LASER versus electromagnetic field in treatment of hemarthrosis in children with hemophilia

Abstract

Children with hemophilia usually have recurrent joint bleeding that leads to joint damage, loss of range of motion, and restriction of mobility, therefore affecting the quality of life in these children. The purpose of this study was to compare the effects of lowlevel laser therapy (LLLT) to that of pulsed electromagnetic field (PEMF) in treatment of hemarthrosis in children with hemophilia. Thirty boys with hemophilia A with ages ranging from 9 to 13 years were selected and assigned randomly, using sealed envelopes, into two equal intervention groups. The study group I received the traditional physical therapy program in addition to LLLT, whereas the study group II received the same physical therapy program given to the study group I in addition to PEMF. Both groups received the treatment sessions three times per week for three successive months. Pain, laboratory investigations, swelling, and range of motion (ROM) of the affected knee joint, in addition to physical fitness were evaluated before, at the end of the sixth week and at 12 weeks of the treatment program. Laser group showed significant improvement in all measured variables after the sixth week of treatment when compared with PEMF. By 12 weeks of treatment, there was a significant improvement in pain, ROM, ESR and leucocytes levels in laser group compared with PEMF, while there was no significant difference in knee circumferences and the 6-min walk test (6MWT) between both groups. Both groups showed significant improvement at 12 weeks of treatment compared with that at 6 weeks. Both LLLT and PEMF are effective modalities in reducing pain, swelling, increasing ROM and improving physical fitness. Twelve weeks of treatment of both modalities demonstrated significant improvement than 6 weeks of treatment. Laser therapy induced significant improvement than electromagnetic therapy in treatment of hemarthrosis-related problems in children with hemophilia.

Physiotherapy interventions for pain management in haemophilia: A systematic review

“…Four studies compared one physiotherapy intervention against another: passive joint mobilizations and exercise vs manual therapy and exercises in adults with haemophilic ankle arthropathy 22 ; high intensity laser therapy (HILT) and exercise vs pulsed electromagnetic field and exercise in treatment of knee haemarthrosis in children 26 ; home exercise programme and self‐monitoring vs home exercise alone for haemophilic in adults with knee and ankle arthropathy 27 ; and HILT and exercise vs placebo HILT and exercise in haemophilic arthropathy of the knee in children 28 …”

“…This Pain is an issue that many PWH state is one of their major concerns, 30 Only two studies included quality of life assessment, 22,25 and three included an assessment of function. [26][27][28] The minimal evalua- intervention, thereby making it difficult to evaluate them in their practical effectiveness or to identify how they may be exerting their effects.…”

“…Blinding of the participants was not possible in any of the included studies, and none of personnel were blinded in any study. Five studies used blinded evaluators to assess outcomes 18,22,[24][25][26] and were rated low risk. Two studies rated unclear as they did not state if outcome assessment was blinded, 23,28 and two rated high risk as outcome assessment was completed by the same individuals delivering the intervention.…”

“…18,22,25,27 Five rated unclear as although they did not report dropouts, they also did not explicitly state that all had completed the intervention. 18,24,26,28,29 One study was rated high risk as although the authors reported three dropouts, they did not specify from which group they came. 23…”

“…Seven studies were included in this comparison ( Figure 5). 18,[22][23][24][26][27][28] 5.1 | Primary outcomes…”