Abstract
BackgroundHemophilic ankle arthropathy is manifested by degenerative functional alterations and chronic pain. Myofascial release techniques are used to treat soft tissue adhesions, relieve pain, and reduce tissue sensitivity.ObjectiveThis study aims to evaluate the safety and efficacy of a protocol using self-myofascial release with a foam roller to be applied in patients with hemophilic ankle arthropathy.MethodsPatients with ankle arthropathy (N=70) will be recruited, enrolled, and assigned to one of two groups—experimental or control—in a 1:1 allocation ratio. Patients will be recruited from 5 centers in different regions of Spain. Patient data will be collected at baseline, posttreatment, and follow-up. The primary outcome will be frequency of ankle joint bleeding (self-reported). The secondary outcomes will be ankle range of motion (measured with a digital goniometer); joint pain (measured with a visual analog scale and an algometer); joint status (measured using the Hemophilia Joint Health Score); muscle strength (measured with a dynamometer); functionality of lower limbs (measured using the 6-minute walking test); activity (self-reported); and muscle flexibility (measured using the fingertip-to-floor test). The treatment program includes 11 exercises that must be administered bilaterally. A mobile app will be developed where each patient will be able to observe the exercises to be carried out. Each session will last 15 minutes with 5 physiotherapy sessions per week for a period of 3 months. It is expected that patients with hemophilia who receive the foam roller intervention will show improvement in mobility, pain, and status of the ankle joint; muscle strength; and function in the lower extremities.ResultsThe study has been approved by the institutional review board of the University of Murcia. Patient recruitment will begin in September 2020, and the intervention period will last until June 2021. Data collection will take place between September 2020 and October 2021.ConclusionsThis protocol describes a randomized clinical trial to examine the safety and efficacy of a self-myofascial release intervention using a foam roller in patients with hemophilic ankle arthropathy.Trial RegistrationClinicalTrials.gov NCT03914287; http://clinicaltrials.gov/ct2/show/NCT03914287.International Registered Report Identifier (IRRID)PRR1-10.2196/15612
Highlights
Hemophilia is a congenital coagulopathy characterized by a deficiency of a clotting factor
Prophylactic treatment has been shown to be highly effective in the prevention of hemophilic arthropathy [5]; many patients, develop these sequelae as a result of late initiation of treatment, poor adherence to prophylaxis, or the development of inhibitors
The objective of this paper is to describe our approach to the design and implementation of a protocol for self-myofascial release using a foam roller for patients with hemophilic ankle arthropathy with the aim of reducing the frequency of joint bleeding; improving range of motion; reducing joint pain; and restoring functionality, structural integrity, muscle flexibility, and muscle strength
Summary
Hemophilia is a congenital coagulopathy characterized by a deficiency of a clotting factor (factor VIII in hemophilia A and factor IX in hemophilia B). The ankle joint, a crucial component of locomotion, is one of the most affected joints (as are the knee and elbow joints) [3], imposing important functional and proprioceptive limitations. These limitations are the result of developing intra-articular alterations such as joint space narrowing, the development of osteophytes, bone deformities, or axial alterations [4]. Prophylactic treatment has been shown to be highly effective in the prevention of hemophilic arthropathy [5]; many patients, develop these sequelae as a result of late initiation of treatment, poor adherence to prophylaxis, or the development of inhibitors (antibodies to factor VIII or factor IX concentrates). Hemophilic ankle arthropathy is manifested by degenerative functional alterations and chronic pain. Myofascial release techniques are used to treat soft tissue adhesions, relieve pain, and reduce tissue sensitivity
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