Tidak direkomendasikan penggunaan metilprednisolon sebagai pereda nyeri pada pasien NPB akut. Saran bagi penelitian berikutnya adalah perlu memperpanjang waktu pengamatan sehingga sampel yang diperoleh lebih besar.
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DAFTAR PUSTAKA
Asarian, L., Geary, N., 2006, Modulation of Appetite by Gonadal Steroid Hormon, The Royal Society, p. 1251
Casazza B.A, 2012, Diagnosis and Treatment of Acute Low Back Pain, Indian Journal of Clinical Practice, Vol. 23, pp. 158-159
Docking, RE., Fleming, J., Brayne C., Zhao J., Macfarlane GJ., Jones GT., 2011, Epidemiology of Back Pain in Older Adults : Prevalence and Risk Factors for Back Pain Onset, British Society for Rheumatology, Oxford University Press, 50 : 1645-1653
Evaniew N., Noonan V.K., Fallah N., Kwon B.K., Rivers C.S., Ahn H., et al, 2015, Methylprednisolone for the Treatment of Patients with Acute Spinal Cord Injuries: A Propensity Score-Matched Cohort Study from a Canadian Multi Center Spinal Cord Injury Registry, Journal Of Neurotrauma, p. 1675
Fauci AS, Kasper DL, Longo DL, et al., 2008, Back and Neck Pain. Harrison’s
Principles of Internal Medicine. 17th Edition. McGraw-Hill, New York
Finckh A, et al., 2006, Short-Term Efficacy of Intravenous Pulse Glucocorticoids in Acute Discogenic Sciatica. A randomized controlled trial. Spine; 31(4):377–81. [PubMed: 16481946]
Friedman, BW., Esses, D., Solorzano, C., Choi, HK., Cole, M., Davitt, Bijur, et al, 2008, A Randomized Placebo Controlled Trial of Single Dose IM Corticosteroid for Radicular Low Back Pain, NIH Public Access, 33(18):E624-E629, pp. 2,5,6 Gupta, P., Bhatia, V., 2008, Corticosteroid Physiology and Priciples Therapy, Indian
Jurnal Pediatric, vol.75, p.1039,1042
Malangu, N., 2012, Drug Inducing Insomnia as an Adverse Effect, dalam : Can’t Sleep? Issue of Being an Insomniac, South Africa, In Tech, pp. 24, 30.
Patrianingrum, M., Oktaliansah, E., Surahman, E., 2015, Prevalensi dan Faktor Risiko Nyeri Punggung Bawah di Lingkungan Kerja Anestesiologi Rumah Sakit Dr. Hasan Sadikin Bandung, Jurnal Anestesi Perioperatif, Vol. 3, hal. 47.
Piccoliori, G., Engl A., Gatterer, D., Sessa, E., Schimetten, J.I.D., Abholz, H.H., 2013, Management of low back pain in general practice – is it of acceptable quality:
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anobservational study among 25 general practices in South Tyrol (Italy), BMC Family Practice, 14:148, p. 4
Prashar, DV., Pahwa, D., Kalia, V., Jindal, G., Kaur, R., 2016, A Comparative Evaluation of The Effect of Diclofenac Sodium with or without Per-Orally Administrated Methylprednisolone on The Sequelae of Impacted Mandibular Third Molar Removal : A cohort randomized double blind clinical trial, Indian Journal of Dentistry, vol.7, pp. 12, 14
Royal Pharmaceutical Society, 2015, British National Formulary 69, Pharmaceutical Press, United Kingdom , pp.495-499
14
LAMPIRAN
15 Lampiran 2. Ethical Clearence Penelitian
16
17 Lampiran 4. Lembar Informasi Subyek (Halaman 2)
18 Lampiran 5. Lembar Informed Concent
19 Lampiran 6. Form Pengambilan Data Obyektif
20 Lampiran 7. Lembar VAS (Visual Analog Scale)
21
22
Lampiran 9. Surat Keterangan Analisis CE&BU (Clinicapidemiology and Biostatical Unit)
23
Lampiran 10. Uji Normalitas Data dengan Uji Saphiro Wilk
Tests of Normality
Jenis Terapi yang diterima ( 1 = Analgesik nonsteroid, 2 = analgesik nonsteroid + Metilprednisolon 4mg) Shapiro-Wilka statistic df Sig. Usia 1 .956 15 .616 2 .959 15 .677
Nilai VAS sebelum menerima terapi
1 .944 15 .442
2 .923 15 .215
Nilai VAS setelah menerima terapi
1 .927 15 .244
2 .945 15 .454
Selisih Nilai VAS Setelah dan Sesudah Terapi
1 .951 15 .542
24
Lampiran 11. Jenis Terapi dengan Usia pada 2 kelompok
Independent Samples Test
Levene's Test for Equality of Variances
t-test for Equality of Means
F Sig. t df
Usia
Equal variances assumed .685 .415 .280 28
Equal variances not
assumed .280 24.597
Independent Samples Test
Levene's Test for Equality of Variances
t-test for Equality of Means
F Sig. t df
Usia
Equal variances assumed .685 .415 .280 28
Equal variances not
assumed .280 24.597
Independent Samples Test
t-test for Equality of Means
95% Confidence Interval of the Difference
Upper
Usia
Equal variances assumed 11.081
25
Lampiran 12. Jenis Terapi dengan Jenis Kelamin pada 2 Kelompok
Chi-Square Tests
Value df Asymp. Sig.
(2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Pearson Chi-Square .144a 1 .705 Continuity Correctionb .000 1 1.000 Likelihood Ratio .144 1 .705
Fisher's Exact Test 1.000 .500
Linear-by-Linear Association .139 1 .710
N of Valid Cases 30
a. 0 cells (.0%) have expected count less than 5. The minimum expected count is 5.50. b. Computed only for a 2x2 table
26
Lampiran 13. Jenis Terapi dengan Terapi Lain (OAINS) pada 2 Kelompok
OAINS (Ya = 1,Tidak = 0) * Jenis Terapi yang diterima ( 1 = Analgesik nonsteroid, 2 = analgesik nonsteroid + Metilprednisolon 4mg)
Chi-Square Tests
Value df Asymp. Sig.
(2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Pearson Chi-Square 1.200a 1 .273 Continuity Correctionb .533 1 .465 Likelihood Ratio 1.208 1 .272
Fisher's Exact Test .466 .233
Linear-by-Linear Association 1.160 1 .281
N of Valid Cases 30
a. 0 cells (.0%) have expected count less than 5. The minimum expected count is 7.50.
27
Lampiran 14. Jenis Terapi dengan Terapi Lain (Analgesik Non-Opioid) pada 2 Kelompok Analgesik Non-Opioid (Ya = 1,Tidak = 0) * Jenis Terapi yang diterima ( 1 = Analgesik nonsteroid, 2 = analgesik nonsteroid +
Metilprednisolon 4mg
Chi-Square Tests
Value df Asymp. Sig.
(2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Pearson Chi-Square 1.200a 1 .273 Continuity Correctionb .533 1 .465 Likelihood Ratio 1.208 1 .272
Fisher's Exact Test .466 .233
Linear-by-Linear Association 1.160 1 .281
N of Valid Cases 30
a. 0 cells (.0%) have expected count less than 5. The minimum expected count is 7.50.
28
Lampiran 15. Jenis Terapi dengan Terapi Lain (Menerima lebih dari 1 Analgesik) pada 2 Kelompok
Lebih dari saman dengan 2 analgesik nonsteroid (Ya = 1,Tidak = 0) * Jenis Terapi yang diterima ( 1 = Analgesik nonsteroid, 2 = analgesik nonsteroid + Metilprednisolon 4mg)
Chi-Square Tests
Value df Asymp. Sig.
(2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Pearson Chi-Square .144a 1 .705 Continuity Correctionb .000 1 1.000 Likelihood Ratio .144 1 .705
Fisher's Exact Test 1.000 .500
Linear-by-Linear Association .139 1 .710
N of Valid Cases 30
a. 0 cells (.0%) have expected count less than 5. The minimum expected count is 5.50.
29
Lampiran 16. Jenis Terapi dengan Terapi Lain (Celecoxib) pada 2 Kelompok Celecoxib (Ya = 1,Tidak = 0) * Jenis Terapi yang diterima ( 1 = Analgesik nonsteroid, 2 = analgesik nonsteroid + Metilprednisolon 4mg)
Chi-Square Tests
Value df Asymp. Sig.
(2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Pearson Chi-Square 2.143a 1 .143 Continuity Correctionb .536 1 .464 Likelihood Ratio 2.916 1 .088
Fisher's Exact Test .483 .241
Linear-by-Linear Association 2.071 1 .150
N of Valid Cases 30
a. 2 cells (50.0%) have expected count less than 5. The minimum expected count is 1.00.
30
Lampiran 17. Jenis Terapi dengan Terapi Lain (Antidepresan) pada 2 Kelompok Antidepresan (Ya = 1,Tidak = 0) * Jenis Terapi yang diterima ( 1 = Analgesik nonsteroid, 2 = analgesik nonsteroid + Metilprednisolon 4mg)
Chi-Square Tests
Value df Asymp. Sig.
(2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Pearson Chi-Square 1.154a 1 .283 Continuity Correctionb .288 1 .591 Likelihood Ratio 1.200 1 .273
Fisher's Exact Test .598 .299
Linear-by-Linear Association 1.115 1 .291
N of Valid Cases 30
a. 2 cells (50.0%) have expected count less than 5. The minimum expected count is 2.00.
31
Lampiran 18. Jenis Terapi dengan Terapi Lain (Antikonvulsan) pada 2 Kelompok Antikonvulsan (Ya = 1,Tidak = 0) * Jenis Terapi yang diterima ( 1 = Analgesik nonsteroid, 2 = analgesik nonsteroid + Metilprednisolon 4mg)
Chi-Square Tests
Value df Asymp. Sig.
(2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Pearson Chi-Square .536a 1 .464 Continuity Correctionb .134 1 .714 Likelihood Ratio .537 1 .464
Fisher's Exact Test .715 .358
Linear-by-Linear Association .518 1 .472
N of Valid Cases 30
a. 0 cells (.0%) have expected count less than 5. The minimum expected count is 7.00.
32
Lampiran 19. Jenis Terapi dengan Terapi Lain (Muscle Relaxant) pada 2 Kelompok Muscle Relaxant (Ya = 1,Tidak = 0) * Jenis Terapi yang diterima ( 1 = Analgesik nonsteroid, 2 = analgesik nonsteroid + Metilprednisolon 4mg)
Chi-Square Tests
Value df Asymp. Sig.
(2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Pearson Chi-Square .600a 1 .439 Continuity Correctionb .150 1 .699 Likelihood Ratio .603 1 .437
Fisher's Exact Test .700 .350
Linear-by-Linear Association .580 1 .446
N of Valid Cases 30
a. 0 cells (.0%) have expected count less than 5. The minimum expected count is 5.00.
33
Lampiran 20. Terapi dengan Nilai VAS sebelum dan Sesudah Terapi
Paired Samples Test
Paired Differences
Mean Std. Deviation Std. Error Mean 95% Confidence Interval of the
Difference
Lower
Pair 1 Nilai VAS sebelum terapi -
Nilai VAS setelah terapi 2.47333 2.31408 .59749 1.19184
Pair 2 Nilai VAS sebelum terapi -
Nilai VAS setelah terapi 2.12000 1.88156 .48582 1.07802
Paired Samples Test
Paired Differences t df Sig. (2-tailed)
95% Confidence Interval of the
Difference
Upper
Pair 1 Nilai VAS sebelum terapi - Nilai
VAS setelah terapi 3.75483 4.140 14 .001
Pair 2 Nilai VAS sebelum terapi - Nilai
34
Lampiran 21. Jenis Terapi dengan Nilai VAS Sebelum Terapi, Setelah Terapi, dan Selisih Nilai VAS pada 2 Kelompok.
Independent Samples Test
Levene's Test for Equality of Variances
t-test for Equality of
Means
F Sig. t
Nilai VAS sebelum menerima terapi
Equal variances assumed .243 .626 -.994
Equal variances not
assumed -.994
Nilai VAS setelah menerima terapi
Equal variances assumed 1.671 .207 -1.290
Equal variances not
assumed -1.290
Selisih Nilai VAS Setelah dan Sesudah Terapi
Equal variances assumed .060 .809 .906
Equal variances not
assumed .906
Independent Samples Test
t-test for Equality of Means
df Sig. (2-tailed) Mean Difference
Nilai VAS sebelum menerima terapi
Equal variances assumed 28 .329 -.98000
Equal variances not assumed 27.038 .329 -.98000
Nilai VAS setelah menerima terapi
Equal variances assumed 28 .208 -1.33333
35 Selisih Nilai VAS Setelah dan
Sesudah Terapi
Equal variances assumed 28 .373 .63333
Equal variances not assumed 27.968 .373 .63333
Independent Samples Test
t-test for Equality of Means
Std. Error Difference
95% Confidence Interval of the Difference
Lower Upper
Nilai VAS sebelum menerima terapi
Equal variances assumed .98616 -3.00005 1.04005
Equal variances not
assumed .98616 -3.00330 1.04330
Nilai VAS setelah menerima terapi
Equal variances assumed 1.03344 -3.45023 .78357
Equal variances not
assumed 1.03344 -3.45680 .79013
Selisih Nilai VAS Setelah dan Sesudah Terapi
Equal variances assumed .69892 -.79833 2.06500
Equal variances not
36
Lampiran 22. Jenis Terapi dengan Selisih Nilai VAS pada 3 Kelompok
ANOVA
Selisih nilai VAS sebelum dan setelah terapi
Sum of Squares df Mean Square F Sig.
Between Groups 2.387 2 1.194 .284 .755
Within Groups 113.515 27 4.204
37
Lampiran 23. Jenis Terapi dengan Outcome Terapi (Pengurangan Nyeri Saat Beraktivitas) pada 2 Kelompok
Pengurangan nyeri saat beraktivitas (0 = tidak, 1 = ya) * Jenis Terapi yang diterima ( 1 = Analgesik nonsteroid, 2 = analgesik nonsteroid + Metilprednisolon 4mg)
Chi-Square Tests
Value df Asymp. Sig.
(2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Pearson Chi-Square 1.154a 1 .283 Continuity Correctionb .288 1 .591 Likelihood Ratio 1.200 1 .273
Fisher's Exact Test .598 .299
Linear-by-Linear Association 1.115 1 .291
N of Valid Cases 30
a. 2 cells (50.0%) have expected count less than 5. The minimum expected count is 2.00.
38
Lampiran 24. Jenis Terapi dengan Outcome Terapi (Pengurangan Nyeri Menjelang/Saat Tidur) pada 2 Kelompok
Pengurangan nyeri saat/menjelang tidur (0 = tidak, 1 = ya) * Jenis Terapi yang diterima ( 1 = Analgesik nonsteroid, 2 = analgesik nonsteroid + Metilprednisolon 4mg)
Chi-Square Tests
Value df Asymp. Sig.
(2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Pearson Chi-Square 2.160a 1 .142 Continuity Correctionb .960 1 .327 Likelihood Ratio 2.288 1 .130
Fisher's Exact Test .330 .165
Linear-by-Linear Association 2.088 1 .148
N of Valid Cases 30
a. 2 cells (50.0%) have expected count less than 5. The minimum expected count is 2.50.
39
Lampiran 25. Jenis Terapi dengan Kejadian Efek Samping (Gangguan GI) pada 2 Kelompok
Gangguan GI (0 = tidak, 1 = ya) * Jenis Terapi yang diterima ( 1 = Analgesik nonsteroid, 2 = analgesik nonsteroid + Metilprednisolon 4mg)
Chi-Square Tests
Value df Asymp. Sig.
(2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Pearson Chi-Square .000a 1 1.000 Continuity Correctionb .000 1 1.000 Likelihood Ratio .000 1 1.000
Fisher's Exact Test 1.000 .759
Linear-by-Linear Association .000 1 1.000
N of Valid Cases 30
a. 2 cells (50.0%) have expected count less than 5. The minimum expected count is 1.00.
40
Lampiran 26. Jenis Terapi dengan Kejadian Efek Samping (Gangguan Nafsu Makan) pada 2 Kelompok
Gangguan Nafsu Makan (0 = tidak, 1 = ya) * Jenis Terapi yang diterima ( 1 = Analgesik nonsteroid, 2 = analgesik nonsteroid + Metilprednisolon 4mg)
Chi-Square Tests
Value
Pearson Chi-Square .a
N of Valid Cases 30
a. No statistics are computed because Gangguan Nafsu Makan (0 = tidak, 1 = ya) is a constant.
41
Lampiran 27. Jenis Terapi dengan Kejadian Efek Samping Obat (Gangguan Tidur) pada 2 Kelompok
Gangguan Tidur (0 = tidak, 1 = ya) * Jenis Terapi yang diterima ( 1 = Analgesik nonsteroid, 2 = analgesik nonsteroid + Metilprednisolon 4mg)
Chi-Square Tests
Value
Pearson Chi-Square .a
N of Valid Cases 30
a. No statistics are computed because Gangguan Tidur (0 = tidak, 1 = ya) is a constant.
42
BIOGRAFI PENULIS
Penulis skripsi yang berjudul “Penggunaan Metilprednisolon
sebagai Pereda Nyeri pada Pasien Nyeri Punggung Bawah Akut di Instalasi Rawat Jalan Rumah Sakit Bethesda Yogyakarta” memiliki nama lengkap Tiara Triasari, lahir di Bantul 7 Mei 1994. Putri ketiga dari pasangan Ismugiyanto dan Qomariyati. Penulis mengawali pendidikan di SDN 1 Pundung Wukirsari pada tahun 2001-2007, SMPN 1 Bantul Yogyakarta pada tahun 2007-2010, SMAN 1 Bantul Yogyakarta 2010-2013, dan melanjutkan studi S1 di Fakultas Farmasi Universitas Sanata Dharma Yogyakarta pada tahun 2013. Selama menjadi mahasiwa di Fakultas Farmasi penulis mengikuti beberapa kegiatan kemahasiswaan dan kepanitiaan seperti menjadi pengurus JMKI (Jaringan Mahasiswa Kesehatan Indonesia) sebagai Koordinator divisi Pengembangan dan Pengkaderan Organisasi periode 2015-2016, menjadi panitia Upgrading 1 JMKI (2015) dan Upgrading 2 JMKI (2015), dan beberapa kepanitiaan yang diadakan oleh FISTARA (Farmasi Islam Sanata Dharma) Fakultas Farmasi pada tahun 2013 dan 2014.
