Abstract
Objective
To evaluate the efficacy of different physical therapy interventions that could validate
decisions taken by health care providers in the field of rehabilitation of patients
with hemophilia according to the International Classification of Functioning, Disability and Health (ICF), including body functions and structures, activity, and participation.
Data Sources
Seven databases—PubMed, Cochrane Library, Scopus, Web of Science, Physiotherapy Evidence
Database, Google Scholar, and Clinicaltrials.gov—were systematically searched for
randomized controlled trials evaluating any physical therapy modality to manage hemophilia.
Study Selection
After abstract and full-text filtration, a methodological quality assessment was performed
using the Physiotherapy Evidence Database scale for the studies that met the eligibility
criteria.
Data Extraction
Relevant data were 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% confidence interval was completed. Statistical heterogeneity
between studies was explored using the I2 test. A 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 randomized controlled trials with 1216 participants were included in this systematic
review; 13 of them dealt with pediatric patients. Most of the studies were of good
quality; 12 studies were of low quality. Meta-analysis showed a significant difference
in favor 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 educational sessions to improve
the quality of life of patients with hemophilic arthropathy. For pediatric patients
with hemophilic arthropathy, using laser therapy is promising for improving functional
capacity.
Keywords
List of abbreviations:
6MWT (6-minute walk test), CI (confidence interval), HJHS (Haemophilia Joint Health Score), ICF (International Classification of Functioning, Disability and Health), PEDro (Physiotherapy Evidence Database), QoL (quality of life), RCT (randomized controlled trial), SMD (standardized mean difference), VAS (visual analog scale)To read this article in full you will need to make a payment
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References
- Manual therapy in the treatment of ankle hemophilic arthropathy. A randomized pilot study.Physiother Theory Pract. 2014; 30: 534-539
- RCT—subjective physical performance and quality of life after a 6-month programmed sports therapy (PST) in patients with haemophilia.Haemophilia. 2017; 23: 144-151
- Management of joint bleeding in hemophilia.Expert Rev Hematol. 2012; 5: 459-468
- The orthopaedic status of severe haemophiliacs in Spain.Haemophilia. 2000; 6: 170-176
- Phys Med Rehabil Clin N Am. 2000; 11 (:323-vi)
- Efficacy of pulsed high-intensity laser therapy on pain, functional capacity, and gait in children with haemophilic arthropathy.Disabil Rehabil. 2018; 40: 462-468
- Physical training increases isometric muscular strength and proprioceptive performance in haemophilic subjects.Haemophilia. 2003; 9 (X): 86-93
- The benefits of exercise for patients with haemophilia and recommendations for safe and effective physical activity.Haemophilia. 2013; 19: 487-498
- Musculoskeletal treatment in haemophilia.EFFORT Open Rev. 2019; 4: 230-239
World Health Organization. International classification of functioning, disability and health: ICF. World Health Organization; 2001. Available at: https://apps.who.int/iris/handle/10665/42407. Accessed July 20, 2022.
- The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.BMJ. 2021; 372: n71
Database PE. Centre for evidence-based physiotherapy. Pedro scale 2015. Available at: https://www.pedro.org.au/. Accessed January 18, 2023.
- Appraising the quality of randomized controlled trials: inter-rater reliability for the Otseeker evidence database.J Eval Clin Pract. 2005; 11: 547-555
- Systematic review of the methodological quality and outcome measures utilized in exercise interventions for adults with spinal cord injury.Spinal Cord. 2012; 50: 718-727
- Therapeutic value of kinesio taping in reducing lower back pain and improving back muscle endurance in adolescents with hemophilia.J Musculoskelet Neuronal Interact. 2020; 20: 256-264
- Effect of pulsed electromagnetic fields on clinical signs and quality of life in patients with hemophilic arthropathy of the knee joint: a randomized controlled trial.Adv Biomed Res. 2020; 9: 81
- Acupuncture as a therapeutic resource for treatment of chronic pain in people with haemophilia.Haemophilia. 2020; 26: e315-e322
- Safety and effectiveness of fascial therapy in the treatment of adult patients with hemophilic elbow arthropathy: a pilot study.Physiother Theory Pract. 2020; (Mar 30. [Epub ahead of print])
- Functionality and range of motion in patients with hemophilic ankle arthropathy treated with fascial therapy. A randomized clinical trial.Musculoskelet Sci Pract. 2020; 49102194
- The effectiveness of manual therapy in addition to passive stretching exercises in the treatment of patients with haemophilic knee arthropathy: a randomized, single-blind clinical trial.Haemophilia. 2021; 27: e110-e118
- Safety and effectiveness of progressive moderate-to-vigorous intensity elastic resistance training on physical function and pain in people with hemophilia.Phys Ther. 2020; 100: 1632-1644
- Do therapeutic exercises improve kinesophobia and health-related quality of life in adult hemophilia patients? A randomized controlled trial.International Journal of Disabilities Sports and Health Sciences. 2020; 3: 11-19
- The effects of six-week resistance, aerobic and combined exercises on the pro-inflammatory and anti-inflammatory markers in overweight patients with moderate haemophilia A: a randomized controlled trial.Haemophilia. 2019; 25: e257-e266
- Effect of manual therapy in patients with hemophilia and ankle arthropathy: a randomized clinical trial [published correction appears in Clin Rehabil 2020;34:NP1].Clin Rehabil. 2020; 34: 111-119
- Pulsed Nd: YAG laser: effects on pain, postural stability, and weight-bearing pattern in children with hemophilic ankle arthropathy.Lasers Med Sci. 2020; 35: 1075-1083
- Effect of low level laser in combination with pneumatic compression in modulation of swelling in patients with knee hemoarthrosis.Med J Cairo Univ. 2018; 86: 1367-1376
- Effect of progressive exercise program on the bleeding frequency in haemophilic patients.International Journal of Recent Advances in Multidisciplinary Research. 2018; : 4026-4031
- Manual and educational therapy in the treatment of hemophilic arthropathy of the elbow: a randomized pilot study.Orphanet J Rare Dis. 2018; 13: 151
- Influence of sensorimotor training on balance and pain parameters in children with hemophilia.Int J Physiother Res. 2017; 5: 1912-1919
- Follow-up of a 6-month programmed sports therapy (PST) in patients with haemophilia.Hamostaseologie. 2017; 37: S9-14
- Effect of using treadmill exercise on mobility skills in hemophilic children.Int J Physiother Res. 2017; 5: 2392-2398
- Effectiveness of an educational physiotherapy and therapeutic exercise program in adult patients with hemophilia: a randomized controlled trial.Arch Phys Med Rehabil. 2017; 98: 841-848
- Effect of whole body vibration training on quadriceps strength, bone mineral density, and functional capacity in children with hemophilia: a randomized clinical trial.J Musculoskelet Neuronal Interact. 2017; 17: 19-26
- RCT of a 6-month programmed sports therapy (PST) in patients with haemophilia—improvement of physical fitness.Haemophilia. 2016; 22: 765-771
- Isokinetic training in children with hemophilia: effects on muscle strength, pain and mobility.Med J Cairo Univ. 2015; 83: 407-415
- The role of antigravity treadmill in haemophilic children aged 8 to 11 years with unilateral knee haemarthrosis without radiological involvement.J Adv Med Med Res. 2015; l0: 1-10
- Effect of treadmill training on quadriceps and hamstring muscles strength in children with knee heamarthrosis.Int J Physiother Res. 2014; 2: 591-598
- Effect of resistance and aerobic exercises on bone mineral density, muscle strength and functional ability in children with hemophilia.Egyptian Journal of Medical Human Genetics. 2014; 15: 139-147
- Effectiveness of two modalities of physiotherapy in the treatment of haemophilic arthropathy of the ankle: a randomized pilot study.Haemophilia. 2014; 20: e71-e78
- Effects of short-term resistance training and pulsed electromagnetic fields on bone metabolism and joint function in severe haemophilia A patients with osteoporosis: a randomized controlled trial.Clin Rehabil. 2014; 28: 440-450
- Effects of short-term aerobic, resistance and combined exercises on the lipid profiles and quality of life in overweight individuals with moderate hemophilia A: a randomized controlled trial.Med J Islam Repub Iran. 2021; 35: 70
- Effect of partial weight bearing program on functional ability and quadriceps muscle performance in hemophilic knee arthritis.Egyptian Journal of Medical Human Genetics. 2013; 14: 413-418
- The effect of aquatic exercise therapy on muscle strength and joint's range of motion in hemophilia patients.Int J Prev Med. 2013; 4: 50-56
- 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.Haemophilia. 2021; 27: e376-e384
- The effects of manual therapy on musculoskeletal system, functional level, joint health and kinesiophobia in young adults with severe haemophilia: a randomized pilot study.Haemophilia. 2021; 27: e230-e238
- Manual therapy reduces the frequency of clinical hemarthrosis and improves range of motion and perceived disability in patients with hemophilic elbow arthropathy. A randomized, single-blind, clinical trial.Disabil Rehabil. 2021; (Mar 8. [Epub ahead of print])
- Saad El-Din Mahmoud L. Effect of neurodynamics nerve flossing on femoral neuropathy in haemophilic patients: a randomized controlled study.J Musculoskelet Neuronal Interact. 2021; 21: 379-386
- Effectiveness of physiotherapy in the treatment of hemophilic arthropathy a systematic review.Ann Hematol Oncol. 2017; 4: 1172
- Spinal reflex excitability changes after lumbar spine passive flexion mobilization.J Manipulative Physiol Ther. 2002; 25: 526-532
- Effects of joint mobilization on joint stiffness and active motion of the metacarpal-phalangeal joint.J Orthop Sports Phys Ther. 1992; 16: 30-36
- Manual therapy effectively decreases the frequency of joint bleeding improves joint health and reduces pain in hemophilic elbow arthropathy: a prospective cohort study.J Rehabil Med Clin Commun. 2020; 31000035
- Physical exercise, pain and musculoskeletal function in patients with haemophilia: a systematic review.Haemophilia. 2016; 22: e119-e129
- Exercise for haemophilia.Cochrane Database Syst Rev. 2016; 12CD011180
- The effect of resistance exercise on strength and safety outcome for people with haemophilia: a systematic review.Haemophilia. 2020; 26: 200-215
- Optimal management of hemophilic arthropathy and hematomas.J Blood Med. 2014; 5: 207-218
- Complications of hemophilia in the elbow: current management.Expert Rev Hematol. 2020; 13: 991-1001
- Physiotherapy interventions for pain management in haemophilia: a systematic review.Haemophilia. 2020; 26: 667-684
- Practical guidance for non-specialist physical therapists managing people with hemophilia and musculoskeletal complications.Health. 2020; 12: 158-179
- A preliminary case series evaluating the safety and immediate to short-term clinical benefits of joint mobilization in hemophilic arthritis of the lower limb.J Man Manip Ther. 2017; 25: 208-214
- WFH guidelines for the management of hemophilia.Haemophilia. 2020; 26: 1-58
Article info
Publication history
Published online: July 19, 2022
Accepted:
May 5,
2022
Received in revised form:
April 27,
2022
Received:
September 24,
2021
Footnotes
The protocol of this systematic review was registered at the International Prospective Register of Systematic Reviews (PROSPERO) on January 09, 2021 (PROSPERO number: CRD42021230169).
Disclosures: none.
Identification
Copyright
© 2022 by the American Congress of Rehabilitation Medicine.
