Uncertainty about how to treat existing hemophilic arthropathy (HA) is the most important issue that will increase functionality and joint health. Recent studies have shown that MT can be used safely for improving joint health, pain and ROM with no bleedings in PwH with elbow and ankle HA. Unlike MT studies in hemophilia, we investigated the effects of MT on important parameters such as muscle strength (MS), functional level, joint health, functional independence score in hemophilia (FISH) and kinesiophobia. These parameters are closely related to functional level and quality of life of PwH. Therefore, evaluation of these parameters and determining the effects of the MT on these parameters are very important for both PwH and also clinicians.
The aim of this study was to investigate the effects of manual therapy in addition to home exercise program on hemophilia functional independence level, joint health, kinesiophobia, functional level, range of motion, muscle strength and pain level in hemophilic individuals with lower extremity joint arthropathy. Hemophilic arthropathy was developed in at least one of the lower extremity joints and aged between 18-30 years 17 severe type hemophilic men were participated in the study. The participants were divided into two groups as Home Exercise Group (HEG) and Manual Therapy Group (MTG) by randomization method. While the HEG was performed the exercise program at home, in addition to the same HEG manual therapy were applied to the MTG by the same physiotherapist 3 days a week for 1 hour. Both groups were followed for a total of 5 weeks and pre-treatment evaluations were repeated post-treatment. The joint health of the hemophilics in both groups were evaluated with Hemophilia Joint Health Score (HJHS), their kinesiophobia level were evaluated with Tampa Kinesophobia Scale, their functionality with the Functional Independence Score in Hemophilia (FISH). In addition, Functional Reach, Timed Up and Go and 5 Times Sit-to- Stand tests were used for functional level. The range of motion was evaluated with a goniometer, muscle strength was measured with a digital dynamometer and pain level was assessed with a Visual Analogue Scale (VAS). Number of hemarthrosis decreased in both groups.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
17
Both groups received for 3 sessions per week, a total of 5 weeks. Home exercises were performed by the patient for 30 minutes at home.In home exercises active ROM for warm-up (5 min), passive stretchening (5 min), strengthening exercises (10 min), proprioceptive and balance exercises (10 min). In manual therapy group, myofascial release techniques (MRT) and Kalternborn mobilization techniques lasted about one hour. In MRT, each manuever was applied for 2 mins and 3 times. The superficial strokes were performed, assisted by slight movements of joints. MRT to posterior capsule of the knee, ligaments, iliotibial tractus, plantar fascia, metatarsal, tarsals, and toes. Kalterborb mobilization tecnqiues; posterior gliding for restricted knee flexion, anterior gliding for restricted knee extension,talocrural posteior gliding for dorsal flexion, talocrural anterior gliding for plantar flexion.3 \* 10 repetitions, 20 sec of per reps and 10 sec of interval.
Cukurova University
Adana, Sarıcam, Turkey (Türkiye)
Hemophilia Joint Health Score
We used the index point of joints. Score ranged from 0 to 20. Low score indicates the good joint health
Time frame: 5 week
Functional Independence Score in Hemophilia
We used the functional independence of patients. Score ranged from 0 to 32. High score indicates the functional independence.
Time frame: 5 week
Tampa Kinesiophobia Scale
Score higher than 37 were associated with a high degree of kinesiophobia.
Time frame: 5 week
Range of motion
Joint range was measured with a universal goniometer.
Time frame: 5 week
Muscle Strength
It was measured with hand-held dynamometer.
Time frame: 5 week
Numerical Pain Scale
It was used for assessment of activity and resting pain.
Time frame: 5 week
Frequency bleeding
It was evaluated from the diaries kept by the patients
Time frame: 5 week
Functional Reach
It was used to assess dynamic balance.
Time frame: 5 week
Timed Up and Go
It was used to evaluate functional mobility, dynamic balance, fall risk and postural stability.
Time frame: 5 week
5 Times Sit to Stand
It was evaluated the functional strength of lower extremity, transitive movements, balance and fall risk.
Time frame: 5 week
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