Effect of Combinations of Quadriceps Exercise and Hip Abductor Exercise on Pain in Knee Osteoarthritis Patients in Orthopedic and Traumatology Outpatient Care


  • Dia Metasari Master of Nursing, Universitas Airlangga, Indonesia
  • Tintin Sukartini Master of Nursing, Universitas Airlangga, Indonesia
  • Arina Qona’ah Master of Nursing, Universitas Airlangga, Indonesia




Background: Osteoarthritis is a disorder of the moving joints. Pain functioning are the main complaints of the disease osteoarthritis of the knee. The purpose of the study was to analyze the effect of a combination of quadricep exercise and hip abductor exercise on pain in knee among osteoarthritis patients.

Subjects and Method: The study was carried out at the East Java Regional Hospital for the period of December 2022 to March 2023. The study population was knee joint osteoarthritis patients of degree 1 to degree 2. The sampling technique used in this study was purposive sampling, with inclusion and exclusion criteria. The number of samples in quantitative research was 60 respondents. The dependent variable is pain, while the independent variable is quadriceps exercise and hip abductor exercise. The instrument used is the WOMAC questionnaire. Analysis of the study was using the Wilcoxon test and the Mann Whitney test.

Results: There was a significant difference in pain between the control and intervention groups after conducting a combination of quadriceps exercises and hip abductor exercises (p=0.043)

Conclusion: The combination of quadriceps exercise and hip abductor exercise is effective on pain reduction in knee osteoarthritis patients.

Keywords: quadriceps, hip abductor, osteoarthritis.

Correspondence: Dia Metasari. Master of Nursing, Universitas Airlangga, Indonesia. Jl. Dr. Ir. H. Soekarno, Mulyorejo, Surabaya, East Java 60115. Email: dia.metasari-2021@fkp.unair.ac.id. Mobile: +628563040303.

Indonesian Journal of Medicine (2023), 08(02): 186-193


Abramoff B, Caldera FE (2020). Osteoarthritis: pathology, diagnosis, and treatment options. Med Clin. 104(2): 293–311.

Badan Penelitian dan Pengembangan Kesehatan (2018). Laporan Nasional RISKESDAS 2018.

Berghmans DDP, Lenssen AF, Emans PJ, Bie RAD (2018). Functions, disabilities and perceived health in the first year after total knee arthroplasty; A prospective cohort study. BMC Musculoskelet. Disord. 19(1): 1–8.

Dowd T (2014). Katharine Kolcaba: Theory of Comfort. Contemp. Nurse. 1: 657–671.

Fathi HM (2019). Unilateral versus bilateral primary knee osteoarthritis: Relation to the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC), C-reactive protein and radiological assessment in Egyptian patients. Egypt Rheumatol. 41(4): 271–276.doi: 10.1016/j.ejr.2018.12.003.

Hawks J, Joyce M (2014). Keperawatan Medikal Bedah: Manajemen Klinis untuk Hasil yang Diharapkan, Edisi 8Buku 2 (Medical Surgical Nursing: Clinical Management for Expected Outcomes, 8th EditionBook 2). Singapura: Elsevier.

Karsten S, Limena S, Phandu M (2019). Translation, adaptation, and validation of western Ontario and McMaster universities osteoarthritis index (WOMAC) for Indonesian. J. Orthop. Traumatol. Indones. 2(3). doi: 10.31282/joti. v2n3.48.

Laksmi A R (2015). Peran Latihan Fisik dalam ManajemenTerpadu Osteoarthritis (The Role of Physical Exercise in the Integrated Management of Osteoarthritis). Medikora. 1: 1–17. doi: 10.21831/medikora.v0i1.4755.

Ma HH, Chou TFA, Tsai SW, Chen CF, Wu PK, Chen WM (2020). The efficacy of continuous versus single-injection femoral nerve block in Total knee Arthroplasty: a systematic review and meta-analysis. BMC Musculoskelet. Disord. 21, 1–9.

Mikuls TR, Johnson SR, Fraenkel L, Arasaratnam RJ, Baden LR, Bermas BL, Chatham W., et al. (2020). American College of Rheumatology guidance for the management of rheumatic disease in adult patients during the COVID‐19 pandemic: version 1. Arthritis Rheumatol. 72(8): 1241–1251.

Moher D, Liberati A, Tetzlaff J, Altman DG (2009). PRISMA 2009 Flow Diagram. In the PRISMA statement. 6. Doi: 10.1371/journal.pmed1000097.

Pramudaningsih IN, Devi WSR (2017). The effect of strengthening exercise on reducing knee pain intensity in patients with Osteoarthritis Krida Husada Academy of Nursing Students of Krida Husada Academy of Nursing. J Profesi Keperawatan. 4: 44–58.

Rashid SA, Moiz JA, Sharma S, Raza S, Rashid SM, Hussain ME (2019). Comparisons of Neuromuscular Training Versus Quadriceps Training on Gait and WOMAC Index in Patients With Knee Osteoarthritis and Varus Malalignment. J. Chiropr. Med. 18(1): 1–8. Doi: 10.1016/j.jcm.2018.07.003.

Sharma L (2021). Osteoarthritis of the knee. N. Engl. J. Med. 384(1). 51–59.

TavakoliFar F, AmiriArdekani E, Tehrany A (2021). Allium sativum l. (garlic) role in osteoarthritis: A systematic review of clinical trials. Biointerface Research in Applied Chemistry. 11(4): 12104–12119. Doi: 10.33263/BRIAC114.1210412119.

Thagadur SC, Seenappa H, Shantappa AH, PAK (2021). A comparative study between quadriceps combined with hip abductor strengthening versus quadriceps strengthening in treating osteoarthritis of knee : A short term pilot study. 4(8): 155–159.

Ulandari R, Puspitasari R (2020). The Effect of Transcutaneous Electrical Nerve Stimulation (TENS) Therapy on Pain Reduction in Elderly Patients with Low Back Pain at AnNisa Tangerang Hospital Physiotherapy in 2020). J. Health. Sci. 1(3): 161–168.

Wang F, Zhang X, Tong X, Zhang M, Xing F, Yang K, Jiao N., et al. (2021). The effects on pain, physical function, and quality of life of quadriceps strengthening exercises combined with Baduanjin qigong in older adults with knee osteoarthritis: a quasi-experimental study. BMC Musculoskelet Disord. 22(1). Doi: 10.1186/s12891021041798.

Wardojo SSI, Rosadi R, Amanati S, Putra YW (2020). Efektifitas Modalitas Latihan Terhadap Penurunan Nyeri Pada Lansia Dengan Osteoartritis Lutut Di Kota Malang (The Effectiveness of Exercise Modalities on Reducing Pain in the Elderly with Knee Osteoarthritis in Malang). J Physiother. 2(2): 39–49.

Winangun W (2019). Diagnosis and comprehensive management of Osteoarthritis). JKB. 5(1): 125. Doi: 10.36679/kedokteran.v5i1.140.

Xie Y, Zhang C, Jiang W, Huang J, Xu L, Pang G, Tang H., et al. (2018). Quadriceps combined with hip abductor strengthening versus quadriceps strengthening in treating knee osteoarthritis: A study protocol for a randomized controlled trial. BMC Musculoskelet Disord. 19(1). Doi: 10.1186/s1289101820417.

Yuenyongviwat V, Duangmanee S, Iamthanaporn K, Tuntarattanapong P, Hongnaparak T (2020). Of hip abductor strengthening exercises in knee osteoarthritis: A randomized controlled trial Effect. BMC Musculoskelet Disord. 21(1). Doi: 10.1186/s1289102003316z.