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MEDISAINS - VOL. 17 NO. 3 (2019) 53-56
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Original Articles
The effectiveness of contrast bath to reduce joint pain in the elderly
Esri Rusminingsih 1, Nur Wulan Agustina, Diah Ayu Nawang Wulan
1 Nursing Study Program, Stikes Muhammadiyah Klaten, Central Java, Indonesia
ARTICLE INFORMATION
A B S T R A C T
Received: November 22, 2019
Revised: Desember 12, 2019
Available online: January 17, 2020
Background: The aging process results in changes in the musculoskeletal sys-
tem causing a decrease in function of joints, loss of elasticity and limited mobility.
This condition also causes joint pain, especially in the joints supporting the body
weight, namely the knee. The previous studies discussed the method of reduc-
ing pain using a contras bath which was implemented by soaking parts of the
body that experience pain alternately with hot and cold water, this was difficult
to apply if the pain occurs in the upper body. Modifications in contrast baths
using compresses to the knee joint have never been implemented before.
Objective: This study aimed to figure out the effect of the contras bath method
using compresses to reduce knee joint pain in the elderly.
Method: The design of this study was pre-experimental with one group of pre-
test-posttest. The sample used was 16 elderly who were selected by random
sampling at Posyandu (a center for pre- and postnatal health care and
information for elderly) in village of Sawit Gantiwarno, Klaten. Contrast bath is
applied by giving compresses of warm and cold water alternately with a ratio of
three minutes: one minute per-day during 20 minutes, for a week. Pain meas-
urement is performed using the Visual Analog Scale (VAS) instrument.
Result: The mean of knee pain before giving a contrast bath was 5.44, whereas
after a contrast bath was 3.50. Bivariate analysis used Wilcoxon, it showed p
value <0.05 which means there was a significant difference in knee joint pain
before and after contrast baths were applied.
Conclusion: Administration of contrast bath can reduce knee joint pain in the
elderly.
KEYWORDS
Contrast Baths; Arthralgia; Knee Joint; Pain;
Pressure
CORRESPONDENCE
Phone: +62 818-0450-7680
E-mail: esrirusminingsih@yahoo.co.id
INTRODUCTION
The aging process results in morphological, functional and
pathological changes. Changes in the musculoskeletal
system due to aging is in the form of hyaline cartilage ero-
sion, degeneration of the ligament and peri articular. This
condition causes a decrease in joint function, loss of elas-
ticity and limited mobility which causes joint pain, espe-
cially in the joints supporting weight, namely the knee in
the elderly. Cartilage disorders result in bones rubbing
against each other, causing pain in the joints, especially
when the joints move or bear a load.1 This joint problem
can cause several diseases such as osteoarthritis, rheu-
matoid arthritis, gout and pseudo-gout, senile mono-artic-
ular arthritis and polymyalgia rheumatism.2 A research re-
veals that knee pain in osteoarthritis affects the physical
activity of elderly with disability/immobility that can cause
various complications.3
The prevalence of joint disease in Indonesia at the age of
55-64 years was 15.5%. It was 18.6% at the age of 65-74
years, while at the age of > 74 years it was 18.9%.4 Other
studies revealed the prevalence of pain which was more
common in older adults (60%-86%).5 A data survey
conducted at the Health Office of Klaten Regency de-
scribed that the cases of joint pain in the elderly reached
11.351 elderly throughout 2018. The elderly who
experienced joint pain in the region also have a vulnerable
age between 60-75 years.
Joint pain in the elderly causes disruption of their daily ac-
tivities, decreases productivity and can also cause frustra-
tion.6 Results of previous studies reveal that knee pain in
osteoarthritis affects the physical activity of the elderly
such as eating, drinking, walking, sleeping, bathing, dress-
ing, defecating and urinate.3 There are several actions that
ESRI RUSMININGSIH / MEDISAINS - VOL. 17 NO. 3 (2019) 53-56
54
can be implemented to reduce pain. In some cases of mild
pain, non-pharmacological measures are the most im-
portant interventions while pharmacological measures are
prepared to anticipate the development of pain. According
to the results of the study, 35.9% of the elderly use pain-
killers at home to treat pain.7 Pharmacological therapy that
is often used to treat joint pain is generally from the group
of Non-Steroid Anti-Inflammatory Drug (NSAID), this drug
has the risk of causing problems due to interactions with
the drug group of H-2 blocker (Ranitidine), which is
11.7%.8
Non-pharmacological therapeutic option which is easy and
inexpensive to reduce joint pain in the elderly is with the
contrast bath technique.9 Previous studies discussed the
method of reducing pain using a contrast bath was con-
ducted by dipping parts of the body that experience pain
alternately with hot and cold water, this is difficult to apply
if the pain occurs in the upper body. Modifications in con-
trast baths using compresses to the knee joint have never
been implemented before.10 This study aims to determine
the effectiveness of contrast baths to reduce knee joint
pain in the elderly.
METHOD
Study Design
This study is a pre-experimental research with one-group
of pre-test post-test design.11
Setting and Respondent
This study was conducted in January to July 2019 at Po-
syandu Lansia Teratai 4 (Integrated Services Center for
the Elderly), Sawit village, Gantiwarno Sub-District of
Klaten Regency. The population was elderly people. In the
experimental study, number of samples used was 10 to 20
people.12 This study used samples of 16 people. The sam-
ple selection was conducted according to inclusion criteria,
namely: 1) Elderly aged 60-74 years, 2) Elderly experienc-
ing knee joint pain on a scale of 4-6. The exclusion criteria
in this study are: 1) Elderly taking analgesic drugs, 2) El-
derly who experience immobility. Based on the inclusion
and exclusion criteria, the sample of 42 people was ob-
tained. Then 14 elderly who fulfilled the sample criteria
were chosen randomly.
Experimental Procedures
The provision of contrast bath therapy referred to the re-
sults of previous studies, namely by stimulating heat and
cold alternately to obtain vasodilation and vasoconstriction
responses from blood vessels.13 The contrast bath was im-
plemented by giving warm and cold compresses using a
towel that has been soaked in hot water (41-430 C) and
cold water (10-180 C) alternately in the knee area for 20
minutes with a compress time ratio of 3: 1 minute. Contrast
bath is done every afternoon for seven days.
The Instruments and Measurement
Pain measurement in this study was carried out using a
Visual Analoge Scale (VAS) tool. The measurement was
applied before and after the contrast bath.
Data Analysis
The researchers used Wilcoxon test for its data analysis
because the data were not normally distributed.
Ethical Consideration
This study has passed an ethics test by the ethics commit-
tee of the Research and Community Service Institute
(LPPM) of the Stikes Muhammadiyah Klaten.
RESULTS
Based on table 1, the mean of respondents aged 66.19 ±
3.728 years, included in the elderly category. Most re-
spondents were female (62.5%) with 100% education of
primary school graduate and the mostly worked as labor-
ers (75%). The average pain in the knee joint of the elderly
before being given a contrast bath was 5.44 and after the
contrast bath it was 3.55.
Table 2 shows that there are eight respondents who
experienced pain relief after contrast baths, while there
were eight respondents who did not experience pain scale
changes. Based on the results of the analysis using
Wilcoxon, it shows a significant value of 0.005 (p <0.05)
which means that there are significant differences in knee
joint pain before and after intervention.
Table 1. Respondent characteristics (n=16)
Characteristics
Result
Age, year (mean±SD)
66.19+3.728
Gender
Male
6 (37.5%)
Female
10 (62.5%)
Education
Primary School Graduate
16 (100%)
Occupation
Jobless
2 (12.5%)
Labor
12 (75%)
Private workers
0 (0%)
Entrepreneur
2 (12.5%)
Pensioner (Retired)
0 (0%)
Pain scale (mean±SD)
Before
5.44+0.629
After
3.55+0.730
DISCUSSION
Table 1 shows the average joint pain in the elderly before
contrast bath which is 5.44. Joint pain that occurs in the
elderly is caused due to changes because of the aging pro-
cess. The joints of the elderly will experience fibrillation,
uneven surface of the joints, and the presence of-
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55
Table 2. Reduce of joint pain, before and after contrast bath (n=16)
Variable
n
Mean Rank
Z
p-value
Pain before contrast bath - Pain
after contrast bath
Negative Ranks
8a
4.50
2.828
0.005
Positive Ranks
0b
0.00
Ties
8c
a. Pain in posttest < Pain in pretest
b. Pain in posttest > Pain in pretest
c. Pain in posttest = Pain in pretest
cracks/indentations on the surface of the joints due to hy-
aline cartilage erosion which results in joint pain, especially
the knee as a weight support.2 This is consistent with the
results of this study, namely the average age of respond-
ents who are almost 66 years old.
Based on table 1 of gender, it is found that the most of
respondents are women; they are 10 (62.5%). Based on
hormonal view, joint pain in the elderly tends to be experi-
enced by women due to a significant decrease in the hor-
mone estrogen associated with menopausal mass. De-
creased hormone estrogen can have an impact on hyaline
cartilage erosion. Knee joint pain is often experienced by
the elderly due to excessive knee support as a weight sup-
port due to strenuous activity. A very strenuous activity
done repeatedly or physically demanding work a person
can increase the risk of knee joint pain.14
After the respondents got contrast bath they experienced
a decrease in pain from 5.44 to 3.50. Table 2 also shows
a significant difference in elderly knee joint pain before and
after contrast bath therapy with a p value of 0.005. The
results of this study were supported by previous studies
that show the provision of contrast baths can reduce pain
in myogenic.15,16 In this study, contrast bath was per-
formed on 16 elderly people who experience knee pain
regularly for 7 days in the afternoon for 20 minutes by com-
bining hot (41-430C) and cold (10-180C) with a duration of
3: 1 minute and repeated for five times. The total amount
of warm compress time taken in this study was 15 minutes.
The results of the study revelaed that the longer duration
of a warm bath which was 10 minutes could increase the
fluctuation of good blood flow and improves blood circula-
tion to the skin.17,18
Table 2 also shows that there were eight respondents who
did not experience changes in the pain response before
and after the contrast bath. The loss of neurons in the brain
and spinal cord occurred as part of the normal aging pro-
cess.19 In the elderly > 65 years old, they would experience
nerve conduction velocity decreases between 5-10% as a
result of aging process. This condition could reduce re-
sponse time and slow down impulse transmission, thereby
it reduced perception of touch sensory and pain.
The administration of warm compresses on the knee joint
will increase the caliber of blood vessels so that it will re-
cover blood circulation in the compressed area. This is in
accordance with the results of the previous determination
which showed the depth of heat penetration would further
dilate blood vessels and affected the increase in blood
flow.20–22 Warm compresses can also stimulate the re-
lease of endorphins and encephalin hormones that are
useful for relieving pain, increasing comfort, and blocking
the transmission of pain stimulus. Other research evi-
dence also showed that giving a warm stimulus can reduce
tissue damage.13
Duration of cold compresses administration was
alternately for 1 minute and repeated 5 times so that its
total time was 5 minutes. The results of previous studies
indicated that administration of cold therapy can reduce
edema through the vasoconstrictive response, as well as
cause evacuation of the spleen and blood circulation.23–25
Shrinking edema can reduce pressure on pain receptors,24
and reduce cell necrosis so that it will reduce pain.16
Vasoconstriction will cause a decrease in cellulite
permiability, cellular diffusion and26 neutrophil migration so
that it can reduce inflammation that has an effect on pain
inhibition.16
CONCLUSIONS AND RECOMMENDATION
Contrast bath is effective to reduce knee joint pain in the
elderly. Elderly people who experience joint pain can use
contrast bath as an alternative method to reduce non-phar-
macological pain.
ACKNOWLEDGEMENT
Our sincere gratitude goes to the village chief and the
village midwife of Sawit Village, Gantiwarno sub-district
who have given permission and support during the study.
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