Altered neural control of gait and its association with pain and joint impairment in adults with haemophilic arthropathy: Clinical and methodological implications

Abstract

Introduction:It is unknown whether altered neural control is associated with clinical outcomes in people with haemophilic arthropathy (PWHA). The dynamic motor control index during walking (Walk-DMC) is a summary metric of neural control. Aims:The primary aim of this study was to apply the Walk-DMC to assess if people diagnosed with haemophilic arthropathy have impaired neural control of gait and investigate the association of Walk-DMC with pain and joint impairment. Method:The Walk-DMC was assessed using surface electromyography in 11 leg muscles. Twenty-two PWHA and 15 healthy subjects walked on a 30-m walkway at 1 m/s.In addition, pain (visual analogue scale), knee flexion contracture (degrees) and joint impairment (Haemophilia Joint Health Score, HJHS) were assessed. The clinical outcomes were correlated with the Walk-DMC. Multiple regression analysis was performed to predict the Walk-DMC using the clinical outcomes. Results:In 13 PWHA the Walk-DMC was beyond the normal range (80-120 pts).PWHA with an altered Walk-DMC showed more years with arthropathy, more pain, higher knee flexion contracture and a higher HJHS score (P < .05, effect size > .8).Significant negative moderate associations between Walk-DMC and pain, knee flexion contracture and HJHS were found (P < .05). The model that best predicted the Walk-DMC was the pain with knee flexion contracture (R 2 = .44; P = .004).Conclusions: PWHA with abnormal neural control of gait also has more years with arthropathy, more pain, and more impaired joints. Our results indicate an association between the Walk-DMC index and joint damage, specifically with pain in combination with knee flexion contracture.

Exercise capacity in people with haemophilia: A systematic review

“…In addition, the biomechanical consequences of multiple arthropathies in the lower limb (restricted joint range of motion and higher co‐activation between muscles), 43,44 may increase the metabolic energy consumed during gait, making locomotion less efficient 43 . The pain may also impact the coordination between muscles in PWH 44 . However, there is no consensus regarding considering pain as a limiting factor for exercise capacity or aerobic training in PWH 16,45 .…”

“…43 The pain may also impact the coordination between muscles in PWH. 44 However, there is no consensus regarding considering pain as a limiting factor for exercise capacity or aerobic training in PWH. 16,45 In general, aerobic exercise can be considered as safe and feasible in PWH when being supervised by experts and when prophylaxis is available.…”

“…Haemophilic arthropathy can lead to various musculoskeletal changes (e.g., muscle atrophy, reduced muscle strength and endurance) 7 . In addition, the biomechanical consequences of multiple arthropathies in the lower limb (restricted joint range of motion and higher co‐activation between muscles), 43,44 may increase the metabolic energy consumed during gait, making locomotion less efficient 43 . The pain may also impact the coordination between muscles in PWH 44 .…”

How does joint impairment affect the functional capacity of the lower limb in early haemophilia‐related arthropathy?

“…Our results suggest that joint damage in PwMH may be accompanied by motor impairment. A motor impairment may increase the intra‐articular load by decreasing muscle coordination (or increasing coactivation) 28 . The physical activity level (i.e., active vs. sedentary) may also explain the difference observed in the 30‐STS; however, no differences were found between groups (Table 1).…”

The good, the bad and the ugly of pain in haemophilia: Recent evidence on the epidemiology, molecular mechanisms and knowledge gaps preventing optimal treatment

“…32 The neural control of gait can be abnormal in subjects with haemophilic arthropathy when associated with long years of impairment, more pain and more joint damage. 33 Haemarthrosis should be promptly diagnosed and carefully managed to prevent HS, and a periodic joint screening should be done through imaging techniques to identify subclinical events. It is worth mentioning that, in the last years, ultrasound has undoubtedly gained a primary role, corroborated by increasing evidence.…”