The 2nd Joint International Conferences | http://proceeding.tenjic.

org/jic2 | ISBN: 978-602-5842-03-0

Handling of Elderly Foot Joint Pain

Using Complementary Therapy of Spices Hydrotherapy in
Posyandu Lansia
Selvia David Richarda,1,*, Tri Sulistyarinia,2
a
Lecture STIKES RS. Baptis Kediri, Jl. Mayjend Panjaitan No. 3B Pesantren Kota Kediri 64102
1
selviadavidrichard000@gmail.com*; 2 trisulistyarini.stikesrsbk@gmail.com
* Corresponding author

ABSTRACT
Keywords: Background: Aging is a natural process that can’t be avoided, running
Hydrotherapy spices
continuously and sustainably. In the elderly there is a decrease in the
Joint foot pain
Elderly musculoskeletal system. Changes in the musculoskeletal system are
characterized by the presence of pain and stiffness in one or more joints,
usually in the hands, wrists, legs, knees, upper and lower spines, pelvis,
and shoulders. Pain management does not always have to take
medication, but there are some nursing actions that can be given to
relieve pain such as complementary therapies, such as foot
hydrotherapy using spices.
Objective: This study aims to determine the effectiveness of spice
hydrotherapy in lowering foot joint pain in Elderly Posyandu Kelurahan
Bangsal Kediri.
Method: This research use Quantitative method with research design
used was Pre Experiment Design form pre-post test design. The
population of this study were all Elderly who suffered foot joint pain in
Posyandu Lansia Kelurahan Bangsal Kediri with sample amount that is
equal to 52 respondents, taking data using purposive sampling
technique. Data collection for pain scale measurements using Numerical
Rating Scale (NRS). Analysis of this research data using Wilcoxon
statistical test.
Result: Elderly joint pain before complementary therapy of spice
hydrotherapy was greater than after therapy with pain scale change of
2.9623.
Conclusion: It was concluded that giving of foot hydrotherapy can
decrease joint pain in Elderly.

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All rights reserved
I. BACKGROUND

Aging is a natural process that can’t be avoided, running continuously and continuously
(MOH, 2001, cited by Maryam, 2008). In the elderly there is a decrease in the musculoskeletal
system. Changes in the musculoskeletal system are characterized by the presence of pain and stiffness
in one or more joints, usually in the hands, wrists, legs, knees, upper and lower spines, pelvis, and
shoulders (Corwin, 2009). Joint pain in elderly is chronically painful because of its sedentary nature.
Chronic pain in the elderly can lead to elderly are highly dependent on others, loss of confidence, and
patterns of daily activity is disrupted. Today many elderly people with joint pain do not know much
about non-pharmacological management in pain. Measures to relieve joint pain not only
pharmacologically but also non-pharmacologically such as complementary therapies, for example
with spice hydrotherapy. Foot hydrotherapy is one of a kind of hydrotherapy using warm water mixed
with spices to soak tired, sore, dry and peeling legs that occur in the elderly (Setyoadi and
Kushariyadi, 2011). The main basis for the use of warm water for treatment in hydrotherapy is the
hydrostatic and hydrodynamic effects. Scientifically, warm water has a physiological effect on the
body such as reducing the load on the joints supporting the body weight and blood vessels.

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Patients with joint pain worldwide have reached 355 million people. It is estimated that this
figure continues to increase until 2025 with an indication of more than 25% will experience paralysis.
The World Health Organization (WHO) reports that 20% of the world's population is suffering from
joint pain. Where 5-10% are those aged 5-20 years and 20% of those aged 55 years (Wiyono, 2010).
Lecturers and students STIKES Baptist Hospital Kediri carry out community service in Posyandu
Elderly, when given the examination service at Posyandu Lansia Kelurahan Bangsal Kediri in 2015
obtained average elderly often complain of sleep disturbance at night at the time of pain arise and also
experiencing disruption of physical activity like walking or from sitting to standing. Some ways used
by patients to overcome the pain that is by way of massage and drink herbal medicine.
The aging process of the musculoskeletal system will cause joint cartilage degeneration,
mostly in the weight-bearing joints. The components of joint capsules rupture and collagen present in
the connective tissue progressively increase which, if not used again, may cause pain (Stanley, 2006).
Pain itself can have a major impact on the quality of life of the elderly. The effects of pain can lead to
decreased activity so that the fulfillment of Activity Daily Living (ADL) elderly becomes disturbed,
other than that pain can also lead to social isolation, sleep disorders and depression.
The reduced function of various organs of the elderly becomes susceptible to acute or chronic
diseases. There is a tendency of degenerative diseases, metabolic diseases, psychosocial disorders,
and infectious diseases increases (Nugroho, 2008). Although no therapy can stop the degenerative
process, certain preventive measures can be made to slow down the process when appropriately
sought. Here the role of nurses in overcoming joint pain in elderly is very important that is by
providing health education to reduce joint pain and also provide intervention in the form of
complementary therapy of spice hydrotherapy. Peni Kusumastuti, 2012, medical rehabilitation
specialist, stated that the water used for this therapy has a temperature of 30-31o Celsius, in
accordance with International standards. Water temperature can increase the flexibility of muscle tie,
flexibility in muscle structure, reduce pain, and give effect on blood vessel system that is heart and
respiratory function or lung. In addition, water temperature 31o Celsius affects tissue oxygenation, so
as to prevent muscle stiffness, able to relieve pain, soothe the soul, and relax the body (Setyoadi and
Kushariyadi, 2011).
Based on the above description, the hypothesis of this study is "Complementary Therapies
Hydrotherapy Spices Can Reduce Foot Joint Pain at Elderly in Kelurahan Bangsal Kediri", the
researcher is interested to conduct research on "Handling of Foot Joint Pain in Elderly Using in
Kelurahan Bangsal Kediri".

II. METHOD

Based on the purpose of research, this research using Quantitative method with research
design used is Pre Experiment Design form pre-post test design. The purpose of this study is to
determine the effectiveness of spice hydrotherapy in Lowering Foot Pain at Posyandu Lansia
Kelurahan Bangsal Kediri. The population of this study were all elderly who had joint pain in Elderly
Posyandu Kelurahan Bangsal Kediri with sample number of 52 respondents. Data were collected by
interviews in the form of direct questions to the research subjects. Elderly who experienced foot pain
was measured by pain scale intensity using Numerical Rating Scale (NRS) before treatment of spice
hydrotherapy for 20 minutes, 5 minutes then performed post test to know the intensity of foot joint
pain in Elderly using Numerical Rating Scale (NRS). The results will be compared between before
and after treatment to determine the effectiveness of spice hydrotherapy in reducing foot joint pain in
Elderly at Posyandu Lansia Kelurahan Bangsal Kediri.
The analysis of this research data was done through the step of measuring the intensity of foot
joints scale on the elderly before and after the spice hydrotherapy was given using pretest and posttest
Numerical Rating Scale (NRS) to compare the results. Initial step of data analysis, both groups of
data is done by normality test with Shapiro Wilk analysis and if normal done by Wilcoxon statistical
test analysis.

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III. RESULT

Table 1. Characteristics of Elderly with Foot Joint Pain in Kelurahan Bangsal Kota Kediri October -
November 2017 (n=53)

Characteristics F Percentage (%)

Gender
Man 10 18,9
Women 43 81,1
Total 53 100
Age
30-39 years old 0 0
40-45 years old 1 1,9
46-50 years old 8 15,1
51-59 years old 27 50,9
60-74 years old 13 24,5
75-90 years old 4 7,6
> 90 years old 0 0
Total 53 100
Long Suffering from Rheumatoid Arthritis
< 1 year 0 0
1 – 2 years 23 43,4
> 2 years 30 56,6
Total 53 100
Currently experiencing pain Reumatoid Arthritis
Yes 53 100
No 0 0
Total 53 100
Pain Intensity
Sometimes 26 49,1
Often 27 50,9
Total 53 100
Joints that experience pain Reumatoid Arthritis
Toes 6 11,3
Ankle 39 73,6
Knee 8 15,1
Others 0 0
Total 53 100
Self Action
Drinking herbal medicine 22 41,5
Warm water compresses 8 15,1
Taking medication 19 35,8
Massage 4 7,6
Others 0 0
Total 53 100

From the data, it was found that most respondents were female (43,1%), more than 50%
respondent age 51-59 years were 27 respondents (50,9%), most respondents did not work as many as
22 respondents (41,5%), more than 50% of respondents who suffered joint pain> 2 years as many as
30 respondents (56.6%), the majority of respondents who are currently pain as much as 50
respondents (94.3%), more than 50% the intensity of joint pain is often as much as 27 respondents
(50,9%), most joints that experience joint pain is ankle as much as 39 respondents (73,6%), most self-
action conducted by patient to reduce pain of drinking herbal joint respondents (41.5%).

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Table 2. Characteristic of Foot Joint Paint at Elderly in Kelurahan Bangsal Kota Kediri October –
November 2017 (n=53)

Before After
Category of Pain
F Percentage (%) F Percentage (%)
No Pain 0 0 0 0
Mild Pain 0 0 20 37,7
Medium Pain 24 45,2 32 60,4
Severe pain is controlled 28 52,9 1 1,9
Severe pain is out of control 1 1,9 0 0
Total 53 100 53 100

Based on table 2 the characteristics of pain before foot hydrotherapy in patients with joint
pain with moderate pain category as many as 24 patients (45.2%), controlled severe pain category as
many as 28 patients (52.9%), uncontrolled weight pain category as much as 1 patient (1.9%).
Characteristics of pain after foot hydrotherapy in patients with pain Reumatoid Arthritis with mild
pain category as many as 20 patients (37.7%), moderate pain category as many as 32 patients
(60.4%), and control weight category as many as 1 patient (1.9 %).

Table 3. Scale of Joint Foot Pain at Elderly in Kelurahan Bangsal Kota Kediri October – November
2017 (n=53)

Criteria Before After Change

Mean
Std. Deviation 6.6792 3.7170 2.9623
Minimal 1.08793 0.98795 1.54372
Maximal 5 2 0
Normality Test of Kolmogorov Smirnov 10 7 6
ρ =0.000
Statistic Test of Wilcoxon
Z = -6.250

Based on table 3 characteristics of pain before foot hydrotherapy in patients with joint pain with
moderate pain category of 24 patients (45.2%), controlled severe pain category of 28 patients
(52.9%), uncontrolled severe pain category 1 patient 1.9%). Characteristics of pain after foot
hydrotherapy in patients with pain Reumatoid Arthritis with mild pain category as many as 20 patients
(37.7%), moderate pain category as many as 32 patients (60.4%), and control weight category as
many as 1 patient (1.9 %).

IV. DISCUSSION

The cause of joint pain is unknown. But there are several factors that influence: genetic,
environmental, hormonal, and immunology. The impact of this situation can be life-threatening to the
sufferer or only cause a disruption of comfort. Problems caused by joint pain not only are obvious
limitations to mobility and daily living activities as well as unclear systemic effects, but can lead to
organ failure and death or result in problems such as pain, tiredness, self-image changes, as well as
sleep disorders (Zairin Noer, 2013). Stiffness in the joints can increase during the night especially
during sleep. This allows the client can easily awaken from sleep at night due to pain. Pain is an
unpleasant sensory of an emotional accompanied by actual or potential tissue damage or tissue
damage as a whole.
Based on the results obtained in the study of many patients with joint pain complaining of
pain with a scale of 7 (controlled severe pain) this is due to stiffness in the joints. Most of the joints
are the ankles. Every morning respondents complain that the joints are difficult to move so that the
activity is disrupted. Physically this can be seen from the employment history of patients who are
most not working. This is because the reduced activity causes joint stiffness. From the results of the
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study more than 50% of patients suffering from joint pain more than 2 years with pain intensity is
often more than 50%. Patients with joint pain most of the women as 43 patients (81.1%) and more
than 50% age range suffering joint pain is 51-59 years as many as 27 patients (50.9%). Joint pain
occurs about 2.5 times more commonly affects women than in men. The ratio between women and
men is 3: 1, and in fertile women the ratio is 5: 1, so the ratio between women and men is
approximately 1: 2, 5-3. Incidence increases with age, especially in women. The incidence trends
occurring in women and fertile women are thought to be due to a disturbance in the hormonal
(estrogen) balance of the body, but to date it has not been ascertained whether hormonal factors are
indeed the cause of the disease. This disease usually first appears at the age of 25-50 years, peak
between the ages of 40 to 60 years. This disease attacks people all over the world, from various tribes.
About one percent of adults suffer from a clear rheumatoid arthritis, and are reported (Lukman, 2009).
This is also evidenced from the demographic data of most patients with joint pain is women. At that
age women in the early elderly and also menglami menopouse, so hormonal disturbed. At that age
women in the early elderly and also menglami menopouse, so hormonal disturbed. In the age range
51-59 years most patients are less activity only at home only and also rarely exercise.
Changes in elderly joint pain in Elderly Posyandu Kelurahan Bangsal Kediri District after the
foot hydrotherapy changed with an average of 2.9623, Std. Deviation 1.54372, minimum 0, and
maximum 6 and obtained Wilcoxon test result is ρ = 0,000. Pain is a multidimensional phenomenon
making it difficult to define. Pain is a subjective personal experience, and no two individuals feel pain
in an identical pattern. Pain can be defined in various ways. Pain is usually associated with some type
of tissue damage, which is a warning sign, but the pain experience is more than that. The impact of
this situation can be life-threatening to the sufferer or only cause a disruption of comfort. The
problems caused by rheumatic diseases are not only the apparent limitations to mobility and daily
living activities as well as unclear systemic effects, but can lead to organ failure and death or result in
problems such as pain, tiredness, changes in self-image, as well as sleep disorders (Joyce M. Black,
2014). The problems caused by rheumatic diseases are not only the apparent limitations to mobility
and daily living activities as well as unclear systemic effects, but can lead to organ failure and death
or result in problems such as pain, tiredness, changes in self-image, as well as sleep disorders
(Lukman, 2009). Foot hydrotherapy is a form of exercise that uses the warm water modalities in the
pond. Water becomes an appropriate medium for injury recovery and relieves regular symptoms of
chronic joint disorders. The effect of the buoyant force can reduce the burden on the joints (Setyoadi
and Kushariyadi, 2011). The main basis for the use of warm water for treatment in hydrotherapy is the
hydrostatic and hydrodynamic effects. Scientifically, warm water has a physiological effect on the
body such as reducing the load on the joints supporting the body weight and blood vessels. These
effects have various impacts, first on blood vessels where warm water makes the blood circulation
smooth. Second, the loading factor in the water will strengthen the muscles and ligaments that affect
the joints of the body. Third, exercise in the water has a positive impact on the heart muscle and
lungs, because it makes the breathing circulation to be better.
Joint pain experienced by the respondent can still be reduced by the nonpharmacological
measures of foot hydrotherapy. Foot hydrotherapy is also one of the management of pain that can be
used in patients with pain Reumatoid Artritis. This is because the buoyant force and water
temperature 31o C affects the blood vessels. The heat makes the blood circulation smooth and
strengthens the muscles and ligaments that affect the joints of the body. Also supported by data that
the scale of pain before and after experiencing significant changes with result of mean value 2,9623.
The degree of pain after foot hydrotherapy is mostly moderate pain due to weakness or fatigue,
anxiety due to the pain it feels, other factors such as previous pain experience in the same location.
From the results of data collection also obtained independent actions that patients use to reduce joint
pain the most patients consume herbal medicine. Of the 53 patients there were 2 patients who did not
change because the patient had been using warm water compress and drink herbs to reduce joint pain.

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V. CONCLUSION

Hydrotherapy of leg for 20 minutes with water temperature 31o C in respondents with joint
pain can decrease pain from moderate pain (6,6792) to mild pain (3,7170), joint scale decreased by
2.9623, with result of change ρ = 0,000. So concluded this research there is influence of foot
hydrotherapy to decrease joint pain in elderly.

VI. SUGGESTIONS

Foot hydrotherapy proved to be able to reduce pain in patients with Rheumatoid Arthritis, it is
expected that respondents are able to perform therapy independently in accordance with daily foot
hydrotherapy procedures and make foot hydrotherapy as an alternative to pain reduction measures in
addition to pharmacological therapy undertaken so that patients are not dependent on pharmacological
drugs.

VII. REFERENCE

[1] Corwin, (2009). Buku Saku Patofisiologi. Jakarta: Buku Kedokteran EGC.

[2] Darmojo, R. Boedhi. (2006). Geriatri (Ilmu Kesehatan Usia Lanjut). Jakarta: FKUI.

[3] Kusyati, (2006). Keterampilan dan Prosedur Laboratorium Kesehatan: Teknik Mengatasi Nyeri,
Jakarta: EGC.

[4] Kenworthy, Snowley, Gilling. (2004). Common Foundation Studies in Nursing, Third Edition,
Churchill Livingstone, USA.

[5] Martono. (2009). Buku Ajar Boedhi – Darmojo Geriatri Ilmu Kesehatan Usia Lanjut. Jakarta: Balai
Penerbit Fakultas Kedokteran Universitas Indonesia.

[6] Maryam. (2008). Mengenal Usia Lanjut Dan Perawatanya. Jakarta: Salemba Medika.

[7] Nugroho, Wahyudi. (2008). Keperawatan Gerontik. Jakarta: EGC.

[8] Peni. (2007). Teknik Hidroterapi Bagi Kesehatan. http://www.wikipedia.com/ teknik-hidroterapi.html.

[9] Perry Potter, (2010). Fundamental of Nursing buku 3 edisi 7. Jakarta: Salemba Medika.

[10] Setyoadi, Kushariyadi, (2011). Terapi modalitas keperawatan pada klien psikogeriatrik. Jakarta:
Salemba Medika.

[11] Stanley, Mickey. (2006). Buku Ajar Keperawatan Gerontik. Edisi 2. Jakarta: EGC.

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