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

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 rehabilitation

• Musculoskeletal 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.

Keywords:

• Haemophilia
• pain management
• reflexive thematic analysis
• exercise
• rehabilitation
• rare disease

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Acknowledgements

The authors wish to express their gratitude to all those people with haemophilia and the healthcare professionals who volunteered to participate in this study. Thanks also to Clive Smith for his insight and input in the development of the topic guides.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

The lead author (NIHR Clinical Doctoral Research Fellow, funder reference: ICA-CDRF-2017-03-050) is funded by Health Education England (HEE)/National Institute for Health Research (NIHR) for this project. This work is also supported by the Research Trainees Coordinating Centre.