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The efficacy of Physical therapy modalities in patients with haemophilia: a systematic review of randomized controlled trials with meta-analysis

      Objective

      To evaluate the efficacy of different physical therapy interventions that could validate decisions taken by health care providers in the field of haemophilic patients’ rehabilitation according to the international classification of function (ICF) that contains; Body Functions and Structures, Activity, and Participation.

      Data sources

      Seven databases; PubMed, Cochrane library, Scopus, Web of science, Physiotherapy Evidence Database (PEDro), Google scholar and Clinicaltrials.gov, were systematically searched for randomized controlled trails (RCTs) evaluating any physical therapy modality to manage haemophilia.

      Study selection

      After abstract and full-text filtration; a methodological quality assessment was performed using the Physiotherapy Evidence Database (PEDro) scale for the studies that met the eligibility criteria.

      Data extraction

      Relevant data was extracted from eligible studies and outcomes were categorized according to the ICF.

      Data synthesis

      Using Review Manager® and Microsoft Excel®, a quantitative analysis using standardized mean differences with the 95%CI was completed. Statistical heterogeneity between studies was explored using the I2 test. The Fixed Effect Model was applied to all data analyses. If heterogeneity was statistically significant, the Der Simonian and Laird random-effects models were used instead.

      Results

      35 RCTs with 1216 participants were included in this systematic review, 13 of them dealt with paediatric patients. Most of the studies were of good quality while 12 studies were of low quality. Meta-analysis has shown significant difference in favour of manual therapy, laser and therapeutic exercises on selected outcomes of body function and structure, activity and participation categories of the ICF model.

      Conclusion

      This systematic review recommends using manual therapy and therapeutic exercise modalities to improve join health status, in combination with the educational sessions to improve the quality of life of patients with haemophilic arthropathy. For paediatrics with haemophilic arthropathy, using laser therapy is promising for improving the functional capacity.

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