Ranges and drivers of risk associated with sports and recreational activities in people with haemophilia: results of the Activity‐Intensity‐Risk Consensus Survey of US physical therapists

Abstract

Introduction Limited evidence describes physical activity‐associated bleeding risks for people with haemophilia, and risks are usually described only generically. Aim To assess activity‐specific ranges of risk for joint, soft tissue and head bleeds by identifying inherent and modifiable risk factors associated with each activity, based on opinions of expert physical therapists (PTs). Methods Physical therapists from US haemophilia treatment centres (HTCs) participated in a survey of 101 physical activities. For each activity, PTs provided minimum/maximum risk scores (low = 1; high = 5), and indicated specific bleeding risks in six joints and three injury types (bruising, muscle bleeding, head injury). Risk drivers were identified from free‐text comments and explored at a consensus meeting, where they were categorized as inherent or modifiable and activity‐driven or patient‐driven. Results Of 32 invited PTs, 17 participated; median experience was 24 years as a PT and 16 years at an HTC. Only a few activities had a wide range of risk assessments encompassing both lower and upper ends of the response range. Joint injury risks were consistent with position and physical requirements, and head and muscle bleed risks were associated with physical contact. Eight PTs participated in the consensus meeting; key risk drivers identified included progression from seasonal to year‐round participation, overtraining and improper body mechanics. Inherent risks included impact with surface/ball/equipment and field/surface condition; modifiable risks included safety equipment and tricks/stunts. Conclusions These data provide a framework for discussion with patients/families, recognizing how certain activities may be modified to decrease risk, and identifying activities with nonmodifiable inherent risks.

<p>Hemophilia and sexual health: results from the HERO and B-HERO-S studies</p>

“…The recently published Activity-Intensity-Risk Consensus Survey engaged HTC-based physical therapists to identify the range and drivers of risk of bleeding in 102 athletic activities. The results of the survey informed discussion guides that can be used by HTC team members to help patients with hemophilia identify activities that are safe and will enable them to maintain an active lifestyle 18. The results of the current study suggest that a similar evaluation of intimate activities would greatly benefit the hemophilia community.…”

Promoting Sports Practice in Persons with Hemophilia: A Survey of Clinicians’ Perspective

“…In our study, interviewed sports physicians thought that boxing is to be avoided, in agreement with previously published opinions. A survey on physical therapists reported that risks for hemophilia patients inherent to a sport included impacts with surface/ball/equipment [33]. The choice of a suitable sport may require specific medical counseling.…”

Sexual issues in people with haemophilia: Awareness and strategies for overcoming communication barriers

“…Apart from anecdotal experiences and biomechanical considerations, there are few data to inform guidelines either in the general sense or for patients with particular target joints. However, the recent approach taken in the Activity Intensity Risk initiative through survey/consensus of 17 expert physiotherapists to evaluate range of risk and risk drivers of 101 physical activities could be extended to evaluate sexual positions 15 …”

“…However, the recent approach taken in the Activity Intensity Risk initiative through survey/consensus of 17 expert physiotherapists to evaluate range of risk and risk drivers of 101 physical activities could be extended to evaluate sexual positions. 15 It is important to note that an increasing number of middle-aged PWH experience erectile dysfunction (ED). 3,5 In addition to discussing the psychosocial issues related to sexuality, HCPs could also evaluate PWH for ED using a single question from the Massachusetts Male Aging Study: 'How often are you able to get and keep an erection good enough for sexual intercourse -always, usually, sometimes or never?…”