldman, Glatthorn, Visscher, 2019. Somatosensory

Electrical Stimulation Does Not Improve Motor

Coordination in Patients with Unilateral Knee

Osteoarthritis. Journal of Clinical Medicine. Licensee

MDPI, Basel, Switzerland.

Zhu, Feng, Peng, 2017. Effect of transcutaneous electrical

nerve stimulation for pain control after total knee

arthroplasty: A Systematic Review and Meta-Analysis.

Journal of Rehabilitation Medicine Journal.

Foundation of Rehabilitation Information.

Zhang and Niu, 2016. Shifting gears in osteoarthritis

research towards symptomatic osteoarthritis. Arthritis

Rheumato. HHS Public Access. Boston

Vaidehi, Kristian, Stephanie, et all, 2017. Clinical utility

and psychometric characteristicsof the measure of

intermittent and constant osteoarthritis pain in adults

with hip andknee osteoarthritis. Archives of Physical

Medicine and Rehabilitation.

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

498