Physiotherapy to Improve Balance and Walking Capacity in Hemophilia

Effects of Manual Therapy and Structured Exercises on Postural Balance and Walking Capacity in Adults With Hemophilia

Introduction: Hemarthrosis is the most common type of bleeding with 70-80% in patient with hemophilia (PwH) and the majority of hemarthrosis occurs in the knee and ankle joints. Recurrent hemarthrosis may cause pain, limited range of motion (ROM), atrophy, swelling, crepitus, and decreased proprioceptive sensation and ultimately causes hemophilic arthropathy. Preventing hemarthrosis and treating arthropathy symptoms in PwH may improve static and dynamic balance and walking capacity. The aim of this study was to investigate the effects of manual therapy and structured exercises on joint health, activity pain, walking capacity and static and dynamic balance.

Method: Thirty-five AwH were randomly assigned to two groups using the computerised simple randomization method: the control group (CG) and the physiotherapy group (PG). The sample sizes for the CG and PG are 17 and 18, respectively. Hemophilia type and severity, treatment regime (prophylaxis or on-demand), age, height and weight were recorded. Joint health was assessed with Hemophilia Joint Health Score (HJHS) version 2.1 by a hemophilia specialist physiotherapist. Activity pain was assessed with Numeric Pain Scale (NPS). Walking capacity was evaluated 6 Minute Walking Test (6MWT). Postural balance (static and dynamic balance) were evaluated with the Pro-kin Technobody Posturographic Platform (Pro-kin 212, Technobody s.r.l, Dalmine, 21044 Bergamo, Italy). Static stability test was used for static balance assessment. Dynamic balance was evaluated with the Limits of Stability (LoS) test. The PG received 12 physiotherapy sessions twice a week for 6 weeks. The physiotherapy intervention consisted of manual therapy and a structured, progressive exercise program. The CG continued with their routine hemophilia care.

Inclusion Criteria:

• Severe or moderate hemophilia A or B
• Aged 18-65
• Having at least 3 points from at least one of the knee and ankle index joints in the Hemophilia Joint Health Score
• Volunteering to attend physiotherapy sessions regularly

Exclusion Criteria:

• Receiving physiotherapy or undergone surgery on lower extremity within the last 6 months
• Having neurological or cognitive disease
• Having visual and vestibular system pathologies