1
|
Bladen M, Harbidge H, Drechsler W, Duport G, Mahaffey R, van der Net J, Pérez-Alenda S, Sayers F, Strike K, Timmer M, Stephensen D. Identifying performance-based outcome measures of physical function in people with haemophilia (IPOP). Haemophilia 2023; 29:1611-1620. [PMID: 37840142 DOI: 10.1111/hae.14886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/03/2023] [Accepted: 10/03/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Recent recommendations of core outcome sets for haemophilia highlight the need for including measures of performance-based physical health and physical function sustainability. To date, there is no consensus on what outcomes might be of value to clinicians and patients. AIM To identify instruments of performance-based physical function to monitor musculoskeletal health in people with haemophilia that are practical in the clinical setting. METHODS Utilising components from the Activities and Participation Category of the WHO International Classification of Functioning (WHO-ICF), a consensus-based, decision analysis approach was used to: identify activities people with haemophilia have most difficulty performing; identify quantitative performance-based measures of identified activities via a scoping review; and obtain views on acceptability of the tests utilising a DELPHI approach. RESULTS Eleven activities were identified: maintaining a standing position, walking long distances, walking up and down stairs, walking on different surfaces, running, hopping, jumping, squatting, kneeling, undertaking a complex lower limb task, undertaking a complex upper limb task. Following a 2-round DELPHI survey of international physiotherapists, the 6-min walk test, timed up and down stairs, 30-s sit to stand, single leg stance, tandem stance, single hop for distance (children only) and timed up and go (adults only) reached consensus. CONCLUSION This study is the first step in defining a core set of performance-based instruments to monitor physical health and sustainability of physical function outcomes in people with haemophilia. Establishing the psychometric properties of the instruments and whether they are meaningful to people with haemophilia is essential.
Collapse
Affiliation(s)
- Melanie Bladen
- Haemophilia Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Hannah Harbidge
- Haemophilia Centre, East Kent Hospitals University NHS Trust, Canterbury, UK
| | - Wendy Drechsler
- Haemophilia Centre, East Kent Hospitals University NHS Trust, Canterbury, UK
| | | | - Ryan Mahaffey
- St Mary's University, School of Sport, Health and Applied Sciences, London, UK
| | - Janjap van der Net
- Center for Child Development, Exercise and physical literacy, UMC Utrecht, Utrecht, Netherlands
| | | | | | - Karen Strike
- Hamilton Niagara Regional Hemophilia Centre, McMaster Children's Hospital, McMaster University, Hamilton, Canada
| | - Merel Timmer
- Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - David Stephensen
- Haemophilia Centre, East Kent Hospitals University NHS Trust, Canterbury, UK
- Royal London Hospital Haemophilia Centre, Barts Health NHS Trust, London, UK
| |
Collapse
|
2
|
Bladen M, Alderson L, Thorpe N, Cortina-Borja M, Main E. Performance on the iSTEP and 10 m-ISWT in boys with haemophilia. Haemophilia 2023; 29:1343-1350. [PMID: 37572336 DOI: 10.1111/hae.14833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 08/14/2023]
Abstract
INTRODUCTION Boys with haemophilia (BwH) have improved health outcomes. Measures of physical function in haemophilia are not challenging or sensitive enough to reflect physical limitations or guide rehabilitation. To identify meaningful tests, we aimed to: evaluate the performance of BwH on two physical performance measures: iSTEP and 10 m-ISWT; identify factors which predict performance and compare BwH to their unaffected peers. METHODS BwH completed both iSTEP and 10 m-ISWT. Disease severity, age, BMI, HJHS, lower limb muscle torque, time spent in moderate to vigorous physical activity, sedentary time, were included as factors to predict performance. Results were compared to unaffected peers. RESULTS 43 boys median age 10 (10 mild/moderate, 26 severe, 7 inhibitors) were recruited. BwH were less likely to complete the iSTEP and performed less well on the 10 m-ISWT than age matched peers. Ceiling effects were apparent for iSTEP, but not the 10 m-ISWT test. Age was the only significant predictor for performance in the iSTEP, with older boys being more likely to achieve a higher level or complete the test. Greater age, lower BMI, milder disease severity and more time spent in MVPA all predicted better performance on the 10 m-ISWT, with BMI and habitual physical activity a potential rehabilitation focus for underperforming individuals. HJHS and muscle strength did not predict performance on either test. CONCLUSION Despite the space need to conduct the 10 m-ISWT, it appears to be a superior performance measure than the iSTEP in BwH and provides clinically meaningful information, which can be interpreted using age-specific normative reference equations.
Collapse
Affiliation(s)
- Melanie Bladen
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Institute of Child Health, University College, London, UK
| | - Lucy Alderson
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Nicola Thorpe
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Mario Cortina-Borja
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Eleanor Main
- Institute of Child Health, University College, London, UK
| |
Collapse
|
3
|
Ramos-Petersen L, Rodríguez-Sánchez JA, Cortés-Martín J, Reinoso-Cobo A, Sánchez-García JC, Rodríguez-Blanque R, Coca JR. A Qualitative Study Exploring the Experiences and Perceptions of Patients with Hemophilia Regarding Their Health-Related Well-Being, in Salamanca. J Clin Med 2023; 12:5417. [PMID: 37629458 PMCID: PMC10455868 DOI: 10.3390/jcm12165417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/28/2023] [Accepted: 08/19/2023] [Indexed: 08/27/2023] Open
Abstract
Hemophilia is a chronic, congenital/hereditary and X-linked disease, characterized by an insufficiency of factors VIII or IX, which are necessary for blood clotting. Those affected by hemophilia often suffer from particular psychosocial problems, both in the acceptance, coping, treatment and self-management of their disease and in their family and social relationships, which are often mediated by these circumstances. The aim of this study was to explore the experiences of people with hemophilia or their family members, of in a specific region of Spain, regarding the impact of having hemophilia. Structured interviews were conducted and developed, using the studies of the World Federation of Hemophilia and Osorio-Guzmán et al. as a guide, as well as a literature review of qualitative work on hemophilia. Data were analyzed using a six-step thematic analysis. A total of 34 interviews were thematically analyzed. The results showed that three key themes emerged from the data: (1) the daily impact of having hemophilia, (2) uncertainty about the disease, (3) the role of associations and (4) support from institutions. The results make it clear that the disease has a major impact on their lives (work, family, leisure and personal environment). The main conclusion is that hemophilia has a negative impact on the daily lives of patients, families and caregivers.
Collapse
Affiliation(s)
- Laura Ramos-Petersen
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain;
| | - Juan Antonio Rodríguez-Sánchez
- Department of Biomedical Sciences and Diagnosis, University of Salamanca, C/Alfonso X el Sabio S/N, 37007 Salamanca, Spain;
| | - Jonathan Cortés-Martín
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, Nursing Department, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (J.C.-M.); (J.C.S.-G.); (R.R.-B.)
| | - Andrés Reinoso-Cobo
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain;
| | - Juan Carlos Sánchez-García
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, Nursing Department, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (J.C.-M.); (J.C.S.-G.); (R.R.-B.)
| | - Raquel Rodríguez-Blanque
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, Nursing Department, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (J.C.-M.); (J.C.S.-G.); (R.R.-B.)
- San Cecilio Clinical University Hospital, 18016 Granada, Spain
| | - Juan R. Coca
- Social Research Unit on Health and Rare Diseases, Sociology and Social Work Department, University of Valladolid, 47002 Valladolid, Spain;
| |
Collapse
|
4
|
Taylor S, Toye F, Donovan-Hall M, Barker K. Past the tipping point: a qualitative study of the views and experiences of men with haemophilia regarding mobility, balance, and falls. Disabil Rehabil 2022; 44:7237-7245. [PMID: 34651530 DOI: 10.1080/09638288.2021.1988731] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE The life expectancy of people with haemophilia is increasing due to improved medical care. This improvement is accompanied by the co-morbidities of ageing, which include musculoskeletal degeneration and the associated effect on proprioception and balance. This study aims to explore the views and everyday experiences of those living with haemophilia regarding this. MATERIALS AND METHODS Nine people with moderate or severe haemophilia aged 43-58 years participated in semi-structured interviews and thematic analysis was used to examine the data. RESULTS Participants described pain and reduced movement in joints as a result of repeated bleeds, which caused problems with mobility and balance. Constant vigilance of their surroundings together with the potential consequences of bleeds caused continual worry. Participants were resourceful in their strategies to cope with the effects of haemophilia, to reduce pain and to minimise the risk of falling. However, participants felt stigmatised because of their condition. CONCLUSION People with haemophilia have difficulties with their mobility and balance that can increase their risk of falling. Healthcare professionals need to understand and address the physical and psycho-social factors that contribute to the risk of falls. A multi-disciplinary approach to devise effective strategies to counteract and monitor the risk of falls would be useful.Implications for RehabilitationHealthcare professionals should identify movements that are fearful and work on ways to increase confidence and ability to perform these.Healthcare professionals need to identify the recovery strategies used to maintain balance and build these movements into home exercise programmes.Effective pain reduction strategies, both pharmacological and non-pharmacological, need to be investigated and optimised.Footwear choice has implications for both pain reduction and balance and should be discussed in routine reviews.Optimising vision would maximise visual input to aid balance.
Collapse
Affiliation(s)
- Stephanie Taylor
- Oxford Haemophilia and Thrombosis Centre, Oxford University Hospital NHS Foundation Trust, UK
| | - Francine Toye
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospital NHS Foundation Trust, UK
| | | | - Karen Barker
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospital NHS Foundation Trust, UK.,Nuffield Department of Orthopaedics and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| |
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
|
Cruz-Montecinos C, Núñez-Cortés R, Vasconcello-Castillo L, Solís-Navarro L, Carrasco-Alonso B, Calatayud J, Pérez-Alenda S, Torres-Castro R. Exercise capacity in people with haemophilia: A systematic review. Haemophilia 2022; 28:891-901. [PMID: 35896002 DOI: 10.1111/hae.14646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Exercise capacity has been established as a protective factor against joint impairment in people with haemophilia (PWH). However, little is known about how exercise capacity is affected in PWH. AIM To analyse exercise capacity, as assessed by standardised laboratory or field tests in PWH. METHODS A systematic review was conducted to identify manuscripts investigating physical capacity in PWH. An electronic search of PubMed/MEDLINE, Embase, Web of Science, CENTRAL and CINAHL was conducted from inception to 13 April, 2022. Two independent reviewers performed data extraction and assessed study quality using the critical appraisal tools of the Joanna Briggs Institute. RESULTS Nineteen studies with 825 patients were included. Most studies used the six-min walk test (6MWT) or peak/maximal oxygen consumption (VO2 max). In children, the distance walked ranged from 274 ± 36.02 to 680 ± 100 m. In adults, the distance walked ranged from 457.5 ± 96.9 to 650.9 ± 180.3 m. VO2 max ranged from 37 ± 8 to 47.42 ± 8.29 ml kg-1 min-1 . Most studies reported lower values of exercise capacity compared to standardised values. Overall, the quality of the studies was moderate. CONCLUSION Most of the studies showed that PWH have lower exercise capacity compared to reference values of 6MWT or VO2 max. Based on these results, it is necessary to emphasise in both the promotion and the prescription of physical exercise in PWH.
Collapse
Affiliation(s)
- Carlos Cruz-Montecinos
- Departament of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.,Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain.,Section of Research, Innovation and Development in Kinesiology, Kinesiology Unit, San José Hospital, Santiago, Chile
| | - Rodrigo Núñez-Cortés
- Departament of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.,Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain.,International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain
| | - Luis Vasconcello-Castillo
- Departament of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.,International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain
| | - Lilian Solís-Navarro
- International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain.,Global Research on Wellbeing (GRoW), Facultat Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | | | - Joaquín Calatayud
- National Research Centre for the Working Environment, Copenhagen, Denmark.,Exercise Intervention for Health Research Group (EXINH-RG), Department of, Physiotherapy, University of Valencia, Valencia, Spain
| | - Sofía Pérez-Alenda
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain
| | - Rodrigo Torres-Castro
- Departament of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.,International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain
| |
Collapse
|
7
|
Biomechanical Gait Analysis of an Adult with Severe Hemophilia: A Case Report. Hematol Rep 2022; 14:112-118. [PMID: 35466181 PMCID: PMC9036226 DOI: 10.3390/hematolrep14020017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 11/17/2022] Open
Abstract
Hemophilia is characterized by recurrent bleeding into the joints leading to irreversible chronic arthropathy with reduced joint range of motion (ROM), which may lead to changes in gait patterns. To analyze the gait pattern in a 35-year-old male with severe hemophilia A, three-dimensional biomechanical analysis was performed during overground walking. The control group data from a public gait dataset of 10 healthy male individuals were used for comparison. The clinical examination was assessed with the Functional Independence Score in Hemophilia (FISH), Haemophilia Activities List (HAL), and Hemophilia Joint Health Score (HJHS). The biomechanical analysis demonstrated a pattern for both left knee and ankle joints with greater similarity to the control group compared to the right knee and ankle joints. ROM based on the HJHS questionnaire also showed greater impairment of the right-side knee joint compared to the left-side knee joint. This unique pattern could be the result of a compensation mechanism due to limited movement during the walking task and the surgical treatment.
Collapse
|
8
|
Cruz-Montecinos C, Maas H, Cerda M, Pérez-Alenda S. Altered neural control of gait and its association with pain and joint impairment in adults with haemophilic arthropathy: Clinical and methodological implications. Haemophilia 2022; 28:497-504. [PMID: 35201643 DOI: 10.1111/hae.14517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/29/2022] [Accepted: 02/04/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION It is unknown whether altered neural control is associated with clinical outcomes in people with haemophilic arthropathy (PWHA). The dynamic motor control index during walking (Walk-DMC) is a summary metric of neural control. AIMS The primary aim of this study was to apply the Walk-DMC to assess if people diagnosed with haemophilic arthropathy have impaired neural control of gait and investigate the association of Walk-DMC with pain and joint impairment. METHOD The Walk-DMC was assessed using surface electromyography in 11 leg muscles. Twenty-two PWHA and 15 healthy subjects walked on a 30-m walkway at 1 m/s. In addition, pain (visual analogue scale), knee flexion contracture (degrees) and joint impairment (Haemophilia Joint Health Score, HJHS) were assessed. The clinical outcomes were correlated with the Walk-DMC. Multiple regression analysis was performed to predict the Walk-DMC using the clinical outcomes. RESULTS In 13 PWHA the Walk-DMC was beyond the normal range (80-120 pts). PWHA with an altered Walk-DMC showed more years with arthropathy, more pain, higher knee flexion contracture and a higher HJHS score (P < .05, effect size > .8). Significant negative moderate associations between Walk-DMC and pain, knee flexion contracture and HJHS were found (P < .05). The model that best predicted the Walk-DMC was the pain with knee flexion contracture (R2 = .44; P = .004). CONCLUSIONS PWHA with abnormal neural control of gait also has more years with arthropathy, more pain, and more impaired joints. Our results indicate an association between the Walk-DMC index and joint damage, specifically with pain in combination with knee flexion contracture.
Collapse
Affiliation(s)
- Carlos Cruz-Montecinos
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Huub Maas
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Mauricio Cerda
- SCIAN-Lab, Programme of Integrative Biology, ICBM, & Center for Medical Informatics and Telemedicine, Faculty of Medicine, University of Chile, Santiago, Chile.,Biomedical Neuroscience Institute, Santiago, Chile
| | - Sofía Pérez-Alenda
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| |
Collapse
|
9
|
Deniz V, Guzel NA, Lobet S, Antmen AB, Sasmaz HI, Kilci A, Boyraz OC, Gunaştı O, Kurdak SS. Effects of a supervised therapeutic exercise program on musculoskeletal health and gait in patients with haemophilia: A pilot study. Haemophilia 2021; 28:166-175. [PMID: 34687122 DOI: 10.1111/hae.14444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 09/30/2021] [Accepted: 10/12/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Episodes of bleeding in patients with haemophilia (PwH) are associated with haemophilic arthropathy, limitations in physical performance, reduced quality of life (QoL), and gait disorders. AIM This non-randomized, controlled, interventional, prospective, single-centre pilot study aimed to assess the effects of an 8-week supervised therapeutic exercise program on musculoskeletal health, gait kinematic parameters (GKP), functional capacity, and QoL in adult PwH. METHODS Nineteen PwH were allocated to an exercise group (n = 10) or a control group (n = 9). The patients in the exercise group followed an 8-week supervised therapeutic exercise program. The Haemophilia Joint Health Score (HJHS), a two-dimensional video-based gait kinematic analysis (2D-GKA), the 6-min walking test (6MWT), and the Haemophilia Quality of Life Questionnaire for Adults (Haem-A-Qol) were used as the outcome measures at baseline, after the exercise program (at the 8th week), and at the 6th-month follow-up. RESULTS A significant improvement was observed in the exercise group in the HJHS-Total and Haem-A-Qol Total scores and the 6MWT value after the exercise program. Moreover, the 2D-GKA revealed improvement in most of the GKP (knee extension during the midstance and late swing phases, ankle dorsiflexion during the midstance phase, and ankle plantar flexion during the preswing phase). However, the gain obtained by the exercise program was not maintained at the 6th-month follow-up for the HJHS-Total and Hem-A-QoL-Total scores and GKP. CONCLUSION The 8-week supervised therapeutic exercise program was successful in achieving improvement in joint health, GKP, functional capacity, and QoL in PwH.
Collapse
Affiliation(s)
- Volkan Deniz
- Department of Physiotherapy and Rehabilitation, Gazi University Faculty of Health Sciences, Ankara, Turkey
| | - Nevin Atalay Guzel
- Department of Physiotherapy and Rehabilitation, Gazi University Faculty of Health Sciences, Ankara, Turkey
| | - Sébastien Lobet
- Service d'hématologie, Cliniques universitaires Saint-Luc, Bruxelles, Belgium.,Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuromusculoskeletal Lab (NMSK), Brussels, Belgium.,Cliniques universitaires Saint-Luc, Secteur de kinésithérapie, Brussels, Belgium
| | - Ali Bülent Antmen
- Department of Pediatric Hematology and Oncology, Acıbadem Hospital, Adana, Turkey
| | - Hatice Ilgen Sasmaz
- Department of Pediatric Hematology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Abdullah Kilci
- Faculty of Sport Sciences, Çukurova University, Adana, Turkey
| | | | - Ozgür Gunaştı
- Division of Sport Physiology, Department of Physiology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Sanli Sadi Kurdak
- Division of Sport Physiology, Department of Physiology, Faculty of Medicine, Çukurova University, Adana, Turkey
| |
Collapse
|
10
|
Thorpe N, Harniess P, Main E, Hubert N, Rand S, Stephensen D, Liesner R, Bladen M. Feasibility, safety and acceptability of select outcome measures in a physiotherapy study protocol for boys with haemophilia. Pilot Feasibility Stud 2021; 7:105. [PMID: 33957997 PMCID: PMC8099992 DOI: 10.1186/s40814-021-00831-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 04/03/2021] [Indexed: 12/20/2022] Open
Abstract
Background There is a lack of functional performance measures for children and young people with haemophilia (CYPwH) with associated control data from typically developing boys (TDB). The literature advocates development of a core set of outcome measures for different chronic conditions. As medical treatment improves, CYPwH are experiencing better outcomes; therefore, more challenging measures are required to monitor physical performance. Such testing is not performed routinely, due to practical and safety concerns. Aim Evaluate the feasibility, safety and acceptability of select outcome measures as part of a study protocol testing CYPwH; including myometry, 10 metre incremental shuttle walk test (10-m ISWT), iSTEP (an incremental step test, with data from TDB), and 1 week of accelerometry-wear at home. Methods Sixty-six boys aged 6–15 years with mild, moderate or severe haemophilia A or B (including inhibitors) attending routine clinics at Great Ormond Street Hospital were approached to participate. Descriptive statistics and content analysis were used to assess outcomes of feasibility, safety and acceptability, which included recruitment/retention rates, protocol completion within routine appointment timeframes, performance testing without serious adverse events/reactions (SAE/SARs), and acceptability to CYPwH of high-level performance measures. Results Outcomes were met: 43 boys completed testing at clinic review (Jan–Nov 2018) within a 10-month timeframe, retention was 95% at completion of protocol and no SAE/SARs were reported throughout testing. Conclusion Feasibility, safety and acceptability of the study protocol have been established in this population. Both high-level performance tests, iSTEP and 10-m ISWT, were an acceptable addition to boys’ routine clinic appointments and could be safe, acceptable choices of outcome measure as part of a core set of tests for CYPwH. Further investigation of the psychometric properties for the iSTEP is now justified, in order for it to be used as a standardised, validated, reliable outcome measure in clinical or research settings. Trial registration Retrospectively registered on September 3, 2019, on ClinicalTrials.gov (ID: NCT04076306). Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00831-1.
Collapse
Affiliation(s)
- Nicola Thorpe
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
| | - Phillip Harniess
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Eleanor Main
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Nicola Hubert
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sarah Rand
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - David Stephensen
- Kent Haemophilia Centre, Kent and Canterbury Hospital, Canterbury, UK
| | - Ri Liesner
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Melanie Bladen
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| |
Collapse
|
11
|
Development of stratified normative data and reference equations for the timed up and down stairs test for healthy children 6-14 years of age. Physiotherapy 2021; 112:31-40. [PMID: 34015718 DOI: 10.1016/j.physio.2021.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To generate normative data on healthy children aged 6-14 years for the timed up and down stairs (TUDS) test, and to provide reference equations. DESIGN AND SETTING Cross-sectional study at two primary schools. PARTICIPANTS Healthy children 6-14 years of age. MAIN OUTCOMES MEASURES Anthropometric data and Minnesota Leisure-Time Physical Activity Questionnaire from children were collected before the start of the TUDS test. Heart rate, blood pressure and perceived exertion were measured at the beginning and at the end of the test. Two trials of the TUDS test were performed with 15-minute of rest on the same day and the better of the two trials was used in the analyses. The reference equations were established using the anthropometric variables as possible predictors of the TUDS test. RESULTS Two hundred fifty eight children (125 boys and 133 girls) were assessed. The mean TUDS test score decreased significantly from 6 to 14 years of age in boys and girls alike, with statistically significant differences between the three age range groups. A significant difference was found between girls and boys in TUDS test score. The 56% of the variation in TUDS test score could be explained by age, height, and weight in boys [TUDSsec score=(9.967-(0.182×Ageyears)+(0.025×Weightkg)-(2.546×Heightm)], while 50% could be explained in girls [TUDSsec score=10.553-(0.194×Ageyears)+(0.019×Weightkg)-(2.406×Heightm)]. The inclusion of physical level activity increased the variability explained (boys: 59%; girls: 51%). CONCLUSIONS TUDS score improved as the age of the children increased, with boys achieving better values than girls within each age group. TUDS test score can be easily predicted from age, height, and weight. The inclusion of the child's physical activity level increased the variance explained by the equation.
Collapse
|
12
|
Pasta G, Annunziata S, Polizzi A, Caliogna L, Jannelli E, Minen A, Mosconi M, Benazzo F, Di Minno MND. The Progression of Hemophilic Arthropathy: The Role of Biomarkers. Int J Mol Sci 2020; 21:E7292. [PMID: 33023246 PMCID: PMC7583947 DOI: 10.3390/ijms21197292] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hemophilia A and B are X-linked congenital bleeding disorders characterized by recurrent hemarthroses leading to specific changes in the synovium and cartilage, which finally result in the destruction of the joint: this process is called hemophilic arthropathy (HA). This review highlights the most prominent molecular biomarkers found in the literature to discuss their potential use in the clinical practice to monitor bleeding, to assess the progression of the HA and the effectiveness of treatments. METHODS A review of the literature was performed on PubMed and Embase, from 3 to 7 August 2020. Study selection and data extraction were achieved independently by two authors and the following inclusion criteria were determined a priori: English language, available full text and articles published in peer-reviewed journal. In addition, further articles were identified by checking the bibliography of relevant articles and searching for the studies cited in all the articles examined. RESULTS Eligible studies obtained at the end of the search and screen process were seventy-three (73). CONCLUSIONS Despite the surge of interest in the clinical use of biomarkers, current literature underlines the lack of their standardization and their potential use in the clinical practice preserving the role of physical examination and imaging in early diagnosis.
Collapse
Affiliation(s)
- Gianluigi Pasta
- Department of Orthopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy; (G.P.); (A.P.); (L.C.); (E.J.); (A.M.); (M.M.); (F.B.)
| | - Salvatore Annunziata
- Department of Orthopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy; (G.P.); (A.P.); (L.C.); (E.J.); (A.M.); (M.M.); (F.B.)
| | - Alberto Polizzi
- Department of Orthopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy; (G.P.); (A.P.); (L.C.); (E.J.); (A.M.); (M.M.); (F.B.)
| | - Laura Caliogna
- Department of Orthopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy; (G.P.); (A.P.); (L.C.); (E.J.); (A.M.); (M.M.); (F.B.)
| | - Eugenio Jannelli
- Department of Orthopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy; (G.P.); (A.P.); (L.C.); (E.J.); (A.M.); (M.M.); (F.B.)
| | - Alessandro Minen
- Department of Orthopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy; (G.P.); (A.P.); (L.C.); (E.J.); (A.M.); (M.M.); (F.B.)
| | - Mario Mosconi
- Department of Orthopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy; (G.P.); (A.P.); (L.C.); (E.J.); (A.M.); (M.M.); (F.B.)
| | - Francesco Benazzo
- Department of Orthopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy; (G.P.); (A.P.); (L.C.); (E.J.); (A.M.); (M.M.); (F.B.)
| | | |
Collapse
|
13
|
Cuesta-Barriuso R, Donoso-Úbeda E, Meroño-Gallut J, Pérez-Llanes R, López-Pina JA. Functionality and range of motion in patients with hemophilic ankle arthropathy treated with fascial therapy. A randomized clinical trial. Musculoskelet Sci Pract 2020; 49:102194. [PMID: 32861358 DOI: 10.1016/j.msksp.2020.102194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/24/2020] [Accepted: 05/18/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hemophilic arthropathy is characterized by loss of function and range motion. Fascial therapy mobilizes the connective tissue, intervening in the state of the injured fascial complex. OBJECTIVES The aim of this study is to assess the safety and effectiveness of a fascial therapy treatment in patients with hemophilic ankle arthropathy. DESIGN Randomized clinical trial. METHODS Sixty-five adult patients with hemophilia from 18 to 65 years of age were recruited. The intervention through fascial therapy lasted 3 consecutive weeks with a weekly session of 45 min each. The dependent variables were frequency of bleeding (selfregistration), ankle range of motion (goniometer) and lower limb functionality (6-Minute Walking Test). Three assess were made: baseline, posttreatment and after follow-up period. ANOVA of repeated measures was performed to compare both groups at the three assess time points. Bonferroni correction has been applied to control the error rate of the significance level. RESULTS Improvements were found (p < 0.001) in terms of a reduced frequency of ankle hemarthrosis. Significant differences were found in the experimental group following intervention (p < 0.001), and when comparing baseline and follow-up assessments (p < 0.05) in all variables. The frequency of hemarthrosis (p = 0.04) and functionality (p = 0.01) improved in patients who received manual therapy as compared to the control group. CONCLUSIONS Fascial therapy achieves improvements in terms of frequency of hemarthrosis in patients with hemophilic ankle arthropathy. Ankle functionality improved in patients treated with manual therapy. This technique can improve ankle range of motion.
Collapse
Affiliation(s)
- Rubén Cuesta-Barriuso
- Department of Physiotherapy, European University of Madrid, Spain; Royal Victoria Eugenia Foundation, Madrid, Spain; Fishemo CEE. Spanish Federation oh Hemophilia, Madrid, Spain.
| | | | | | - Raúl Pérez-Llanes
- Department of Physiotherapy. Faculty of Health Sciences. Catholic University San Antonio-UCAM, Murcia, Spain
| | | |
Collapse
|
14
|
Calatayud J, Pérez-Alenda S, Carrasco JJ, Cruz-Montecinos C, Andersen LL, Bonanad S, Querol F, Megías-Vericat JE, Casaña J. 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. [PMID: 32525975 DOI: 10.1093/ptj/pzaa106] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 10/24/2019] [Accepted: 04/16/2020] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Strength training is recommended for people with hemophilia; however, published data are anecdotal and have methodological limitations. The purpose of this study was to evaluate the safety and effectiveness of progressive moderate-to-vigorous intensity elastic resistance training on physical function and pain in this patient population. METHODS A randomized controlled trial was conducted in a university laboratory setting where 20 patients (17 with severe, 1 with moderate, and 2 with mild hemophilia) aged 21 to 53 years received evaluations at baseline and 8-week follow-up. Participants were allocated to intervention (progressive strength training) or control (usual daily activities) groups. The intervention group trained 2 days per week during 8 weeks with elastic resistance. Intensity during the first 2 weeks was a 20-repetition maximum and increased progressively toward 15, 12, and finally 10 repetition maximum. The primary outcome was muscle strength. Secondary outcomes were the Timed "Up and Go" Test score, sit-to-stand, range of motion, Haemophilia Joint Health Score, kinesiophobia score, global impression of pain change, general self-rated health status, and desire to exercise. RESULTS The intervention group showed greater strength improvements than the control group in almost all of the joints, with moderate to high effect sizes. The intervention group also showed better Timed "Up and Go" and sit-to-stand scores than the control group (moderate effect size), greater range of motion at the knee flexion with the right leg (trivial effect size), and better Haemophilia Joint Health Score at the left knee (small effect size). The intervention group showed greater overall pain reduction, self-rated overall status, and desire to exercise than the control group. CONCLUSIONS Progressive strength training with elastic resistance performed twice a week during 8 weeks is safe and effective in people with hemophilia to improve muscle strength and functional capacity, reduce general pain, and improve self-rated health status and desire to exercise. IMPACT This study provides evidence for the use of a specific strength training regimen for people with hemophilia. LAY SUMMARY People with hemophilia of differing levels of severity, with adequate coverage with clotting factor, can safely engage in progressive strength training and can improve their functioning.
Collapse
Affiliation(s)
- Joaquín Calatayud
- Department of Physiotherapy, Exercise Intervention for Health Research Group, University of Valencia, Valencia, Spain; and National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Sofía Pérez-Alenda
- Department of Physiotherapy, Multispeciality Research Group, Physiotherapy in Motion, University of Valencia, Gascó Oliag 5, Valencia CP 46100 Spain; and Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Juan J Carrasco
- Department of Physiotherapy, Multispeciality Research Group, Physiotherapy in Motion and Intelligent Data Analysis Laboratory, University of Valencia
| | - Carlos Cruz-Montecinos
- Department of Physiotherapy, Multispeciality Research Group, Physiotherapy in Motion, University of Valencia and Department of Physical Therapy, Faculty of Medicine, Laboratory of Clinical Biomechanics, University of Chile, Santiago, Chile
| | - Lars L Andersen
- National Research Centre for the Working Environment and Department of Health Science and Technology, Sport Sciences, Aalborg University, Aalborg, Denmark
| | - Santiago Bonanad
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe
| | - Felipe Querol
- Department of Physiotherapy, Multispeciality Research Group, Physiotherapy in Motion, University of Valencia and Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe
| | - Juan E Megías-Vericat
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe and Pharmacy Department, Drug Clinical Area, University and Polytechnic Hospital La Fe
| | - José Casaña
- Department of Physiotherapy, Exercise Intervention for Health Research Group, University of Valencia
| |
Collapse
|
15
|
Bladen M, Carroll L, Dodd C, Drechsler W, Hashem F, Patel V, Pellatt‐Higgins T, Saloniki E, Stephensen D. Results of feasibility and safety of randomised controlled trial of a musculoskeletal exercise intervention versus usual care for children with haemophilia. Haemophilia 2020; 26:e223-e225. [PMID: 32372451 PMCID: PMC7780159 DOI: 10.1111/hae.14026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/27/2020] [Accepted: 04/17/2020] [Indexed: 01/21/2023]
Affiliation(s)
- Melanie Bladen
- Great Ormond Street Hospital for ChildrenHeamophilia CentreLondonUK
| | | | - Charlene Dodd
- Kent Thrombosis and Haemophilia CentreKent and Canterbury HospitalCanterburyUK
| | - Wendy Drechsler
- Faculty of Life Sciences & MedicineKing College LondonLondonUK
| | - Ferhana Hashem
- Centre for Health Service StudiesUniversity of KentCanterburyUK
| | - Vishal Patel
- Barts Health NHS TrustHaemophilia CentreLondonUK
| | | | - Eirini Saloniki
- Centre for Health Service StudiesUniversity of KentCanterburyUK
| | - David Stephensen
- Barts Health NHS TrustHaemophilia CentreLondonUK
- Kent Thrombosis and Haemophilia CentreKent and Canterbury HospitalCanterburyUK
| |
Collapse
|
16
|
Fujii T, Fujii T, Takedani H. Long-term impact of haemarthrosis on arthropathy and activities of daily living in Japanese persons with haemophilia. Haemophilia 2020; 26:e124-e127. [PMID: 32026532 DOI: 10.1111/hae.13937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 01/18/2020] [Accepted: 01/21/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Teruhisa Fujii
- Division of Blood Transfusion, Hiroshima University Hospital, Hiroshima, Japan
| | - Tomie Fujii
- Nursing Practice and Research Center, Nihon Fukushi University, Tokai, Japan
| | - Hideyuki Takedani
- Department of Joint Surgery, Research Hospital of The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
17
|
Calatayud J, Pérez-Alenda S, Carrasco JJ, Escriche-Escuder A, Cruz-Montecinos C, Andersen LL, Bonanad S, Querol F, Casaña J. Electromyographic and Safety Comparisons of Common Lower Limb Rehabilitation Exercises for People With Hemophilia. Phys Ther 2020; 100:116-126. [PMID: 31584672 DOI: 10.1093/ptj/pzz146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 04/19/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND Ankles and knees are commonly affected in people with hemophilia and thus are targets for prevention or rehabilitation. However, to our knowledge, no studies have evaluated muscle activity and safety during exercises targeting the lower limbs in people with hemophilia; this lack of information hinders clinical decision-making. OBJECTIVE The aim of this study was to compare the tolerability of, safety of, and muscle activity levels obtained with external resistance (elastic or machine)-based and non-external resistance-based lower limb exercises in people with hemophilia. DESIGN This was a cross-sectional study. METHODS Eleven people who had severe hemophilia and were undergoing prophylactic treatment participated. In a single experimental session, participants performed knee extension and ankle plantar flexion during 3 exercise conditions in random order: elastic band-based resistance (elastic resistance), machine-based resistance (machine resistance), and no external resistance. Exercise intensities for the 2 external resistance-based conditions were matched for perceived exertion. Muscle activity was determined using surface electromyography (EMG) for the rectus femoris, biceps femoris, gastrocnemius lateralis, and tibialis anterior muscles. Participants were asked to rate exercise tolerability according to a scale ranging from "very well tolerated" to "not tolerated" and to report possible adverse effects 24 and 48 hours after the session. RESULTS No adverse effects were reported, and exercise tolerability was generally high. In the knee extension exercise, the rectus femoris normalized EMG values during the elastic resistance and machine resistance conditions were similar; 29% to 30% higher activity was obtained during these conditions than during the non-external resistance condition. In the ankle plantar flexion exercise, the gastrocnemius lateralis normalized EMG value was 34% higher during the machine resistance condition than without external resistance, and the normalized EMG values during the elastic resistance and other conditions were similar. LIMITATIONS The small sample size and single training session were the primary limitations of this study. CONCLUSIONS Exercises performed both with elastic bands and with machines at moderate intensity are safe, feasible, and efficient in people with severe hemophilia, providing comparable activity levels in the agonist muscles.
Collapse
Affiliation(s)
- Joaquín Calatayud
- Department of Physiotherapy, Exercise Intervention for Health Research Group (EXINH-RG), University of Valencia, Valencia, Spain; and National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Sofía Pérez-Alenda
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Valencia, Spain; and Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, c/Gascó Oliag 5, CP 46010, Valencia, Spain
| | - Juan J Carrasco
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia; and Intelligent Data Analysis Laboratory, University of Valencia
| | | | - Carlos Cruz-Montecinos
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia; Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; and Laboratory of Biomechanics and Kinesiology, San José Hospital, Santiago, Chile
| | - Lars L Andersen
- National Research Centre for the Working Environment; and Sport Sciences, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Santiago Bonanad
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe
| | - Felipe Querol
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe; and Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia
| | - José Casaña
- Department of Physiotherapy, Exercise Intervention for Health Research Group (EXINH-RG), University of Valencia
| |
Collapse
|
18
|
Lobet S, Meité N, Koninckx MI, Van Overstraeten A, Kamagate AM, Hermans C, Lambert C. Implementation and assessment of a self- and community-based rehabilitation programme in patients with haemophilia from Côte d'Ivoire. Haemophilia 2019; 25:859-866. [PMID: 31393670 DOI: 10.1111/hae.13833] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/04/2019] [Accepted: 07/15/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION In resource-constrained countries, few patients with haemophilia (PWH) have access to clotting factor concentrates (CFC), with increased musculoskeletal (MSK) complications. Physiotherapy actively contributes to preventing MSK complications, minimizing joint damage and reducing pain. AIM To assess the impact of a 20-week self- and community-based rehabilitation (CBR) programme in Ivorian PWH. METHODS Fifty participants underwent a clinical and functional baseline assessment with identification of joints' functional defects and initiation of an individualized exercise programme comprising exercises to improve strength, joint mobility and proprioception. Hemophilia Joint Health Score (HJHS), 2-minute walking test (2MWT), Timed Up and Go (TUG), goniometry and maximal isometric voluntary contractions using the MicroFET2 were performed at baseline (T1) and at Week 20 (T2). RESULTS At T2, there was a significant improvement in both the 2MWT and TUG tests. The HJHS total score decreased significantly from 23.6 ± 14.2 at T1 to 20.4 ± 13 at T2. A significant improvement in joint health was found in the left elbow, right knee and right ankle, with elements correlating with joint function responsible for these improvements. A strong programme adherence was observed, with 94% of participants reporting regular exercise performance and a high degree of satisfaction. CONCLUSION The programme with its encouraging results is meant to be the first step towards a more ambitious project. Self-based and CBR programmes are inexpensive and efficient treatment options designed to minimize the detrimental effects of joint and muscle bleedings, and to increase the functional independence and quality of life of PWH with limited access to CFC and physiotherapy.
Collapse
Affiliation(s)
- Sébastien Lobet
- Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuromusculoskeletal Lab, Université Catholique de Louvain, Bruxelles, Belgium.,Department of Physical medicine and rehabilitation, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium.,Hemostasis and Thrombosis Unit, Department of Hematology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - N'Dogomo Meité
- Department of Clinical hematology, Centre Hospitalier Universitaire de Yopougon, Abidjan, Côte d'Ivoire
| | - Marie-Inès Koninckx
- Faculté des Sciences de la Motricité, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Antoine Van Overstraeten
- Faculté des Sciences de la Motricité, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Amed Mama Kamagate
- Department of Physical medicine and rehabilitation, Centre Hospitalier Universitaire de Yopougon, Abidjan, Côte d'Ivoire
| | - Cédric Hermans
- Hemostasis and Thrombosis Unit, Department of Hematology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Catherine Lambert
- Hemostasis and Thrombosis Unit, Department of Hematology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| |
Collapse
|
19
|
Hashem F, Bladen M, Carroll L, Dodd C, Drechsler WI, Lowery D, Patel V, Pellatt-Higgins T, Saloniki E, Stephensen D. Protocol for a feasibility randomised controlled trial of a musculoskeletal exercise intervention versus usual care for children with haemophilia. BMJ Open 2019; 9:e029474. [PMID: 31375620 PMCID: PMC6688743 DOI: 10.1136/bmjopen-2019-029474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Haemophilia is a rare, inherited disorder in which blood does not clot normally, resulting in bleeding into joints and muscles. Long-term consequence is disabling joint pain, stiffness, muscle weakness, atrophy and reduced mobility. The purpose of this proposed feasibility of a randomised controlled trial (RCT) is to test the feasibility of an age-appropriate physiotherapy intervention designed to improve muscle strength, posture and the way boys use their joints during walking and everyday activities. METHODS AND ANALYSIS A small-scale two-centre RCT of a 12-week muscle strengthening exercise intervention versus usual care for young children with haemophilia will be conducted. Primary outcomes will be safety and adherence to the exercise intervention. Secondary outcomes will include recruitment, retention and adverse event rates, clinical data, muscle strength, joint biomechanics and foot loading patterns during walking, 6 min timed walk, timed-up-and-down-stairs, EQ-5D-Y, participants' perceptions of the study, training requirements and relevant costs. Recruitment, follow-up, safety and adherence rates will be described as percentages. Participant diary and interview data will be analysed using a framework analysis. Demographic and disease variable distributions will be analysed for descriptive purposes and covariant analysis. Estimates of differences between treatment arms (adjusted for baseline) and 75% and 95% CIs will be calculated. ETHICS AND DISSEMINATION The study has ethical approval from the London-Fulham Research Ethics Committee (17/LO/2043) as well as Health Research Authority approval. As well as informing the design of the definitive trial, results of this study will be presented at local, national and international physiotherapy and haemophilia meetings as well as manuscripts submitted to peer-reviewed journals. We will also share the main findings of the study to all participants and the Haemophilia Society.
Collapse
Affiliation(s)
- Ferhana Hashem
- Centre for Health Service Studies, University of Kent, Canterbury, Kent, UK
| | - Melanie Bladen
- Haemophilia Centre, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | | | - Charlene Dodd
- Haemophilia Centre, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - Wendy I Drechsler
- School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - David Lowery
- Centre for Health Service Studies, University of Kent, Canterbury, Kent, UK
| | - Vishal Patel
- Haemophilia Centre, Barts Health NHS Trust, London, UK
| | - T Pellatt-Higgins
- Centre for Health Service Studies, University of Kent, Canterbury, Kent, UK
| | - Eirini Saloniki
- Centre for Health Service Studies, University of Kent, Canterbury, Kent, UK
| | - David Stephensen
- Haemophilia Centre, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
- Haemophilia Centre, Barts Health NHS Trust, London, UK
| |
Collapse
|
20
|
Stephensen D, Bladen M, McLaughlin P. Recent advances in musculoskeletal physiotherapy for haemophilia. Ther Adv Hematol 2018; 9:227-237. [PMID: 30181843 PMCID: PMC6116756 DOI: 10.1177/2040620718784834] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/27/2018] [Indexed: 12/16/2022] Open
Abstract
Physiotherapy is directed towards the movement needs and potential of individuals, providing treatment and rehabilitation to develop, maintain and restore maximum movement and functional ability throughout the lifespan. Recent systematic reviews and randomized controlled trials have extended evidence for the clinical efficacy of physiotherapy interventions and rehabilitation for people with haemophilia. This narrative review synthesizes recent evidence to discuss; differentiating musculoskeletal bleeding and haemophilic arthropathy, efficacy of physiotherapy and rehabilitation for acute musculoskeletal bleeding and arthropathy, as well as monitoring musculoskeletal health. Whilst robust evidence is emerging, there is a need for more well designed randomized clinical studies with larger numbers and homogeneity of participants and collaboration of all researchers and clinicians to identify a core set of outcome measures that can be used to monitor musculoskeletal health.
Collapse
Affiliation(s)
- David Stephensen
- East Kent Hospitals University NHS Foundation
Trust, Ethelbert Road, Canterbury CT1 3NG, UK
| | - Melanie Bladen
- Great Ormond Street Hospital for Children NHS
Foundation Trust, London, UK
| | | |
Collapse
|
21
|
Fouasson-Chailloux A, Maugars Y, Vinatier C, Trossaert M, Menu P, Rannou F, Guicheux J, Dauty M. Clinical relevance of 3D gait analysis in patients with haemophilia. Haemophilia 2018; 24:703-710. [DOI: 10.1111/hae.13563] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2018] [Indexed: 02/06/2023]
Affiliation(s)
- A. Fouasson-Chailloux
- CHU Nantes; Physical Medicine and Rehabilitation Center; Nantes France
- Inserm; UMR 1229; RMeS, Regenerative Medicine and Skeleton; Université de Nantes; ONIRIS; Nantes France
- UFR Odontologie; Université de Nantes; Nantes France
| | - Y. Maugars
- Inserm; UMR 1229; RMeS, Regenerative Medicine and Skeleton; Université de Nantes; ONIRIS; Nantes France
- UFR Odontologie; Université de Nantes; Nantes France
- CHU Nantes; Nantes France
- Rheumatologic Department; CHU Nantes; Nantes France
| | - C. Vinatier
- Inserm; UMR 1229; RMeS, Regenerative Medicine and Skeleton; Université de Nantes; ONIRIS; Nantes France
- UFR Odontologie; Université de Nantes; Nantes France
| | - M. Trossaert
- CHU Nantes Centre Régional de traitement de l'hémophilie; Nantes France
| | - P. Menu
- CHU Nantes; Physical Medicine and Rehabilitation Center; Nantes France
- Inserm; UMR 1229; RMeS, Regenerative Medicine and Skeleton; Université de Nantes; ONIRIS; Nantes France
- UFR Odontologie; Université de Nantes; Nantes France
| | - F. Rannou
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis; Hôpitaux Universitaires-Paris Centre; Groupe Hospitalier Cochin; Assistance Publique-Hôpitaux de Paris; Paris France
| | - J. Guicheux
- Inserm; UMR 1229; RMeS, Regenerative Medicine and Skeleton; Université de Nantes; ONIRIS; Nantes France
- UFR Odontologie; Université de Nantes; Nantes France
- CHU Nantes; Nantes France
| | - M. Dauty
- CHU Nantes; Physical Medicine and Rehabilitation Center; Nantes France
- Inserm; UMR 1229; RMeS, Regenerative Medicine and Skeleton; Université de Nantes; ONIRIS; Nantes France
- UFR Odontologie; Université de Nantes; Nantes France
| |
Collapse
|