Manual therapy reduces the frequency of clinical hemarthrosis and improves range of motion and perceived disability in patients with hemophilic elbow arthropathy. A randomized, single-blind, clinical trial

Abstract

Purpose

To evaluate the effectiveness of manual therapy in reducing the frequency of clinical hemarthrosis, increasing range of motion and improving the perception of disability in the upper limbs in patients with hemophilic elbow arthropathy.

Materials and methods

Sixty-nine patients were randomized into experimental (N = 35) and control group (N = 34). The outcome measures were: frequency of clinical hemarthrosis, the elbow range of motion and the perception of disability in the upper limbs (DASH questionnaire). The intervention included one 50 min weekly session, for three weeks, of upper limb fascial therapy according to our treatment protocol.

Results

There were differences (p < 0.001) in the repeated measures analysis for frequency of elbow clinical hemarthrosis (F = 20.64) and range of motion in flexion (F = 17.37) and extension (F = 21.71). No differences were found in the overall perceived disability (F = 0.91; p = .37). We found group interaction with the (p < 0.001) in the frequency of elbow clinical hemarthrosis, range of motion and overall perceived disability.

Conclusions

Manual therapy is safe in patients with hemophilia and elbow arthropathy. Fascial therapy reduces the frequency of hemarthrosis, increases the range of motion and improves the perceived disability in the upper limbs. Trial registration number: id NCT03009591

IMPLICATIONS FOR REHABILITATION

• Impairments in the range of motion, pain and disability may occur in patients with hemophilic elbow arthropathy since early age.

• There is a need to validate safe and effectiveness protocols of rehabilitation to treat these patients.

• Prophylactic replacement is the most effective treatment for the prevention of hemarthrosis.

• Physiotherapists need to be trained in the specific management of patients with hemophilia.

• Manual therapy can be a safe and effective tool in the treatment of hemophilic arthropathy.

Keywords:

• Hemophilic arthropathy
• elbow
• manual therapy
• range of motion
• disability

Acknowledgements

The authors are especially grateful to the Spanish Federation of Haemophilia, Galician Association of Hemophilia, Malaga Association of Hemophilia, Association of Hemophilia of Vizcaya, Association of Hemophilia of Community of Valencia, Association of Hemophilia of Aragón-La Rioja, Association of Hemophilia of Valladolid-Palencia, Murcia Regional Association of Hemophilia, Association of Hemophilia of Burgos and Salamanca Association of Hemophilia for their help in recruiting the sample.

Disclosure statement

The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

Additional information

Funding

The authors state that this work has received financial support from Baxalta US Inc, a Takeda company, Lexington, MA USA [Grant ID Number: H16-36143]. The funders played no role in the design, conduct, or reporting of this study.