Effects of Plyometric-Based Hydro-Kinesiotherapy on Pain, Muscle Strength, Postural Stability, and Functional Performance in Children with Hemophilic Knee Arthropathy: A Randomized Trial

Abstract

Aim

To explore how plyometric-based hydro-kinesiotherapy (Plyo-HKT) would affect pain, muscle strength, postural stability, and functional performance in a convenience sample of children with hemophilic knee arthropathy (HKA).

Methods

Forty-eight children with HKA (age: 8–16 years) were randomly allocated to the Plyo-HKT group (n = 24; underwent the Plyo-HKT for 45 min, twice/week over 12 wk in succession) or the comparison group (n = 24; performed the standard exercise rehabilitation at an equivalent frequency and duration). Pain, peak concentric torque of quadriceps and hamstring (produced at two angular velocities: 120 and 180 ^o/sec), dynamic limits of postural stability (DLPS), and functional performance [Functional Independence Score in Hemophilia (FISH) and 6-Minute Walk Test (6-MWT)] were assessed pre- and post-intervention.

Results

In contrast with the comparison group, the Plyo-HKT group achieved more favorable pre-to-post changes in pain (p = .028, η²_p = 0.10), peak torque of quadriceps [120°/sec (p = .007, η²_P = 0.15); 180°/sec (p = .011, η²_P = 0.13)] and hamstring [120°/sec (p = .024, η²_P = 0.11); 180°/sec (p = .036, η²_P = 0.09)], DLPS_directional [forward (p = .007, η²_P = 0.15); backward (p = .013, η²_P = 0.12); affected side (p = .008, η²_P = 0.14); non-affected side (p = .002, η²_P = 0.20)], DLPS_overall (p < .001, η²_P = 0.32), and functional performance [FISH (p < .001, η²_p = 0.26); 6-MWT (p = .002, η²_p = 0.19)].

Conclusion

Plyo-HKT is likely helpful for reducing pain, improving strength, enhancing postural stability, and boosting functional capabilities in children with HKA. Physical rehabilitation practitioners should, therefore, consider this intervention strategy.

Keywords:

• Bleeding disorders
• explosive strength training
• functional capacity
• peak torque
• plyometrics
• postural stability

Acknowledgements

The willingness of the children and families to participate in this work is greatly appreciated by the authors. Their enthusiasm is certainly unforgettable.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study is supported via funding from Prince Sattam bin Abdulaziz University project number (PSAU/2024/R/1445).

Notes on contributors

Ragab K. Elnaggar

Ragab K. Elnaggar, PT, Ph.D., is a Professor in the Department of Physical Therapy for Pediatrics at Cairo University. His research focuses on physical rehabilitation, community participation of children and adolescents with physical disabilities, and the transition to adulthood. Through his work, Prof. Elnaggar aims to develop innovative approaches and practical solutions that empower children/adolescents with physical disabilities, enabling them to lead fulfilling and independent lives within their communities.

Alshimaa R. Azab

Alshimaa R. Azab, PT, Ph.D., is a Professor in the Department of Physical Therapy for Pediatrics at Cairo University.

Ahmed S. Alhowimel

Ahmed S. Alhowimel, PT, Ph.D., Associate Professor in the Department of Physical Therapy and Health Rehabilitation at Prince Sattam Bin Abdulaziz University.

Mazyad A. Alotaibi

Mazyad A. Alotaibi, PT, Ph.D., Assistant Professor in the Department of Physical Therapy and Health Rehabilitation at Prince Sattam Bin Abdulaziz University.

Mohamed S. Abdrabo

Mohamed S. Abdrabo, PT, Ph.D., Associate Professor in the Basic Sciences Department at the Faculty of Physical Therapy, Cairo University.

Mahmoud S. Elfakharany

Mahmoud S. Elfakharany, PT, Ph.D., Associate Professor in the Department of Physical Therapy for Pediatrics at Cairo University.