Musculoskeletal treatment in haemophilia

Atilla, Bülent; Guney, Hande

doi:10.1302/2058-5241.4.180068

Cited by 28 publications

(27 citation statements)

References 35 publications

(76 reference statements)

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“…In the absence of treatment, joint and muscle bleeds are common in people with haemophilia (PWH) [1], and progression to arthropathy is often unavoidable [2,3]. Haemarthrosis leads to synovial hypertrophy and neoangiogenesis, further increasing susceptibility to mechanical damage [4].…”

Section: Introductionmentioning

confidence: 99%

“…In partnership with pharmacologic options, non-pharmacological management is critical to preserve or improve joint health and physical functioning and to encourage regular physical activity [1,29]. Physiotherapy plays an important role in prevention of-and rehabilitation after-joint and musculoskeletal bleeds, and is a key component of comprehensive care for PWH [1,5,14]. Despite significant advances in pharmacological treatment, there remains insufficient inclusion or recognition of musculoskeletal involvement as an integral part of haemophilia care.…”

Section: Introductionmentioning

confidence: 99%

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The Role of Physiotherapy in the New Treatment Landscape for Haemophilia

Lobet

Timmer

Königs

et al. 2021

JCM

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The physiotherapist plays an essential role for people with haemophilia, an inherited bleeding disease responsible for musculoskeletal complications. Yet, with the advent of new and advanced therapies, the medical landscape is changing, and physiotherapy must adapt alongside. This paper considers whether there will still be a need for physiotherapy in the era of advanced therapies, and discusses ways in which services should evolve to complement emerging treatment paradigms for haemostasis in people with haemophilia. Ultimately, physiotherapy will remain an important element of care, even for people with little joint damage and low risks in the era of the new mild phenotype. However, competencies will need to evolve, and physiotherapists in both primary care and specialist treatment centres should work with haematology colleagues to develop more sensitive tools for detecting early joint changes. Physiotherapists will also play a crucial role in counselling and physically coaching, monitoring the musculoskeletal status of people with haemophilia who have transitioned to new treatments.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Role of Physiotherapy in the New Treatment Landscape for Haemophilia

Lobet

Timmer

Königs

et al. 2021

JCM

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“…The treatment of hemophilic arthropathy is challenging also for the orthopedic department, as almost 80-90% of the bleeding episodes occur in the musculoskeletal system (84). These lesions include acute hemarthrosis (85), chronic synovitis (86), hemophilic arthropathy (87), intramuscular bleedings (87), hemophilic pseudotumors (88) and fractures (89).…”

Section: Surgical Interventions For the Hemophilic Patientmentioning

confidence: 99%

Current therapeutic approaches in the management of hemophilia—a consensus view by the Romanian Society of Hematology

et al. 2021

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Hemophilia A (HA) and hemophilia B (HB) are rare disorders, being caused by the total lack or under-expression of two factors from the coagulation cascade coded by genes of the X chromosome. Thus, in hemophilic patients, the blood does not clot properly. This results in spontaneous bleeding episodes after an injury or surgical intervention. A patient-centered regimen is considered optimal. Age, pharmacokinetics, bleeding phenotype, joint status, adherence, physical activity, personal goals are all factors that should be considered when individualizing therapy. In the past 10 years, many innovations in the diagnostic and treatment options were presented as being either approved or in development, thus helping clinicians to improve the standard-of-care for patients with hemophilia. Recombinant factors still remain the standard of care in hemophilia, however they pose a challenge to treatment adherence because they have short halflife, which where the extended half-life (EHL) factors come with the solution, increasing the half-life to 96 hours. Gene therapies have a promising future with proven beneficial effects in clinical trials. We present and critically analyze in the current manuscript the pros and cons of all the major discoveries in the diagnosis and treatment of HA and HB, as well as identify key areas of hemophilia research where improvements are needed.

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“…Repeated hemarthroses in target joints hinder recovery of ROM and muscle strength [2]. They can also trigger multiple episodic joint swelling [6] [14], which causes changes within the joint and may be one of the key reasons for poor proprioception and joint awareness, unless the person undergoes rehabilitation at each occurrence [5] [6]. Importantly, PWH may also have sub-clinical bleeding episodes that, although not detectable by them or their PT on physical examination, can also cause joint damage over time, due to exposure of the structures to blood [15].…”

Section: Musculoskeletal Bleeding and The Joint In The Adult With Hemophiliamentioning

confidence: 99%

“…Physical therapy may be helpful to preserve or improve the joint mobility, function, and muscle strength of PWH [5] [6].…”

Section: Introduction and Aimsmentioning

confidence: 99%

Practical Guidance for Non-Specialist Physical Therapists Managing People with Hemophilia and Musculoskeletal Complications

Forsyth¹,

Blamey²,

Lobet³

et al. 2020

Health

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People with hemophilia (PWH) have impaired blood coagulation and hemostasis. Bleeding into joints and muscles is the main manifestation of the disorder, causing severe joint damage and muscle complications. Lifelong, regular physical therapy is therefore important for PWH, in order to support recovery from bleeds and reduce recurrences. Ideally, these individuals should be in the care of a hemophilia treatment center (HTC), where a physical therapist (PT) should be a regular part of the comprehensive team. However, not all PWH have convenient access to an HTC, and they may be referred to local non-specialist PTs, who may have only limited experience with the condition, for day-to-day physical therapy treatment. This article, written by four experienced hemophilia PTs, introduces key aspects of the pathology of the hemophilic joint in adult PWH with musculoskeletal complications or established joint disease (or those with inhibitors) that are relevant to PTs. The characteristic differences between the joints of PWH and those of people with similar pathologies are clarified. Practical advice on how the physical therapy consultation can be adjusted for PWH is given, and the importance of communicating with the HTC emphasized. The aim of this narrative review is to raise awareness of hemophilia and joint disease for non-specialist PTs, and serve as helpful background information for PTs who encounter PWH with musculoskeletal complications or established joint disease in their clinics.

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Musculoskeletal treatment in haemophilia

Cited by 28 publications

References 35 publications

The Role of Physiotherapy in the New Treatment Landscape for Haemophilia

The Role of Physiotherapy in the New Treatment Landscape for Haemophilia

Current therapeutic approaches in the management of hemophilia—a consensus view by the Romanian Society of Hematology

Practical Guidance for Non-Specialist Physical Therapists Managing People with Hemophilia and Musculoskeletal Complications

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