Differences Use of Yoga and Self Tapping Towards Long Pain of Primary Dysmenorrhea on Adolescent Info

Info Artikel Masuk Revisi Diterima DOI Number : : 15 September 2017 : 15 November 2017 : 30 November 2017 : 10.18196/ijnp.1370 Abstract Background: Dysmenorrhea is a common complaint in young women, characterized by pain. Dysmenorrhea pain has a significant impact on women's l ives, such as l imitations in daily activities. Primary dysmenorrhea can be treated using yoga and self-tapping. Objective: understanding differences on use of Complementary and Alternative Medicine (CAM), such as yoga and self-tapping towards changing long pain of primary dysmenorrheal . Method: Study was conducted by quasi experiment with nonequivalent pretest-posttest control group design. Study was conducted on November 2016 until February 2017 in SMK “A” Pedan Klaten and SMK “B” Klaten. Sample of study amounted 88 respondent divided on 47 respondents on experimental group and 41 respondent as control group. The experimental group was given a yoga intervention; control group was given self-tapping. Measuring tool used Numerical Rating Scale (NRS). Data analysis used t-test for independent sample, Mann-Whitney test and Wilcoxon. Result: Statistically yoga and self-tapping were equally effective in reducing the long pain of primary dysmenorrheal with p values of 0.000 and 0.012 respectively. Clinically yoga is more effective in reducing the long pain of primary dysmenorrhea with mean 1,49 compared with self-tapping 0,46. Conclusion: Yoga become more effective intervention on reduction long pain of primary dysmenorrhea compared to self-tapping.


Introduction
Dysmenorrhea is a common complaint and often occurs on girls adolescent and women in reproductive age with marked cramps in lower abdominal area during menstruation.Primary dysmenorrhea occurred without pathological conditions in female reproductive organs.The heaviest duration of pain usually occurred on 48 to 72 hours in a single menstrual cycle 1,2,3 .
Pain period have a significant impact on women's lives.The highest prevalence of primary dysmenorrhea occurred on girls adolescent, ranging from 20% -90%, sixty percent occurred on adolescents aged 12-17 years old and peaks at the age of 20-24 years.Based on research conducted by Rodrigues (2011), 62.8 % of respondents experience menstrual pain and 65.7% experience limitations in daily activities due to dysmenorrheal 4 .Prevalence of limitations in daily activities was influenced by the intensity and duration of pain.A similar study was conducted in Canberra and Western Australia showed an estimated prevalence of adolescents absent from school due to menstrual symptoms of 80% -94% 1,3,5,6,7 .
The prevalence of primary dysmenorrhea in Indonesia is estimated to be 55% in women of reproductive age 8 .Based on Mardiyah et al's research (2015) who study on adolescents in Madrasah Aliyah Negeri (MAN) 1 Semarang result, it was found that 65.2% of respondents experiencing dysmenorrhea 9 .Wijayanti (2008)  conducted research on the students SMA Muhammadiyah 1 Yogyakarta 63.6% of the students had primary dysmenorrhea 10 .
Management of primary dysmenorrhe a can be done by pharmacological and nonpharmacological approaches.Nonpharmacological approaches have been used with some degree of success.Based on data from the 2007 National Health Interview Survey (NHIS), forty percent of adults use complementary therapies such as acupuncture, deep breathing exercises, massage therapy, meditation, naturopathy and yoga 11,12,13 .
Yoga is a mind-body practice derived from ancient Indian philosophy, consisting of physical posture (asana), breathing exercises (pranayama), and meditation (dhyana), which integrate the balance of body and mind in harmony 14 .In addition, therapy that can be used to overcome the pain is self-tapping.Self-tapping is a tapping touch is a thorough maintenance technique using a rhythmic touch.Gentle massage helps to reduce the tension in the body and mind and increase feelings of prosperity and positive thoughts 15 .
Based on preliminary study was conducted in SMK "A" Pedan Klaten, girls have experienced dysmenorrhea pain during menstruation on 1-3 days of 200 students (59%).Sixty point five percent feel annoyed at the time of learning and 56% cannot learn effectively.
Based on the above description, researchers are interested to know the difference between the use of yoga and self-tapping on changes in the long pai n of primary dysmenorrhea.This is supported by the absence of a study comparing yoga and self-tapping interventions to address long pain of primary dysmenorrhea.The researcher also uses 1 person facilitator and 6 facilitator assistants, research facilitator is yoga instructor from Yoga First Klaten certified studio, licensed yoga alliance and has experience of yoga teaching for more than 5 years.The yoga facilitator was assisted by three facilitators from the First Yoga studio Klaten.They were certified and have at least 2 years of yoga experience.As for self-tapping is taught by a research assistant who has been trained to teach self tappping movements.The self-tapping facilitator will be assisted by 3 assistants who have previously performed apperception related to the procedure and research implementation.

Methods
Implementation of data collection begins with screening using questionnaires and measurements of height and weight to all prospective respondents who previously had been given explanation of the research.Prospective respondents who fulfilled inclusion and exclusion criteria were taken 100 people (each school 50 people).Further explaining the research process and informing consent, and distributing NRS instruments (pretest) and explaining how to fill it.
The collection of pretest data was done by asking respondents to fill in NRS instruments every day during menstruation.The first pain intensity measurements were performed for up to 10 hours after the first day's menstruation, for subsequent measurements taken at the same time as the first day of measurement.NRS instrument filling is monitored by researchers and research assistants either directly or through social media such as WhatsApp group (WA group), BlackBerry Messenger group (BBM group) or Short Message Service (SMS).After menstruation is complete respondents are asked to collect back NRS instruments that been filled to researchers or research assistant.
Subsequently given health education, the respondents were divided into two groups (experimental group and control group).Experimental group was taught yoga and control group taught selftapping.The facilitator explains the general guidelines of yoga practice or self tapping, followed by demonstration of yoga or self-tapping procedures assisted by assistant facilitators followed by all respondents.After the demonstration the respondents were divided into 4 smaller groups (consisting of 12-13 people), each group was guided by the facilitator's assistant until the respondent was able to intervene properly using the teach-back technique (re demonstration) and evaluated using the observation sheet in the form check list.
Furthermore, researchers will distribute NRS (posttest) instruments, monitoring sheets and health education evaluation questionnaires after intervention.
Respondents were asked to complete NRS instruments and monitoring sheets daily as long as the respondent had menstruation.Measuring the intensity of pain, blood pressure and heart pul se on the first day was performed maximum of 10 hours after the respondent intervened (yoga intervention was done for 30 minutes each session while self-tapping was done for 20 minutes each session).For the next measurement is done at the same time with the first day measurement time.
Researchers and research assistants monitor the implementation of NRS instrument intervention and completeness as well as monitoring sheets directly or indirectly through social media, as described previously.After the menstruation is complete the respondent is asked to reassemble the NRS (posttest) instrument and the completed monitoring sheet completely.Data analysis was performed using t-test for independent sample, Mann-Whitney and Wilcoxon test.

Results
After analyzing data can be presented characteristics and homogeneity of respondents by age, age of menarche, Body Mass Index (BMI), long periods and anxiety in Table 1 3 above shows that statisticall y there was a significant decrease in l ong pain before and after intervention onl y in the experimental groups, whereas the control group did not have significant decrease in long pain.Clinically, the mean difference of decrease in long pain before and after intervention of the experimental group was higher than control group.

Discussion
Characteristic of respondent included age, age of menarche, body mass index (BMI), menstrual period and anxiety of respondents.According to Potter and  Perry (2006) several factors that potentially affected pain such as age.Average age of respondents on treatment group was 15,4 years old and 15,2 years old on control group 16 .According to Banikarim et al (2015)  prevalence of primary dysmenorrhea i n girls adolescent ranged from 60-93% 17 .Primary dysmenorrhea is common in women less than 25 years old 18,19 .
Another risk factor for dysmenorrhea i s age of menarche.This is the age at which a woman receives the first menstruation that occurs in the age range 10-16 years or at puberty before entering the reproductive period 8 .The mean age of menarche in this study was more than 12 years.According to Kolhe (2016), age of menarche affects primary dysmenorrhea, this opinion is in line with Perry et al (2014) Which states that severe dysmenorrhea is always associated with early menarche 18,19 .Women who have menarche less than 12 years have a risk to experience pain during menstruation 20,21 .
Body Mass Index (BMI) is a measure that compares the weight (in kilograms) with the square of the height (in meters).Body Mass Index between the experimental group and control group in this study was homogeneous (p = 0.73), with mean ≥18.5.According to Osayande et al (2014) a low Body Mass Index is a risk factor for dysmenorrhea 21 .According to Perry et  al (2014) The average duration of menstrual blood discharge is 5 days, with a range of 3-6 days 19 .The mean duration of menstruation between the experimental and control groups in thi s study was 5.9 and 6.28 days.According to ACOG (2015), most women experience menstruation for 2-7 days.
In this study, the instant anxiety score (state anxiety) as measured by STAI Y-1 instrument between the experimental group and the homogeneous control group, as well as the trait anxiety measured using the STAIY-2 instrument having a homogeneous score.Respondents in this study did not experience the momentary anxiety and basic anxiety.Anxiety has a reciprocal relationship with pain perception.When anxiety increases then the perception of pain will increase, in other hand if the perception of pain increases then anxiety will increase.People who have stable emotions will more easily tolerate pain than people who have unstable emotions.Base d on the results of research Dhayita (2011)  there is a significant relationship between emotional stability before menstruation with the emergence of dysmenorrhea.
Wijayanti (2008) Examined the relationship of stress with the incidence of primary dysmenorrhea, the results statistically there is a significant relationship between stress with the incidence of primary dysmenorrhea in adolescents 10 .According to Kolhe (2016) psychosocial factors play a role in the perception and severity of pain.
1. Differences long pain of primary dysmenorrhea before and after yoga.The results of this study were statistically significant differences in the long pain of primary dysmenorrhea before and after yoga (table 3).The results of this study confirm previous research conducted by Rakhshaee  (2011).There was a significant difference in intensity and duration of pain before and after intervention in the yoga group 24 .Siahaan (2011) also conducted a study that aims to determine the influence of yoga on dysmenorrhea level, the result is influence of yoga on dysmenorrhea 25 .Based on research Rani et al (2011)  yoga nidra can also reduce the intensity of pain, gastrointestinal symptoms.

Differences long pain of primary
dysmenorrhea before and after sel f tapping.In this study the control group was given self tapping intervention, the result statistically not significant difference of long pain before and afte r self tapping (table 3).This study are statistically inconsistent with research conducted by Akbar (2015), the result there is a significant difference of pain intensity primary dysmenorrhea and after self tapping 27 .
3. Differences long pain of primary dysmenorrhea experimental group who performed yoga with a control group that performed self tapping.The results of this study statistically showed decrease in long pain before and after intervention only in yoga intervention.The mean difference of decrease in long pain before and after yoga intervention in the experimental group were higher than the control group (Table 3).So the conclusions of interpretation of long pain in the experimental group were statistically and clinically compatible, whereas in the control group were statistically and clinically incompatible.
The results of this study confirm previous research conducted by Sakuma  et al (2012), the results were statistically significant differences in pain intensity before and after intervention between yoga groups compared with the control group.While the clinical average decrease in intensity of menstrual pain group gi ve n by intervention home-based simple yoga is higher than the control group 14 .Manurung (2015) also conducted a study on the effectiveness of yoga on dysmenorrhea pain in adolescents, the results were statistically significant differences in pain intensity before and after intervention in the experimental group taught yoga compared to the untreated control group 28 .

Conclusion
Yoga become more effective intervention on reduction long pain of primary dysmenorrhea compared to self tapping.
are obtained based on the Wilcoxon test In Table

Table 1 .
: Characteristics of research and homogeneity of experimental and control group in SMK "A" Pedan Klaten and SMK "B" Klaten 2017.

Table 2 .
Description of homogeneity of data on long pain prior to intervention of experimental and control group in SMK "A" Pedan Klaten and SMK "B" Klaten 2017.

Table 3 .
An illustration of the long pain of experimental and control group before and after intervention in SMK "A" Pedan Klaten and SMK "B" Klaten 2017.