Comprehensive care on paper only? The challenge for physiotherapy provision in day to day haemophilia practice

The Role of Physiotherapy in the New Treatment Landscape for Haemophilia

“…The WFH have positioned physiotherapy as a life-long requirement for PWH [12], and we hereby emphasise the core role of the physiotherapist will not change with the advent of new innovations in pharmacological care for haemophilia. The presence of pre-existing muscle and joint damage from years of bleeding are still seen presently, and in the future a more preventative role will be key to optimize joint health outcomes.…”

“…Physiotherapy has adapted to many changes in the haemophilia landscape in recent decades (Figure 2), and is now recognised as an essential part of the multidisciplinary team [12,14,35,36]. The WFH recommends regular replacement therapy to reduce bleed frequency in combination with physiotherapy aimed at preserving muscle strength and functional ability in order to prevent and treat chronic haemophilic arthropathy [14].…”

“…A recent EAHAD survey also showed considerable heterogeneity in physiotherapy roles and responsibilities across Europe [36], and this is likely to be even more diverse on a global scale [2]. This is particularly true regarding access to and the type of physiotherapy provided, as well as the skill set and autonomy of physiotherapists to make independent assessment and treatment decisions [36]; the full set of physiotherapy competencies are not currently recognised or utilised in all haemophilia treatment centres [12]. As well as supporting the concept of expert physiotherapy as part of the core multidisciplinary team for PWH, we recommend that PWH have direct access to a local physiotherapist.…”

“…Much of haemophilia care focuses on pharmacological parameters to prevent bleeds, improving but not eliminating joint disease. Since long-term outcomes are mainly musculoskeletal [3,6,11], a comprehensive care model is needed to achieve better outcomes in PWH [12][13][14].…”

“…This paper considers whether there will still be a need for physiotherapy in the era of advanced therapies, and discusses ways in which physiotherapy services should evolve to complement emerging treatment paradigms for haemostasis in PWH [11,12]. It is also intended for local primary-care physiotherapists, who must also be aware of the evolution of treatments in order to interact effectively with both PWH and the team in the haemophilia treatment centre.…”