The role of physical medicine and rehabilitation in haemophiliac patients

Corte‐Rodríguez, Hortensia De la; Rodríguez-Merchán, E. Carlos

doi:10.1097/mbc.0b013e32835a72f3

Cited by 53 publications

(34 citation statements)

References 45 publications

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“…The reported symptoms are pain, deformity, a lack of joint mobility, muscular hypotrophy which are associated with symptoms of arthropathy derived from the haemarthrosis [6]. It is important to recall that amyotrophies, muscular imbalances, and weakness are also neurological symptoms, with which we may rule out other diseases of neuromuscular origin.…”

Section: Discussionmentioning

confidence: 99%

“…It is important to recall that amyotrophies, muscular imbalances, and weakness are also neurological symptoms, with which we may rule out other diseases of neuromuscular origin. For all these reasons, presenting those cases, we would like to emphasise the importance of having an exhaustive musculoskeletal examination, for a satisfactory differential diagnosis of the problems derived from coagulopathy and neurological disease [6]. …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Coexistence of Factor VII Deficiency and Hereditary Spastic Paraplegia in Two Siblings

Corte‐Rodríguez

Rodríguez-Merchán

Álvarez‐Román

et al. 2016

Case Reports in Hematology

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We present the case of two patients aged 12 years and 7 years who were referred to our hospital for factor VII deficiency inherited in an autosomal recessive pattern, who had suffered from previous multiple joint haemarthroses. They presented with fine motor symptoms and difficulty in walking. During physical examination we observed neurological symptoms (general hypotonia, muscular hypotrophy, exaggerated tendon reflexes, pes cavus, and spastic gait). Given that the symptoms were not justified by the deficiency of coagulation factor VII and on suspicion of hereditary spastic paraplegia (HSP), tests were carried out. Findings from the tests confirmed the diagnosis of HSP (axonal degeneration of the central motor pathway and pyramidal tracts), further complicated by mixed neuropathy. This disease was also inherited in an autosomal recessive pattern with no direct genetic association with factor VII deficiency. Neurological symptoms had gone unnoticed due to a history of multiple joint haemarthrosis; musculoskeletal examination led to a satisfactory differential diagnosis. Haematological prophylaxis was commenced with rFVIIa at 30 mcg/kg, three days per week. A rehabilitation programme was prescribed so that the patient could remain independent for as long as possible, based on orthosis, physiotherapy, and occupational therapy. Response to treatment is currently satisfactory and no new bleeding has presented. As far as we are aware, the coexistence of these two diseases (factor VII deficiency and HSP) has not been previously reported in the literature.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Coexistence of Factor VII Deficiency and Hereditary Spastic Paraplegia in Two Siblings

Corte‐Rodríguez

Rodríguez-Merchán

Álvarez‐Román

et al. 2016

Case Reports in Hematology

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“…Physical therapy in haemophilia aims to evaluate, diagnose, and treat any disability, while preventing injury or deterioration; this has helped to revolutionize the management of haemophilia patients in developed countries [21]. Specific treatment objectives of physical therapy include alleviation of pain, ROM recovery, prevention of muscle atrophy, as well as improvement in functional ability, reduction of joint bleed frequency, and improvement in QoL [21]. …”

Section: Chronic Pain In Haemophiliamentioning

confidence: 99%

Pain and pain management in haemophilia

Auerswald

Dolan

Duffy

et al. 2016

Blood Coagulation &Amp; Fibrinolysis

103

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Joint pain is common in haemophilia and may be acute or chronic. Effective pain management in haemophilia is essential to reduce the burden that pain imposes on patients. However, the choice of appropriate pain-relieving measures is challenging, as there is a complex interplay of factors affecting pain perception. This can manifest as differences in patients’ experiences and response to pain, which require an individualized approach to pain management. Prophylaxis with factor replacement reduces the likelihood of bleeds and bleed-related pain, whereas on-demand therapy ensures rapid bleed resolution and pain relief. Although use of replacement or bypassing therapy is often the first intervention for pain, additional pain relief strategies may be required. There is an array of analgesic options, but consideration should be paid to the adverse effects of each class. Nevertheless, a combination of medications that act at different points in the pain pathway may be beneficial. Nonpharmacological measures may also help patients and include active coping strategies; rest, ice, compression, and elevation; complementary therapies; and physiotherapy. Joint aspiration may also reduce acute joint pain, and joint steroid injections may alleviate chronic pain. In the longer term, increasing use of prophylaxis or performing surgery may be necessary to reduce the burden of pain caused by the degenerative effects of repeated bleeds. Whichever treatment option is chosen, it is important to monitor pain and adjust patient management accordingly. Beyond specific pain management approaches, ongoing collaboration between multidisciplinary teams, which should include physiotherapists and pain specialists, may improve outcomes for patients.

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“…Haemophilic arthropathy has an onset early in life, is progressive, irreversible, and involves multiple peripheral joints, weight bearing as well as non‐weight bearing, leading to marked functional impairments . The role of physiotherapy in haemophilia is described as: general health prevention, rehabilitation following acute musculoskeletal bleeding, maintenance of mobility and function to maximize physical activities and participation in chronic situations as well as preoperative and postoperative rehabilitation . How these roles are implemented is likely to vary depending on the specific health care resources and autonomy of physiotherapists in each country, as well as the haemophilia treatment centre (HTC).…”

Section: Introductionmentioning

confidence: 99%

Scope of practice of haemophilia physiotherapists: A European survey

et al. 2019

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Introduction European guidelines on the care of haemophilia recommend ready access to a range of services provided by a multidisciplinary team of specialists including physiotherapy. However, the scope of physiotherapy provided is unknown. Methods The Physiotherapists Committee of the European Association for Haemophilia and Allied Disorders (EAHAD) conducted a web‐based survey to quantify the role and scope of practice of physiotherapists involved in haemophilia care. The survey was sent to more than 200 physiotherapists registered on the EAHAD database. Questions concerned their work practices including assessment and treatment activities and level of autonomy. Results Eighty physiotherapists from twenty‐four European countries responded. Considerable heterogeneity exists in roles, responsibilities, and clinical practice of physiotherapists, particularly in access to and type of physiotherapy treatment provided, as well as the skill set and autonomy of physiotherapists to make independent assessment and treatment decisions. Discussion This pan‐European survey establishes a context to support physiotherapy role development and professional identity. Key recommendations include the following: (a) establishing a pan‐European network to support collaboration and education for physiotherapists working in haemophilia, (b) developing a core skills and capability framework to ensure person‐centred approaches are central as well as working in partnership with those with the condition to maximize early recovery, support self‐management and enablement in remaining active and independent, (c) regular training, standardized validation and maintenance of competency for assessment tools, (d) well‐designed randomized clinical studies with larger numbers of participants from multiple sites should be the focus of future research.

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The role of physical medicine and rehabilitation in haemophiliac patients

Cited by 53 publications

References 45 publications

Coexistence of Factor VII Deficiency and Hereditary Spastic Paraplegia in Two Siblings

Coexistence of Factor VII Deficiency and Hereditary Spastic Paraplegia in Two Siblings

Pain and pain management in haemophilia

Scope of practice of haemophilia physiotherapists: A European survey

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