Pilot randomized controlled trial to evaluate the effect of aquatic and land physical therapy on musculoskeletal dysfunction of sickle cell disease patients

Abstract

ObjectiveTo compare the effect of aquatic and land-based physiotherapy in reducing musculoskeletal hip and lower back pain and increasing overall physical capabilities of sickle cell disease patients.MethodsInformed written consent was obtained from all volunteers who were submitted to evaluations using different functional scales: Lequesne's Algofunctional Questionnaire and Oswestry Disability Index, trunk and hip range of motion, goniometry, trunk and hip muscle strength assessment using load cell, and surface electromyography of the iliocostalis, long dorsal (longissimus), gluteus maximus, gluteus medius and tensor fasciae latae muscles. Ten patients were randomized into two groups: aquatic physiotherapy with a mean age of 42 years (range: 25–67) and conventional physiotherapy with a mean age of 49 years (range: 43–59). Both groups were submitted to a twelve-week program of two sessions weekly.ResultsAfter the intervention, significant improvements were observed regarding the Lequesne index (p-value = 0.0217), Oswestry Disability Index (p-value = 0.0112), range of motion of trunk extension (p-value = 0.0320), trunk flexion muscle strength (p-value = 0.0459), hip extension and abduction muscle strength (p-value = 0.0062 and p-value = 0.0257, respectively). Range of motion of trunk and hip flexion, extension, adduction and abduction, trunk extensor muscle strength and all surface electromyography variables showed no significant statistical difference.ConclusionPhysical therapy is efficient to treat musculoskeletal dysfunctions in sickle cell disease patients, irrespective of the technique; however, aquatic therapy showed a trend toward improvement in muscle strength. Further studies with a larger patient sample and longer periods of therapy are necessary to confirm these results.

Musculoskeletal complications in sickle cell anemia patients: a ten-year retrospective review of hospital-based records (1991-2000) in two Nigerian hospitals

“…26 The disease is thought to have a high tropism for patients with SCA. 23 However, Zanoni et al, 3 are of the opinion that in addition to the sensitivity of salmonella with SCA patients, the bad hygienic life conditions of the concerned population can explain an endemicity of salmonellosis in some regions especially in the developing countries, therefore buttressing the high prevalence of osteomyelitis among SCA patients in a developing country like Nigeria. The prevalence of septic arthritis in the current study is similar with previous reported prevalence of 6-15%.…”

“…Even though Physiotherapy has been seen to improve and efficiently treat musculoskeletal dysfunctions in SCA patients. 3,31 According to 32 majority of sickle cell patients managed with chemotherapy alone were seen as very unstable, hence, the recent development and treatment concepts advocate combination of several types of therapies other than chemotherapy alone, especially as regards joints pain and pain crisis. Therefore management of SCA requires holistic interdisciplinary evidence-based approaches.…”

“…Therefore management of SCA requires holistic interdisciplinary evidence-based approaches. 3 As SCA patients can benefit from physiotherapy there is a need for a functional referral system in these hospitals. There is also a need to develop further programme of physiotherapy care for individuals with SCA, consideration should be tailored toward Facilitation, delivery and exchange of information between those charged with managing the condition, i.e.…”

“…1,2 These hemoglobinopathies include sickle cell anaemia (HbS), sickle cell hemoglobin C disease (HbC) and sickle cell thalassaemia. 3 Only the variant sickle cell (HbS) with genotype SS and (HbC) sickle hemoglobin C are known to cause illness in Nigeria while sickle cell thalassaemia is of two types, the beta plus thalassaemia (Hbs β+ Thal.) and the alpha thalassaemia.…”

“…Therefore there is lack of a holistic care towards these individuals even though few studies have elaborated on the role of physiotherapy in SCD individuals. 3 In fact most studies on musculoskeletal presentations of SCA in Nigeria have focused on selected disease conditions. 9,17,18 This study therefore determine the musculoskeletal complications, types of treatments given including physiotherapy and the mortality rate in SCA patients in two Nigerian hospitals.…”