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Case report

Manual therapy effectively decreases the frequency of joint bleeding improves joint health and reduces pain in hemophilic elbow arthropathy: A prospective cohort study

Raúl Pérez-Llanes, Elena Donoso-úbeda, Javier Meroño-Gallut, José Antonio López-Pina, Rubén Cuesta-Barriuso
Department of Physiotherapy. Faculty of Health Sciences, Catholic University San Antonio-UCAM, 30107 Murcia, Spain
DOI: 10.2340/20030711-1000035


Objective: To verify the safety and effectiveness of manual therapy intervention using fascial therapy in adult patients with haemophilic elbow arthropathy.
Methods: Prospective cohort study. A total of 28 patients with haemophilic elbow arthropathy was recruited in 3 cities in Spain. Patients received onefascial therapy session per week for 3 weeks. The dependent variables were: frequency of joint bleeding, joint pain (visual analogue score) and joint status (Hemophilia Joint Health Score). Outcomes were measured at baseline (T0), post-treatment (T1) and after 3 months´ follow-up (T2). Using Student´s t-test, the means obtained in the evaluations were compared. The analysis of variance (ANOVA) test of repeated measures provided the intra-subject effect. The chosen level of significance was p<0.05.
Results: A total of 28 patients were recruited according to the selection criteria. No joint bleeding occurred during or after the intervention. The primary outcome, frequency of bleeding, improved after intervention (p<0.001). The secondary variables joint status and joint pain improved after the experimental period (p<0.001). There were significant changes in the repeated measures factor in the frequency of haemarthrosis (F=20.61; p=0.00), joint status (F=64.11; p=0.00) and perceived pain (F=33.15; p=0.00).
Conclusion: Manual therapy using fascial therapy did not produce haemarthrosis in patients with haemophilic elbow arthropathy. Fascial therapy can improve the perception of pain and joint state, maintaining this improvement after a follow-up period of 3 months.

Lay Abstract

Haemophilia is a rare disease in which there is a deficiency in some of the blood proteins, which makes it difficult for blood to clot. Patients with haemophilia can present degenerative lesions in joints such as the knee, ankle or elbow, due to joint bleeding, which appears spontaneously with minimal trauma. From an early age, these patients may develop mobility limitations, bleeding, and chronic pain, leading to degenerative damage, known as haemophilic arthropathy. This study examined the safety and efficacy of manual therapy in 28 patients with haemophilia and elbow arthropathy after 3 weeks of treatment. Manual therapy was shown to reduce joint bleeding, improving pain and joint status of the elbow in patients with elbow haemophilic arthropathy.


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