Introduction: Recurrent joint bleeds in haemophilia patients often cause musculoskeletal changes leading to functional capacity impairment. Aim: In this study, we assessed the effects of aquatic activities performed to improve functional capacity in these patients. Methods: The interventional protocol consisted of 24 hydrotherapy sessions during three months, in comparison with 24 swimming sessions. The pre-and postintervention assessment consisted of Functional Independence Score, haemophilia joint health score (HJHS), Pediatric Haemophilia Activities List (PedHAL), surface electromyography (SEMG) of thigh muscles to assess muscle electric activity, and load cell on extensor and flexor thigh muscles to evaluate muscular strength. Results: Forty-seven haemophilia patients were enrolled in this study, and 32 (23 severe haemophilia A, one moderate haemophilia A and 8 severe haemophilia B), median age 12y (6 to 40y), concluded the aquatic intervention. We observed a statistically significant increase with substantial improvement in functional capacity in the pre-and post-intervention evaluation of hydrotherapy in comparison with the swimming protocol, with HJHS (p = .006 and p = .001 respectively), PedHAL (Sum score) (p = .022 and p = .001) and score FISH (p = .021). The swimming group revealed significant improvements in muscular strength, in all muscles tested (p = .005 and p = .001). SEMG signal amplitude reached significantly higher levels in all muscles evaluated after both interventions except for the vastus medialis (right) in the hydrotherapy group. Conclusion: Our results concluded that both swimming and hydrotherapy were associated with physical improvement in haemophilia patients; however, only hydrotherapy lead to a more significant improvement in functional capacity.

To the Editor, People with haemophilia (PWH) usually begin to suffer pain at a young age. Physical and psychological components can accentuate patients' pain. Pain has been identified as the most challenging and prevalent symptom, affecting up to 80% of PWH, and is the leading cause of disability in these patients. 1 Some factors such as cognitive and social behaviour contribute to the impact of pain and are associated with poor prognosis following the onset of musculoskeletal pain. 1,2 There is a complex interaction of factors that influence pain perception, such as mood swings, emotional problems, hypervigilance, kinesiophobia, catastrophic thoughts and negative beliefs. Negative thoughts can affect the sensation of pain. As a result, pain can be interpreted as a threat, and an overreaction can be initiated in response to this threat. 3 Kinesiophobia is defined as an excessive, irrational and debilitating fear to carry out a movement resulting from a feeling of vulnerability due to a painful injury and may be associated with pain and disability. Kinesiophobia alters how people move, causing adjustments in motor behaviour, which affects the performance of actions related to the management and control of pain. 3 This study aimed to measure kinesiophobia and catastrophic thoughts in PWH and analyze their impact on clinical and functional parameters, especially in PWH with chronic pain.In this study, we enrolled patients diagnosed with haemophilia A or B aged over 12 years. The evaluation was performed from August 2018 to July 2019, during PWH routine consultation at the haemophilia unit of Hemocentro UNICAMP, Brazil. Patients were considered eligible for the study when they could perform all clinical and functional assessments and adequately respond to all applied questionnaires.

Sickle cell disease is a genetic disease that results in sickling of red blood cells, triggering phenomena of vaso-occlusion, pain and organ damage. Bone involvement is the most common clinical manifestation, and may cause chronic and progressive disorders such as avascular necrosis of the femoral head and spine damage, which in turn leads to disturbances in gait and activity and function limitation due to pain. There are few studies in the literature on the role of physiotherapy as a resource capable of preventing and treating disorders of the locomotor system of sickle cell disease patients. The aim of this study was to evaluate and compare the effect of two physical therapy programs for patients with sickle cell disease to decrease musculoskeletal pain in the hip and lower back and increase the functionality of these patients. One of the programs was conventional physical therapy in the soil compared with a protocol of exercises performed in a swimming pool. The study began with an evaluation of the volunteers the from functional scales (Scale LEFS – Lower Extremity Functional Scale; Lequesne’s Algofunctional Questionnaire and Oswestry Disability Index), measuring the range of motion (ROM) in flexion and extension of the trunk, flexion, extension, adduction and abduction of the hip, the assessment of muscle strength (MS) of the trunk flexors and extensors, flexors, extensors, adductors and hip abductors through load cell and surface electromyography (SEMG) of iliocostalis, dorsal longissimus, gluteus maximus, gluteus medius and tensor fasciae latae. The final sample consisted of 10 volunteers, randomized to two different groups: aquatic physiotherapy (AP) and conventional physiotherapy (CP). The AP group was composed of five volunteers with a median age of 42 (25-67) years. The CP group consisted of five volunteers with a median age of 49 (43-59) years. After randomization, subjects from both groups underwent intervention for twelve week, with two sessions per week, totaling 24 sessions. At the end of the intervention, patients were reassessed for comparison of pre-and post-intervention results. For statistical analysis ANOVA was used for repeated measures with transformation stations. Significance was established at the 5% level (p<0.05). Both programs lead to statistically significant improvement after the intervention for the variables Lequesne index (p=0.0217), Oswestry Disability Index (p=0.0112), trunk extension ROM (p=0.0320), ROM trunk flexion (p=0,0459) and MS extension (p=0.0062) and abduction (p=0.0257) of the hip. The variables Scale LEFS, trunk flexion ROM, ROM of flexion, extension, adduction and hip abduction, extension of MS trunk, MS flexion and hip adduction and all SEMG variables showed no statistically significant difference. However no difference was detected between aquatic or conventional physiotherapy. These results suggest that physical therapy seems to be a resource capable of preventing and treating musculoskeletal dysfunctions of patients with sickle cell disease, regardless of the technique used. Keywords: Sickle cell disease, physical therapy, aquatic therapy. Disclosures No relevant conflicts of interest to declare.

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Hemophilia is characterized by recurrent bleeding into the joints leading to irreversible chronic arthropathy with reduced joint range of motion (ROM), which may lead to changes in gait patterns. To analyze the gait pattern in a 35-year-old male with severe hemophilia A, three-dimensional biomechanical analysis was performed during overground walking. The control group data from a public gait dataset of 10 healthy male individuals were used for comparison. The clinical examination was assessed with the Functional Independence Score in Hemophilia (FISH), Haemophilia Activities List (HAL), and Hemophilia Joint Health Score (HJHS). The biomechanical analysis demonstrated a pattern for both left knee and ankle joints with greater similarity to the control group compared to the right knee and ankle joints. ROM based on the HJHS questionnaire also showed greater impairment of the right-side knee joint compared to the left-side knee joint. This unique pattern could be the result of a compensation mechanism due to limited movement during the walking task and the surgical treatment.