Physiotherapy Treatment in Patients with Hemophilia and Chronic Ankle Arthropathy: A Systematic Review

Abstract

Haemophilic arthropathy of the ankle causes pain and deterioration in gait, causing disability. Although some physiotherapy modalities are effective in the management of acute bleeding, the results are unknown in chronic arthropathy. Our objective was to determine the most effective physiotherapy procedures for treating the haemophilic arthropathy of the ankle and to assess the methodological quality of the studies. A systematic review was carried out in the Cochrane Database, PubMed, MEDLINE, ISI Web of Knowledge, PEDro, TESEO, and specialized journals (Haemophilia and Haematologica). It included articles with at least one group undergoing any kind of physiotherapy treatment and with pretest and posttest evaluation, published before April 2013. An analysis of variables was performed and assessed the methodological quality of studies. Five studies met the criteria for inclusion. Hydrotherapy treatments, strength training and balance strength, balance training, and sports therapy, have improved range of movement, pain, balance, and subjective physical performance. The proposed methodological analysis was not possible due to the low quality of the studies. Although the results are positive, they lack rigorous evidence on the effects of treatments. Studies are needed to establish the efficacy of the various forms of physiotherapy in the haemophilic arthropathy of the ankle.

Effects of exercise in people with haemophilia: An umbrella review of systematic reviews and meta‐analyses

“…Seven reviews reported data regarding disease severity 6,8,[21][22][23][24]28 ; In three of them, no data related to the age range of the participants were reported.…”

“…Among the most cited, the comparisons were the effects of aquatic exercise versus no treatment, 21,25-27 and aquatic exercises versus exercise landbased, 6,21,25,28 and strengthening exercises versus no intervention 6,23,26,28 which were addressed in four reviews each. Among the most cited, the comparisons were the effects of aquatic exercise versus no treatment, 21,25-27 and aquatic exercises versus exercise landbased, 6,21,25,28 and strengthening exercises versus no intervention 6,23,26,28 which were addressed in four reviews each.…”

Effectiveness of Physiotherapy in the Treatment of Hemophilic Arthropathy a Systematic Review

“…Previous reviews [15,38] indicated the need to implement more ambitious methodological criteria in the development of physiotherapy studies in patients with hemophilia. The implementation of studies that include blinding systems, with a good dropout rate, and statistical analyzes according to the scientific model, support the evidence of the results obtained in each of the articles under study.…”

Comparison of supervised physiotherapy program verses convensional exercises in the management of hemarthrosis in haemophilic patients

“…In general symptoms are internal or external bleeding episodes, which are called "bleeds". There are three categories, depending on the percentage of the blood-clotting factor: severe hemophilia (<1% FVIII/IX), characterised by spontaneous bleeding; moderate hemophilia (1-5% FVIII/FIX) 6 , with bleeding from slight injuries; and mild hemophilia (>5-40% FVIII/FIX) with bleeding during surgical procedures The most common musculoskeletal injuries caused by haemophilia are hemarthrosis, synovitis and muscular haematomas. The patient ends up suffering haemophilic arthropathy and functional troubles 7 With physiotherapy we can achive a lot in patients to relieve their pain sensitivity troubles, stimulating the hemorrhagic reabsorption that are intervening in the inflammatory process and obtaining an appropriate physical condition, improve the life quality and prevent and treat the injuries and their possible consequences.…”

“…Active resistive exercises are exercises prescribed or performed against progressive resistance to build further muscle strength 6 .Strength training exercises condition the muscles to adapt to new demands and increases strength thus allowing the capability of longer work loads 12. Regular exercise may help reduce further destruction in haemophilic joints by strengthening muscle ligaments and tendons surrounding the joint thereby protecting them from damage caused by recurrent haemarthrotic events. Besides these, isokinetic exercises like static bicycling can be incorporated later in the patients exercise regime 18 Gradual walking and stair climbing are also effective in the management of haemophilic patients…”