Abstract
Despite fall-related injuries having serious consequences for older haemophilic patients, few studies have investigated their postural stability and risk of falls. The aim was to examine postural stability, joint function and joint mobility in haemophiliacs and age-matched controls. Centre of pressure excursions in four 60 s balance conditions, two minute walk test, passive ankle and knee range of motion, Haemophilia Joint Health Score, and Haemophilia Early Arthropathy Detection with Ultrasound score were measured in eight men with haemophilia (people with heamophilia, PWH), and eight age-matched men without haemophilia (people without heamophilia, PWOH). PWH have significantly worse postural stability under physically perturbed conditions (p = 0.001–0.028, η p 2 = 0.19–0.34), reduced joint function (p = 0.001–0.010, d = 1.33–2.62) and mobility (p < 0.001–0.025, d = 1.01–4.61), and increased centre of pressure (CoP) velocity (p < 0.001–0.003) when compared to PWOH. Postural stability among PWH did not deteriorate with time standing, although significant decreases compared to PWOH across all time intervals were observed (Eyes Open Foam (EOF) CoP ellipse (time x group) p = 0.011, η p 2 = 0.28; path (time × group) p = 0.035, η p 2 = 0.21; EOF CoP antero-posterior (AP) (time × group) p = 0.021, η p 2 = 0.24). Joint function, mobility, and postural stability are reduced in PWH compared to PWOH, driven by differences in the CoP AP range. Dynamic tests incorporating physical perturbation may be more effective than static balance tests on a level surface, and longer period of time to assess postural stability may determine whether fatigue affects ability of PWH to maintain postural stability. Adoption of a possible ‘hip strategy’ by which to achieve balance suggests falls prevention programs need to focus on increasing hip strength and retraining ankle strategy movement to allow PWH to improve balance stability.
Highlights
Haemophilia is a disorder of bleeding, in which most of the bleeding occurs into muscles and joints, leading to severe destructive arthritis
This study has provided pilot data on significant differences between older people with haemophilia (PWH) and people without haemophilia (PWOH), which can provide a focus for further studies seeking to measure and improve balance and falls risk in PWH
Ability to maintain postural stability in both PWH and PWOH is greatly decreased when a physical perturbation is introduced, but not affected by removal of visual reference, which was in contrast to adolescents [23]
Summary
Haemophilia is a disorder of bleeding, in which most of the bleeding occurs into muscles and joints, leading to severe destructive arthritis. There is currently no known cure, but as a result of medical advancements, many people with haemophilia (PWH) are living longer. The most recent review [1] concluded that the current life expectancy of haemophilia patients has approached that of males in the general population. Age-related co-morbidities including cardiovascular disease, hypertension, diabetes, cancer, renal disease and overweight/ obesity have been described in the PWH [2,3,4,5,6], but joint arthropathy remains the main co-morbidity [3,6]. Data comparing falls incidence in the general population from 2000 with that of 2010 show that the incidence of fractures following a fall are on the increase, possibly due to the increase in diabetes and obesity [7]
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