EFEKTIVITAS TEKNIK ACTIVE CYCLE OF BREATHING KOMBINASI POSTURAL DRAINAGE TERHADAP SATURASI OKSIGEN DAN CLEARANCE SPUTUM TB PARU MULTI DRUG RESISTANT

Abstract

Tuberkulosis Paru Multi Drug Resistant (MDR-TB) merupakan salah satu tantangan kesehatan global dengan tingkat mortalitas yang tinggi dan terapi yang kompleks. Pasien MDR-TB kerap mengalami hipoksemia akibat gangguan pertukaran gas serta retensi sputum yang berisiko menimbulkan komplikasi berupa atelektasis dan perburukan fungsi paru. Kondisi ini membutuhkan intervensi tambahan selain pengobatan farmakologis. Teknik Active Cycle of Breathing (ACBT) dan Postural Drainage (PD) secara teoritis mampu meningkatkan saturasi oksigen dan memperbaiki clearance sputum, namun bukti empiris mengenai efektivitasnya pada pasien MDR-TB masih terbatas. Oleh karena itu, penelitian ini penting untuk mengisi gap pengetahuan tersebut sekaligus mengeksplorasi intervensi fisioterapi yang sederhana dan terjangkau sebagai terapi adjuvan dalam tatalaksana MDR-TB.Penelitian ini bertujuan untuk menganalisis efektivitas kombinasi ACBT dan PD dalam meningkatkan saturasi oksigen serta clearance sputum pada pasien MDR-TB. Desain penelitian menggunakan quasi-experimental dengan rancangan pretest–posttest control group. Sebanyak 30 pasien MDR-TB direkrut sebagai sampel penelitian dan dibagi ke dalam dua kelompok, yaitu kelompok intervensi (n=15) yang mendapatkan terapi ACBT + PD dan kelompok kontrol (n=15) yang hanya memperoleh perawatan standar. Intervensi diberikan selama empat minggu dengan frekuensi tiga kali per minggu. Saturasi oksigen diukur menggunakan pulse oximeter, sedangkan clearance sputum dievaluasi berdasarkan volume dan karakteristik sputum. Analisis data dilakukan dengan paired t-test untuk melihat perbedaan intrakelompok dan independent t-test untuk membandingkan hasil antar kelompok.Hasil penelitian menunjukkan bahwa rata-rata saturasi oksigen pada kelompok intervensi meningkat signifikan dari 91,80% ± 3,25 menjadi 95,60% ± 2,80 (p=0,018), sedangkan kelompok kontrol tidak mengalami perubahan bermakna dengan nilai rata-rata 91,40% ± 3,10. Pada aspek clearance sputum, kelompok intervensi mengalami peningkatan volume dari 8,90 ± 2,20 ml menjadi 15,70 ± 3,05 ml (p=0,007), sedangkan kelompok kontrol tetap relatif stabil yaitu 9,10 ± 2,30 ml. Analisis bivariat menegaskan bahwa terdapat perbedaan bermakna baik pada saturasi oksigen maupun volume sputum antara kelompok intervensi dan kontrol.Berdasarkan hasil tersebut, dapat disimpulkan bahwa kombinasi ACBT dan PD terbukti efektif dalam meningkatkan oksigenasi serta memperbaiki clearance sputum pada pasien TB paru MDR.

Kata Kunci : Active Cycle of Breathing; Postural Drainage; MDR-TB; saturasi oksigen; clearance sputum

ABSTRACT

Multidrug-resistant pulmonary tuberculosis (MDR-TB) remains a major global health challenge with high mortality rates and complex treatment regimens. Patients with MDR-TB often experience hypoxemia due to impaired gas exchange and sputum retention, which may lead to complications such as atelectasis and further deterioration of lung function. These conditions require adjunctive interventions in addition to pharmacological therapy. The Active Cycle of Breathing Technique (ACBT) and Postural Drainage (PD) are theoretically capable of improving oxygen saturation and enhancing sputum clearance; however, empirical evidence regarding their effectiveness in MDR-TB patients remains limited. Therefore, this study is important to address the existing knowledge gap and explore simple, affordable physiotherapy interventions as adjuvant therapy in the management of MDR-TB.This study aimed to analyze the effectiveness of combining ACBT and PD in improving oxygen saturation and sputum clearance in MDR-TB patients. A quasi-experimental design with a pretest–posttest control group was employed. A total of 30 MDR-TB patients were recruited and divided into two groups: the intervention group (n=15), which received ACBT + PD therapy, and the control group (n=15), which received standard care only. The intervention was administered for four weeks with a frequency of three sessions per week. Oxygen saturation was measured using a pulse oximeter, while sputum clearance was evaluated based on volume and characteristics. Data analysis was conducted using paired t-tests for intragroup comparisons and independent t-tests for intergroup comparisons.The results showed that the mean oxygen saturation in the intervention group significantly increased from 91.80% ± 3.25 to 95.60% ± 2.80 (p=0.018), while the control group showed no significant changes with a mean value of 91.40% ± 3.10. In terms of sputum clearance, the intervention group experienced a significant increase in sputum volume from 8.90 ± 2.20 ml to 15.70 ± 3.05 ml (p=0.007), whereas the control group remained relatively stable at 9.10 ± 2.30 ml. Bivariate analysis confirmed significant differences between the intervention and control groups in both oxygen saturation and sputum volume.In conclusion, the combination of ACBT and PD is proven effective in improving oxygenation and enhancing sputum clearance among patients with MDR pulmonary tuberculosis.

Keywords: Active Cycle of Breathing; Postural Drainage; MDR-TB; oxygen saturation; sputum clearance