Effect of manual therapy in patients with hemophilia and ankle arthropathy: a randomized clinical trial

Abstract

Objective: The aim of this study was to evaluate the effects of a manual therapy using fascial therapy on joint bleeding, joint pain and joint function in patients with hemophilic ankle arthropathy. Setting: Hemophilia patient associations. Design: Randomized, controlled trial, multicenter and intention-to-treat analysis. Participants: A total of 65 patients with hemophilic ankle arthropathy. Intervention: The experimental group ( n = 33) received one fascial therapy session per week for three weeks. The control group ( n = 32) received no treatment. Outcome measure: The primary outcome was frequency of joint bleeding measured using self-reporting. Secondary outcomes were joint pain (under load-bearing and non-load-bearing conditions) measured using the visual analog scale; joint condition was measured using the Hemophilia Joint Health Score. Outcomes were measured at baseline, posttreatment and after five months of follow-up. Results: Improvements in the frequency joint bleeding at T0, T1 and T2 were significantly higher in the experimental group (T0: mean (SD) = 1.56 (1.30); T1: mean (SD) = 0.00 (0.00); T2: mean (SD) = 0.27 (0.57)) compared to the control group (T0: mean (SD) = 1.70 (1.78); T1: mean (SD) = 0.05 (0.21); T2: mean (SD) = 0.58 (0.85)). Mean improvement of joint state after the study period was 1.74 points (±1.66) for patients in the experimental group, while the control group exhibited a joint deterioration with 0.43 points (±0.85). Ankle joint pain under load-bearing and non-load-bearing conditions improved in the experimental group with −1.72 (±1.86) and −0.50 (±1.39) points, respectively. Conclusion: The study showed that fascial therapy is favorable for patients with hemophilic ankle arthropathy.

The effectiveness of manual therapy in addition to passive stretching exercises in the treatment of patients with haemophilic knee arthropathy: A randomized, single‐blind clinical trial

“…In our study, we observed improvement in knee joint condition in patients with haemophilia who received manual therapy, especially in pain, range of motion and crepitus. Such improvements after the administration of traction and joint gliding techniques have already been reported by studies applying other manual therapy techniques 21,27 …”

“…The Hemophilia Joint Health Score was developed to assess joint health in people with haemophilia by evaluating joint structure and function. The age range of the patients included in our study was 23‐44 (IQR: 9.00), being similar to that of other studies using this scoring system to measure joint health in patients with haemophilic arthropathy 21,27 . This measuring instrument is used as a study variable in clinical trials and is considered optimal for assessing arthropathy in children and young adults.…”

“…Such improvements after the administration of traction and joint gliding techniques have already been reported by studies applying other manual therapy techniques. 21,27 Haemophilic knee arthropathy is characterized by pain, inflammation and joint stiffness, which results in muscle contracture in flexion. 28 Note: T0 -T1: outcome measures between baseline to post-treatment assessments; T1-T2: outcome measures between post-treatment to follow-up assessments: T0 -T2: outcome measures between baseline to follow-up assessments (T0).…”

“…The age range of the patients included in our study was 23-44 (IQR: 9.00), being similar to that of other studies using this scoring system to measure joint health in patients with haemophilic arthropathy. 21,27 This measuring instrument is used as a study variable in clinical trials and is considered optimal for assessing arthropathy in children and young adults. In our study, we observed improvement in knee joint condition in patients with haemophilia who received manual therapy, especially in pain, range of motion and crepitus.…”

“…Patients submitted their self-reports to the evaluator after treatment and at follow-up. 21 In the 48 hours following each treatment session, telephone monitoring was performed to evaluate any possible development of knee hemarthrosis. Knee joint health was evaluated using version 2.1. of the Hemophilia Joint Health Score.…”