Blood Flow Restriction in Improving Muscle Strength of Patients With Hemophilic Knee Arthropathy

Change from baseline pressure pain threshold after treatment and at four weeks

With a pressure algometer (model Wagner FPN100) we will measure the pressure pain threshold, at the joint level and at a distance (in another part of the body). This device measures in Newton / cm2 the pressure at which the subject perceives pain under pressure. A pressure will be made on the chosen point, which we will increase at an approximate speed of 50kPa / s until the patient warns us that the sensation begins to be painful. Hemophilic arthropathy will be assessed in the knee (inner edge of the patella) and ankle (lateral malleolus).

Time frame: Screening visit, within the first seven days after treatment and after four weeks follow-up

Change from baseline muscle strength after treatment and at four weeks

With a pressure dynamometer (microFET®2 Digital Handheld model) we will measure the strength of the quadriceps and triceps surae. This device measures in Newton the force that the patient exerts in the requested muscular action. The higher the value, the greater the muscle strength. We will carry out the measurements bilaterally. The patient will be asked 4 maximum isometric contractions of 5 seconds, with a rest of 30 seconds between them, against the dynamometer located in the hand of the evaluator

Time frame: Screening visit, within the first seven days after treatment and after four weeks follow-up

Change from baseline electrical activity of the muscles after treatment and at four weeks

Using surface electromyography (model SHIMMMER2, Shimmer, Ireland), we will evaluate the electrical activity of the musculature and its level of activation. The placement of the electrodes will be marked on the standing subjects, and they will be placed following the European recommendations for the use of the SEMG. A bipolar SEMG system will be used with circular electrodes 10 mm in diameter, 20 mm apart, placed longitudinally, in the direction of the fibers of the studied muscle, and with a remote reference electrode

Time frame: Screening visit, within the first seven days after treatment and after four weeks follow-up

Change from baseline range of motion after treatment and at four weeks

The range of motion of the knee joint will be measured using a universal goniometer, using the protocol for measuring joint motion described by the American Academy of Orthopaedic Surgeons

Time frame: Screening visit, within the first seven days after treatment and after four weeks follow-up

Change from baseline joint status after treatment and at four weeks

With the Hemophilia Joint Health Score scale, specific for its use in patients with hemophilia, the joint status of patients with hemophilic arthropathy will be evaluated. It evaluates 8 items: inflammation and duration of this, pain, muscle atrophy and strength, crackles, and loss of flexion and extension. It has a score of 0 (no joint damage) to 20 points (maximum joint damage) per joint (elbows, knees and ankles). A gait rating is added to the 120 points (range 0-4 points), the maximum rating on this scale being 124 points

Time frame: Screening visit, within the first seven days after treatment and after four weeks follow-up

Change from baseline functionality after treatment and at four weeks

With the Timed Up and Go Test, basic mobility skills, strength, balance and agility will be evaluated. This test can help predict an individual's risk of falls and other adverse outcomes. This test measures the time it takes for a patient to get up from a chair (without using their arms to get up), walk to a line on the floor 3 m away, turn around, and return to the chair and sit down. Two measurements will be made per patient and the best value will be used for analysis. The unit of measurement is seconds, where the shorter the time, the better the score.

Time frame: Screening visit, within the first seven days after treatment and after four weeks follow-up