Effectiveness of two modalities of physiotherapy in the treatment of haemophilic arthropathy of the ankle: a randomized pilot study

Abstract

Although different techniques of physiotherapy have been described for the treatment of haemophilic arthropathy (HA) of ankle, hardly any studies have been applied manual therapy or educational physiotherapy and home exercises. The aim of this study was to assess the effectiveness of manual therapy and educational physiotherapy in the treatment of HA of the ankle. Thirty-one patients with HA of the ankle with a mean age of 35.29 (SD: 12.877) years randomized to manual therapy group (n = 11), educational group (n = 10) and a control group (n = 10). The two physiotherapy programmes were one with manual therapy articular traction, passive stretching of the gastrocnemius muscles, and exercises for muscle strength and proprioception (MT group) and the other with educational sessions and home exercises (E group). The study lasted for 12 weeks. The treatment with manual therapy improved the gastrocnemius muscle circumference, and the pain of ankle (P < 0.05). Six months later, MT group still enjoyed improvement. In the educational group there were improvements, but not significant, in the measured variables. No patient had ankle haemarthrosis during the study. The treatment with manual therapy improved the circumference of gastrocnemius and lessened pain in the patients with haemophilic arthropathy of the ankle.

Effectiveness of Physiotherapy in the Treatment of Hemophilic Arthropathy a Systematic Review

“…In a first phase, after discarding the 116 articles repeated among the various documentary sources, the titles and abstract of the remaining 67 studies were analyzed. Finally, following the selection process, only 10 articles [19][20][21][22][23][24][25][26][27][28] met the established criteria. Figure 1 shows the flow diagram with the selection made according to the criteria described above.…”

“…The development of home exercise programs and ergonomic bicycle and treadmill exercises to develop muscle strength, gait and proprioception were the most used therapeutic tools in the studies analyzed in the present review [19][20][21]24,25,27,28]. Joint traction (level I-II) and active and passive kinesitherapy are also used in the approach of hemophilic arthropathy [22,23]. -Jamar hand dynamometer -Samples of venous blood -Moderate intensity aerobic exercise training at 65% to 75% of the maximum heart rate achieved in a reference ST performed according to a modified Bruce protocol (EG1).…”

“…Two articles [23,28] include an educational physiotherapy program in adult patients with hemophilia, and finally one article studies the safety and efficacy of a laser electrotherapy technique in hemophilia [26]. Table 2 details the methodological characteristics of the treatments carried out in the studies under review, as well as the results obtained in each one.…”

“…The level of evidence of the studies obtained through the Van Tulder scale shows us that three studies [23,26,28] score a maximum of 9 out of 11 points. Blinding of the therapist and the patient or rater are the only items in which these articles did not achieve a positive score.…”

“…Similarly, five articles [20][21][22][23]25] scored 6 points out of 9, mainly as a result from not describing the method of randomization and comparison between groups. Finally, two articles [19,24] scored 5 points, the main methodological deficiencies being blinding and randomization, while another article only reached a score of 4 points [27].…”