1
|
Lippi L, de Sire A, Turco A, Santi RM, Polverelli M, Ammendolia A, Follenzi A, Invernizzi M. Efficacy of rehabilitation interventions on functioning in patients with hemophilic arthropathy: A systematic review with meta-analysis. J Back Musculoskelet Rehabil 2024; 37:853-870. [PMID: 38578880 DOI: 10.3233/bmr-230320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
BACKGROUND Hemophilic arthropathy is a detrimental condition that crucially affects functional outcomes in hemophilic patients. In recent years, due to the advances in systemic therapies, growing attention has been raised in the rehabilitation field in order to improve functional outcomes of hemophilic patients. However, the optimal rehabilitation modalities in these patients are far from being fully characterized. OBJECTIVE The present study aimed to assess the effects of different rehabilitation interventions on physical functioning and health-related quality of life of hemophilic arthropathic patients. METHODS The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Five databases were systematically searched for randomized controlled trials (RCTs) published until June 22nd, 2023. The selection criteria included adult patients with hemophilia A and B receiving rehabilitation interventions. The outcomes were muscle strength, physical function, pain intensity, physical performance, and health-related quality of life. RESULTS Out of 1,743 identified records, 17 studies were included in the qualitative synthesis. Rehabilitation interventions were categorized into exercise intervention, fascial therapy, and multimodal intervention. The findings suggested positive outcomes in terms of muscle modifications, range of motion improvements, joint health enhancements, pain intensity reduction, and quality of life improvements. More in detail, meta-analyses showed significant improvements in pain intensity [ES: -1.10 cm (-1.37, -0.82), p< 0.00001], joint health [ES: -1.10 (-1.38, -0.82), p< 0.00001], In accordance, exercise interventions showed significant benefits in terms of joint health [ES: -2.54 (-3.25, -1.83), p< 0.00001)] and quality of life [ES: 1.17 (0.48, 1.86), p< 0.0000)]. CONCLUSION Rehabilitation interventions have a positive impact on functional outcomes and health-related quality of life of hemophilic arthropathic patients. Further studies are needed to better elucidate the role of a comprehensive intervention combining different rehabilitation approaches to treat hemophilic arthropathy.
Collapse
Affiliation(s)
- Lorenzo Lippi
- Department of Scientific Research, Campus LUdeS Lugano (CH), Off-Campus Semmelweis, University of Budapest, Budapest, Hungary
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Alessio Turco
- Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
| | - Roberto Mario Santi
- Hemorrhagic and Thrombotic Diseases Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Marco Polverelli
- Rehabilitation Unit, Department of Rehabilitation, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Antonia Follenzi
- Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Marco Invernizzi
- Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| |
Collapse
|
2
|
Chen CM, Lin CH, Kung KY. Effects of Physical Therapy on Joint Pain, Joint Range of Motion, Joint Health, Strength, and Mobility in Patients With Hemophilia: A Systematic Review and Meta-analysis. Am J Phys Med Rehabil 2023; 102:577-587. [PMID: 36811546 DOI: 10.1097/phm.0000000000002212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVE This study investigated the effects of physical therapy, including exercise, manual therapy, and physical agent modality, on joints, muscle strength, and mobility of patients with hemophilia. METHODS PubMed, Embase, MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus were searched from inception to September 10, 2022. Randomized controlled trials comparing pain, range of motion, and health of joints, as well as muscle strength and mobility (timed up and go test) between physical therapy and control groups were included. RESULTS Fifteen randomized controlled trials with 595 male patients with hemophilia were included. In comparisons between physical therapy and control groups, physical therapy significantly reduced joint pain (standardized mean difference = -0.87; 95% confidence interval, -1.14 to -0.60), increased joint range of motion (standardized mean difference = 0.24; 95% confidence interval, 0.14-0.35), enhanced joint health (standardized mean difference = -1.08; 95% confidence interval, -1.38 to -0.78), improved muscle strength (standardized mean difference = 1.42; 95% confidence interval, 1.16-1.69), and timed up and go test performance (standardized mean difference = -1.25; 95% confidence interval, -1.89 to -0.60). The comparisons demonstrate moderate to high evidentiary quality grades. CONCLUSIONS Physical therapy is effective in reducing pain, increasing joint range of motion, enhancing joint health, as well as improving muscle strength and mobility in patients with hemophilia. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES Upon completion of this article, the reader should be able to: (1) Recognize the overall effectiveness of physical therapy for patients with hemophilia; (2) Determine how therapeutic exercise can help improve various outcomes of major joints in these patients; and (3) Appraise that physical therapy is safe and can be implemented in clinical practice for these patients. LEVEL Advanced. ACCREDITATION The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Collapse
Affiliation(s)
- Chien-Min Chen
- From the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan (C-MC, K-YK); School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan (C-MC); and Department of Physical Medicine and Rehabilitation, Lin Shin Hospital, Taichung, Taiwan (C-HL)
| | | | | |
Collapse
|
3
|
Effectiveness of myofascial therapy on hemophilic arthropathy: A systematic review and meta-analysis of clinical trials. Heliyon 2022; 8:e12552. [PMID: 36590485 PMCID: PMC9801115 DOI: 10.1016/j.heliyon.2022.e12552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/24/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Background Recurrent hemarthrosis is one of the major complications affecting joint functions, and causing chronic pain in hemophilia patients. Objective To summarize the existing evidence of the effects of myofascial therapy (MFT) on joint status, joint pain, and hemarthrosis in hemophilic arthropathy. Methods This systematic review and meta-analysis was done according to PRISMA checklist. Finally, four clinical trials included and were pooled using STATA 13. Standardized mean difference (SMD) considered as the effect size. Results All patients in the case group received 3 interventions of MFT over a 3-week period and were evaluated for 1-5 months. Joint pain with and without load was significantly decreased after three weeks in the intervention group compared to controls (SMD: -0.61, 95% CI: -1.02, -0.21 and 0.58, 95% CI: -0.88, -0.28 respectively). Also, joint status significantly improved three weeks later in patients with MFT compared to controls. (SMD: -0.49, 95% CI: -0.79, -0.19) and this improvement remained until the end of the follow-up period (SMD: -0.54, 95% CI: -0.84, -0.24). Conclusion This meta-analysis showed that MFT can be an effective intervention improving the joint status and decreasing pain perception in patients with hemophilic arthropathy. Consequently, it can play an important role in achieving higher functionality and quality of life in these patients. However, due to the small number of studies and other limitations, further well-designed trials and updated meta-analysis are needed for more accurate results and interpretation.
Collapse
|
4
|
Donoso-Úbeda E, Pérez-Llanes R, Meroño-Gallut J, Ucero-Lozano R, Cuesta-Barriuso R. Self-Induced Myofascial Release in Patients with Hemophilic Ankle Arthropathy: A Pilot Observational Study. Life (Basel) 2022; 12:life12122008. [PMID: 36556374 PMCID: PMC9781155 DOI: 10.3390/life12122008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Hemophilic ankle arthropathy is manifested by degenerative functional alterations (reduced muscle strength, mobility, and proprioception) and chronic pain. Myofascial release techniques are used to treat soft tissue adhesions, relieve pain, and reduce tissue sensitivity. The aim was to evaluate the safety of self-induced myofascial release in patients with hemophilic ankle arthropathy and to assess possible changes in musculoskeletal variables. Methods: We recruited 20 patients with ankle hemophilic arthropathy. Patients carried out a daily self-induced myofascial release exercise program using a foam roller over a period of 8 weeks. The primary variable was the frequency of hemarthrosis (regular telephone follow-up). Secondary variables were pain intensity (visual analog scale), range of motion (goniometry), and functional capacity of the lower limbs (six-minute walk test). Three evaluations were performed: pre-treatment (T0), post-treatment (T1), and at 8 weeks follow-up (T2). Results: There was a lower, non-significant, association in the frequency of hemarthrosis between the experimental and follow-up periods, compared to the pre-study period (SE = 0.50; 95%CI: −1.67; 0.28). There were significant within-subject changes in intensity of pain (T0: 4.91; T1: 2.79; T2: 2.46; p < 0.001), plantar flexion (T0: 125.55; T1: 131.5; T2: 130.30; p = 0.01), and functionality of the lower limbs (T0: 173.06; T1: 184.85; T2: 178.39; p = 0.009). Conclusions: Self-induced myofascial release is safe in patients with hemophilic ankle arthropathy. A protocol based on self-induced myofascial release can lead to changes in pain intensity, range of ankle motion in plantar flexion, and functionality in hemophilic patients.
Collapse
Affiliation(s)
- Elena Donoso-Úbeda
- Department of Physiotherapy, Catholic University San Antonio-UCAM, 30107 Guadalupe, Spain
| | - Raúl Pérez-Llanes
- Department of Physiotherapy, Catholic University San Antonio-UCAM, 30107 Guadalupe, Spain
| | | | - Roberto Ucero-Lozano
- Department of Physiotherapy, Faculty of Sport Sciences, European University of Madrid, 28670 Madrid, Spain
| | - Rubén Cuesta-Barriuso
- Department of Surgery and Medical-Surgical Specialties, University of Oviedo, 33006 Asturias, Spain
- Royal Victoria Eugenia Foundation, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-985103386
| |
Collapse
|
5
|
Cuesta-Barriuso R, Donoso-Úbeda E, Meroño-Gallut J, Ucero-Lozano R, Pérez-Llanes R. Hemophilic Arthropathy: Barriers to Early Diagnosis and Management. J Blood Med 2022; 13:589-601. [PMID: 36277171 PMCID: PMC9586168 DOI: 10.2147/jbm.s343924] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022] Open
Abstract
Hemophilia is a congenital coagulopathy characterized by a deficiency of one of the clotting factors. It is characterized by the development of hematomas and hemarthrosis, either spontaneously or after minor trauma. The recurrence of hemarthroses leads to progressive and degenerative joint damage from childhood (hemophilic arthropathy). This arthropathy is characterized by disabling physical effects that limit the functionality and quality of life of these patients. Medical progress achieved over the last decade in the drug treatment of hemophilia has improved the medium and long-term prospects of patients with more effective and long-lasting drugs. The universal use of safer, more effective and prolonged prophylactic treatments may promote the prevention of bleeding, and also therefore, of the development of hemarthrosis and joint damage. A number of imaging instruments have been developed for the assessment of hemarthrosis and hemophilic arthropathy, using ultrasound, magnetic resonance imaging and simple radiology. Different physical examination scores and questionnaires allow the assessment of joint health, self-perceived activity and functionality of patients with hemophilia. The approach to these patients should be interdisciplinary. Assessment of the processes that affect pain in these patients and the development of pain education models should be implemented. Expert advice and information to patients with hemophilia should be based on individual functional prevention diagnoses, advice on available therapies and sports practice, as well as health recommendations.
Collapse
Affiliation(s)
- Rubén Cuesta-Barriuso
- Department of Surgery and Medical-Surgical Specialties, University of Oviedo, Oviedo, Spain,Royal Victoria Eugenia Foundation, Madrid, Spain,Correspondence: Rubén Cuesta-Barriuso, Department of Surgery and Medical-Surgical Specialties, University of Oviedo, Campus de El Cristo s/n, Faculty of Medicine, Oviedo, 33006, Spain, Tel +34 985 103 386, Email
| | - Elena Donoso-Úbeda
- Department of Physiotherapy, Catholic University San Antonio-UCAM, Murcia, Spain
| | | | | | - Raúl Pérez-Llanes
- Department of Physiotherapy, Catholic University San Antonio-UCAM, Murcia, Spain
| |
Collapse
|
6
|
Pérez‐Llanes R, Donoso‐Úbeda E, Meroño‐Gallut J, Ucero‐Lozano R, Cuesta‐Barriuso R. Safety and efficacy of a self‐induced myofascial release protocol using a foam roller in patients with haemophilic knee arthropathy. Haemophilia 2022; 28:326-333. [PMID: 35098608 PMCID: PMC9303237 DOI: 10.1111/hae.14498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/05/2022] [Accepted: 01/17/2022] [Indexed: 11/26/2022]
Abstract
Background Haemophilic knee arthropathy presents functional and structural alterations and chronic pain. Self‐induced myofascial release aims to treat fascial restrictions and improve functionality. Aim This study investigated the safety and effectiveness of a self‐induced myofascial release protocol in patients with haemophilic knee arthropathy. Methods Twenty‐five patients with bilateral haemophilic knee arthropathy were recruited (n = 50 knees). The patients followed an intervention protocol, with daily exercises for 8 weeks. The dependent variables were: safety of the technique (periodic telephone monitoring), joint state (Haemophilia Joint Health Score), pain intensity (visual analogue scale), pressure pain threshold (pressure dynamometer), range of motion (universal goniometer) and hamstring flexibility (Fingertip‐To‐Floor test). The resulting values were measured at baseline (T0) and after the intervention (T1). Paired t‐test compared the means between the assessments. Effect size was obtained using Cohen's d mean difference formula. The minimum detectable change of each variable was calculated. Results There were no cases of joint bleeding either during or after the procedure. The results showed improvements after the experimental period in joint state (Mean difference [MD]: 1.38; 95% confidence interval [95%CI]: .94;1.81), pain intensity (MD: 1.19; 95%CI: .70;1.67), pressure pain threshold (MD: ‐23.25; 95%CI: ‐26.25;‐19.84), flexion (MD: ‐4.36; 95%CI: ‐5.70;‐3.01), loss of extension (MD: 4.10; 95%CI: 3.01;5.18) and hamstring flexibility (MD: 3.54; 95%CI: 2.61;4.46). Conclusions Myofascial self‐release using a foam roller is safe in patients with haemophilic knee arthropathy. A myofascial self‐release protocol can improve perceived pain, range of motion and knee joint status, as well as hamstring flexibility in patients with haemophilic knee arthropathy.
Collapse
Affiliation(s)
- Raúl Pérez‐Llanes
- Department of Physical Therapy, Faculty of Health Sciences Catholic University of Murcia Murcia Spain
| | - Elena Donoso‐Úbeda
- Department of Physical Therapy, Faculty of Health Sciences Catholic University of Murcia Murcia Spain
| | | | | | - Rubén Cuesta‐Barriuso
- Department of Surgery and Medical‐Surgical Specialties, Faculty of Medicine University of Oviedo Oviedo Spain
- Royal Victoria Eugenia Foundation Madrid Spain
| |
Collapse
|