Manual therapy in the treatment of patients with hemophilia B and inhibitor

Abstract

BackgroundThe main clinical manifestations of hemophilia are muscle and joint bleeding. Recurrent bleeding leads to a degenerative process known as hemophilic arthropathy. The development of inhibitors (antibodies against FVIII/FIX concentrates) is the main complication in the treatment of hemophilia. The objective was to assess the safety and efficacy of manual therapy treatment in a patient with hemophilia and inhibitor.Case presentationA 26-year-old patient with hemophilia B and inhibitor received physiotherapy treatment based on manual therapy for 3 months, with a frequency of 2 sessions per week. The joint status was evaluated using the Hemophilia Joint Health Score; pain was assessed with the Visual Analog Scale; and the range of movement was evaluated using a universal goniometer. The patient developed no joint bleeding in the knees or ankles as a result of the physiotherapy treatment. Following treatment, improvements were noted in the range of movement of knees and ankles, the perception of pain in both knees, and ankle functionality.ConclusionsUntil now, manual therapy using joint traction was contraindicated in patients with hemophilia and inhibitor, as it was feared to cause possible joint bleeding. This is the first case study to address the safety and efficacy of manual therapy in a patient with hemophilia and an inhibitor. The results of this study may help to establish which manual therapy treatments are indicated in patients with hemophilic arthropathy and inhibitors. Thus, a physiotherapy program based on manual therapy may be safe in patients with hemophilia and inhibitor and such therapy may improve joint condition, pain, and joint range of motion in patients with hemophilia and inhibitor. Randomized clinical trials are needed to confirm the results of this case study.

The effects of manual therapy on musculoskeletal system, functional level, joint health and kinesiophobia in young adults with severe haemophilia: A randomized pilot study

“…This is because one of the physiological effects of MT is pain inhibition that may be caused not only by the neural pathways, but also by the mechanical effect on the tissues and the body fluids, and the psychosomatic effect. Our results were consistent with MT studies in HA 17‐21 . Heijnen and De Kleijn 17 suggested that both interventions were effective in reducing pain and increasing functional level.…”

“…The majorities of studies were with validity and reliability, and mostly, the effectiveness of HJHS was not evaluated. Cuesta Barriuso and Trelles‐Martinez 21 reported in their case study with inhibitor that MT decreased the index‐HJHS of the right ankle from 10 to 8 points (%20↓) and the left ankle from 9 to 8 points (% 11.1↓), but the index‐HJHS of the knee did not change. On the contrary, the decreases in index‐HJHS in both joints were found to be significant in MTG.…”

“…Firstly, Heijnen and De Kleijn 17 reported that the joint traction used in MT relieves pain and causes soft joint motion. Recent studies have shown that MT can be used safely for improving joint health, reducing pain and improving ROM in elbow and ankle HA without causing haemarthrosis 18‐20 even in the case of an inhibitor 21 . The common feature of these studies involving MT was the use of grade I and II joint traction.…”

The effects of manual therapy and exercises on pain, muscle strength, joint health, functionality and quality of life in haemophilic arthropathy of the elbow joint: A randomized controlled pilot study

“…Some studies have shown that manual therapy has safe and convenient techniques for haemophilia although previously stated as theoretically contraindication. Significant decrease in frequency of haemarthrosis of elbow joint with manual therapy & exercises was seen, and this result was found compatible with literature 4,8,27 . It has been reported that manual therapy stimulates joint mechanoreceptors, 28 releases soft tissues by reducing muscle‐reflexogenic activity and provides reflex inhibition by oscillatory movements during mobilizations 29 .…”

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

“…This scale, with scores ranging from 0 (no pain) to 10 points (maximum pain experienced by the patient), has been widely used in the assessment of joint pain in patients with hemophilia. 14,15 This evaluation was carried out by asking patients to define their perception of ankle joint pain, under load-bearing and non-load-bearing conditions.…”