Jurnal Keterapian Fisik Vol.
No.
November 2025 https://doi.
org/10.
37341/jkf.
Original Research Effects of Active Assisted and Isometric Exercises Combined with Ultrasound in Knee Osteoarthritis Ida Ayu Astiti Suadnyana1*.
I Putu Prisa Jaya2.
IA Pascha Paramurthi3 Nyoman
Dwi Sutrisnawati4
1,2,3
Physiotherapy Department.
Faculty of Health Sciences.
Bali International University Hospital Administration Department Faculty of Health Sciences.
Bali International University ABSTRACT Background: Knee Osteoarthritis is a chronic degenerative joint disease of the knee cartilage which is characterized by pain and joint stiffness which has an impact on the functional activities of the elderly.
Physiotherapy has an important role in reducing pain by using electrotherapy modalities .
and also exercise therapy .
ctive assisted exercise and isometric exercis.
The aim of this study is to determine the difference in effectiveness between adding active assisted exercise and isometric exercise to ultrasound intervention in reducing pain among elderly patients with knee osteoarthritis.
ARTICLE HISTORY
Received: April 17th, 2025 Accepted: December 2nd, 2025 Methods: This research was conducted at the Physiotherapy Clinic of Merdeka Medical Center from June to July 2024.
The study used an experimental pre-testAepost-test control group design with purposive sampling.
Twenty-six elderly participants were selected and allocated into two groups of thirteen participants each.
Knee pain was measured using the Visual Analogue Scale (VAS), administered before and after the intervention in both groups.
Data were analyzed using SPSS.
Based on the results of the paired samples t-test in groups 1 astitisuadnyana@unbi.
Physiotherapy Department.
Faculty Health Sciences.
Bali International University.
Jl.
Sroja.
Gang Jeruk No.
Tonja.
Denpasar.
Bali.
Indonesia.
KEYWORDS
active assisted exercise, isometric exercise, knee osteoarthritis, pain.
CONTACT Ida Ayu Astiti Suadnyana Results: The p value was 0.
001, indicating a significant difference between group 1 and group 2 in reducing pain.
Isometric exercise combined with ultrasound reduced knee pain 3% more than active assisted exercise combined with ultrasound in elderly patients with knee osteoarthritis.
Conclusion: Isometric exercise with ultrasound reduces knee pain in the elderly compared to active assisted exercise.
Therefore, isometric exercise with ultrasound should be recommended as a preferred physiotherapy intervention to reduce pain in this population.
Cite this as: Effects of Active Assisted and Isometric Exercises Combined with Ultrasound in Knee Osteoarthritis.
Jurnal Keterapian Fisik, 10.
, https://jurnalketerapianfisik.
com/index.
php/jpt/article/view/464 INTRODUCTION Indonesia is currently entering the aging population phase, namely the proportion of the elderly population is increasing.
Based on the Indonesian population census in 2023, 11.
75% of the Indonesian population is categorized as elderly (Badan Pusat http://jurnalketerapianfisik.
com/index.
php/jkf | 110 Statistik Indonesia, 2.
Elderly is a natural process that occurs in someone who is entering the final stages of life.
This process occurs continuously when a person experiences several changes that affect the function and abilities of the entire body, which is called the aging process.
age increase, every part of the human body becomes more susceptible to movement and function disorders, which can reduce the quality of life of the elderly.
Physical changes that occur in the elderly include changes in the nervous system, cardiovascular system, respiratory system, digestive and metabolic system, urinary system, reproductive system, and musculoskeletal system (Flint & Tadi, 2.
Osteoarthritis constitutes a heterogeneous group of conditions that lead to joint symptoms and signs associated with impaired integrity of the articular cartilage, in addition to associated changes in the underlying bone at the joint margins.
Osteoarthritis is also a global health problem that reaches 151.
4 million people and 27.
4 million people in Southeast Asia.
In Indonesia, the prevalence of osteoarthritis is 8.
1% of the total population (Gan et al.
, 2.
Osteoarthritis can occur in all joints but is more often seen in weight-bearing joints such as the knee (Krupa & Dinesh, 2.
Knee osteoarthritis is a chronic degenerative joint disease of the knee cartilage characterized by clinical, histological and radiological changes.
In knee osteoarthritis, patients will experience complaints in the form of joint stiffness and pain which have an impact on functional activities.
Around 80% of seniors aged 60 years suffer from knee joint osteoarthritis and an estimated 1-2 million seniors experience disability due to osteoarthritis (Syamsia et al.
, 2.
Treatment for knee osteoarthritis includes nonoperative and operative measures .
and involves cross-disciplines such as doctors, nurses, physiotherapy (Somaiya et al.
, 2.
The role of physiotherapy in treating osteoarthritis conditions is very important, especially in reducing pain, namely with electrotherapy modalities and also exercise The electrotherapy modality used in this research is ultrasound.
Ultrasound has been used as a non-invasive and safe physiotherapy for musculoskeletal conditions (Dantas et al.
, 2.
Giving ultrasound can increase blood circulation in the tissue, thereby reducing pain.
Ultrasound not only relieves the pain of osteoarthritis patients but has potential cartilage healing effects (Yousef et al.
, 2.
Furthermore, exercise therapy, namely active assisted exercise, is exercise that is carried out alone .
and also with the help of forces from outside the body so that the movements that occur are actively participatory.
This exercise can also control muscle performance as a muscle group so that it can have an impact on reducing pain (Syah et al.
, 2.
In cases of knee osteoarthritis, strengthening exercises are also needed to reduce Strengthening training is an exercise that aims to increase muscle strength where this exercise will cause muscle morphological changes, namely increasing the diameter of muscle fibers (Zeng et al.
, 2021.
The bigger the muscle that is formed, the more mitochondria it contains.
The recommended strengthening exercise with resistance is isometric exercise on the quadriceps muscles.
Increasing quadriceps muscle strength causes reduced pressure on the knee, thereby reducing pain (Basuki et al.
, 2.
Isometric exercises are easy and safe to do (Kangeswari et al.
, 2.
Therefore, researchers wish to combine exercise therapy and electrotherapy to reduce pain in patients with knee osteoarthritis so that patients with knee osteoarthritis can find appropriate, effective and efficient http://jurnalketerapianfisik.
com/index.
php/jkf | 111 The novelty of this research lies in directly comparing the effectiveness of two exercise modalities active assisted exercise and isometric exercise when each is combined with ultrasound for elderly patients with knee osteoarthritis.
The aim of this study was to determine the difference in the effectiveness of adding active assisted exercise and isometric exercise to ultrasound intervention in reducing pain in elderly people with knee osteoarthritis at Poly Physiotherapy Merdeka Medical Center.
MATERIALS AND METHOD
The research design used in this study was quasi-experimental with a pre-test and post-test control group design.
This design was selected because random allocation of participants was not feasible in the clinical setting, while a comparison between two intervention groups was still required.
It enables evaluation of changes in pain within each group over time .
reAepos.
and allows control of baseline differences by comparing post-intervention outcomes between groups while taking initial scores into account, thereby providing stronger evidence of intervention effects than a simple preAe post or cross-sectional design.
This research was conducted at the Merdeka Medical Center (MMC) Physiotherapy Clinic in June-July 2024.
Data collection was carried out for 6 weeks.
The target population in this study was the entire elderly population with a diagnosis of knee osteoarthritis at the Poly Physiotherapy Merdeka Medical Center.
The accessible population is the elderly with a diagnosis of knee osteoarthritis at the Poly Physiotherapy Merdeka Medical Center who have met the inclusion criteria and exclusion criteria and are willing to be the sample in this study.
The sample size was calculated using the pocock formula with the number of samples in each group were 13 people, where the total subjects in this study were 26 The sample collection technique in this research uses a non-probability sampling technique in the form of purposive sampling, sampling based on predetermined inclusion and exclusion criteria.
Non-probability sampling is a sampling technique that does not provide an equal chance for each element or member of the population to be selected as a sample for this research.
The samples in the study were knee osteoarthritis patients at the Poly Physiotherapy Merdeka Medical Center who met the following inclusion criteria such as male or female seniors aged 60-90 years, seniors who had been diagnosed with knee osteoarthritis by a doctor based on medical records (X-ray.
, seniors who have been diagnosed with osteoarthritis genu by physiotherapy based on physical examination, have a good cognitive, have signed informed consent.
The exclusion criteria in this research is fracture, stroke, severe hearing loss, parkinson's and dementia.
And the last drop out criteria was samples got worse after being given training, patients suddenly fell ill or were injured for some reason during data collection.
The independent variables in this research are ultrasound, active assisted exercise, isometric exercise and the dependent variable is pain.
The procedure in this research begins with research preparation by arranging permission for a research introduction letter to the Bali International University institution and requesting permission and approval from the Head of Poly Physiotherapy MMC.
Next, carrying out the research requires approval from the subjects being researched and if they are willing, the subjects are expected to sign informed consent.
Fill out the form and conduct an interview to obtain data on the subject's characteristics regarding age, gender and occupation.
Next, measure pain using a visual http://jurnalketerapianfisik.
com/index.
php/jkf | 112 analogue scale (VAS) and also provide physiotherapy.
Ultrasound was given with an intensity of 1.
0 W/cmA, a frequency of 1 MHz and a duration is 5 minutes for 6 weeks.
Ultrasound is given two times a week using continuous mode at the painful point.
Active assisted exercise is given in 5 sets with 8-10 repetitions.
This training is carried out for 6 weeks, where the training frequency is 2 times per week.
Giving isometric exercises to increase muscle strength, done in 5 sets with 8-10 repetitions .
old for 8 seconds and rest for 4 second.
This training was carried out for 6 weeks, where the training frequency was 2 times per week.
After week 6, pain measurements were carried out again using a visual analogue scale (VAS), an instrument with well-established validity and reliability for assessing subjective pain intensity.
Data analysis in this research used a computer software program, namely SPSS.
The first analysis carried out was a descriptive statistical test to analyze age, gender and occupation whose data was taken before the initial intervention was carried out.
Next, a data normality test was carried out using the Shapiro-Wilk test to determine whether the data distribution was normal or abnormal.
After the normality test, continue with the data homogeneity test using Levene's Test which aims to determine data variations.
The significance limit used is =0.
Hypothesis testing is carried out to assess pre and post tests in each group.
Because the data is normally distributed, we used the paired samples t-test to test differences in results before and after treatment.
And finally, a different test was carried out to assess the difference in effectiveness between group 1 and group 2 using a parametric test, namely the independent t-test.
This research has also been ethically approved by the Health Research Commission Bali International University 055/UNBI/EC/V/2024.
All participants received a clear explanation of the study procedures and provided written informed consent, their confidentiality and anonymity were ensured, participation was entirely voluntary with the right to withdraw at any time, and the interventions were designed to minimize any potential risks or discomfort in accordance with the principles of respect for persons, beneficence, and justice.
RESULTS
The characteristics of respondents based on age, gender and occupation can be seen in the following table:
Table 1.
Distribution sample by Age.
Gender and Occupation .
= .
Characteristic Age Gender Occupation Group 1 .
= .
Category Total Men Woman Total Housewife Entrepreneur Group 2 .
= .
http://jurnalketerapianfisik.
com/index.
php/jkf | 113 Characteristic Group 1 .
= .
Category Merchant Lecturer Retired Total Group 2 .
= .
Note: n = number of observation.
% = percentage Based on Table 1.
Most participants in both groups were aged 60Ae65 years, with fewer participants in the older age categories .
7%).
The proportion of women .
7%) was slightly higher than men in both groups.
Regarding occupation, housewives .
4%) participants constituted the largest proportions.
As a prerequisite for determining the statistical test, it can be using normality test and data homogeneity test are carried out before and after treatment.
The normality test uses the shapiro wilk test, while the homogeneity test uses Levene's test.
The results of this analysis can be seen in the following table:
Table 2.
Results of Normality Test and Homogeneity Test Before and After Intervention Data Group Pre-Test Post-Test Shapiro Wilk Test Group 1 Group 2 Statistic p-value Statistic p-value LeveneAos Test Based on the table 2 it can be seen from the results of the normality test using the shapiro wilk test that the probability value for the data group before the intervention in group 1 was obtained where the p-value = 0.
-value > 0.
and after the intervention the p-value = 0.
-value > 0.
while in group 2 before the intervention the p value = 0.
-value > 0.
and after the intervention the p value = 063 .
-value > 0.
These results indicate that the data is normally distributed.
the homogeneity test using levene's test, the value of p-value = 0.
-value > 0.
was obtained for the group before the intervention and for the group after the intervention the value was p-value = 0.
-value > 0.
which indicates that the data before and after the intervention had homogeneous data.
To test the mean increase before and after intervention in treatment group 1 and treatment group 2, the paired-samples t-test was used which aims to determine the difference in mean increase before and after intervention.
The test results can be seen in the following table:
Table 3.
Within-Group Comparison of Pain Scores Before and After Intervention .
= .
Group 1 Group 2 Before Intervention After Intervention MD A SD 23 A 0.
77 A 1.
Confidence Interval Lower Upper <0.
<0.
Note: MD = Mean Different.
SD = Standard Deviation.
*t-dependent http://jurnalketerapianfisik.
com/index.
php/jkf | 114 Based on Table 3 the results show differences in mean improvement analyzed using the paired-samples t-test before and after intervention in group 1 with ultrasound and active assisted exercise with a value of p-value < 0.
-value < 0.
which means that there is a significant difference of improvement before and after giving the Testing the group 2 hypothesis with ultrasound and isometric exercise using the paired-samples t-test obtained a value of p-value < 0.
-value < 0.
which means that there is a significant difference in the increase before and after To test the comparison of the average increase before and after in the two groups given ultrasound and active assisted exercise treatment in group 1 and ultrasound and isometric exercise in group 2, the Independent T-test was used.
The results can be seen in the following table:
Tabel 4.
Between-Group Comparison of Post-Intervention Pain Scores .
= .
Pre-Test Post-Test Group Mean A SD Group 1 Group 2 Group 1 Group 2 31 A 0.
38 A 1.
08 A 0.
62 A 1.
95% Confidence Interval Upper Lower p-value* Note: SD = Standard Deviation.
*t-independent Based on Table 4 which shows the results of calculating the mean difference in pain reduction, the value obtained is p-value = 0.
< 0.
for the difference between before and after the intervention in the two groups.
This means there is a significant difference between the two interventions.
The mean reduction in pain in group 2 .
ltrasound and isometric exercis.
was greater than in group 1 .
ltrasound and active assisted exercis.
The percentage of pain reduction after intervention in group 1 .
ltrasound and active assisted exercis.
and group 2 .
ltrasound and isometric exercis.
can be seen in the following table:
Table 5.
Comparative Percentage Reduction in Pain Between Groups .
= .
Analysis Result Pain Reduction Before Intervention Pain Reduction After Intervention Difference Pain Reduction Percentage (%) Group 1 Group 2 Based on Table 5 which shows the percentage results of pain reduction in group .
2%) and in group 2 .
3%).
Thus, it can be said that group 2 intervention .
ltrasound and isometric exercis.
resulted in a greater reduction in pain that group 1 .
ltrasound and active assisted exercis.
DISCUSSION