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DiBenedetti D, Neme D, Pan-Petesch B, Willemze A, Wynn T, Kragh N, Wilson A. Patient Experience With Efanesoctocog Alfa for Severe Hemophilia A: Results From the XTEND-1 Phase 3 Clinical Study Exit Interviews. Clin Ther 2024:S0149-2918(24)00272-8. [PMID: 39414418 DOI: 10.1016/j.clinthera.2024.09.010] [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: 04/08/2024] [Revised: 08/12/2024] [Accepted: 09/08/2024] [Indexed: 10/18/2024]
Abstract
PURPOSE Hemophilia A is a rare bleeding disorder that leads to recurrent hemarthrosis, which can ultimately result in reduced mobility and poor quality of life. Qualitative exit interviews provide insights into patient perspectives and support the interpretation of quantitative trial data, such as patient-reported outcome measures. In the Phase 3 XTEND-1 study (NCT04161495) of efanesoctocog alfa in participants with severe hemophilia A, exit interviews were conducted to understand pre- and post-study experiences with pain and physical functioning and to evaluate participants' treatment experiences. METHODS In XTEND-1, participants (≥12 years old) received once-weekly efanesoctocog alfa prophylaxis 50 IU/kg for 52 weeks (Arm A) or on-demand efanesoctocog alfa 50 IU/kg for 26 weeks followed by 26 weeks once-weekly prophylaxis (50 IU/kg; Arm B). Optional qualitative exit interviews were conducted using a semi-structured guide in a subset of participants following study completion. Interviews included open-ended questions about participants' pre- and post-study experiences with hemophilia A and targeted questions relating to improvements in patient-reported outcomes assessed during XTEND-1, including the Haemophilia Quality of Life Questionnaire for Adults Physical Health subscale (Haem-A-QoL PH). Content validity of the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity 3a measure was also assessed, particularly the worst pain item. FINDINGS Exit interviews were conducted with 29 of 159 patients enrolled in XTEND-1 (mean [range] age 40 [16-73] years). Of 17 participants enrolled in Arm A, 13 (76.5%) reported a "wearing off" feeling with pre-study treatment, including more aches/pain, breakthrough bleeds, and limited physical activities. Joint pain was the most reported pre-study symptom (96.6%; n = 28/29), followed by a reduced ability to move without pain (89.7%, n = 26/29). Improvements following efanesoctocog alfa prophylaxis in ≥1 Haem-A-QoL PH domain were reported by 89.7% (n = 26/29) of participants, with improvements in joint pain, the ability to move without pain, and painful swellings reported by at least 21 (84%) participants. Participants reported that the PROMIS Pain Intensity 3a items were relevant, clear, and easy to answer. Most participants (96.6%) were "quite satisfied" or "very satisfied" with efanesoctocog alfa prophylaxis. All participants preferred efanesoctocog alfa over pre-study treatment. IMPLICATIONS The exit interviews demonstrated that once-weekly efanesoctocog alfa prophylaxis resulted in patient-relevant and meaningful improvements in pain and physical functioning, consistent with the quantitative findings from XTEND-1. These results support the validity of the Haem-A-QoL PH and PROMIS Pain Intensity 3a assessed during XTEND-1, demonstrating the potential for change with efficacious treatment. TRIAL REGISTRY ClinicalTrials.gov TRIAL REGISTRATION NUMBER: NCT04161495 REGISTRY URL: https://clinicaltrials.gov/study/NCT04161495.
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Affiliation(s)
| | - Daniela Neme
- Hemophilia Foundation, Soler 3485, CABA, Argentina
| | - Brigitte Pan-Petesch
- Hématologie Hémostase, Centre Hospitalier Régional Universitaire de Brest, Hôpital A. Morvan, Brest, France
| | | | - Tung Wynn
- Division of Hematology & Oncology, Department of Pediatrics, University of Florida, Gainesville, Florida
| | | | - Amanda Wilson
- Sanofi, 270 Albany Street, Cambridge, 02139, Massachusetts
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Ucero-Lozano R, Donoso-Úbeda E, Cuesta-Barriuso R, Pérez-Llanes R. Immersive VR movement visualization in patients with hemophilic knee arthropathy: randomized, multicenter, single-blind clinical trial. Disabil Rehabil 2024:1-8. [PMID: 39244653 DOI: 10.1080/09638288.2024.2401138] [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: 03/06/2024] [Revised: 08/30/2024] [Accepted: 08/31/2024] [Indexed: 09/10/2024]
Abstract
PURPOSE To evaluate the efficacy of an immersive movement visualization intervention in patients with hemophilia and hemophilic knee arthropathy. MATERIALS AND METHODS Randomized, single-blind clinical study. Twenty-eight patients with hemophilia were recruited. Patients were randomized to an experimental group (four weeks of immersive movement visualization) and a control group (no intervention). The intensity of pain, pressure pain threshold in the knee, tibialis anterior muscle, lower back level, conditioned pain modulation, range of knee motion, and lower limb functionality were evaluated. RESULTS There were statistically significant differences in the intergroup effect on knee pain intensity (F = 23.71; p < 0.001) and lower limb functionality (F = 7.11; p = 0.003). 42.86% of the patients in the experimental group exhibited changes greater than the minimum detectable change (MDC) in functionality. 39.29% of the patients subject to the intervention experienced changes greater than the MDC in the knee pressure pain threshold. CONCLUSIONS Immersive motion visualization can improve the intensity of joint pain and functionality in patients with hemophilic knee arthropathy. Functionality, pressure pain threshold, and pain intensity improved in those patients who conducted immersive movement visualization.Implications for rehabilitationImmersive visualization of movement significantly improves intensity of joint pain, functionality, pressure pain threshold, joint health, and conditioned pain modulation in patients with hemophilic knee arthropathy.The fact that it is a therapy without potential aversive stimuli makes it a possible access pathway for patients with high levels of kinesiophobia and/or catastrophism.This low-cost, home-based technology allows its use in patients far from hemophilia reference centers or with difficult access to physiotherapy treatments.The immersive visualization of movement influences the democratization of treatment, in accordance with the WHO's Sustainable Development Goal 3 (health and well-being for all).
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Affiliation(s)
- Roberto Ucero-Lozano
- Department of Physiotherapy, European University of Madrid, Madrid, Spain
- InHeFis Research Group, Instituto Asturiano de Investigación Sanitaria (ISPA), Oviedo, Spain
| | - Elena Donoso-Úbeda
- InHeFis Research Group, Instituto Asturiano de Investigación Sanitaria (ISPA), Oviedo, Spain
- Department of Physiotherapy, Catholic University San Antonio-UCAM Murcia, Murcia, Spain
| | - Rubén Cuesta-Barriuso
- InHeFis Research Group, Instituto Asturiano de Investigación Sanitaria (ISPA), Oviedo, Spain
- Department of Surgery and Medical-Surgical Specialties, University of Oviedo, Oviedo, Spain
| | - Raúl Pérez-Llanes
- InHeFis Research Group, Instituto Asturiano de Investigación Sanitaria (ISPA), Oviedo, Spain
- Department of Physiotherapy, University of Murcia, Murcia, Spain
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Ferri Grazzi E, Hawes C, Camp C, Hinds D, O'Hara J, Burke T. Exploring the relationship between condition severity and health-related quality of life in people with haemophilia A across Europe: a multivariable analysis of data from the CHESS II study. Health Qual Life Outcomes 2024; 22:58. [PMID: 39075533 PMCID: PMC11288067 DOI: 10.1186/s12955-024-02267-6] [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: 04/27/2023] [Accepted: 06/24/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Haemophilia A (HA; Factor VIII deficiency) is a congenital X-linked bleeding disorder characterized by trauma-related or spontaneous bleeding events, most notably arising within the intraarticular space and resulting in chronic inflammation and degeneration of affected joints. Endogenous clotting factor activity relative to normal levels determines the severity of HA symptoms, as mild (> 5-40%), moderate (1-5%), or severe (< 1%). Within the current environment of rapid evolution in HA management, we seek to understand the interplay of condition severity and health-related quality of life (HRQoL) to characterise and differentiate unmet needs among people with HA (PwHA). METHODS A generalised linear regression model (GLM) was developed to explore the relationship between HA severity and EQ-5D-5 L index score from adult HA patients sampled in the "Cost of Haemophilia across Europe - a Socioeconomic Survey II" (CHESS II) cross-sectional, retrospective burden of illness study among adults with hereditary haemophilia A or B from eight European countries. HA patients of any severity with no active inhibitors during the 12 months prior to data capture and a completeEQ-5D-5 L response were included. A base GLM model was specified with covariates for demographic and clinical characteristics (age, body mass index, country, employment, HA severity, annual bleeding rate, problem joints, and chronic pain). RESULTS Of 381 evaluable patients, 221 (58.0%) had severe HA, 96 (25.2%) had moderate HA, and 64 (16.8%) had mild HA. Among the covariates included in the GLM model and after controlling for haemophilia-related outcomes, a significant association was observed between mild HA and higher EQ-5D-5 L index score (average marginal effects, 0.084; p = 0.016) relative to severe HA. Patient country of residence and magnitude of HA-related chronic pain were also associated with significant differences in index scores, with the latter showing a negative relationship with HRQoL outcomes. CONCLUSIONS Condition severity and chronic pain are significant predictors of HRQoL in PwHA. Durable bleeding protection and effective management of chronic pain have the potential to address unmet treatment needs in this population.
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Affiliation(s)
| | | | | | - David Hinds
- BioMarin Pharmaceutical, San Rafael, CA, USA
| | - Jamie O'Hara
- HCD Economics, Keckwick Lane, Daresbury, Cheshire, WA4 4FS, UK
- University of Chester, Chester, UK
| | - Tom Burke
- HCD Economics, Keckwick Lane, Daresbury, Cheshire, WA4 4FS, UK
- University of Chester, Chester, UK
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Álvarez-Román MT, Nuñez Vazquez RJ, Benitez Hidalgo O, Quintana Paris L, Entrena Ureña L, Lopez Jaime FJ, la De Corte-Rodríguez H, García Dasí M, Bosch P, Mingot Castellano ME, Guerra Garaeta I, Soto-Ortega I. Humanistic burden of haemophilia A without inhibitors: A cross-sectional analysis of the HemoLIFE study. Haemophilia 2024; 30:950-958. [PMID: 38825766 DOI: 10.1111/hae.15057] [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: 10/16/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 06/04/2024]
Abstract
AIM To evaluate the impact of haemophilia A without inhibitors on humanistic outcomes in patients and caregivers. Herein, we report a cross-sectional analysis of the baseline data of persons with haemophilia (PWH) participating in the prospective study HEMOLIFE. METHODS These data are part of a prospective, observational, and multicentre study currently being conducted in 20 hospitals in Spain by haematologists. We included subjects 12 years or older diagnosed with haemophilia. The evaluations included the Maladjustment Scale, Haemophilia-Specific Quality of Life Questionnaire for Adults (HaemoQol)/HaemoQol Short Form (Children), haemophilia-specific version of the Work Productivity and Impairment Questionnaire plus the Classroom Impairment Questionnaire (WPAI+CIQ:HS), Haemophilia Activity List (HAL)/Paediatric Haemophilia Activities List (pedHAL), visual analogue scale (VAS) for evaluating pain, Coping Pain Questionnaire-Reduced (CAD-R), and Hospital Anxiety and Depression Scale (HADS). RESULTS A total of 81 PWH were recruited at 18 centres; 66 PWH were ≥18 years (i.e., adults), and PWH 15 were <18 years (i.e., paediatric patients). Out of the 79 evaluable subjects, 16 (20%) showed an impact of haemophilia on daily life, and the areas most affected were "leisure time" (58% showed maladjustment) and "work/studies" (47% showed maladjustment). Patients reported a higher impact of haemophilia on quality of life (mean [SD] of the transformed score) in the dimensions of "sport" (49.4 [28.6]), "physical health" (40.5 [25.8]) and "future" (37.7 [28.9]). In adults, according to HAL scores, greater impairment of function was observed in "lying/sitting/kneeling/standing," "function of legs" and "leisure activities and sports," with mean normalized scores of 64.7, 65.1 and 69.0, respectively. Productivity was mostly impacted by presenteeism. The pain was infrequent and moderate. According to the HADS scores, nine (11.5%) patients had clinical anxiety and depression. CONCLUSION PWH without inhibitors exhibited impairments in adjustment, quality of life and functionality, especially related to leisure and sports activities, and exhibit relevant levels of anxiety and depression.
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Affiliation(s)
| | | | - Olga Benitez Hidalgo
- Servicio de Hematología, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Laura Quintana Paris
- Unidad de Hematología y Hemoterapia, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Laura Entrena Ureña
- Servicio de Hematología y Hemoterapia, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - Hortensia la De Corte-Rodríguez
- Physical and Rehabilitation Medicine Department, La Paz University Hospital, Madrid, Spain
- IdiPAZ Institute for Health Research, Madrid, Spain
| | - María García Dasí
- General Health Psychologist, Freelance Independent Consultor, Valencia, Spain
| | - Pau Bosch
- Unidad de Trombosis y Hemostasia, Hospital Universitario y Politécnico de La Fe, Valencia, Spain
| | - María Eva Mingot Castellano
- Servicio de Hematología, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Sevilla, Spain
| | | | - Inmaculada Soto-Ortega
- Sección de Hemostasia y Trombosis, Hospital Universitario Central de Asturias, Oviedo, Spain
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Qvigstad C, Sørensen LQ, Tjønnfjord GE, Holme PA. The association between unemployment and treatment among adults with hemophilia. Res Pract Thromb Haemost 2024; 8:102514. [PMID: 39188890 PMCID: PMC11345527 DOI: 10.1016/j.rpth.2024.102514] [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: 04/09/2024] [Revised: 06/24/2024] [Accepted: 07/02/2024] [Indexed: 08/28/2024] Open
Abstract
Background People with hemophilia often experience pain and suffer from comorbidities related to their bleeding disorder. Consequently, unemployment due to disability is prevalent among people with hemophilia. Objectives To explore associations between unemployment due to disability and treatment while adjusting for known risk factors for unemployment. Methods Collecting data from 20 hemophilia centers from 15 European countries, the Age-related DeVelopments ANd ComorbiditiEs in hemophilia study recruited 785 participants aged 40 years and over with hemophilia A or B. A comprehensive electronic case report form included items related to patient characteristics, demographic information, past and current treatment regimens, and medical history, including a lifelong history of comorbidities. Baseline data from the Age-related DeVelopments ANd ComorbiditiEs in hemophilia study was analyzed using descriptive statistics and logistic regression models. Results Employment status was available for 756 of 785 participants aged 40 to 88 years (median, 53 years). We used regression analysis to compare people with hemophilia who were fully employed with those who were unemployed due to disability. This analysis included 424 participants. Using multivariable logistic regression, we found that age (odds ratio [OR], 1.07; P < .01), severe hemophilia (OR, 10.81; P < .01), current smoker (OR, 2.53; P < .01), and psychiatric disorder (OR, 4.18; P = .02) were associated with increased odds of unemployment due to disability. In contrast, prophylactic treatment (OR, 0.44; P = .01) was associated with decreased odds. Conclusion Our analysis suggests that by maintaining factor levels above a critical threshold (3%-5%), prophylactic treatment for people with hemophilia could help avoid unemployment due to disability. While prophylaxis is more costly and can be burdensome, the benefits to material well-being and quality of life could be substantial.
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Affiliation(s)
- Christian Qvigstad
- Department of Haematology, Oslo University Hospital Rikshospitalet, Rikshospitalet, Norway
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Rikshospitalet, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Geir E. Tjønnfjord
- Department of Haematology, Oslo University Hospital Rikshospitalet, Rikshospitalet, Norway
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Rikshospitalet, Norway
| | - Pål André Holme
- Department of Haematology, Oslo University Hospital Rikshospitalet, Rikshospitalet, Norway
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Rikshospitalet, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Mansueto MF, Bigi S, Follino M, Lupi A, Coppola A. Patient Perspective on Disease Burden and Gene Therapy for Hemophilia A and B: The "Haemvolution for Patients" Italian Survey. Semin Thromb Hemost 2024. [PMID: 38889801 DOI: 10.1055/s-0044-1787664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Hemophilia is a rare X-linked congenital bleeding disorder due to a deficiency of factor VIII (hemophilia A [HA]) or factor IX (hemophilia B [HB]). Replacement and nonreplacement treatments are available but have limitations. Gene therapy (GT) provides an effective, long-term, single-dose treatment option, now approaching clinical practice. This study aimed to understand patient perspectives on GT for HA and HB in Italy using a qualitative questionnaire distributed through Italian patient associations, addressing patient views on daily life, treatments, unmet needs, quality of life (QoL), and GT for hemophilia. In total, 141 participants had HA, and 14 had HB (severe 78.6%). Daily life was most affected by pain and/or joint function limitations (57.5% of participants), high infusion frequency (42.5%), management of breakthrough bleeding episodes (40.3%), and anxiety/fear of severe or sudden bleeding (38.8%). Despite current treatments, about half of the participants experienced three or more annual bleeding episodes. Most participants knew of GT (87.2%) and expected improvements in QoL (60.5%), reduced frequency of current treatments (53.5%), and a permanent cure (49.1%); 46.4% were unaware of its once-off dosage and 46.4% were not concerned about the costs they anticipated to be associated with GT. Although several fears were reported, 25.0% of participants were willing to undergo GT with the support of a multidisciplinary team. This survey provided valuable insight into patient perspectives on hemophilia and GT in Italy. Overall, relevant proportions of patients still experience limitations affecting their daily life. Most were positive about GT and anticipated improvements in their clinical outcomes and QoL.
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Affiliation(s)
- Maria Francesca Mansueto
- Centro Emofila e Divisione di Ematologia, Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Palermo, Italy
| | - Sarah Bigi
- Dipartimento di Scienze Linguistiche e Letterature Straniere, Università Cattolica del Sacro Cuore, Milan, Italy
| | | | - Angelo Lupi
- Federation of Haemophilia Associations (FedEmo), Rome, Italy
| | - Antonio Coppola
- Regional Reference Centre for Inherited Bleeding Disorders, Department of General and Specialist Medicine, University Hospital of Parma, Parma, Italy
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Kenet G, Nolan B, Zulfikar B, Antmen B, Kampmann P, Matsushita T, You CW, Vilchevska K, Bagot CN, Sharif A, Peyvandi F, Young G, Negrier C, Chi J, Kittner B, Sussebach C, Shammas F, Mei B, Andersson S, Kavakli K. Fitusiran prophylaxis in people with hemophilia A or B who switched from prior BPA/CFC prophylaxis: the ATLAS-PPX trial. Blood 2024; 143:2256-2269. [PMID: 38452197 PMCID: PMC11181353 DOI: 10.1182/blood.2023021864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 03/09/2024] Open
Abstract
ABSTRACT Fitusiran, a subcutaneous investigational small interfering RNA therapeutic, targets antithrombin to rebalance hemostasis in people with hemophilia A or B (PwHA/B), irrespective of inhibitor status. This phase 3, open-label study evaluated the efficacy and safety of fitusiran prophylaxis in males aged ≥12 years with hemophilia A or B, with or without inhibitors, who received prior bypassing agent (BPA)/clotting factor concentrate (CFC) prophylaxis. Participants continued their prior BPA/CFC prophylaxis for 6 months before switching to once-monthly 80 mg fitusiran prophylaxis for 7 months (onset and efficacy periods). Primary end point was annualized bleeding rate (ABR) in the BPA/CFC prophylaxis and fitusiran efficacy period. Secondary end points included spontaneous ABR (AsBR) and joint ABR (AjBR). Safety and tolerability were assessed. Of 80 enrolled participants, 65 (inhibitor, n = 19; noninhibitor, n = 46) were eligible for ABR analyses. Observed median ABRs were 6.5 (interquartile range [IQR], 2.2-19.6)/4.4 (IQR, 2.2-8.7) with BPA/CFC prophylaxis vs 0.0 (IQR, 0.0-0.0)/0.0 (IQR, 0.0-2.7) in the corresponding fitusiran efficacy period. Estimated mean ABRs were substantially reduced with fitusiran by 79.7% (P = .0021) and 46.4% (P = .0598) vs BPA/CFC prophylaxis, respectively. Forty-one participants (63.1%) experienced 0 treated bleeds with fitusiran vs 11 (16.9%) with BPAs/CFCs. Median AsBR and AjBR were both 2.2 with BPA/CFC prophylaxis and 0.0 in the fitusiran efficacy period. Two participants (3.0%) experienced suspected or confirmed thromboembolic events with fitusiran. Once-monthly fitusiran prophylaxis significantly reduced bleeding events vs BPA/CFC prophylaxis in PwHA/B, with or without inhibitors, and reported adverse events were generally consistent with previously identified risks of fitusiran. This trial was registered at www.ClinicalTrials.gov as #NCT03549871.
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Affiliation(s)
- Gili Kenet
- The National Hemophilia Centre, Amalia Biron Thrombosis Research Institute, Sheba Medical Centre, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - Beatrice Nolan
- Department of Hematology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Bulent Zulfikar
- Division of Pediatric Hematology-Oncology, Istanbul University Oncology Institute, Istanbul, Turkey
| | - Bulent Antmen
- Department of Pediatric Hematology/Oncology and Bone Marrow Transplantation Unit, Faculty of Medicine, Acibadem University, Adana Hospital, Adana, Turkey
| | - Peter Kampmann
- Department of Hematology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Tadashi Matsushita
- Department of Transfusion Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Chur-Woo You
- Department of Pediatrics, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, South Korea
| | - Kateryna Vilchevska
- Department of Hematology, Ohmatdyt National Children’s Specialized Hospital, Kyiv, Ukraine
| | - Catherine N. Bagot
- Department of Haematology, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | | | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Guy Young
- Hemostasis and Thrombosis Center, Cancer and Blood Diseases Institute, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Claude Negrier
- UR4609 Hemostasis and Thrombosis, Claude Bernard University Lyon 1, Lyon, France
| | | | | | | | | | | | | | - Kaan Kavakli
- Department of Haematology, Ege University Faculty of Medicine, Children's Hospital, Izmir, Turkey
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Feldberg G, Ricciardi JBS, Zorzi AR, Yamaguti-Hayakawa GG, Ozelo MC. Promoting pain coping skills in haemophilia: A remote intervention integrating exercise and pain education. Haemophilia 2024; 30:800-808. [PMID: 38523258 DOI: 10.1111/hae.14991] [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: 11/02/2023] [Revised: 02/26/2024] [Accepted: 03/01/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Chronic joint pain is a significant and widespread symptom in people with haemophilia (PWH). Despite medical advancements, effective pain management remains challenging. AIM This study presents an innovative approach that integrates remote physical exercises, pain neuroscience education, and coping strategies to address chronic pain in PWH. METHODS The remote intervention consisted of sixteen 5-min videos encompassing physical exercises for chronic pain management and pain education strategies. These videos formed an 8-week remote intervention program. Clinical and physical assessments were conducted before and after the intervention. RESULTS A total of thirty-one PWHs, with a median age of 34 years (ranging from 16 to 59 years), completed the remote intervention. The study revealed significant improvements in pain intensity, disability, and physical performance among PWH with chronic pain. Enhanced functional capacity was evident in the Timed Up and Go and Single Leg Stance tests, accompanied by improved scores on the Functional Independence Score in Haemophilia (FISH). Although lacking a control group, our findings are consistent with other successful exercise and pain education programs. CONCLUSIONS This innovative intervention holds promise for managing chronic pain in PWH, underscoring patient empowerment, education, and collaboration. Notably, our study stands out by uniquely combining pain education and coping strategies, bolstering evidence for effective pain management.
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Affiliation(s)
- Glenda Feldberg
- Hemophilia Treatment Center (HTC) "Cláudio Luiz Pizzigatti Corrêa", Hemocentro UNICAMP, University of Campinas, Campinas, SP, Brazil
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, SP, Brazil
| | - Janaína B S Ricciardi
- Hemophilia Treatment Center (HTC) "Cláudio Luiz Pizzigatti Corrêa", Hemocentro UNICAMP, University of Campinas, Campinas, SP, Brazil
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, SP, Brazil
| | - Alessandro R Zorzi
- Department of Orthopedic, Rheumatology and Traumatology, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, Brazil
| | - Gabriela G Yamaguti-Hayakawa
- Hemophilia Treatment Center (HTC) "Cláudio Luiz Pizzigatti Corrêa", Hemocentro UNICAMP, University of Campinas, Campinas, SP, Brazil
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, SP, Brazil
| | - Margareth C Ozelo
- Hemophilia Treatment Center (HTC) "Cláudio Luiz Pizzigatti Corrêa", Hemocentro UNICAMP, University of Campinas, Campinas, SP, Brazil
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, SP, Brazil
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Miesbach W, von Drygalski A, Smith C, Sivamurthy K, Pinachyan K, Bensen-Kennedy D, Drelich D, Kulkarni R. The current challenges faced by people with hemophilia B. Eur J Haematol 2024; 112:339-349. [PMID: 38082533 DOI: 10.1111/ejh.14135] [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: 03/10/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 02/17/2024]
Abstract
Hemophilia B (HB) is a rare, hereditary disease caused by a defect in the gene encoding factor IX (FIX) and leads to varying degrees of coagulation deficiency. The prevailing treatment for people with HB (PWHB) is FIX replacement product. The advent of recombinant coagulation products ushered in a new era of safety, efficacy, and improved availability compared with plasma-derived products. For people with severe HB, lifelong prophylaxis with a FIX replacement product is standard of care. Development of extended half-life FIX replacement products has allowed for advancements in the care of these PWHB. Nonetheless, lifelong need for periodic dosing and complex surveillance protocols pose substantive challenges in terms of access, adherence, and healthcare resource utilization. Further, some PWHB on prophylactic regimens continue to experience breakthrough bleeds and joint damage, and subpopulations of PWHB, including women, those with mild-to-moderate HB, and those with inhibitors to FIX, experience additional unique difficulties. This review summarizes the current challenges faced by PWHB, including the unique subpopulations; identifying the need for improved awareness, personalized care strategies, and new therapeutic options for severe HB, which may provide future solutions for some of the remaining unmet needs of PWHB.
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Affiliation(s)
| | | | | | | | | | | | | | - Roshni Kulkarni
- Michigan State University Center for Bleeding and Clotting Disorders, Lansing, Michigan, USA
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Martins SCM, DE Andrade E, Silva MBE, Ozelo MC, Campos GCDE, Pagnano RG. EFFECTIVENESS OF VISCOSUPPLEMENTATION IN THE TREATMENT OF HEMOPHILIC ARTHROPATHY: A SYSTEMATIC REVIEW. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e271857. [PMID: 38115879 PMCID: PMC10726718 DOI: 10.1590/1413-785220233105e271857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/28/2023] [Indexed: 12/21/2023]
Abstract
Objective To describe the efficacy of using viscosupplementation in patients with hemophilic arthropathy (HA), on pain, limb functionality, and quality of life. Methods A systematic review of the literature was performed following the PRISMA guidelines without limitations of language or year of publication. The search was performed on the following medical databases: PubMed, Cochrane Library, EMBASE, BVS/BIREME, Scopus, Web of Science, EBSCOhost, and PROQUEST in April 2020. The search used the following word: (hemophilia AND joint diseases) OR (haemophilic arthropathy OR hemophilic arthropathy) AND viscosupplementation. Results The systematic review identified 127 articles, 10 of which were selected for data extraction and qualitative analysis. The 10 selected articles included 297 joints with HA in 177 hemophilic subjects. Our review showed positive results in alleviating pain and improving functional capacity, and quality of life. No major adverse effects were observed. Conclusion There is a lack of scientific evidence regarding viscosupplementation with hyaluronic acid, but the results presented in this research suggest that it is an effective and safe therapeutic option to alleviate pain and improve functional capacity in patients with HA. Level of Evidence II, Systematic Review.
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Affiliation(s)
- Samilly Conceição Maia Martins
- Universidade Estadual de Campinas, Faculdade de Ciencias Medicas, Departamento de Ortopedia e Traumatologia, Campinas, SP, Brazil
| | - Erion DE Andrade
- Universidade Estadual de Campinas, Faculdade de Ciencias Medicas, Departamento de Neurologia e Neurocirurgia, Campinas, SP, Brazil
| | - Mayara Branco E Silva
- Universidade Estadual de Campinas, Faculdade de Ciencias Medicas, Departamento de Ortopedia e Traumatologia, Campinas, SP, Brazil
| | - Margareth Castro Ozelo
- Universidade Estadual de Campinas, Centro de Hematologia e Hemoterapia, Unidade de Hemofilia "Claudio Luiz Pizzigatti Correa", Campinas, SP, Brazil
- Universidade Estadual de Campinas, Faculdade de Ciencias Medicas, Departamento de Medicina Interna, Campinas, SP, Brazil
| | - Gustavo Constantino DE Campos
- Universidade Estadual de Campinas, Faculdade de Ciencias Medicas, Departamento de Ortopedia e Traumatologia, Campinas, SP, Brazil
| | - Rodrigo Gonçalves Pagnano
- Universidade Estadual de Campinas, Faculdade de Ciencias Medicas, Departamento de Ortopedia e Traumatologia, Campinas, SP, Brazil
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11
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O'Mahony B, Dunn AL, Leavitt AD, Peyvandi F, Ozelo MC, Mahlangu J, Peerlinck K, Wang JD, Lowe GC, Tan CW, Giermasz A, Tran H, Khoo TL, Cockrell E, Pepperell D, Chambost H, López Fernández MF, Kazmi R, Majerus E, Skinner MW, Klamroth R, Quinn J, Yu H, Wong WY, Robinson TM, Pipe SW. Health-related quality of life following valoctocogene roxaparvovec gene therapy for severe hemophilia A in the phase 3 trial GENEr8-1. J Thromb Haemost 2023; 21:3450-3462. [PMID: 37678546 DOI: 10.1016/j.jtha.2023.08.032] [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: 12/13/2022] [Revised: 08/11/2023] [Accepted: 08/27/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Severe hemophilia A (HA) negatively impacts health-related quality of life (HRQOL). OBJECTIVES We aimed to analyze HRQOL in adult men with severe HA without inhibitors after valoctocogene roxaparvovec gene transfer in the phase 3 trial GENEr8-1. METHODS Participant-reported outcomes were the hemophilia-specific quality of life questionnaire for adults (Haemo-QOL-A), the EQ-5D-5L instrument, the Hemophilia Activities List (HAL), and the Work Productivity and Activity Impairment Questionnaire: Hemophilia Specific (WPAI+CIQ:HS). Participants completed the questionnaires at baseline and through 104 weeks postinfusion with 6 × 1013 vg/kg of valoctocogene roxaparvovec. Scores were analyzed per participant characteristics and outcomes. RESULTS For 132 HIV-negative participants, mean change from baseline in Haemo-QOL-A Total Score met the anchor-based clinically important difference (CID: 5.5) by week 12; the mean (SD) increase was 7.0 (12.6) at week 104. At week 104, improvement in Consequences of Bleeding, Treatment Concern, Worry, and Role Functioning domain scores exceeded the CID (6). EQ-5D-5L Utility Index scores improved above the CID at week 52, but not at week 104. EQ-5D-5L visual analog scale and HAL scores increased from baseline to week 104. Participants reported less activity and work impairment at week 104 than baseline. Participants with problem joints had lower mean baseline Haemo-QOL-A Total and domain scores than those without them, but improved over 104 weeks, except for 11 participants with ≥3 problem joints. Participants with 0 bleeds during the baseline prophylaxis period reported Haemo-QOL-A score improvements above the CID, including in the Consequences of Bleeding domain. CONCLUSION Valoctocogene roxaparvovec provided clinically meaningful HRQOL improvement for men with severe HA.
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Affiliation(s)
- Brian O'Mahony
- Irish Haemophilia Society, Dublin, Ireland; Trinity College, Dublin, Ireland.
| | - Amy L Dunn
- The Division of Hematology, Oncology, and BMT at Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Andrew D Leavitt
- University of California San Francisco, San Francisco, California, USA
| | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy; Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Margareth C Ozelo
- Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Johnny Mahlangu
- Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand and NHLS, Johannesburg, South Africa
| | - Kathelijne Peerlinck
- Department of Vascular Medicine and Haemostasis and Haemophilia Centre, University Hospitals Leuven, Leuven, Belgium
| | - Jiaan-Der Wang
- Center for Rare Disease and Hemophilia, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Gillian C Lowe
- West Midlands Comprehensive Care Haemophilia Centre, Queen Elizabeth Hospital, Birmingham, UK
| | - Chee Wee Tan
- Department of Haematology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia
| | - Adam Giermasz
- Hemophilia Treatment Center, University of California Davis, Sacramento, California, USA
| | - Huyen Tran
- Haemostasis & Thrombosis Unit, Haemophilia Treatment Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Teh-Liane Khoo
- Institute of Haematology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Erin Cockrell
- Pediatric Hematology Oncology, Saint Joseph's Children's Hospital, Tampa, Florida, USA
| | - Dominic Pepperell
- Department of Haematology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Hervé Chambost
- AP-HM, Department of Pediatric Hematology Oncology, Children Hospital La Timone & Aix Marseille University, INSERM, INRA, C2VN, Marseille, France
| | | | - Rashid Kazmi
- Department of Haematology, Southampton University Hospital, Southampton, UK
| | - Elaine Majerus
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Mark W Skinner
- Institute for Policy Advancement Ltd, Washington, DC, USA; McMaster University, Hamilton, Ontario, Canada
| | - Robert Klamroth
- Comprehensive Care Haemophilia Treatment Center, Vivantes Klinikum im Friedrichshain, Berlin, Germany; Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Medical Faculty, University of Bonn, Germany
| | | | - Hua Yu
- BioMarin Pharmaceutical Inc, Novato, California, USA
| | - Wing Yen Wong
- BioMarin Pharmaceutical Inc, Novato, California, USA
| | | | - Steven W Pipe
- Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor, Michigan, USA
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12
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Eichler H, Nagao A, Waller J, Stuber A. Real-World Experience of People with Hemophilia A Receiving Turoctocog Alfa Pegol (N8-GP): Results from a Patient Experience Survey. Patient Prefer Adherence 2023; 17:3001-3014. [PMID: 38027080 PMCID: PMC10661914 DOI: 10.2147/ppa.s394216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Turoctocog alfa pegol (N8-GP) is an extended half-life recombinant factor VIII molecule used for the treatment of hemophilia A (HA). The purpose of this study was to investigate real-world experiences of patients with HA treated with N8-GP. Patients and Methods A 25-minute online survey was completed by adults (≥18 years) and caregivers of adolescents (12-16 years) with HA receiving N8-GP across six countries (Germany, Italy, Portugal, Spain, UK and US). Patients were recruited using a multichannel approach through recruitment panels, referrals from healthcare professionals and patient associations. The survey comprised a questionnaire with metrics including satisfaction and preferences for N8-GP, quality of life (QoL) and long-term impact. Results A total of 62 participants (98% male [n=61], mean age 29 years) comprising 46 patients and 16 caregivers completed the survey. Patients (60% non-severe [n=37] and 40% severe [25]) were on N8-GP for a mean period of 1.4 years. Patients expressed satisfaction (95% vs 42%, p<0.001) and preference (91% vs 9%, p<0.001) for N8-GP vs their previous treatments. Most patients with severe HA (87%, p=0.038) and patients on prophylaxis (84%, p<0.001) stated lower frequency of injections as their main reason for satisfaction, while improved QoL drove satisfaction for non-severe patients (81%, p=0.053). Overall, patients perceived that QoL score improved (74.8 vs 65.9, p=0.01) with N8-GP treatment compared with previous treatments. Flexibility to store at room temperature was one of the key convenience factors driving satisfaction. Patients believed that N8-GP can offer a long-term impact in areas such as ability to perform day-to-day activities (68%), independence to live like a person without hemophilia (63%), ability to travel (60%) with a feeling of optimism and hopefulness (82%). Conclusion Lower frequency of injections, storage flexibility and improved QoL drove satisfaction and preference for N8-GP over previous treatments among patients with HA.
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Affiliation(s)
- Hermann Eichler
- Institute of Clinical Hemostaseology and Transfusion Medicine, Saarland University, Homburg, Germany
| | - Azusa Nagao
- Department of Blood Coagulation, Ogikubo Hospital, Tokyo, Japan
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13
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Khair K, McLaughlin P, Roussel N, Boyton M, Holland M. Prevalence and perceptions of pain in people with haemophilia: A UK study. Haemophilia 2023; 29:1509-1518. [PMID: 37694815 DOI: 10.1111/hae.14860] [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: 03/10/2023] [Revised: 08/11/2023] [Accepted: 08/30/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Joint bleeds in haemophilia cause destruction of articular structures, impaired function and pain. Up to 70% of people with haemophilia (PWH) report chronic pain. Little is known about the pain experiences in PWH in the UK. AIM To identify prevalence and perceptions of pain among PWH living in the UK. METHODS A cross-sectional, non-interventional survey study conducted among PWH (all severities). The survey incorporated elements from validated tools (EQ-5D; EQ-VAS) and was distributed via participating treatment centres. RESULTS Five hundred and ninety-nine PWH responded, 91% aged > 18. 81% used factor prophylactically or on demand. More pain was reported by those treated on demand versus prophylaxis particularly in those who reported daily pain. 65% reported 'problem joints' based on individual impact rather than medically defined 'target joints', 2/3 reported multiple joint issues. The ankle was most commonly affected. 59% reported frequent pain, with 56% aware of pain constantly or most of the time and were more likely to report less favourable EQ-5D or EQ-VAS scores (p < .001). Pain frequency/awareness was consistent across all severities. Most discussed pain with care teams, 31% only when asked; 25% did not discuss it. Pain discussions resulted in physiotherapy referral (63%) analgesia prescription (48%), and a minority specialist pain referral (9%). Most felt well supported with regard to their pain, but 70% reported learning to live with it. CONCLUSION Pain affects PWH of all ages and severities even in a well-resourced country significantly impacting quality of life. Clinicians must be more aware of chronic pain in PWH. Biopsychosocial approaches to pain assessment and management are recommended.
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Affiliation(s)
| | - Paul McLaughlin
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free Hospital, London, UK
| | - Nathalie Roussel
- Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Antwerp, Belgium
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14
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Young L, Chen Y, Alvir J, Burke T, Ferri Grazzi E, Winburn I. The impact of bleeding event frequency on health-related quality of life and work productivity outcomes in a European cohort of adults with haemophilia A: insights from the CHESS II study. Orphanet J Rare Dis 2023; 18:227. [PMID: 37537683 PMCID: PMC10398941 DOI: 10.1186/s13023-023-02690-w] [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: 12/12/2022] [Accepted: 04/02/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Haemophilia A carries a substantial healthcare burden, affecting health-related quality of life (HRQoL). The Cost of Haemophilia in Men: a Socioeconomic Survey II (CHESS II), a retrospective real-world study, characterised the burden of haemophilia and its impact on HRQoL and work productivity. The current analysis explored the impact of bleeding events on HRQoL and work productivity in Europe. This analysis focused on data collected from males aged 18 to 64 years with haemophilia A without inhibitors who were receiving replacement factor products or a monoclonal antibody and were not participating in a clinical trial at the time of study recruitment. Descriptive statistics were analysed using scores from EuroQoL's EQ-5D-5L index and EQ-VAS analogue scale and the Work Productivity and Activity Index Specific Health Problem (WPAI:SHP) percentage scores stratified by the number of annual bleeding events (ABs) 0, 1, 2, 3-4, or ≥ 5. RESULTS Of 918 males with haemophilia A in CHESS II, 318 met inclusion criteria and had data available for HRQoL measures; mean age (SD) was 33.8 (12.1) years and 96% were White. Mean (SD) ABs of 2.7 (2.9) occurred over the preceding 12 months: 20% had 3 or 4 ABs; 17% had ≥ 5 ABs. Mean EQ-5D-5L index scores for patients with 0, 1, 2, 3-4, or ≥ 5 ABs were 0.92, 0.76, 0.76, 0.71, and 0.56, respectively. Mean (SD) EQ-VAS scores were 86.9 (13.6), with 0 ABs versus 69.5 (19.1) for 3 or 4 ABs and 61.2 (17.2) for ≥ 5 ABs. Mean percentage of overall work productivity loss on the WPAI:SHP questionnaire ranged from 9.70 to 0 ABs to 47.65 for ≥ 5 ABs. CONCLUSIONS In this European sample of adult men with haemophilia A, HRQoL and work productivity scores were lower among those reporting more AB events. Bleeding burden appears to affect HRQoL and productivity; however, this cross-sectional analysis limits the ability to draw firm conclusions on causality.
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Affiliation(s)
- Lisa Young
- Pfizer Ltd, Walton-on-the-Hill Tadworth, Surrey, UK.
| | | | | | - Tom Burke
- HCD Economics, Daresbury, Cheshire, UK
- Faculty of Health and Social Care, University of Chester, Chester, UK
| | | | - Ian Winburn
- Pfizer Ltd, Walton-on-the-Hill Tadworth, Surrey, UK
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15
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Peng Z, Zhu X, Wang C, Zhou M, Xu X, Chen Y. Depression and anxiety among hemophilia patients enrolled in clinical trials: a multi-center cohort study. Ann Hematol 2023:10.1007/s00277-023-05277-4. [PMID: 37212910 DOI: 10.1007/s00277-023-05277-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/14/2023] [Indexed: 05/23/2023]
Abstract
Hemophilia patients enrolled in clinical trials often exhibit various physical and psychological symptoms. However, little is known about anxiety and depression among them. This study assessed the effects of depression and anxiety on hemophilia patients enrolled in clinical trials and identified risk factors for these disorders. A multi-center, cohort study was conducted from January to December 2022. Sixty-nine hemophilia patients who enrolled in clinical trials participated at baseline (T1, prior to treatment initiation) and completed the informed consent. Risk factors were measured at baseline to predict depression and anxiety at 3 months (T2). Sixty-four hemophilia patients were included in the final analysis. More hemophilia patients had moderate-severe depression (28 [43.75%]) and anxiety (16 [25.00%]) at T2 than at T1 (12 [18.75]), (5 [7.81%]). Depression was aggravated in 23 (35.94%) patients and anxiety was aggravated in 12 (18.75%) patients. Frequently acquired medical information (OR 11.378, CI 1.319-98.114, P = 0.027), baseline GAD-7 (OR 1.341, CI 1.015-1.772, P = 0. 039) and PHQ-9 (OR 1.465, CI 1.039-2.065, P = 0.029) are important factors predicting depression and anxiety in hemophilia patients. Hemophilia patients enrolled in a clinical trial have significant anxiety and depression. The frequency of acquiring medical information and the baseline PHQ-9 and GAD-7 scores were risk factors for anxiety and depression. Thus, hemophilia patients should receive education regarding clinical trials and undergo evaluations of their anxiety and depression; these changes will enable prompt detection of their psychological burden and identify potential psychological intervention strategies.
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Affiliation(s)
- Zhen Peng
- Drug Clinical Trial Institution, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Xiaoyu Zhu
- Department of Hematology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Chongwei Wang
- Drug Clinical Trial Institution, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Mingfeng Zhou
- Department of Clinical Operation, Beijing Hiphar Medical Technology Co. LTD, Hefei, Anhui, China
| | - Xiaoling Xu
- Drug Clinical Trial Institution, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Yin Chen
- Department of Scientific Research, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
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16
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Velvin G, Dammann B, Haagensen T, Johansen H, Strømme H, Geirdal AØ, Bathen T. Work participation in adults with rare genetic diseases - a scoping review. BMC Public Health 2023; 23:910. [PMID: 37208707 DOI: 10.1186/s12889-023-15654-3] [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: 11/09/2022] [Accepted: 04/11/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Work participation is a crucial aspect of health outcome and an important part of life for most people with rare genetic diseases. Despite that work participation is a social determinant of health and seems necessary for understanding health behaviours and quality of life, it is an under-researched and under-recognized aspect in many rare diseases. The objectives of this study was to map and describe existing research on work participation, identify research gaps, and point to research agendas in a selection of rare genetic diseases. METHODS A scoping review was performed by searching relevant literature in bibliographic databases and other sources. Studies addressing work participation in people with rare genetic diseases published in peer reviewed journals were assessed using EndNote and Rayyan. Data were mapped and extracted based on the research questions concerning the characteristics of the research. RESULTS Of 19,867 search results, 571 articles were read in full text, and 141 satisfied the eligibility criteria covering 33 different rare genetic diseases; 7 were reviews and 134 primary research articles. In 21% of the articles the primary aim was to investigate work participation. The extent of studies varied between the different diseases. Two diseases had more than 20 articles, but most had only one or two articles. Cross-sectional quantitative studies were predominant, with few utilizing prospective or qualitative design. Nearly all articles (96%) reported information about work participation rate, and 45% also included information about factors associated with work participation and work disability. Due to differences in methodologies, cultures and respondents, comparison between and within diseases are difficult. Nevertheless, studies indicated that many people with different rare genetic diseases experience challenges related to work, closely associated to the symptoms of the disease. CONCLUSION While studies indicate high prevalence of work disability in many patients with rare diseases, the research is scarce and fragmented. More research is warranted. Information about the unique challenges of living with different rare diseases is crucial for health and welfare systems to better facilitate work participation. In addition, the changing nature of work in the digital age, may also open up new possibilities for people with rare genetic diseases and should be explored.
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Affiliation(s)
- Gry Velvin
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Oslo, 1450, Norway.
| | - Brede Dammann
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Oslo, 1450, Norway
| | - Trond Haagensen
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Oslo, 1450, Norway
| | - Heidi Johansen
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Oslo, 1450, Norway
| | - Hilde Strømme
- Library of Medicine and Science, University of Oslo, Oslo, Norway
| | - Amy Østertun Geirdal
- Department of Social Work, Child Welfare and Social Policy, Faculty of Social Science, Oslo Metropolitan University, Oslo, Norway
| | - Trine Bathen
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Oslo, 1450, Norway
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17
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Steen Carlsson K, Winding B, Astermark J, Baghaei F, Brodin E, Funding E, Holmström M, Österholm K, Bergenstråle S, Lethagen S. High use of pain, depression, and anxiety drugs in hemophilia: more than 3000 people with hemophilia in an 11-year Nordic registry study. Res Pract Thromb Haemost 2023; 7:100061. [PMID: 36908766 PMCID: PMC9999211 DOI: 10.1016/j.rpth.2023.100061] [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: 08/25/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 02/01/2023] Open
Abstract
Background Pain is a common feature of hemophilia, but prevalence of depression and anxiety is less studied. Registry data on prescription drugs can provide an objective measure of the magnitude of these complications. Objectives To identify treatment patterns of prescribed pain, antidepressant, and antianxiety medications compared with those of matched controls in 4 Nordic countries. Methods The MIND study (NCT03276130) analyzed longitudinal individual-level national data during 2007-2017. People with hemophilia (PwH) were identified from National Health Data Registers by diagnosis or factor replacement treatment and compared with population controls. Three subgroups were defined by the use of factor concentrates and sex (moderate-to-high factor consumption (factor VIII [FVIII] use of ≥40 IU/kg/week or FIX use of ≥10 IU/kg/week), low factor consumption, and women including carriers). Results Data of 3246 PwH, representing 30,184 person-years, were analyzed. PwH (including children and adults) used more pain, depression, and anxiety medications compared with controls. This was most accentuated in the moderate-to-high factor consumption group and notably also observed in men with low factor consumption and women including carriers, usually representing a milder phenotype. A higher opioid use was observed across all age groups: 4- to 6-fold higher in the moderate-to-high factor consumption group and 2- to 4-fold higher in the low factor consumption group. Conclusion The consistent higher use of pain, depression, and anxiety medications among PwH compared with population controls, regardless of age, sex, or factor consumption, in broad national data suggests a need for improved bleed protection and hemophilia care for all severities including mild hemophilia.
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Affiliation(s)
- Katarina Steen Carlsson
- The Swedish Institute for Health Economics, Lund, Sweden.,Lund University, Department of Clinical Sciences, Malmö, Lund, Sweden
| | | | - Jan Astermark
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Malmö, Sweden
| | - Fariba Baghaei
- Coagulation Centre, Department of Medicine/Section of Hematology and Coagulation, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Elisabeth Brodin
- Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, Section for Clinical Neuroscience and Rehabilitation, The Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Eva Funding
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen University, Copenhagen, Denmark
| | - Margareta Holmström
- Coagulation Unit, Centre of Hematology, Karolinska University Hospital, Stockholm, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Klaus Österholm
- HUS Internal Medicine and Rehabilitation, Physiatric Outpatient Clinic, Helsinki University Hospital, Helsinki, Finland
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18
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Manco-Johnson MJ. Long-term prophylaxis: what are our options and how to define success? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2022; 2022:579-585. [PMID: 36485126 PMCID: PMC9820516 DOI: 10.1182/hematology.2022000397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Currently, we are at an enviable place in hemophilia treatment. Although full prophylaxis with standard half-life recombinant or plasma-derived factor concentrates has been definitively shown to be inadequate for full protection against bleeding and arthropathy, a number of novel therapies with improved hemostatic enhancement are clinically available or in promising clinical trials. In order to compare outcomes among a number of very efficacious therapies, it is necessary to have sensitive tools employed in long-term follow-up for several years for participants with no or minimal joint disease. The tool kit must be comprehensive, with outcomes of bleeding, factor level restoration or hemostatic capacity, joint structure, joint function, pain, quality of life, and patient satisfaction. This article reviews the history of prophylaxis, the promise of emerging therapies, and the sensitive tools used to assess long-term efficacy for joint structure and function.
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Affiliation(s)
- Marilyn Jean Manco-Johnson
- Correspondence Marilyn Jean Manco-Johnson, University of Colorado Anschutz Medical Center, 13199 E Montview Blvd, Ste 100, Aurora CO, 80045; e-mail:
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19
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McLaughlin P, Hurley M, Chowdary P, Stephensen D, Khair K. The experiences and beliefs of people with severe haemophilia and healthcare professionals on pain management, and their views of using exercise as an aspect of intervention: a qualitative study. Disabil Rehabil 2022; 44:8420-8428. [PMID: 34951552 DOI: 10.1080/09638288.2021.2018054] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To explore the experiences, views and beliefs of people with severe haemophilia and healthcare professionals (HCPs) on approaches for pain management, as well as their views on exercise being used as an aspect of management. METHODS Taking a qualitative inquiry approach using focus groups and semi-structured interviews, participants included people with severe haemophilia living with chronic pain and haemophilia HCPs. Data were analysed using reflexive thematic analysis. RESULTS Fourteen men with haemophilia with a median age of 47 (range 23-73) and six haemophilia HCPs agreed to participate. Of the people with haemophilia, 11 attended two focus groups and three were interviewed over telephone. Healthcare professionals were interviewed face-to-face. Two themes were conceptualised from the data: (i) haemophilia management and pain management is discordant (imbalance between good haemophilia care but poor pain management, historical medico-social influences on pain management, the need for trust); (ii) uncertain about exercise but clear on what matters (conflicting views on exercise, the need for proof of safety, personalised care). CONCLUSIONS Options for effective pain management remain limited and what is used is heavily influenced by beliefs and experience. Exercise as a treatment option in pain management is conceptually acceptable for people with haemophilia. Effective pain management requires understanding of individual beliefs and fears, and a personalised approach supported by knowledgeable, trusted clinicians.Implications for rehabilitationMusculoskeletal joint pain and its relationship with bleeding in people with haemophilia continues to be a management challenge.Current pain management strategies are of limited effectiveness with little evidence of an approach that reflects the multi-modal pain experience.Whilst exercise and rehabilitation approaches are conceptually possible for people with severe haemophilia, barriers remain regarding perception of overall safety and effectiveness.People with severe haemophilia may consider exercise as part of a pain management strategy if it is individualised, and they are supported to do it by clinicians who understand them and their haemophilia.
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Affiliation(s)
- P McLaughlin
- St George's University of London and Kingston University, London, UK.,Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | - M Hurley
- St George's University of London and Kingston University, London, UK
| | - P Chowdary
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | - D Stephensen
- East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - K Khair
- Centre for Outcomes and Experience Research in Child Health, Illness and Disability (ORCHID) Research Unit, Great Ormond Street Hospital for Children NHS Trust, London, UK.,Haemnet, London, UK
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20
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Nguyen NAT, Auquier P, Beltran Anzola A, d'Oiron R, Biron-Andréani C, Lienhart A, Rauch A, Baumstarck K, Boucekine M, Milien V, Rosso-Delsemme N, Tabele C, Giraud N, Sannié T, Chambost H, Resseguier N. Occupational integration of adults with severe haemophilia (INTHEMO): A study based on the FranceCoag registry. Haemophilia 2022; 28:962-976. [PMID: 35858674 DOI: 10.1111/hae.14620] [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: 02/09/2022] [Revised: 06/13/2022] [Accepted: 06/22/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Health of people with severe haemophilia (PwSH) improves thanks to the advancements in haemophilia care, giving them more opportunities in occupational integration. However, there is little literature on the occupational integration of PwSH. OBJECTIVES The main objective of our study was to assess the occupational integration of PwSH and to compare it with that of the general population. The secondary objective was to study the association between individual characteristics (sociodemographic, clinical and psycho-behavioural) and occupational integration of PwSH. METHODS A multicentre, non-interventional, cross-sectional study was conducted in 2018-2020 on PwSH, aged over 18 and under 65 years and included in the FranceCoag registry. Measurements included indicators of occupational integration, sociodemographic, clinical and psycho-behavioural characteristics. The indicators of occupational integration were compared with those of the general population, using indirect standardization. The data of the general population were available from the National Institute of Statistics and Economic Studies (INSEE). Determinants of occupational integration were explored using structural equation modelling. RESULTS Of 1262 eligible people, 588 were included. PwSH had a lower employment rate than the general population (standardized ratio, .85; 95% CI, .77-.94). There were more PwSH at tertiary education level than expected (standardized ratio, 1.38; 95% CI, 1.17-1.61). HIV infection, poor physical health and mental health concerns were associated with a higher risk of unemployment in PwSH. CONCLUSION Employment rate of PwSH is lower than that of the general population despite their higher education level. Target interventions focusing on determinants of difficult occupational integration could be helpful for PwSH.
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Affiliation(s)
- Ngoc Anh Thu Nguyen
- CEReSS - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France.,Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France
| | - Pascal Auquier
- CEReSS - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France.,Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France.,FranceCoag Network, Marseille, France
| | - Any Beltran Anzola
- CEReSS - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France.,Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France
| | - Roseline d'Oiron
- Haemophilia Treatment Centre, Bicêtre Hospital, University Hospital of Paris (APHP), Kremlin-Bicêtre, France
| | | | - Anne Lienhart
- Haemophilia Treatment Centre, Hospital Edouard Herriot, University Hospital of Lyon, Bron, France
| | - Antoine Rauch
- Haemophilia Treatment Centre, University Regional Hospital of Lille, Lille, France
| | - Karine Baumstarck
- CEReSS - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France.,Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France.,FranceCoag Network, Marseille, France
| | - Mohamed Boucekine
- CEReSS - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France.,Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France.,FranceCoag Network, Marseille, France
| | - Vanessa Milien
- FranceCoag Network, Marseille, France.,Haemophilia Treatment Centre, Timone Hospital, University Hospital of Marseille (APHM), Marseille, France
| | - Natacha Rosso-Delsemme
- Haemophilia Treatment Centre, Timone Hospital, University Hospital of Marseille (APHM), Marseille, France
| | - Clemence Tabele
- CEReSS - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France.,FranceCoag Network, Marseille, France
| | - Nicolas Giraud
- Association française des hémophiles (AFH), Paris, France
| | - Thomas Sannié
- Association française des hémophiles (AFH), Paris, France
| | - Hervé Chambost
- FranceCoag Network, Marseille, France.,Haemophilia Treatment Centre, Timone Hospital, University Hospital of Marseille (APHM), Marseille, France
| | - Noémie Resseguier
- CEReSS - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France.,Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France
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21
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Quinn J, Delaney KA, Wong WY, Miesbach W, Bullinger M. Psychometric Validation of the Haemo-QOL-A in Participants with Hemophilia A Treated with Gene Therapy. Patient Relat Outcome Meas 2022; 13:169-180. [PMID: 35879931 PMCID: PMC9307866 DOI: 10.2147/prom.s357555] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/07/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The hemophilia-specific health-related quality of life (HRQOL) questionnaire (Haemo-QOL-A) is validated for detecting QOL changes following standard therapy for hemophilia A, but has not been rigorously evaluated after gene therapy. This post hoc analysis evaluated the psychometric properties of Haemo-QOL-A in adult people with severe hemophilia A (PWSHA) receiving valoctocogene roxaparvovec (AAV5-hFVIII-SQ) in 2 clinical trials (phase 1/2, NCT02576795; phase 3, NCT03370913). Patients and Methods Adult PWSHA (factor VIII levels ≤1 IU/dL) received 1 AAV5-hFVIII-SQ infusion (6×1013 vg/kg). Participants were assessed using the Haemo-QOL-A and the EuroQOL (EQ)-5D-5L and visual analog scale (VAS) questionnaires pre- and post-infusion. Psychometric analyses included convergent and discriminant validity, internal consistency, and reliability. Clinically important difference (CID) was estimated using 3-point change in EQ-5D-5L VAS as anchor. Results Haemo-QOL-A data were analyzed from 7 (phase 1/2, 3-year follow-up) and 16 participants (phase 3, 26-week analysis). Change in Haemo-QOL-A Total Scores correlated with EQ-5D-5L VAS score change at 26 weeks (Pearson’s correlation 0.77). At 26 weeks, increased Haemo-QOL-A Physical Functioning was associated with decreased EQ-5D-5L Pain and Discomfort and decreased Anxiety and Depression (Spearman’s Rank correlations −0.73 and −0.62, respectively, P <0.01). Internal consistency analysis showed good reliability for all domains (Cronbach’s alpha >0.7) except Treatment Concern (Cronbach’s alpha = 0.31). Anchor-based CID estimates were met for Haemo-QOL-A Total Score (≥5.5) and domain scores (≥6) for Consequences of Bleeding, Physical Functioning, Role Functioning, and Worry. Conclusion Our preliminary results suggest that the Haemo‐QOL‐A is a valid, reliable instrument for HRQOL assessment in PWSHA undergoing gene therapy. Future research should be undertaken to confirm these findings in a larger number of participants.
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Affiliation(s)
- Jennifer Quinn
- BioMarin Pharmaceuticals UK Ltd, London, UK
- Correspondence: Jennifer Quinn, BioMarin Pharmaceuticals UK Ltd, 10 Bloomsbury Way, London, WC1A 2SL, UK, Tel +44 7976 129 039, Email
| | | | | | - Wolfgang Miesbach
- Medical Clinic 2, Institute of Transfusion Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - Monika Bullinger
- Department of Medical Psychology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
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22
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Steen Carlsson K, Winding B, Astermark J, Baghaei F, Brodin E, Funding E, Holmström M, Österholm K, Bergenstråle S, Andersson E, Lethagen S. Pain, depression and anxiety in people with haemophilia from three Nordic countries: Cross-sectional survey data from the MIND study. Haemophilia 2022; 28:557-567. [PMID: 35460313 PMCID: PMC9543565 DOI: 10.1111/hae.14571] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 03/15/2022] [Accepted: 04/08/2022] [Indexed: 11/29/2022]
Abstract
Introduction People with haemophilia (PwH) may experience symptoms of haemophilia‐related pain, depression or anxiety, which can negatively impact health‐related quality of life. Aim To obtain the perspective of PwH and treaters from Sweden, Finland and Denmark on the management of haemophilia‐related pain, depression and anxiety using cross‐sectional survey data from the MIND study (NCT03276130). Methods PwH or their caregivers completed a survey about experiences of pain, depression and anxiety related to haemophilia, and the standard EQ‑5D‐5L instrument. Five investigators at haemophilia treatment centres (HTC) were sent a complementary survey containing questions about the management of pain and depression/anxiety. Results There were 343 PwH (mild: 103; moderate: 53; severe: 180; seven lacking severity information) and 71 caregiver responses. Experience of pain in the last 6 months was reported by 50% of PwH respondents and 46% of caregiver respondents. Anxiety/depression was reported by 28% of PwH respondents. Reporting of pain and anxiety/depression was associated with disease severity. Whilst 62% of PwH who had experienced pain at any time point (n = 242) felt this was adequately addressed and treated at their HTC, only 24% of those who had experienced depression/anxiety (n = 127) felt this was adequately addressed. Disease severity was negatively associated with EQ‐5D‐5L utility value (p < .001). In the HTC survey, 4/5 and 2/5 agreed that pain and depression/anxiety, respectively, are adequately addressed. Conclusions Pain and depression/anxiety occur more frequently with increasing haemophilia severity, with negative impacts on health‐related quality of life. PwH with depression/anxiety or unaddressed pain could benefit from improved management strategies.
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Affiliation(s)
- Katarina Steen Carlsson
- The Swedish Institute for Health Economics, Lund, Sweden.,Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | | | - Jan Astermark
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Malmö, Sweden
| | - Fariba Baghaei
- Coagulation Centre, Department of Medicine/Section of Hematology and Coagulation, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Elisabeth Brodin
- Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, Section for Clinical Neuroscience and Rehabilitation, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva Funding
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Margareta Holmström
- Coagulation Unit, Centre of Hematology, Karolinska University Hospital, Stockholm, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Klaus Österholm
- HUS Internal Medicine and Rehabilitation, Physiatry Outpatient Clinic, Helsinki University Hospital, Helsinki, Finland
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23
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Pasi J, Hermans C, Hakimi Z, Nazir J, Aballéa S, Ezzalfani M, Fatoye F. Improvement in pain-related quality of life in patients with hemophilia A treated with rFVIIIFc individualized prophylaxis: post hoc analysis from the A-LONG study. Ther Adv Hematol 2022; 13:20406207221079482. [PMID: 35237394 PMCID: PMC8882950 DOI: 10.1177/20406207221079482] [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: 04/30/2021] [Accepted: 01/20/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Pain, a common symptom of hemophilia, begins early in life primarily due to joint bleeding. Recurrent bleeding adversely affects patients’ pain-related physical functioning, which can negatively impact their quality of life (QoL). Objective: Post hoc analysis of data from the A-LONG study (NCT01181128), to assess change over time in pain-related QoL in patients with severe hemophilia A treated prophylactically with recombinant factor VIII Fc fusion protein (rFVIIIFc). Methods: Patients who completed Haem-A-QoL (17–65 years) and EQ-5D-3L (⩾12–65 years) questionnaires at baseline (BL) and end of study (EoS). Individual-level changes were assessed using three pain-related items of the Haem-A-QoL ‘Physical Health’ domain and the pain/discomfort item of EQ-5D-3L. Distributions of responses (EoS versus BL) were compared using McNemar’s test. Results: A significantly greater proportion of patients reported they did not experience painful swellings ( n = 87; 66% versus 46%, p < 0.01) or pain in their joints ( n = 89; 42% versus 27%; p < 0.05) at EoS versus BL. The proportion of patients who did not find it painful to move numerically increased at EoS versus BL ( n = 86; 47% versus 38%; p = NS). A significantly greater proportion of patients reported no pain/discomfort at EoS versus BL ( n = 116; 45% versus 34%; p < 0.05). Conclusion: This study reports the effect of FVIII prophylaxis on patient-reported measures of pain over time in patients with severe hemophilia A. The results of this post hoc analysis showed improvements in pain from BL to EoS in patients receiving rFVIIIFc individualized prophylaxis indicating effective pain management, a key component of patient care.
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Affiliation(s)
- John Pasi
- Barts and The London School of Medicine and Dentistry, Haematology Day Unit and Haemophilia Centre, 2nd Floor, Central Tower, The Royal London Hospital, Whitechapel, London E1 1BB, UK
| | - Cédric Hermans
- Division of Hematology, Hemostasis and Thrombosis Unit, Saint-Luc University Hospital, Université catholique de Louvain, Brussels, Belgium
| | | | | | | | | | - Francis Fatoye
- Department of Health Professions, Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK
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24
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Newman JR, Durben N, Baumann K, Lambing AY, Nichols CD, Witkop M, Santaella ME, Buckner TW. Physical therapy within US HTCs: A multicentre survey of utilization, practice patterns and pain management approaches. Haemophilia 2022; 28:343-350. [DOI: 10.1111/hae.14501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/12/2022] [Accepted: 01/23/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Jennifer R. Newman
- University of North Carolina at Chapel Hill Hemophilia and Thrombosis Center Chapel Hill NC USA
| | - Nancy Durben
- The Hemophilia Center at Oregon Health & Science University Portland Oregon USA
| | - Kimberly Baumann
- Center for Bleeding and Clotting Disorders at M Health Fairview Minneapolis Minnesota USA
| | | | | | | | | | - Tyler W. Buckner
- University of Colorado School of Medicine Hemophilia and Thrombosis Center Aurora Colorado USA
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25
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Arya S, Siad FM, Wilton P, Page D, Boma-Fischer L, Floros G, Winikoff R, Teitel J, Sholzberg M. Invisible bleeds: Lived experiences and barriers to care for men with hemophilia. J Thromb Haemost 2022; 20:296-306. [PMID: 34689399 DOI: 10.1111/jth.15570] [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: 08/02/2021] [Revised: 10/10/2021] [Accepted: 10/20/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Guidelines of the World Federation of Hemophilia support the provision of equitable, optimal care for people with hemophilia (PWH). However, limited research exists examining the lived experiences of PWH or the barriers to care they may encounter. The primary objective of this exploratory study was to describe the experiences of men with hemophilia in Canada. METHODS We conducted a qualitative descriptive study using a semistructured interview guide and analyzed transcribed interviews using inductive thematic content analysis. Inclusion criteria were: age ≥18 years, English-speaking, and confirmed diagnosis of inherited hemophilia A or B. RESULTS A total of 11 participants were interviewed. Median age was 39 years old (29-73 years old), and diagnoses included severe hemophilia A (n = 5), mild hemophilia A (n = 2), and severe hemophilia B (n = 4). Three primary themes arose: (1) impact on identity and daily life; (2) dynamic changes in treatment; and (3) barriers to care and identified needs. Major subthemes included chronic pain and activity limitation, psychosocial burden, and symptom normalization. Multidisciplinary care, coordinated surgical care, improved emergency care, and clear care plans were identified as ongoing needs. DISCUSSION Men with hemophilia described significant symptom burden and areas of ongoing need. Collaborative efforts between hematologists, emergency room physicians, and surgeons to establish hospital-specific testing, treatment and referral guidelines, and regular hemophilia treatment center audits may help address these care gaps, providing more person-centered, equitable care. Future work is required to implement these strategies and monitor their effects.
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Affiliation(s)
- Sumedha Arya
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Fartoon M Siad
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - David Page
- Canadian Hemophilia Society, Montreal, QC, Canada
| | | | - Georgina Floros
- Department of Nursing, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rochelle Winikoff
- Division of Hematology-Oncology, CHU Ste-Justine, Montreal, QC, Canada
| | - Jerome Teitel
- Department of Medicine, University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michelle Sholzberg
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine and Laboratory Medicine & Pathobiology, St. Michael's Hospital, Toronto, Ontario, Canada
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26
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Di Minno MND, Napolitano M, Giuffrida AC, Baldacci E, Carulli C, Boccalandro E, Bruno C, Forneris E, Ricca I, Passeri W, Martinelli M, Rivolta GF, Solimeno LP, Martinoli C, Rocino A, Pasta G. Diagnosis and treatment of chronic synovitis in patients with haemophilia: consensus statements from the Italian Association of Haemophilia Centres. Br J Haematol 2021; 196:871-883. [PMID: 34923621 PMCID: PMC9299781 DOI: 10.1111/bjh.17919] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/28/2021] [Accepted: 10/13/2021] [Indexed: 01/19/2023]
Abstract
Although synovitis is recognized as a marker of joint disease activity, its periodic assessment is not included in routine clinical surveillance of patients with haemophilia (PwH). In order to evaluate the current knowledge and to identify controversial issues, a preliminary literature search by the Musculoskeletal Committee of the Italian Association of Haemophilia Centres (AICE) has been conducted. Statements have been established and sent to the Italian AICE members to collect their level of agreement or disagreement by a Delphi process. Thirty‐seven consensus recommendations have been drafted. We found a general agreement on the indication to consider the presence of synovitis as a marker of joint disease activity in PwH. Accordingly, there was agreement on the indication to search for synovitis both in patients reporting joint pain and in asymptomatic ones, recognizing ultrasound as the most practical imaging technique to perform periodic joint screening. Interestingly, after detection of synovitis, there was agreement on the indication to modify the therapeutic approach, suggesting prophylaxis in patients treated on demand and tailoring treatment in patients already under prophylaxis. Whereas the need of an early consultation with a physiotherapist is recommended for PwH affected by chronic synovitis, the exact timing for an orthopaedic surgeon consultation is currently unknown.
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Affiliation(s)
| | - Mariasanta Napolitano
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | | | - Erminia Baldacci
- Hematology, University Hospital Policlinico Umberto I, Rome, Italy
| | - Christian Carulli
- Department of Health Sciences, Orthopaedic Clinic, University of Florence, Florence, Italy
| | - Elena Boccalandro
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Center, IRCCS Cà Granda Foundation, Maggiore Hospital Policlinic, Milan, Italy
| | - Clarissa Bruno
- Haemophilia Center and Thrombosis, Policlinico, Bari, Italy
| | - Eleonora Forneris
- Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Irene Ricca
- Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Walter Passeri
- Rehabilitation Service, "Domus Salutis" Casa di Cura, "Teresa Camplani" Foundation, Brescia, Italy
| | - Marco Martinelli
- Rehabilitation Service, "Domus Salutis" Casa di Cura, "Teresa Camplani" Foundation, Brescia, Italy
| | - Gianna Franca Rivolta
- Regional Reference Centre for Inherited Bleeding Disorders, University Hospital of Parma, Parma, Italy
| | - Luigi Piero Solimeno
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Center, IRCCS Cà Granda Foundation, Maggiore Hospital Policlinic, Traumatology and Orthopaedic Unit, Milan, Italy
| | - Carlo Martinoli
- Department of Health Science (DISSAL), University of Genoa, Unit of Radiology and IRCCS San Martino Hospital, Genoa, Italy
| | - Angiola Rocino
- Haemophilia and Thrombosis Centre, Haematology, Ospedale del Mare, ASL Napoli 1 Centro, Naples, Italy
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27
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Ucero-Lozano R, López-Pina JA, Ortiz-Pérez A, Cuesta-Barriuso R. The relationship between chronic pain and psychosocial aspects in patients with haemophilic arthropathy. A cross-sectional study. Haemophilia 2021; 28:176-182. [PMID: 34878699 DOI: 10.1111/hae.14469] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 11/23/2021] [Accepted: 11/23/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Pain is a major characteristic in haemophilic arthropathy. Identifying the psychosocial variables affected by pain can help when addressing these patients. AIM To assess the relationship between perceived intensity of chronic pain and joint damage, kinesiophobia, catastrophism, anxiety and perceived quality of life in adult patients with haemophilic arthropathy. METHODS Multicentre cross-sectional descriptive study. Seventy-seven adult patients with haemophilic arthropathy were recruited. The usual and maximum pain intensity (Visual Analog Scale), joint status (Haemophilia Joint Health Score), Kinesiophobia (Tampa Scale of Kinesiophobia), catastrophism (Pain catastrophizing scale), anxiety (State-Trait Anxiety inventory) and perceived quality of life (36-Item Short Form Health Survey) were evaluated. The correlation between usual and maximum pain intensity with quantitative variables was obtained with Spearman`s correlation test. Kruskal-Wallis one-way ANOVA analysed differences in perceived pain according to the severity and type of treatment, and development of inhibitors. RESULTS The usual intensity of perceived pain correlated positively with catastrophism, kinesiophobia, and state and trait anxiety. The same results were obtained when analysing the maximum perception of pain. We found an inverse correlation between the physical component of perceived quality of life and usual and maximum pain intensity perceived by patients. CONCLUSION Psychosocial factors affect the painful experience of patients with haemophilic arthropathy. Pain intensity affects the quality of life of these patients.
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Affiliation(s)
- Roberto Ucero-Lozano
- Department of Physiotherapy, Faculty of Sport Sciences, European University of Madrid, Madrid, Spain
| | | | - Alba Ortiz-Pérez
- Health Psychologist, Free exercise of the profession, Madrid, Spain
| | - Rubén Cuesta-Barriuso
- Department of Surgery and Medical-Surgical Specialties, University of Oviedo, Oviedo, Spain.,Royal Victoria Eugenia Foundation, Madrid, Spain
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28
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Paredes AC, Costa P, Roque S, Fernandes S, Lopes M, Carvalho M, Mateus A, Almeida A, Pinto PR. Effectiveness of hypnosis for pain and health-related quality-of-life among people with hemophilia: Three-month outcomes of a randomized controlled pilot trial. Complement Ther Clin Pract 2021; 45:101486. [PMID: 34601386 DOI: 10.1016/j.ctcp.2021.101486] [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: 12/18/2020] [Revised: 09/07/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND PURPOSE Pain is a common condition among people with hemophilia (PWH), negatively impacting quality of life. However, effective treatment remains a challenge. This two-arm, parallel randomized controlled pilot trial aimed to examine the three-month effects of hypnosis intervention on clinical and psychosocial variables, and on the inflammatory profile of PWH. MATERIALS AND METHODS The study was conducted between January and October 2018, in a Reference Center for Congenital Coagulopathies. Adult (age ≥18) patients were randomized to experimental group (EG) or control group (CG). The EG received four weekly hypnosis sessions plus treatment-as-usual, and the CG maintained treatment-as-usual only. Outcomes were evaluated at one week and three months post-intervention and included pain, joint status, health-related quality of life (HRQoL), emotional state and inflammatory profile (leukocytes, C-reactive protein, cytokines). The randomization sequence was computer-generated, and allocation was concealed until enrolment. The outcome assessor was blind to allocation, but blinding of the participants was not possible due to the differences in procedure. RESULTS Twenty patients were randomized to EG (n = 10; 8 analyzed) or CG (n = 10; 10 analyzed). Two-way mixed ANOVA showed significant time × group interactions on pain interference with normal work and with relations with other people, and on perception of health status. The EG significantly improved in pain interference with normal work and perception of health status. There was no report of harm. CONCLUSION Hypnosis may be a promising intervention to manage hemophilia-related pain and promote HRQoL, with benefits lasting up to three months.
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Affiliation(s)
- Ana Cristina Paredes
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS / 3B's - PT Government Associate Laboratory, Braga / Guimarães, Portugal
| | - Patrício Costa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS / 3B's - PT Government Associate Laboratory, Braga / Guimarães, Portugal; Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Susana Roque
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS / 3B's - PT Government Associate Laboratory, Braga / Guimarães, Portugal
| | - Susana Fernandes
- Congenital Coagulopathies Reference Centre, Department of Transfusion Medicine and Blood Bank, São João University Hospital Centre, Porto, Portugal
| | - Manuela Lopes
- Congenital Coagulopathies Reference Centre, Department of Transfusion Medicine and Blood Bank, São João University Hospital Centre, Porto, Portugal
| | - Manuela Carvalho
- Congenital Coagulopathies Reference Centre, Department of Transfusion Medicine and Blood Bank, São João University Hospital Centre, Porto, Portugal
| | - António Mateus
- Orthopedics and Trauma Department, São João University Hospital Centre, Porto, Portugal
| | - Armando Almeida
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS / 3B's - PT Government Associate Laboratory, Braga / Guimarães, Portugal
| | - Patrícia R Pinto
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS / 3B's - PT Government Associate Laboratory, Braga / Guimarães, Portugal.
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Paredes AC, Teixeira P, Almeida A, Pinto PR. Prevalence and Interference of Chronic Pain Among People With Hemophilia: A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2021; 22:1134-1145. [PMID: 33945849 DOI: 10.1016/j.jpain.2021.03.157] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
Chronic pain is a common condition among people with hemophilia (PWH), associated with joint deterioration due to repeated joint bleeds. This systematic review and meta-analysis aimed to determine the prevalence of chronic pain due to haemophilia and to analyze its interference in the lives of patients. A systematic search was performed in May and June 2019 and updated in February 2021, using PubMed, EMBASE, Web of Science and SciElo. The search included terms related to hemophilia, pain, pain prevalence and pain interference. Studies were included if they reported data referring to hemophilia-related chronic pain among adult males (age ≥18). From 3,258 identified studies, 11 met the inclusion criteria. Three studies used a proposed definition for hemophilia-related chronic pain and 8 used direct questions developed by the authors. For the global samples, prevalence ranged from 17% to 84%. The random-effects meta-analysis including all studies demonstrated a pooled prevalence of chronic pain of 46% (95% Confidence Interval, CI = 34%-58%). Subgroup analysis of samples including all disease severities or including only severe patients revealed a pooled prevalence of 48% (95% CI = 29%-67%) and 53% (95% CI = 38%-69%), respectively. High heterogeneity between studies was observed in all models. Information concerning chronic pain interference was retrieved from 1 study, reporting a mean interference of 3.7 (0-10 numerical rating scale from the Brief Pain Inventory). This systematic review revealed a wide prevalence range of hemophilia-related chronic pain across studies, varying methodologies and sample characteristics. Research in the hemophilia field should clearly distinguish between acute and chronic pain and provide complete characterization of study samples. PERSPECTIVE: Pain is a central issue in the lives of people with hemophilia, posing a significant challenge for healthcare providers. A clear picture of chronic pain due to hemophilia is precluded by high heterogeneity among studies and various definitions used to investigate its prevalence.
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Affiliation(s)
- Ana Cristina Paredes
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Pedro Teixeira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Armando Almeida
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Patrícia Ribeiro Pinto
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
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O’Donovan M, Quinn E, Johnston K, Singleton E, Benson J, O'Mahony B, Noone D, Duggan C, Gilmore R, Ryan K, O'Donnell JS, O’Connell NM. Recombinant factor IX-Fc fusion protein in severe hemophilia B: Patient-reported outcomes and health-related quality of life. Res Pract Thromb Haemost 2021; 5:e12602. [PMID: 34667923 PMCID: PMC8505226 DOI: 10.1002/rth2.12602] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/24/2021] [Accepted: 09/07/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION In 2017, all people with severe hemophilia B in Ireland switched to recombinant factor IX Fc fusion protein concentrate (rFIXFc) prophylaxis. Patient-reported outcomes (PROs) and health-related quality of life (HRQoL) are important to evaluate with new treatments. AIMS To assess HRQoL in people with severe hemophilia B and their experience after switching to rFIXFc prophylaxis. METHODS Participants completed a Patient Reported Outcomes Burden and Experience (PROBE) questionnaire on initiation and following two years of rFIXFc prophylaxis. The PROBE questionnaire has four domains: demographics, general health, haemophilia-specific, and European Quality of Life 5-Dimensions (EQ-5D-5L) questionnaire. RESULTS Twenty-three participants completed the questionnaire at both time points. The number of activities where chronic pain occurred and interfered with the activity was reduced by 25% and 33%, respectively (P < .001), following two years of rFIXFc prophylaxis. There was a 9% decrease in chronic pain during the second year of rFIXFc prophylaxis compared to baseline, but the rate remained high, at 74%. A 25% reduction in the number of affected activities of daily living (ADLs) was reported following 2 years of rFIXFc prophylaxis (P = .007). The most common health problems were arthritis, hypertension, anxiety/depression, and gingivitis. The median EQ-5D-5L score was similar following two years of rFIXFc prophylaxis, 0.76 (range, -0.01 to 0.95), compared to 0.77 (range, 0.36-1) at baseline. CONCLUSION This study of real-world patient experience using PROs demonstrates a reduction in chronic pain and improvement in ADLs in participants after switching to rFIXFc prophylaxis. It provides important insights into patient-identified health care needs and living with severe hemophilia B.
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Affiliation(s)
- Mairead O’Donovan
- National Coagulation CentreSt James’s HospitalDublinIreland
- School of MedicineTrinity College DublinDublinIreland
| | - Eimear Quinn
- National Coagulation CentreSt James’s HospitalDublinIreland
| | - Kate Johnston
- National Coagulation CentreSt James’s HospitalDublinIreland
- School of MedicineTrinity College DublinDublinIreland
| | | | - Julie Benson
- National Coagulation CentreSt James’s HospitalDublinIreland
| | - Brian O'Mahony
- School of MedicineTrinity College DublinDublinIreland
- Irish Haemophilia SocietyDublinIreland
| | | | | | | | - Kevin Ryan
- National Coagulation CentreSt James’s HospitalDublinIreland
| | | | - Niamh M. O’Connell
- National Coagulation CentreSt James’s HospitalDublinIreland
- School of MedicineTrinity College DublinDublinIreland
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Improving assessment and management of pain in hemophilia: an Italian Delphi consensus statement. Blood Rev 2021; 51:100885. [PMID: 34544642 DOI: 10.1016/j.blre.2021.100885] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 08/06/2021] [Accepted: 08/26/2021] [Indexed: 12/12/2022]
Abstract
Comprehensive evidence-based guidelines and well-validated assessment scales for pain in people with hemophilia (PwH) are needed. Here, we report 28 statements covering five topics on pain assessment and management in pediatric and adult PwH that were developed by 60 Italian hemophilia specialists during a Delphi consensus process. Overall, a clear consensus was achieved for 19 of the 28 statements. Consensus was reached on all statements on the topic of pain assessment and quality of life (QoL), including the need for regular pain assessment on a quantitative scale, the importance of distinguishing between different pain types, and the need to evaluate the impact of pain on patient QoL. The other four topics concerned acute and chronic pain management in adults and in children. Consensus was reached on statements regarding non-pharmacologic treatment and the use of first-line paracetamol (acetaminophen). There was a lack of consensus regarding the use of non-steroidal anti-inflammatory drugs, cyclooxygenase-2 inhibitors, or opioids.
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O'Hara J, Noone D, Jain M, Pedra G, Landis S, Hawes C, Burke T, Camp C. Clinical attributes and treatment characteristics are associated with work productivity and activity impairment in people with severe haemophilia A. Haemophilia 2021; 27:938-946. [PMID: 34273215 DOI: 10.1111/hae.14302] [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: 05/12/2020] [Revised: 01/21/2021] [Accepted: 03/15/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Few studies have examined the real-world impact of haemophilia on daily activities and work productivity in people with severe haemophilia A (PWSHA). AIM To determine clinical attributes and treatment characteristics associated with impairment in daily activities and work among PWSHA using the patient-reported Work Productivity and Activity Impairment-General Health Questionnaire (WPAI-GH). METHODS PWSHA were asked to complete the WPAI-GH as part of the Cost of Haemophilia in Europe: A Socioeconomic Survey (CHESS) study. Outcomes were determined for activity impairment (AI), absenteeism, presenteeism and overall work productivity loss (WPL). Descriptive statistics and regression analyses were used to evaluate the association between these outcomes and clinical and treatment attributes. RESULTS Overall, 376 participants completed the AI element of WPAI-GH; 175 were employed and thus also reported on work impact. Mean ± standard deviation scores were as follows: AI = 34.2% ± 25.8%; absenteeism = 0.06% ±0.2%; presenteeism = 26.8% ± 22.4%; WPL = 28.6% ± 24.0%. Increased AI and WPL were associated with high haemophilia-related morbidity, measured both as chronic pain (p < .001 for both) and joint synovitis (AI: p <0.001; WPL: p = .017). In descriptive and multivariate analyses, lifelong prophylaxis was associated with reduced AI (p < .001 and p = .031, respectively); high therapy adherence was associated with reduced AI (p = .001 and p = .012, respectively) and with reduced WPL (p < .001 and p = .012, respectively). CONCLUSION The WPAI-GH identified haemophilia-related morbidity and treatment characteristics, including therapy regimen and adherence, as key attributes impacting functional impairment and work contributions of PWSHA. Early prophylactic intervention and greater adherence to therapy may lead to lower AI and WPL in PWSHA.
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Affiliation(s)
- Jamie O'Hara
- HCD Economics, The Innovation Centre, Daresbury, UK
| | - Declan Noone
- European Haemophilia Consortium, Brussels, Belgium
| | | | | | | | | | - Tom Burke
- HCD Economics, The Innovation Centre, Daresbury, UK.,BioMarin Europe, London, UK
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Park YS, Hwang TJ, Cho GJ, Kim SK, Park SK, Kim JY, Baek HJ, Kim Y, Lee H, Shin J, Nam C, Sun J, Yoo KY. Patients' and parents' satisfaction with, and preference for, haemophilia A treatments: a cross-sectional, multicentre, observational study. Haemophilia 2021; 27:563-573. [PMID: 34128300 PMCID: PMC8362144 DOI: 10.1111/hae.14304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 03/08/2021] [Accepted: 03/15/2021] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Reports on patients' satisfaction and preferred characteristics for treatments would be worthwhile when choosing an optimal treatment reflecting patients' perspectives. AIM To identify the characteristics and treatment patterns of patients with haemophilia A, or their caregivers, in Korea and explore patient preferences and satisfaction with their treatment. METHODS This cross-sectional, multicentre, observational study was conducted from April 2018 to September 2019 at six nationwide hospitals and three Korea Hemophilia Foundation clinics. Patients aged ≥16 years, or legal caregivers of paediatric patients, who had used factor VIII (FVIII) concentrates for ≥1 month were enrolled. Satisfaction with treatment was measured using the Treatment Satisfaction Questionnaire for Medication (TSQM); preference was evaluated using discrete choice experiment (DCE), with 10 series of two hypothetical treatment options created from D-efficient block design, which varied across five attributes. RESULTS Overall, 505 patients (mean age 31 years) were enrolled in the study. Patients had received FVIII concentrate for an average of 102.9 months (prophylaxis: 53.5%; on-demand: 22.2%). Mean TSQM scores were 64.6 (effectiveness domain), 97.9 (side effects), 57.1 (convenience) and 66.8 (global satisfaction). The number of vials per injection, and the frequency of drug administration, was significantly associated with treatment satisfaction. According to DCE, simpler treatment options were preferred by patients/caregivers. CONCLUSION The lowest satisfaction levels were shown in the treatment convenience domain. Patients/parents preferred simpler and easier treatment characteristics. In an attempt to enhance the overall satisfaction of patients and caregivers with treatment, consideration of more convenient characteristics is required in future decisions regarding treatment selection.
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Affiliation(s)
- Young Shil Park
- Department of PediatricsKyung Hee University Hospital at GangdongSeoulSouth Korea
| | - Tai Ju Hwang
- Korea Hemophilia Foundation Gwangju ClinicGwang‐JuSouth Korea
| | - Goon Jae Cho
- Korea Hemophilia Foundation Busan ClinicBusanSouth Korea
| | - Soon Ki Kim
- Department of PediatricsInha University HospitalIncheonSouth Korea
| | - Sang Kyu Park
- Department of PediatricsUlsan University HospitalUlsanSouth Korea
| | - Ji Yoon Kim
- Department of PediatricsKyungpook National University HospitalDaeguSouth Korea
- Department of Pediatric Hematology and OncologyKyungpook National University Chilgok HospitalDaeguSouth Korea
| | - Hee Jo Baek
- Department of PediatricsChonnam National University Hwasun HospitalChonnam National University Medical SchoolGwangjuSouth Korea
| | - Young‐Joo Kim
- Medical DepartmentPfizer Pharmaceuticals Korea LtdSeoulSouth Korea
| | - Ho‐Jin Lee
- Medical DepartmentPfizer Pharmaceuticals Korea LtdSeoulSouth Korea
| | - Ji‐Soo Shin
- Medical DepartmentPfizer Pharmaceuticals Korea LtdSeoulSouth Korea
| | - Chung‐Mo Nam
- Department of Biostatistics and ComputingYonsei UniversitySeoulSouth Korea
| | - Jiyu Sun
- Department of Biostatistics and ComputingYonsei UniversitySeoulSouth Korea
| | - Ki Young Yoo
- Korea Hemophilia Foundation Clinic (KHF ClinicSeoulSouth Korea
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Lobet S, Timmer M, Königs C, Stephensen D, McLaughlin P, Duport G, Hermans C, Mancuso ME. The Role of Physiotherapy in the New Treatment Landscape for Haemophilia. J Clin Med 2021; 10:jcm10132822. [PMID: 34206923 PMCID: PMC8267623 DOI: 10.3390/jcm10132822] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/16/2021] [Accepted: 06/23/2021] [Indexed: 12/21/2022] Open
Abstract
The physiotherapist plays an essential role for people with haemophilia, an inherited bleeding disease responsible for musculoskeletal complications. Yet, with the advent of new and advanced therapies, the medical landscape is changing, and physiotherapy must adapt alongside. This paper considers whether there will still be a need for physiotherapy in the era of advanced therapies, and discusses ways in which services should evolve to complement emerging treatment paradigms for haemostasis in people with haemophilia. Ultimately, physiotherapy will remain an important element of care, even for people with little joint damage and low risks in the era of the new mild phenotype. However, competencies will need to evolve, and physiotherapists in both primary care and specialist treatment centres should work with haematology colleagues to develop more sensitive tools for detecting early joint changes. Physiotherapists will also play a crucial role in counselling and physically coaching, monitoring the musculoskeletal status of people with haemophilia who have transitioned to new treatments.
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Affiliation(s)
- Sébastien Lobet
- Hemostasis and Thrombosis Unit, Division of Hematology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium;
- Neuromusculoskeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 53, 1200 Brussels, Belgium
- Secteur de Kinésithérapie, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium
- Correspondence:
| | - Merel Timmer
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, 3584 Utrecht, The Netherlands;
| | - Christoph Königs
- Department of Paediatrics and Adolescent Medicine, Haemophilia Treatment Centre, Goethe University, 60323 Frankfurt, Germany;
| | - David Stephensen
- Kent Haemophilia Centre, East Kent Hospitals University NHS Trust, Canterbury CT1 3NG, UK;
- Haemophilia Centre, Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK
| | - Paul McLaughlin
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free London NHS Foundation Trust, London NW3 2QG, UK;
| | - Gaetan Duport
- Association Française des Hemophiles, 75739 Paris, France;
| | - Cédric Hermans
- Hemostasis and Thrombosis Unit, Division of Hematology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium;
| | - Maria Elisa Mancuso
- Center for Thrombosis and Hemorrhagic Diseases, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy;
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Cuesta-Barriuso R, Pérez-Llanes R, Donoso-Úbeda E, López-Pina JA, Meroño-Gallut J. Effects of myofascial release on frequency of joint bleedings, joint status, and joint pain in patients with hemophilic elbow arthropathy: A randomized, single-blind clinical trial. Medicine (Baltimore) 2021; 100:e26025. [PMID: 34011108 PMCID: PMC8137002 DOI: 10.1097/md.0000000000026025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/26/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Chronic joint injury of the elbow joint is common in patients with hemophilia. Myofascial release is used for the management of pain and functionality in patients with chronic restrictions. OBJECTIVE To evaluate the effectiveness of myofascial release in patients with hemophilic elbow arthropathy. METHODS Sixty-nine patients with hemophilia took part in this randomized controlled trial. They were recruited from 10 hemophilia patient Associations. They were randomly allocated to experimental (n = 35) or control group (n = 34). The intervention consisted of three 50-min sessions of fascial therapy over a 3-week period. The intervention included 11 bilaterally administered maneuvers in both upper limbs (from shoulder girdle to forearm). The study variables were frequency of elbow bleeding (self-report), joint status (Hemophilia Joint Health Score), and joint pain (visual analog scale) at baseline, after the intervention, and at the 3-month follow-up. RESULTS There were significant changes (P < .001) in the repeated measures factor in the frequency of hemarthrosis (F = 20.64), joint status (F = 31.45), and perceived joint pain (F = 30.08). We found group interaction with the (P < .001) in the frequency of hemarthrosis (F = 21.57), joint status (F = 99.98), and perceived joint pain (F = 44.26). There were changes (P < .01) in the pairwise comparison analysis between the pretreatment assessment and the posttreatment and follow-up assessments. CONCLUSIONS Myofascial release decreases frequency of elbow bleedings, and improved joint status and perception of elbow pain in patients with hemophilic elbow arthropathy. Myofascial release may be recommended to improve joint status and joint pain in patients with hemophilic elbow arthropathy.
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Affiliation(s)
- Rubén Cuesta-Barriuso
- Department of Physiotherapy, Faculty of Sport Sciences, European University of Madrid
- Royal Victoria Eugenia Foundation
- Fishemo CEE, Spanish Federation of Hemophilia, Madrid
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Arbab Siyar N, Amiri Majd M, Baghdassarians A. The effectiveness of cognitive-behavioural therapy on emotional regulation and quality of life in children with Haemophilia. Haemophilia 2021; 27:599-605. [PMID: 33993585 DOI: 10.1111/hae.14155] [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: 02/10/2020] [Revised: 08/07/2020] [Accepted: 09/01/2020] [Indexed: 11/28/2022]
Abstract
AND BACKGROUND DATA Haemophilia has known as an inherited bleeding disorder accompanied by remarkable pain, emotional distress, and impaired quality of life (QoL) and emotional regulation. Psychological interventions, such as cognitive-behavioural therapy (CBT), have cost-effectiveness to promote emotional well-being, QoL and emotional regulation; however, they have been scarcely used in the treatment of haemophilia. OBJECTIVES OF THE STUDY This research aimed at examining the effect of CBT on emotional regulation and QoL in children with haemophilia using quasi-experimental research with pretest and post-test design and a control group. METHOD 30 subjects were selected using convenient sampling and divided into two groups (n = 15). Both groups responded to the QoL questionnaire, the Persian version of the Pediatric Quality of Life Inventory (PedsQL) developed and the Cognitive Emotion Regulation Questionnaire (CERQ-k) in the pretest. The experimental group was then subjected to the CBT intervention through 9 sessions. The analysis of covariance was used for data analysis. RESULTS There was a significant increase in the QoL and emotion regulation in the experimental group than the control group. CONCLUSION The CBT training was effective to stop negative thinking and control their anger at school and also to adopt more appropriate strategies to deal efficaciously with concerns in social situations. Awareness about the thoughts, feelings and behaviours and being able to solve problems enables children to have better social relations and friendships with peers and also in other social situations. It also can increase the QoL and emotion regulation.
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Affiliation(s)
- Nikoo Arbab Siyar
- Department of General Psychology, Central Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Mojtaba Amiri Majd
- Department of Psychology, Faculty of Humanities Abhar Branch, Islamic Azad University, Abhar, Iran
| | - Anita Baghdassarians
- Department of Psychology, Central Tehran Branch, Islamic Azad University, Tehran, Iran
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Ucero-Lozano R, López-Pina JA, Ortiz-Pérez A, Cuesta-Barriuso R. Quality of life and its predictors among adult patients with haemophilic arthropathy. An observational study. BMC Musculoskelet Disord 2021; 22:448. [PMID: 33992116 PMCID: PMC8126122 DOI: 10.1186/s12891-021-04319-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/05/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Recurrent hemarthrosis that begin in childhood lead to progressive joint deterioration. Patients with haemophilia have chronic pain, functional disability and a reduced perception of health-related quality of life. PURPOSE To analyse the perceived quality of life of adult patients with haemophilic arthropathy and its relationship with pain, joint condition, kinesiophobia and catastrophism. METHODS Eighty-three adult patients with haemophilia were included in this multicentre, cross-sectional, descriptive study. Perceived quality of life (36-Item Short Form Health Survey), perceived usual and maximum pain (visual analogue scale), joint condition (Haemophilia Joint Health Score), kinesiophobia (Tampa Scale of Kinesiophobia) and catastrophism (Pain Catastrophizing Scale) were assessed. Sociodemographic, clinical and therapeutic variables and drug consumption for pain control were collected. Descriptive statistics used means and standard deviations. The correlation of quality of life with the dependent variables was calculated with the Pearson correlation test. The differences in quality of life as a function of the binomial variables were calculated with Student's t-test for independent samples. RESULTS Physical component of quality of life perceived by patients with hemophilia is lower than Spanish population (30.51 VS 48.85). Regarding the mental component, patients with hemophilia showed higher values (56.07 VS 49.97). Catastrophism correlated (p < .05) with all items of quality of life questionnaire. Kinesiophobia correlated (p < .05) with all items of quality of life except to role-emotional (r = -.18; p > .05). Habitual and maximal joint pain correlated with all items except to role-emotional (r = - .19 and r = - .09, respectively) and mental component score (r = - .16 and r = - .07, respectively). Catastrophism and weekly drug intake were inversely correlated with quality of life. Age was positively correlated with perceived quality of life. There were differences in quality of life as a function of the severity of haemophilia and the intake of drugs for pain control. CONCLUSIONS The perceived quality of life of adult patients with haemophilia is worse than that of the Spanish population. Pain, kinesiophobia, catastrophism, haemophilia severity and the intake of pain-control medication influence the quality of life of these patients.
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Affiliation(s)
| | | | - Alba Ortiz-Pérez
- Health Psychologist, Free Exercise of the Profession, Madrid, Spain
| | - Rubén Cuesta-Barriuso
- Department of Physiotherapy, University of Murcia, Murcia, Spain.
- Royal Victoria Eugenia Foundation, Madrid, Spain.
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Young adult outcomes of childhood prophylaxis for severe hemophilia A: results of the Joint Outcome Continuation Study. Blood Adv 2021; 4:2451-2459. [PMID: 32492157 DOI: 10.1182/bloodadvances.2019001311] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/10/2020] [Indexed: 11/20/2022] Open
Abstract
The Joint Outcome Study (JOS), a randomized controlled trial, demonstrated that children with severe hemophilia A (HA) initiating prophylactic factor VIII (FVIII) prior to age 2.5 years had reduced joint damage at age 6 years compared with those treated with episodic FVIII for bleeding. The Joint Outcome Continuation Study (JOS-C) evaluated early vs delayed prophylaxis effects on long-term joint health, following JOS participants to age 18 years in an observational, partially retrospective study. Index joint magnetic resonance imaging (MRI) scores of osteochondral (OC) damage (primary outcome), joint physical examination scores, and annualized rates of joint/other bleeding episodes (secondary outcomes) were collected. Thirty-seven of 65 JOS participants enrolled in JOS-C, including 15 randomized to prophylaxis at mean age 1.3 years ("early prophylaxis"); 18 initially randomized to episodic treatment, starting "delayed prophylaxis" at mean age 7.5 years; and 4 with high-titer inhibitors. At JOS-C exit, MRI OC damage was found in 77% of those on delayed and 35% of those on early prophylaxis for an odds ratio of OC damage, in the delayed vs early prophylaxis group, of 6.3 (95% confidence interval, 1.3, 29.9; P = .02). Annualized bleeding rates were higher with delayed prophylaxis (mean plus or minus standard deviation, 10.6 ± 6.6 vs 3.5 ± 2.1; P < .001), including when only comparing time periods on prophylaxis (6.2 ± 5.3 vs 3.3 ± 1.9; P < .05). In severe HA, early initiation of prophylaxis provided continued protection against joint damage throughout childhood compared with delayed initiation, but early prophylaxis was not sufficient to fully prevent damage. This trial was registered at www.clinicaltrials.gov as #NCT01000844.
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Mulder K, McCabe E, Strike K, Nilson J. Developing clinical practice guidelines for physiotherapists working with people with inherited bleeding disorders. Haemophilia 2021; 27:674-682. [PMID: 33915602 DOI: 10.1111/hae.14327] [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: 03/17/2021] [Accepted: 04/16/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Several bleeding disorders are characterized by haemorrhage into joints and muscles. These conditions are best managed by interdisciplinary teams that include physiotherapists. In 1997, physiotherapists from haemophilia treatment centres in Canada formed the Canadian Physiotherapists in Hemophilia Care (CPHC). The guiding principles of the CPHC reflect a commitment to evidence-based practice, education and collaboration. AIM To describe the process used by CPHC to develop evidence-based clinical practice guidelines to inform best practice, guide decision-making and help educate physiotherapists, students, and other team members about the physiotherapy management of people with bleeding disorders. METHODS We followed the procedures outlined in the American Physical Therapy Association's Clinical Practice Guideline Process Manual (2018). Namely, we selected a working group, determined the scope of the guidelines, performed a literature search, selected and appraised the evidence, drafted the guidelines as practice statements, assigned a strength of recommendation to each practice statement and disseminated the guidelines. RESULTS Thirty-nine practice statements were developed in nine practice areas. Strength of evidence was strong for two statements, moderate for one and weak for three. The remainder were graded as theoretical or best practice. CONCLUSION To our knowledge, these are the first evidence-based clinical practice guidelines that cover all aspects of physiotherapy management of people with bleeding disorders. Some areas, such as exercise and manual therapy, have been well investigated. However, the overall low levels of evidence and low strengths of recommendations highlight the need for more rigorous research with this population.
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Affiliation(s)
- Kathy Mulder
- Manitoba Bleeding Disorders Program, Children's Hospital, Winnipeg, MB, Canada
| | - Erin McCabe
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.,Northern Alberta Bleeding Disorders Clinic, Kaye Edmonton Clinic, Edmonton, AB, Canada
| | - Karen Strike
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, ON, Canada.,Hamilton Niagara Regional Hemophilia Program, McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
| | - JoAnn Nilson
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.,Saskatchewan Bleeding Disorders Program, Chronic Disease Management, Saskatchewan Health Authority, Saskatoon, SK, Canada
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van Overbeeke E, Hauber B, Michelsen S, Goldman M, Simoens S, Huys I. Patient Preferences to Assess Value IN Gene Therapies: Protocol Development for the PAVING Study in Hemophilia. Front Med (Lausanne) 2021; 8:595797. [PMID: 33768101 PMCID: PMC7985056 DOI: 10.3389/fmed.2021.595797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 02/15/2021] [Indexed: 12/16/2022] Open
Abstract
Introduction: Gene therapies are innovative therapies that are increasingly being developed. However, health technology assessment (HTA) and payer decision making on these therapies is impeded by uncertainties, especially regarding long-term outcomes. Through measuring patient preferences regarding gene therapies, the importance of unique elements that go beyond health gain can be quantified and inform value assessments. We designed a study, namely the Patient preferences to Assess Value IN Gene therapies (PAVING) study, that can inform HTA and payers by investigating trade-offs that adult Belgian hemophilia A and B patients are willing to make when asked to choose between a standard of care and gene therapy. Methods and Analysis: An eight-step approach was taken to establish the protocol for this study: (1) stated preference method selection, (2) initial attributes identification, (3) stakeholder (HTA and payer) needs identification, (4) patient relevant attributes and information needs identification, (5) level identification and choice task construction, (6) educational tool design, (7) survey integration, and (8) piloting and pretesting. In the end, a threshold technique survey was designed using the attributes “Annual bleeding rate,” “Chance to stop prophylaxis,” “Time that side effects have been studied,” and “Quality of Life.” Ethics and Dissemination: The Medical Ethics Committee of UZ KU Leuven/Research approved the study. Results from the study will be presented to stakeholders and patients at conferences and in peer-reviewed journals. We hope that results from the PAVING study can inform decision makers on the acceptability of uncertainties and the value of gene therapies to patients.
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Affiliation(s)
- Eline van Overbeeke
- Clinical Pharmacology and Pharmacotherapy, University of Leuven, Leuven, Belgium
| | - Brett Hauber
- Health Preference Assessment, RTI Health Solutions, Durham, NC, United States
| | - Sissel Michelsen
- Clinical Pharmacology and Pharmacotherapy, University of Leuven, Leuven, Belgium.,Healthcare Management Centre, Vlerick Business School, Ghent, Belgium
| | - Michel Goldman
- Institute for Interdisciplinary Innovation in Healthcare, Université Libre de Bruxelles, Brussels, Belgium
| | - Steven Simoens
- Clinical Pharmacology and Pharmacotherapy, University of Leuven, Leuven, Belgium
| | - Isabelle Huys
- Clinical Pharmacology and Pharmacotherapy, University of Leuven, Leuven, Belgium
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García-Dasí M, Pérez-Alenda S, Carrasco JJ, Marques-Sule E, Aguilar-Rodríguez M, Moreno-Segura N, Gómez-Tomás C, Querol F, Bonanad S. Effects of a non-pharmacological approach for chronic pain management in patients with haemophilia: efficacy of cognitive-behavioural therapy associated with physiotherapy. Haemophilia 2021; 27:e357-e367. [PMID: 33650767 DOI: 10.1111/hae.14284] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION More than half of adult patients with severe haemophilia (PWH) suffer pain daily, with chronic pain (CP) in more than 15% of cases, thereby reducing their quality of life (QoL). However, there are no evidence-based therapeutic guidelines for pain management. AIM To evaluate the effectiveness of a combined protocol based on psychology and physiotherapy in the improvement of CP self-efficacy in PWH with CP. Secondary outcomes are changes in QoL, emotional status, pain and kinesiophobia. METHODS In this prospective controlled trial study, recruited patients were allocated either to an experimental group (EG, n = 10) or to a control group (CG, n = 9). EG received interventions over four months: one cognitive-behavioural therapy (CBT) session per month and three home exercise sessions per week. Self-efficacy (Chronic Pain Self-Efficacy Scale), QoL (A36 Hemophilia-QoL), emotional status (Hospital Anxiety and Depression Scale and Rosenberg's Self-esteem Scale), pain (Visual Analogue Scale) and kinesiophobia (Tampa Scale for Kinesiophobia) were assessed at three time points (Week 0, Month 4 and Month 7). The intervention effects were determined with mixed 2-factor ANOVAs. RESULTS The EG showed a significant improvement (p < .05) in the control of symptoms and pain management scores on the Self-Efficacy Scale, QoL, self-esteem emotional status, pain and kinesiophobia. The intervention effects remained significant (p < .05) over time for pain management, QoL, pain and kinesiophobia. CONCLUSION The non-pharmacological treatment applied based on CBT and physiotherapy showed to be effective in improving CP self-efficacy, QoL and emotional status, while reducing pain and kinesiophobia in PWH with CP.
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Affiliation(s)
- María García-Dasí
- Instituto de Investigaciones Sanitarias La Fe, University and Polytechnic Hospital La Fe, Valencia, Spain.,Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Sofía Pérez-Alenda
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Valencia, Spain.,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
| | - Elena Marques-Sule
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Marta Aguilar-Rodríguez
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Valencia, Spain.,Research unit in Clinical biomechanics (UBIC), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | | | - Cinta Gómez-Tomás
- Grupo de Investigación en Fisioterapia y Readaptación al Deporte, Universidad Católica San Antonio de Murcia, Murcia, España
| | - Felipe Querol
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Valencia, Spain.,Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Santiago Bonanad
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Valencia, Spain
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Witkop M, Wang M, Hernandez G, Recht M, Baumann K, Cooper DL. Impact of haemophilia on patients with mild-to-moderate disease: Results from the P-FiQ and B-HERO-S studies. Haemophilia 2021; 27 Suppl 1:8-16. [PMID: 33522654 DOI: 10.1111/hae.14251] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/22/2020] [Accepted: 12/28/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Epidemiologic studies suggest that joint bleeding occurs in patients with mild-to-moderate haemophilia, including women and girls. However, most previous studies on the impacts of haemophilia focus on men with severe disease. AIM To identify unmet needs in men and women with mild-to-moderate haemophilia. METHODS The Pain, Functional Impairment, and Quality of Life (P-FiQ) study assessed the impact of pain on functional impairment and health-related quality of life in men with haemophilia A or B of any severity. The Bridging Hemophilia B Experiences, Results and Opportunities Into Solutions (B-HERO-S) study evaluated the psychosocial needs of adults and children with haemophilia B of any severity, including women and girls. Both studies employed patient-reported outcome measures. RESULTS In the P-FiQ study, 16% (62/381) of participants had mild and 13% (50/381) had moderate haemophilia. In the B-HERO-S study, 29% (86/299) of adult participants were female, 25% (74/299) had mild haemophilia, and 63% (189/299) had moderate haemophilia. In addition, 63% (46/74) of patients with mild and 86% (162/189) of patients with moderate haemophilia routinely infused factor products to prevent bleeding. Patients reported difficulty gaining access to factor products (54%; 142/263) and a haemophilia treatment centre (17%; 44/263). During the P-FiQ study, 78% (48/62) of patients with mild and 87% (44/50) with moderate haemophilia described problems with pain on the Brief Pain Inventory. Patients also reported issues with anxiety, depression and relationships. CONCLUSIONS Mild-to-moderate haemophilia has physical and psychosocial impacts on patients. We offer some solutions to help alleviate these impacts and resolve unmet needs.
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Affiliation(s)
| | - Michael Wang
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Grace Hernandez
- The Center for Inherited Blood Disorders, Orange, California, USA
| | - Michael Recht
- Oregon Health & Science University, Portland, Oregon, USA
| | - Kim Baumann
- University of Minnesota Medical Center, Minneapolis, Minnesota, USA
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Banchev A, Batorova A, Faganel Kotnik B, Kiss C, Puras G, Zapotocka E, Zupancic-Salek S. A Cross-National Survey of People Living with Hemophilia: Impact on Daily Living and Patient Education in Central Europe. Patient Prefer Adherence 2021; 15:871-883. [PMID: 33953547 PMCID: PMC8091596 DOI: 10.2147/ppa.s303822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/30/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Information about the impact of hemophilia on daily living and information preferences for patients and their caregivers in Central Europe has been limited. METHODS This cross-national survey was conducted between April 1 and October 15, 2020 and utilized a self-administered questionnaire to collect data (Typeform™) from people living with hemophilia in Bulgaria, Croatia, Czech Republic, Hungary, Slovakia and Slovenia. The questionnaire included 22 questions regarding difficulties in daily life and preferences for receiving hemophilia-related information. Respondents were stratified into two main groups, people with hemophilia (PwH) or their caregivers (CPwH). Results were analyzed using descriptive statistics. RESULTS Of the 364 respondents, 232 were PwH (63.7%) and 132 were CPwH (36.3%). In total, 70.3% of hemophilia patients/caregivers responded that they are kept sufficiently informed about life with hemophilia, with 68.0%, 59.1% and 56.3% of respondents obtaining information from their physicians, patient associations and via digital media (internet and social media), respectively. However, 97.8% of respondents expressed an interest in additional information, particularly new hemophilia treatment options (62.1%), which in contrast to other topics was indicated most frequently by both patients and caregivers in all six countries. Most frequent difficulties in everyday life with hemophilia were identified as mobility problems (41.8%), unexpected bleeding (38.5%), pain (35.4%), and uncertainty with what they can or cannot do (25.0%). During the 2020 COVID-19 pandemic, 52.5% of respondents reported that they did not experience any major change in daily living with hemophilia. CONCLUSION Based on our Central European survey, hemophilia mostly affects peoples' lives by causing mobility difficulties, unexpected bleeding, pain and uncertainty in daily activities. Although the majority of respondents reported being educated about hemophilia, most PwH and CPwH respondents sought additional information, highlighting the need for continuous personalized patient education to cope with present challenges.
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Affiliation(s)
- Atanas Banchev
- Department of Pediatric Hematology and Oncology, University Hospital ‘Tzaritza Giovanna – ISUL’, Sofia, Bulgaria
| | - Angelika Batorova
- National Hemophilia Center, Department of Hematology and Transfusion Medicine, Faculty of Medicine of Comenius University and University Hospital, Bratislava, Slovakia
| | - Barbara Faganel Kotnik
- Department of Oncology and Hematology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Csongor Kiss
- Department of Pediatric Hematology-Oncology, Institute of Pediatrics, University of Debrecen, Debrecen, Hungary
| | - Gediminas Puras
- Department of Medical Affairs CEER, Swedish Orphan Biovitrum AG, Basel, Switzerland
| | - Ester Zapotocka
- Department of Pediatric Hematology/Oncology, University Hospital Motol, Prague, Czech Republic
| | - Silva Zupancic-Salek
- Department of Medicine, University Hospital Center Zagreb, Zagreb, Croatia
- Correspondence: Silva Zupancic-Salek Department of Medicine, University Hospital Centre Zagreb, Rebro, Kispatic Str 12, Zagreb, 10 000, CroatiaTel +385 1 337 5199Fax +385 1 332 4650 Email
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Pain assessment and management in Italian Haemophilia Centres. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2020; 19:335-342. [PMID: 33263519 DOI: 10.2450/2020.0085-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/25/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although the widespread use of factor VIII/IX replacement therapy has significantly reduced the severity of arthropathy in persons with haemophilia (PWH), some develop degenerative joint changes, associated with significant pain. The aim of this survey was to investigate the management and perception of pain among Italian physicians who treat PWH. MATERIALS AND METHODS Between September and October 2017, a questionnaire was distributed to 35 Italian haemophilia treatment centres (60 physicians). RESULTS Fifty-three haemophilia specialists completed the survey. We found that there was good agreement (98.1%) on the need to investigate pain at each clinical visit, but there was heterogeneity in the opinions of haemophilia specialists with regards to the availability of validated guidelines (35.8%) and whether pain specialists should be a part of the comprehensive care team in daily clinical practice (58.5%). Haemophilia specialists also agreed pain should be evaluated using a rating scale validated in PWH (88.7%). Pain was mainly managed by the haemophilia specialists themselves, supported by a physiatrist and physiotherapist, while a pain specialist was only involved in 26.4% of cases. The combination of paracetamol with tramadol or codeine was the most common first-line treatment, while cyclo-oxygenase-2 inhibitors, non-steroidal anti-inflammatory drugs, and opioids were less commonly used. DISCUSSION There are some unmet needs in Italy regarding pain management for PWH and the management of pain in these patients by haemophilia specialists. There is a lack of evidence-based guidelines for these specialists to use, as well as a reluctance to involve pain specialists. The lack of spontaneous reporting of pain by PWH, despite using pain relief, highlights the need for clinicians to actively ask patients about any pain they may be experiencing.
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O'Hara S, Castro FA, Black J, Chaplin S, Ruiz L, Hampton RJ, Sima CS, O'Hara J. Disease burden and remaining unmet need in patients with haemophilia A treated with primary prophylaxis. Haemophilia 2020; 27:113-119. [PMID: 33084176 DOI: 10.1111/hae.14171] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 09/14/2020] [Accepted: 09/21/2020] [Indexed: 01/01/2023]
Abstract
AIMS There is evidence that people with haemophilia A still experience morbidity and functional limitation due to joint damage despite prophylaxis. This study aimed to compare their quality of life and work-related function with that of the general population and patients with osteoarthritis. METHODS Data from the Cost of Haemophilia in Europe: a Socioeconomic Survey (CHESS) database were compared with published data from normative populations and patients with osteoarthritis in Europe and the United States. RESULTS In the predominantly young (age 18-35 years) adult CHESS population treated with primary prophylaxis, about 30% reported a target joint; the average frequency of bleeds was one per year; half reported chronic pain. Levels of anxiety and depression were similar to those reported by people using on-demand treatment. Employment and productivity were lower than in the general population. The level of presenteeism (attending work with impairment) was comparable with that reported for a much older population with osteoarthritis who had more extensive joint damage and greater prevalence of pain. CONCLUSION Compared with the general population, clinical outcomes and quality of life are indicated to be impaired for young adults whose haemophilia is managed by primary prophylaxis. Primary prophylaxis is not associated with lower levels of anxiety and depression than on-demand treatment, and pain is common. The level of presenteeism is comparable to that reported in people with osteoarthritis, an older population with more joint disease. Further studies are needed to fully assess the implications of compromised work performance among young adults with haemophilia as they seek to build a career.
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Affiliation(s)
| | - Felipe A Castro
- PHC Data Science, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - James Black
- PHC Data Science, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | | | | | - Roger J Hampton
- PHC Data Science, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Camelia S Sima
- PHC Data Science, F. Hoffmann-La Roche Ltd., South San Francisco, CA, USA
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Brown LJ, La HA, Li J, Brunner M, Snoke M, Kerr AM. The societal burden of haemophilia A. I - A snapshot of haemophilia A in Australia and beyond. Haemophilia 2020; 26 Suppl 5:3-10. [PMID: 32935397 DOI: 10.1111/hae.14102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 05/03/2020] [Accepted: 06/18/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Few studies, both in Australia and overseas, have examined the social impacts of living with haemophilia A (HA) or the economic costs associated with the disorder. The purpose of this paper is to examine the epidemiology and societal burden of people with HA (PwHA) in Australia, with a particular focus on men with this disorder. METHODS The epidemiology and societal burden of HA in Australia, with a particular focus on men with this disorder, were assessed, using data available in the Australian and international literature and publicly available data. RESULTS The mean annual prevalence of HA is approximately 1-2 per 10 000 males. Prophylactic treatment is used in one-quarter (25.1%) of people with moderate HA, and 82.2% of people with severe HA. Within the latter group, 16.1% have inhibitors for Factor VIII, predisposing them to worse morbidity, mortality and quality of life when compared to the non-inhibitor population. Joint pain and joint disease occur commonly in PwHA, with up to 70% of adults with HA experiencing joint problems. HA is associated with poor physical health, and PwHA miss school and work due to bleeding-related events. CONCLUSION HA is associated with substantial economic burden; with large differences in costs reported between countries. Overall, HA imposes a significant burden of disease on PwHA, their families and the community at large.
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Affiliation(s)
- Laurie J Brown
- NATSEM, Institute for Governance and Policy Analysis, University of Canberra, Canberra, ACT, Australia
| | - Hai A La
- NATSEM, Institute for Governance and Policy Analysis, University of Canberra, Canberra, ACT, Australia
| | - Jinjing Li
- NATSEM, Institute for Governance and Policy Analysis, University of Canberra, Canberra, ACT, Australia
| | | | - Martin Snoke
- Roche Products Pty Limited, Sydney, NSW, Australia
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Visweshwar N, Zhang Y, Joseph H, Jaglal M, Ayala I. Chronic pain in patients with hemophilia: is it preventable? Blood Coagul Fibrinolysis 2020; 31:346-352. [PMID: 32815911 DOI: 10.1097/mbc.0000000000000939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
: Current management of chronic pain in patients with hemophilia (PWH) focuses on pain relief with analgesics and symptom control. The clinical practice of managing chronic pain in PWH varies considerably across hemophilia treatment centers. Here, we aim to study the appropriate intervention of hemophilic arthropathy for prevention and treatment of chronic pain in PWH. Medline, Embase, Cochrane databases were searched for randomized controlled trials, and the European Hemophilia Therapy Standardization Board, The World Federation of Hemophilia, Nordic Hemophilia Guidelines, American Society of the International Pain Physicians and the Medical and Scientific Advisory Council guidelines were studied through November 2019 for chronic pain in PWH for a narrative review. We found no standardized approach for the prevention and management of chronic pain in PWH. Evidence suggests that prophylactic factor concentrate therapy, programmed exercise and educational intervention may help PWH manage their chronic pain.
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Affiliation(s)
| | - Yumeng Zhang
- Department Internal Medicine, University of South Florida
| | | | | | - Irmel Ayala
- Hemophilia Treatment Center, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
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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.
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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
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Arya S, Wilton P, Page D, Boma-Fischer L, Floros G, Dainty KN, Winikoff R, Sholzberg M. Healthcare provider perspectives on inequities in access to care for patients with inherited bleeding disorders. PLoS One 2020; 15:e0229099. [PMID: 32078655 PMCID: PMC7032703 DOI: 10.1371/journal.pone.0229099] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/29/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The ways in which social determinants of health affect patients with inherited bleeding disorders remains unclear. The objective of this study was to understand healthcare provider perspectives regarding access to care and diagnostic delay amongst this patient population. METHODS A healthcare provider survey comprising 24 questions was developed, tested, and subsequently disseminated online with recruitment to all members of The Association of Hemophilia Clinic Directors of Canada (N = 73), members of the Canadian Association of Nurses in Hemophilia Care (N = 40) and members of the Canadian Physiotherapists in Hemophilia Care (N = 44). RESULTS There were 70 respondents in total, for a total response rate of 45%. HCPs felt that there were diagnostic delays for patients with mild symptomatology (71%, N = 50), women presenting with abnormal uterine bleeding as their only or primary symptom (59%, N = 41), and patients living in rural Canada (50%, N = 35). Fewer respondents felt that factors such as socioeconomic status (46%, N = 32) or race (21%, N = 15) influenced access to care, particularly as compared to the influence of rural location (77%, N = 54). DISCUSSION We found that healthcare providers identified patients with mild symptomatology, isolated abnormal uterine bleeding, and residence in rural locations as populations at risk for inequitable access to care. These factors warrant further study, and will be investigated further by our group using our nation-wide patient survey and ongoing in-depth qualitative patient interviews.
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Affiliation(s)
- Sumedha Arya
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Pamela Wilton
- Canadian Hemophilia Society, Montreal, Quebec, Canada
| | - David Page
- Canadian Hemophilia Society, Montreal, Quebec, Canada
| | - Laurence Boma-Fischer
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Department of Hematology, St. Michael's Hospital, Toronto, Canada
| | - Georgina Floros
- Department of Hematology, St. Michael's Hospital, Toronto, Canada
- Department of Nursing, St. Michael’s Hospital, Toronto, Canada
| | - Katie N. Dainty
- North York General Hospital, Toronto, Canada
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Michelle Sholzberg
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Department of Medicine and Laboratory Medicine & Pathobiology, St. Michael's Hospital, Toronto, Canada
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Krüger S, Hilberg T. Understanding the pain profile in patients with haemophilia: Impaired descending pain inhibition as measured by conditioned pain modulation. Haemophilia 2020; 26:236-242. [PMID: 32030862 DOI: 10.1111/hae.13939] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/21/2020] [Accepted: 01/21/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Haemophilic arthropathy is associated with pain that often becomes chronic, likely caused by peripheral and central mechanisms. In the field of haemophilia, to our knowledge, the role of the descending pain pathway, which can also be involved in these pain processes, has not been examined to date. AIM In light of the dearth of existing literature, we sought to evaluate the function of endogenous descending pain modulation in patients with haemophilia. METHODS Thirty adult patients with moderate to severe haemophilia A or B (median [interquartile range] age 51.0 [42.0-54.0]) and 23 healthy adult controls (age 46.5 [36.8-54.3]) underwent conditioned pain modulation (CPM) in order to examine the function of endogenous pain modulation. The CPM response was determined by scoring a test stimulus (heat) alone as well as under the influence of a conditioning stimulus (cold) on the basis of a numeric rating scale (NRS) (0 = 'no pain' to 100 = 'worst possible pain'). RESULTS Patients with haemophilia demonstrated a statistically significant reduced CPM response when compared with the age-matched healthy controls (median (interquartile range) NRS score: patients: -10 (-17.5-[-7.5]) vs controls: -20 (-30.0-[-13.75]); P = .002). The determined difference in the CPM response between both cohorts showed a medium effect size of r = .433. CONCLUSION The results of this study indicate that an impaired degree of endogenous pain modulation could be present in patients with haemophilia. Therefore, the function of the descending pain pathway should be considered regarding an individual and comprehensive pain management.
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Affiliation(s)
- Steffen Krüger
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Thomas Hilberg
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
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