Standard and water rehabilitation: An analysis of over 14 years' experience in patients with haemophilia or other clotting factor disorders after orthopaedic surgery

Abstract

Introduction In people with haemophilia (PWH) with severe arthropathy, total joint replacement (TJR) can be undertaken if conservative management fails. Post‐operative rehabilitation treatment is an important part of the comprehensive management of patients undergoing TJR. Aim To compare post‐operative standard rehabilitation (SR) and SR plus water rehabilitation (WR) in PWH undergoing TJR. Methods PWH who were admitted to our centre between June 2003 and December 2016 for rehabilitation after TJR were included in the study. Rehabilitation included SR (ie, manual and mechanical mobilization, scar tissue massage, light muscle strengthening exercises and walking training with and without crutches) with or without WR. WR exercises with floats of different size and volume were performed when possible. Range of motion (ROM), muscle strength, pain level, perceived health status and length of hospital stay were analysed retrospectively. Results A total of 184 patients (233 rehabilitation programmes were enrolled in the study, corresponding to 160 after total knee replacement [TKR], 37 after total ankle replacement [TAR] and 36 after total hip replacement [THR]). Fifty‐eight (25%) patients were treated with WR in addition to SR (32 for TKR, 19 for TAR and 7 for THR) with an average of 5.7 hours of WR. Muscle strength, pain and perceived health status improved significantly after rehabilitation. Conclusion This non‐randomized study seems to indicate that WR plus SR improves muscle strength, pain and perceived health status more than SR alone in PWH undergoing TJR. It would be necessary, however, to carry out randomized comparative studies to confirm these provisional conclusions.

Effects of exercise in people with haemophilia: An umbrella review of systematic reviews and meta‐analyses

“…In addition, PWH who perform physical activities also demonstrate a reduction in bleeding frequency as a result of muscle strengthening and decreased body weight, thus contributing to a lower joint impact. As a result, the consumption of coagulation factors is also reduced, which, in turn, favours emotional and social well‐being and reduces drug dependence …”

“…As a result, the consumption of coagulation factors is also reduced, which, in turn, favours emotional and social well-being and reduces drug dependence. 6,8,9 In this sense, there is an increase in the number of randomized controlled trials (RCTs) investigating the effects of exercise in PWH. The increase in the number of RCTs brings with it the increase in the number of systematic reviews, especially in the last two decades.…”

The evolution of physiotherapy in the multidisciplinary management of persons with haemophilia (PWH): A scoping review

“…Physiotherapy programmes carried out in water have long been employed, as reported by von Mackensen et al., 57 Passeri et al 58 . and Mazloum et al 59 .…”

“…Fifty‐two articles 1,15,17–66 dealt with rehabilitation and preventive physiotherapy. Most of them aimed to map the options for the management of PWH or demonstrate the role of physiotherapy, not only in the presence of clinical problems but also for preventive purposes and to allow a healthy growth.…”

“…One of the most important of them, being the first of its kind, is the Mulder's exercise protocol. 71 More recently, specific physiotherapy interventions, from strength and endurance training to hydrotherapy [56][57][58][59] and telerehabilitation, [66][67][68] were introduced, ultimately demonstrating that exercise and sport offer many benefits to the individual, in biomechanical and psychological terms but also with a positive impact on quality of life.…”