The Effects of Manual Therapy in Hemophilic Patients
Condition: Hemophilia; Arthropathy Hemophilic
MeSH terms: Joint Diseases; Hemophilia A
Study type: Interventional

Summary: 
      Uncertainty about how to treat existing hemophilic arthropathy (HA) is the most important
      issue that will increase functionality and joint health. Recent studies have shown that MT
      can be used safely for improving joint health, pain and ROM with no bleedings in PwH with
      elbow and ankle HA. Unlike MT studies in hemophilia, we investigated the effects of MT on
      important parameters such as muscle strength (MS), functional level, joint health, functional
      independence score in hemophilia (FISH) and kinesiophobia. These parameters are closely
      related to functional level and quality of life of PwH. Therefore, evaluation of these
      parameters and determining the effects of the MT on these parameters are very important for
      both PwH and also clinicians.
    

Detailed description: 
      The aim of this study was to investigate the effects of manual therapy in addition to home
      exercise program on hemophilia functional independence level, joint health, kinesiophobia,
      functional level, range of motion, muscle strength and pain level in hemophilic individuals
      with lower extremity joint arthropathy. Hemophilic arthropathy was developed in at least one
      of the lower extremity joints and aged between 18-30 years 17 severe type hemophilic men were
      participated in the study. The participants were divided into two groups as Home Exercise
      Group (HEG) and Manual Therapy Group (MTG) by randomization method. While the HEG was
      performed the exercise program at home, in addition to the same HEG manual therapy were
      applied to the MTG by the same physiotherapist 3 days a week for 1 hour. Both groups were
      followed for a total of 5 weeks and pre-treatment evaluations were repeated post-treatment.
      The joint health of the hemophilics in both groups were evaluated with Hemophilia Joint
      Health Score (HJHS), their kinesiophobia level were evaluated with Tampa Kinesophobia Scale,
      their functionality with the Functional Independence Score in Hemophilia (FISH). In addition,
      Functional Reach, Timed Up and Go and 5 Times Sit-to- Stand tests were used for functional
      level. The range of motion was evaluated with a goniometer, muscle strength was measured with
      a digital dynamometer and pain level was assessed with a Visual Analogue Scale (VAS). Number
      of hemarthrosis decreased in both groups.
    

Intervention name(s): Manual therapy
Intervention type(s): Other
Intervention description(s): Both groups received for 3 sessions per week, a total of 5 weeks. Home exercises were performed by the patient for 30 minutes at home.In home exercises active ROM for warm-up (5 min), passive stretchening (5 min), strengthening exercises (10 min), proprioceptive and balance exercises (10 min). In manual therapy group, myofascial release techniques (MRT) and Kalternborn mobilization techniques lasted about one hour. In MRT, each manuever was applied for 2 mins and 3 times. The superficial strokes were performed, assisted by slight movements of joints. MRT to posterior capsule of the knee, ligaments, iliotibial tractus, plantar fascia, metatarsal, tarsals, and toes. Kalterborb mobilization tecnqiues; posterior gliding for restricted knee flexion, anterior gliding for restricted knee extension,talocrural posteior gliding for dorsal flexion, talocrural anterior gliding for plantar flexion.3 * 10 repetitions, 20 sec of per reps and 10 sec of interval.
Other intervention name(s): Home exercise
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Hemophilia; Arthropathy; Physiotherapy; Manual therapy; Joint health