Comprehensive elements of a physiotherapy exercise programme in haemophilia – a global perspective

Abstract

Summary. Exercise programmes for people with haemophilia are usually designed and implemented to help manage the recovery after a haemarthrosis or a muscle bleed, or as a tool to help prevent bleeding episodes from occurring. In this article, we have identified individual components of exercise that are often applied as separate entities, but may also need to be implemented in concert for optimized impact. Although it may be necessary on occasion to bias an exercise programme towards one component over the others, it is important to recognize that the various elements of exercise are not mutually exclusive. Decreased flexibility, strength and proprioception, will result in an impairment of balance and a loss of function. Programme design should whenever possible be guided by proven methodology in terms of how each component is incorporated, and more specifically how long to perform the exercise for and how many repetitions should be performed. We recognize, however, that this is not always possible and that there is significant value in drawing from the experience of clinicians with specialized training in the management of haemophilia. In this study, both perspectives are presented, providing reference‐based reviews of the mechanics of the various elements of exercise as well as the expert opinions of the authors. Research that has been completed using patients with conditions other than haemophilia may or may not have a direct application with the bleeding disorders population, but the programme design based on principles of tissue healing in addition to disease specific knowledge should be encouraged.

Pain and pain management in haemophilia

“…These components are flexibility and stretching, strength, sensorimotor retraining (or proprioception), balance, and overall function [22] (Table 2). …”

“…When considering the financial cost of medical and pharmaceutical technologies used to treat haemophilia, physiotherapy is far less expensive than replacement therapy and may be more easily performed by patients and caregivers in the home setting [22]. Furthermore, the cost of regular physiotherapy may be offset by reduced factor consumption.…”

“…Furthermore, the cost of regular physiotherapy may be offset by reduced factor consumption. This means that it is possible for haemophilia patients around the world to improve their joint and muscle status, even if they live in countries where resources are scarce [22]. …”

Management of muscle haematomas in patients with severe haemophilia in an evidence‐poor world

“…The goal of physiotherapy in phase 1 is to decrease pain and swelling [8], support wound healing and maintain haemostasis. PRICE is an established strategy to achieving this goal, but its component practices are based on limited clinical evidence.…”

O efeito do exercício aeróbico aquático na hemartrose experimental induzida em ratos

“…Dentro do processo de reabilitação e prevenção da artropatia hemofílica, diferentes modalidades de exercícios têm sido recomendadas (Bossard et al, 2008;Blamey et al, 2010;Schafer et al, 2016) com os objetivos de manutenção da força muscular (Hilberg et al, 2001;Tiktinsky et al, 2002;Harris, Boggio et al, 2006;González et al, 2007), evitar retração de tecidos periarticulares e musculares Heijnen, Kleijn, 1999), melhora da propriocepção (Hilberg et al, 2001) e do equilíbrio (Gallach et al, 2008;Fearn et al; (Olofsson et al, 2015). Porém, em paciente com hemofilia A grave, apesar de ter sido reportado um aumento na concentração de FvW (Zourikian et al, 2016), nenhuma alteração na meia-vida do FVIII foi identificada (Olofsson et al, 2015;Zourikian et al, 2016).…”