Physiotherapy interventions for pain management in haemophilia: a systematic review

P Mclaughlin,M Hurley,P Chowdary,K Khair,D Stephensen

doi:10.1016/j.physio.2020.03.050

Abstract

Purpose: Haemophilia is an inherited bleeding disorder characterised by recurrent and spontaneous bleeding into joints and muscles, and fatal bleeding in the untreated state. People with haemophilia (PWH) experience acute pain from an early age from musculoskeletal bleeding episodes. As a result of such bleeds, many PWH have chronically painful, multi-joint haemophilic arthritis. 35-50% of PWH report living with chronic musculoskeletal pain, with most reporting their pain was poorly managed by their healthcare providers.

Highlights

Haemophilia is an inherited bleeding disorder characterized by recurrent and spontaneous bleeding into joints and muscles and fatal bleeding in the untreated state.[1,2] People with haemophilia (PWH) experience transient episodes of acute pain from an early age from musculoskeletal bleeding episodes
Ankle There was no clear benefit on pain intensity with home exercises and education mean difference (MD) −0.55 visual analogue scale (VAS), MD −0.3 VAS, or with manual therapy and exercise MD 0.06 VAS
Three studies included a measure of function as an outcome measure of intervention. It is not clear if there is any beneficial effect on function as measured by the 6-minute walk test (6MWT) with LASER and sham LASER, MD 29.33 minutes, or LASER and exercise compared to Pulsed electromagnetic field therapy (PEMF) and exercise, MD 14.47 minutes

Summary

Introduction

Haemophilia is an inherited bleeding disorder characterized by recurrent and spontaneous bleeding into joints and muscles and fatal bleeding in the untreated state.[1,2] People with haemophilia (PWH) experience transient episodes of acute pain from an early age from musculoskeletal bleeding episodes. Some PWH continue to have bleeding into their joints and muscles, which can lead to debilitating arthritis with chronic and recurrent pain.[3]. People with haemophilia over the age of 65 had no access to regular treatment until they were in adulthood, with those currently aged in their 40's having no access to effective treatment for the majority of their childhood.[4] many PWH have chronically painful, multi-joint haemophilic arthritis, involving elbow, knee and ankle joints.[5,6,7]. PWH living with pain report limitations in mobility and independence, increased anxiety, poor quality of life and frustration due to restrictions in activities of daily living.[7,11,12]

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Conclusion