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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.
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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
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Scaturro D, Vitagliani F, Tomasello S, Mangano MS, Signa G, Letizia Mauro G. Postural Assessment Systems in the Prevention of Haemophilic Arthropathy: A Narrative Review. J Funct Morphol Kinesiol 2022; 7:jfmk7030068. [PMID: 36135426 PMCID: PMC9504687 DOI: 10.3390/jfmk7030068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/17/2022] Open
Abstract
This narrative review aims to give an overview of some postural evaluation systems currently used in patients with haemophilia. Among them, first, we analyse the HJHS scale, recognized as a specific evaluation tool for haemophilic arthropathy. Second, we focus on other systems usually used in non-haemophilic patients that have also shown good applicability in this patient category, such as gait analysis, stabilometry, and baropodometric examination. This review underlines the use these tools could have in clinical practice to identify the early postural alterations in patients with haemophilia and set up personalised rehabilitation programs.
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Affiliation(s)
- Dalila Scaturro
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy
- Correspondence: ; Tel.: +39-3206945411
| | - Fabio Vitagliani
- Faculty of Medicine and Surgery, University of Catania, 95100 Catania, Italy
| | - Sofia Tomasello
- Faculty of Medicine and Surgery, University of Palermo, 90127 Palermo, Italy
| | | | - Gabriele Signa
- Faculty of Medicine and Surgery, University of Catania, 95100 Catania, Italy
| | - Giulia Letizia Mauro
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy
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Etzweiler D, Albisetti M, Meichtry A, Huber EO. The effect of age on the pressure pain threshold of asymptomatic ankles and knees in young individuals with haemophilia. Haemophilia 2021; 27:683-689. [PMID: 34015164 DOI: 10.1111/hae.14344] [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: 09/30/2020] [Revised: 04/24/2021] [Accepted: 05/03/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Despite adequate medical treatment, many young adults with haemophilia develop joint alterations-especially in ankles and knees. Undetected over years, subtle structural changes cause subclinical symptoms, before problems become obvious. To objectify these silent pressure pains, the pressure pain threshold (PPT) can be measured by algometry. AIM The aim was to investigate and compare the effect of age on PPTs in asymptomatic ankles and knees between boys and young adults with haemophilia and age-matched controls, in order to gain better knowledge about the alteration of the periarticular structures with increasing age. MATERIAL AND METHODS Nineteen persons with haemophilia (PwH; severe or moderate; 8-30 years) and 19 age-matched controls with 'healthy' ankles and knees were recruited. Asymptomatic joints with a Haemophilia Joint Health Score = 0 were included. The PPT was measured on four periarticular points per joint, and the data were analysed with a linear mixed model. RESULTS The PPT of the control group increased with age, whereas the PPT of the PwH decreased. The difference in age effect per year in kPa between PwH and controls was as follows: β [95%-CI]: -15.41 [-31.63; 0.79]. Although the result was not statistically significant (p = .08), a clear tendency was shown. CONCLUSION The results suggest that subclinical alterations in the periarticular structures of these joints may evolve unnoticed over time. However, further research is warranted to determine whether this observed trend is confirmed in a larger sample and at what age the PPT begins to decrease in PwH compared to controls.
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Affiliation(s)
- Denise Etzweiler
- Division of Haematology, University Children's Hospital Zurich, Zurich, Switzerland.,School of Health Professions, Institute of Physiotherapy, University of Applied Sciences, Winterthur, Switzerland
| | - Manuela Albisetti
- Division of Haematology, University Children's Hospital Zurich, Zurich, Switzerland
| | - André Meichtry
- School of Health Professions, Institute of Physiotherapy, University of Applied Sciences, Winterthur, Switzerland
| | - Erika O Huber
- School of Health Professions, Institute of Physiotherapy, University of Applied Sciences, Winterthur, Switzerland
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Tat NM, Tat AM, Oner AF, Karaman K, Kaplan S, Can F. Static postural balance evaluation and an investigation of the relationship with joint health in children with severe haemophilia: a controlled cross-sectional study. Haemophilia 2021; 27:e245-e252. [PMID: 33486846 DOI: 10.1111/hae.14240] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/30/2020] [Accepted: 12/12/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Recurrent hemarthroses disturbing force/movement control are likely to impair postural balance. AIM To investigate the possible changes in static postural balance parameters in children with haemophilia (CwH) and to reveal its relationship with Haemophilia Joint Health Score (HJHS). METHODS Twenty-one CwH aged 6-18 who had haemophilic arthropathy in at least one lower limb joint and 21 healthy peers were evaluated by using a force platform. Centre of pressure (CoP) signals were displayed as a map in both anteroposterior direction (APD) and mediolateral direction (MLD) by statokinesigram. Accordingly, the amplitude, velocity and standard deviation of CoP displacements along with the perimeter and ellipse area were measured. Assessments were made under eyes opened and eyes closed in bipedal stance for 60 s. Joint health and muscle strength were evaluated with HJHS and digital dynamometer, respectively. RESULTS Velocity and amplitude of CoP displacements in MLD were increased in CwH (p˂0.05). It was also found that these parameters were moderate correlated with the clinical score of the lower limb joints (p˂0.05). In CwH, standard deviation of CoP displacements in the APD was significantly higher in eyes closed, while standard deviation in MLD was significantly higher in eyes opened (p˂0.05). CONCLUSION Disturbances during bipedal stance reveal the need for balance evaluation in CwH. Increased mediolateral oscillations may be an early sign of disorders of the musculoskeletal system in CwH. In addition to improving joint health, postural balance exercises that increase MLD stability have to be included in the rehabilitation programme of CwH.
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Affiliation(s)
- Necati M Tat
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Necmettin Erbakan University, Konya, Turkey
| | - Ayse M Tat
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Necmettin Erbakan University, Konya, Turkey
| | - Ahmet F Oner
- Faculty of Medicine, Department of Pediatric Hematology and Oncology, Yuzuncu Yil University, Van, Turkey
| | - Kamuran Karaman
- Faculty of Medicine, Department of Pediatric Hematology and Oncology, Yuzuncu Yil University, Van, Turkey
| | - Seyhmus Kaplan
- Faculty of Medicine, Department of Sports Medicine, Yuzuncu Yil University, Van, Turkey
| | - Filiz Can
- Faculty of Physical Therapy and Rehabilitation, Department of Orthopaedic Rehabilitation, Hacettepe University, Ankara, Turkey
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Cruz-Montecinos C, Carrasco JJ, Guzmán-González B, Soto-Arellano V, Calatayud J, Chimeno-Hernández A, Querol F, Pérez-Alenda S. Effects of performing dual tasks on postural sway and postural control complexity in people with haemophilic arthropathy. Haemophilia 2020; 26:e81-e87. [PMID: 32197275 DOI: 10.1111/hae.13955] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/14/2020] [Accepted: 02/24/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION People with haemophilic arthropathy (PWHA) have impairments in postural control. However, little is known about the effects of demanding conditions, including the unipedal stance and dual tasks, on postural control in PWHA. AIM Determine the effects of performing dual tasks while in the one-leg stance on postural sway and postural control complexity in PWHA vs. healthy active (HAG) and non-active (HNAG) groups of individuals. METHODS Fifteen PWHA and 34 healthy subjects (18 active and 16 non-active) were recruited. Vertical (V), mediolateral (ML) and anteroposterior (AP) centre of mass signals were acquired using a 3-axis accelerometer placed at the L3/L4 vertebrae of subjects as they performed the one-leg stance under single and dual-task conditions. Sway balance and the complexity of postural control were studied via root mean square (RMS) acceleration and sample entropy, respectively. Increased complexity of postural sway was attributed to increased automatism of postural control. RESULTS RMS values for PWHA were higher than HAG under both conditions for the V and ML axes, and higher than HNAG under the dual-task condition for the ML axis. Sample entropy was lower in PWHA than healthy individuals under the dual-task condition for V and ML axes, and the single-task condition for the ML axis (P < .05). CONCLUSION PWHA had poorer postural sway and decreased postural control complexity when performing a one-leg stance than healthy people, especially when the dual-task condition was applied. These results may help to design new approaches to assess and improve postural control in PWHA.
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Affiliation(s)
- Carlos Cruz-Montecinos
- Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.,Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Juan J Carrasco
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Intelligent Data Analysis Laboratory, University of Valencia, Valencia, Spain
| | - Benjamín Guzmán-González
- Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Verónica Soto-Arellano
- Haemophilia and Inherited Bleeding Disorder Treatment Center, Roberto del Río Hospital, Santiago, Chile
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain.,National Research Centre for the Working Environment, Copenhagen, Denmark
| | | | - Felipe Querol
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Haemostasis and Thrombosis Unit, Universitary and Polytechnic Hospital La Fe, Valencia, Spain
| | - Sofía Pérez-Alenda
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Haemostasis and Thrombosis Unit, Universitary and Polytechnic Hospital La Fe, Valencia, Spain
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Mateo F, Soria-Olivas E, Carrasco JJ, Bonanad S, Querol F, Pérez-Alenda S. HemoKinect: A Microsoft Kinect V2 Based Exergaming Software to Supervise Physical Exercise of Patients with Hemophilia. SENSORS (BASEL, SWITZERLAND) 2018; 18:E2439. [PMID: 30050026 PMCID: PMC6111835 DOI: 10.3390/s18082439] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/06/2018] [Accepted: 07/24/2018] [Indexed: 12/19/2022]
Abstract
Patients with hemophilia need to strictly follow exercise routines to minimize their risk of suffering bleeding in joints, known as hemarthrosis. This paper introduces and validates a new exergaming software tool called HemoKinect that intends to keep track of exercises using Microsoft Kinect V2's body tracking capabilities. The software has been developed in C++ and MATLAB. The Kinect SDK V2.0 libraries have been used to obtain 3D joint positions from the Kinect color and depth sensors. Performing angle calculations and center-of-mass (COM) estimations using these joint positions, HemoKinect can evaluate the following exercises: elbow flexion/extension, knee flexion/extension (squat), step climb (ankle exercise) and multi-directional balance based on COM. The software generates reports and progress graphs and is able to directly send the results to the physician via email. Exercises have been validated with 10 controls and eight patients. HemoKinect successfully registered elbow and knee exercises, while displaying real-time joint angle measurements. Additionally, steps were successfully counted in up to 78% of the cases. Regarding balance, differences were found in the scores according to the difficulty level and direction. HemoKinect supposes a significant leap forward in terms of exergaming applicability to rehabilitation of patients with hemophilia, allowing remote supervision.
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Affiliation(s)
- Fernando Mateo
- Department of Electronic Engineering, University of Valencia, Avda. Universitat, 46100-Burjassot, Spain.
- Intelligent Data Analysis Laboratory, University of Valencia, Avda. Universitat, 46100-Burjassot, Spain.
| | - Emilio Soria-Olivas
- Department of Electronic Engineering, University of Valencia, Avda. Universitat, 46100-Burjassot, Spain.
- Intelligent Data Analysis Laboratory, University of Valencia, Avda. Universitat, 46100-Burjassot, Spain.
| | - Juan J Carrasco
- Intelligent Data Analysis Laboratory, University of Valencia, Avda. Universitat, 46100-Burjassot, Spain.
- Department of Physiotherapy, University of Valencia, Carrer de Gascó Oliag, 5, 46010-Valencia, Spain.
| | - Santiago Bonanad
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Avinguda de Fernando Abril Martorell, 106, 46026-Valencia, Spain.
| | - Felipe Querol
- Department of Physiotherapy, University of Valencia, Carrer de Gascó Oliag, 5, 46010-Valencia, Spain.
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Avinguda de Fernando Abril Martorell, 106, 46026-Valencia, Spain.
| | - Sofía Pérez-Alenda
- Department of Physiotherapy, University of Valencia, Carrer de Gascó Oliag, 5, 46010-Valencia, Spain.
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Avinguda de Fernando Abril Martorell, 106, 46026-Valencia, Spain.
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Houghton DE, Sud S, Moll S, Rollins-Raval MA. Perils in the thrombophilia workup: Frequency and circumstances of erroneously ordered factor V activity tests for thrombophilia. Vasc Med 2017; 22:527-528. [PMID: 28965480 DOI: 10.1177/1358863x17728122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Damon E Houghton
- 1 University of North Carolina, Department of Medicine, Chapel Hill, NC, USA
| | - Shivani Sud
- 2 University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Stephan Moll
- 1 University of North Carolina, Department of Medicine, Chapel Hill, NC, USA
| | - Marian A Rollins-Raval
- 3 University of North Carolina, Department of Pathology and Laboratory Medicine, Chapel Hill, NC, USA
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Cruz-Montecinos C, De la Fuente C, Rivera-Lillo G, Morales-Castillo S, Soto-Arellano V, Querol F, Pérez-Alenda S. Sensory strategies of postural sway during quiet stance in patients with haemophilic arthropathy. Haemophilia 2017; 23:e419-e426. [DOI: 10.1111/hae.13297] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2017] [Indexed: 11/27/2022]
Affiliation(s)
- C. Cruz-Montecinos
- Laboratory of Clinical Biomechanics; Department of Physical Therapy; Faculty of Medicine; University of Chile; Santiago Chile
- Laboratory of Biomechanics and Kinesiology San José Hospital; Santiago Chile
| | - C. De la Fuente
- Facultad Cs de la Rehabilitación; Universidad Andrés Bello; Santiago Chile
- Carrera de Kinesiología; UDA Cs de la salud, Escuela de Medicina; Pontificia Universidad Católica de Chile; Santiago Chile
| | - G. Rivera-Lillo
- Laboratory of Clinical Biomechanics; Department of Physical Therapy; Faculty of Medicine; University of Chile; Santiago Chile
- Center of Integrated Studies in Neurorehabilitation; Clinica Los Coihues; Santiago Chile
- Department of Neuroscience; Faculty of Medicine; University of Chile; Santiago Chile
| | - S. Morales-Castillo
- Laboratory of Biomechanics and Kinesiology San José Hospital; Santiago Chile
| | - V. Soto-Arellano
- Haemophilia and Inherited Bleeding Disorder Treatment Center; Roberto del Río Hospital; Santiago Chile
| | - F. Querol
- Department of Physiotherapy; University of Valencia; Valencia Spain
- Haemostasis and Thrombosis Unit; University and Polytechnic Hospital La Fe; Valencia Spain
| | - S. Pérez-Alenda
- Department of Physiotherapy; University of Valencia; Valencia Spain
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