E:\2021\NERS APRIL 2021\20-jurn 138 Jurnal Ners dan Kebidanan, Volume 8, Issue 1, April 2021, page 138–143 Systematic Review: The Effect of Massage Effleurage on Dysmenorrhea Niken Bayu Argaheni Department of Midwifery, Universitas Sebelas Maret, Indonesia JURNAL NERS DAN KEBIDANAN (JOURNAL OF NERS AND MIDWIFERY) http://jnk.phb.ac.id/index.php/jnk JNK History Article: Received, 02/11/2020 Accepted, 09/03/2021 Published, 05/04/2021 Keywords: Dysmenorrhea, Effects, Effleurage, Massage Article Information Abstract Introduction: In Indonesia, the incidence of dysmenorrhea is 64.25% con- sisting of primary dysmenorrhea amounted to 54.89% and secondary dys- menorrhea of 9.36%. Some women experienced menstrual pain or cramps, also known as dysmenorrhea. The purpose of this research was to find out the effect of abdominal massage effleurage on decreasing the pain scale of primary dysmenorrhea. Method: Systematic review using the database: Google Scholar. The search results that meet the criteria were then analyzed for articles. Result: Primary dysmenorrhea pain could be relieved by massage techniques such as abdominal effleurage massage. Conclusion: To deal with dysmenorrhea pain, it is advisable for young women not to consume it imme- diately pharmacological drugs but using massage therapy such as massage effleurage abdomen. 138 Correspondence Address: STIKes Bahrul Ulum Jombang – East Java, Indonesia P-ISSN : 2355-052X Email: bedonku@gmail.com E-ISSN : 2548-3811 DOI: 10.26699/jnk.v8i1.ART.p138–143 This is an Open Access article under the CC BY-SA license (http://creativecommons.org/licenses/by-sa/4.0/) © 2021 Journal of Ners and Midwifery https://doi.org/10.26699/jnk.v8i1.ART.p138-143 https://crossmark.crossref.org/dialog/?doi=10.26699/jnk.v8i1.ART.p138-143&domain=pdf&date_stamp=2021-04-15 139Argaheni, Systematic Review: The Effect of Massage Effleurage on Dysmenorrhea INTRODUCTION One of the most common disorders during menstruation is dysmenorrhea. Dysmenorrhea is pain that is felt in the lower abdomen and occurs before, during or after menstruation. Dysmenorrhea is divided into two based on the presence or absence of accompanying abnormalities, namely primary dysmenorrhea, namely pain that occurs during menstruation due to myometrial contraction due to prostaglandin production without any abnormalities in the pelvis and secondary dysmenorrhea, namely pain that is felt with abnormalities in the pelvis (Bobak and Lowdermilk 2005; Kingston 2009; Sholihah and Azizah 2020). In Indonesia, the incidence of dysmenorrhea is 64.25% consisting of primary dysmenor rhea amounted to 54.89% and secondary dysmenorrhea of 9.36% (Jama and Azis 2020). Based on data, it shows that primary dysmenorrhea is experienced by 60-75% of young women. And three quarters of these had dysmenorrhea with mild or moderate intensity. Meanwhile, the other quarter experienced dysmenorrhea with severe levels and sometimes rendered the sufferer powerless to endure the pain (Umami, Lutfiasari, and Pradian 2016). Pain that is felt during menstruation often causes discomfort to a woman so that it can result in her being unable to carry out her daily activities (Reeder and Martin 2011). To suppress pain, women simply do compresses warm, regular exercise, and adequate rest. If menstrual pain is felt up interfere with daily activities, usually given non-steroidal anti- inflammatory drugs. (Andari, Fatsiwi Nunik; Amin, M; Purnamasari 2018; Jama and Azis 2020). T her e a r e sever a l wa ys to dea l with dysmenorrhea pain, with adequate rest, regular exercise (especially walking), massage, yoga and warm compress on the stomach area. Pain can also be tr ea ted with va r ious a lter na tives, either pha r ma cologica l a nd non-pha r ma cologica l. Pharmacologically can be overcome with analgesic drugs, while non pharmacologically it can be overcome with anticipatory guidance, heat and cold compr ess, tr a nscuta neous electr ica l ner ve stimulation (TENS), distraction, relaxation, guided imagination, hypnosis, acupuncture, biological feedba ck, and ma ssage effleur age. Massa ge effleurage is one of non-pharmacological method that is considered effective in reducing pain (Andanawarih, Jannah, and Artanti 2020; Andari, Fatsiwi Nunik; Amin, M; Purnamasari 2018; Andria, Sudarti, and Retnaningsih 2016; Jama and Azis 2020) One method that can be used to r educe dysmenor r hea pa in is effleur a ge ma ssa ge. Effleurage massage is the act of pressing by hand on the soft tissues of the body without causes displacement or changes in joint position. Movement in doing effleurage massage include placing both palms on the stomach and simultaneously moved in a circular direction center to the symphysis or can also use one palm with a circular motion or one direction. With effleurage massage, the hypoxia in the tissue will decrease so that the oxygen level in the tissue increases which causes pain to decrease. In addition, effleurage massage can increase the release of endorphins so that the pain threshold increases (Alviana 2015; Andanawarih, Jannah, and Ar tanti 2020; Apay et a l. 2012; Bobak a nd Lowdermilk 2005; Chayati and Na’mah 2019; Hikmah, Amelia, and Ariani 2018; Murtiningsih and Andani 2018). The purpose of this research is to find out effect of abdominal massage effleurage on decreasing the pain scale of primary dysmenorrhea. METHODS The research method was systematic review, used eight stages, namely determining questions, determining inclusion and exclusion criteria, literature search, article selection, perform critical appraisal, perform data extraction, data synthesis and map the results findings. The sources of the research derived from the literature through the internet in the form of research results obtained about massage effleurage against dysmenorrhea. The article inclusion criteria used: 1) An article that describes the Effect of Massage Effleurage on Dysmenorrhea. 2) Published articles have complete sections. 3) Published in 2016-2020. The exclusion criteria for articles included: Incomplete article composition. The search was carried out using the Google Scholar database using keywords: “massage, effleurage, dysmenorrhea”. The articles that appear are then sorted so that no articles with the same title are found. Then the articles were sorted based on the inclusion and exclusion criteria that had been determined. Articles that include abstracts only will be eliminated. So that we get the articles to be analyzed. The articles that have been obtained are then extracted. Extraction of articles is based on the author of the article, the year the article was 140 Jurnal Ners dan Kebidanan, Volume 8, Issue 1, April 2021, page 138–143 published, the number of sa mples used, the measuring instrument used, the results of the research conducted, and the article database. After getting the article that was reviewed, the writer made a critical appraisal and stage the end is charting the data. Filtering and selection of articles using PRISMA Flowchart. Search results using the keywords “massage, effleurage, dysmenorrhea” use the electronic Google Scholar database. Search results using these three keywords resulted in 190 articles. Then filtering the articles with inclusion and exclusion criteria was obtained 31 articles. Selection of the next article by eliminating article duplication with the result of 11 articles. Subsequently, article elimination was carried out based on a complete arrangement of 7 articles. Records identified through database searching (n = 186) Sc re en in g In cl ud ed El ig ib ili ty Id en ti fic at io n Additional records identified through other sources (n = 4) Records after duplicates removed (n = 147) Records screened (n = 31) Records excluded (n = 116) Full-text articles assessed for eligibility (n = 11) Full-text articles excluded, with reasons (n = 4) Studies included in quantitative synthesis (meta- analysis) (n = 7) Picture 1 Prisma Flow Diagram 141Argaheni, Systematic Review: The Effect of Massage Effleurage on Dysmenorrhea RESULT Fatma Jama, Asna Azis Nurul Hikmah, Coryna Rizky Amelia, Dewi Ariani Afri za Uma mi , Dessy Lutfiasari, Galuh Pradian Y Putr i An da na wa ri h , Miftachul Jannah, Swasti Artanti Nur Rahmawati Sholihah, Imroatul Azizah Suwanto, Mujtahidatul Islamiyah Fatsiwi Nunik Andari, M. Amin, Yesi Purnamasari Researcher 2020 2018 2018 2020 2020 2018 2018 16 24 32 15 58 18 119 Year N The results showed the value of  = 0.000,where the value of  is smaller than  = 0.05, then Ha is accepted and H0 is rejected. So, it can be concluded that there are differences in the results before and after giving the abdominal effleurage massage so that there is effect of abdominal effleurage massage with dysmenorrhea pain scale. The most effective action in reducing the intensity of dysmenorrhea pain is the effleurage massage using rose aromatherapy oil for 15 minutes based on the Two Way Anova test mean value of 3.83 and the significance value for the time variable is 0.015 (significant), the variable type of oil is 0.000 (significant) and the significance figure between the time variable and type of oil is 0.154 (not significant). From the results of this study, it is advisable for young women to apply this method when experiencing dysmenorrhea because it is easy to do so that these teenagers can still carry out their daily activities well. The results showed the  value for effleurage technique 0,000 and to warm compresses 0,001, which means  value <0.005 so that it can be concluded there is a difference between before and after treatment. While Mann Whitney test results Y2-Y4 show  value: 0,296 which means  value > 0,005 so that it can conclude there is no difference in the effectiveness of the two treatments. In conclusion this study, effleurage technique and warm compress equally effective, both techniques can be used to reducing the pain of dysmenorrhea. It was found that the significance value (p) is 0.00 using the provision that the degree of error () is 5% or 0.05 so that there is a difference between menstrual pain before effleurage massage and after effleurage massage. In this study, it was found that therewas a decrease in the level of menstrual pain after effleurage massage compared to before effleurage massage, this proves that massage with the effleurage technique can reduce pain. This research showed a significant difference between the intervention groups and the control group was found after the intervention group was given the effleurage massage treatment (p <0.05). The conclusion of this research is effleurage massage has a significant effect on reducing pain in the lower abdomen during menstruation (dysmenorrhea). It is recommended to promote effleurage massage as an alternative to non-pharmacological treatment for female adolescents to reduce pain due to their dysmenorrhea. The results of research showed the mean value of pretest = 3.22 and mean posttest = 2.22, and significant value (2-tailed) = 0.000, where p = 0.000