Effectiveness of myofascial therapy on hemophilic arthropathy: A systematic review and meta-analysis of clinical trials

Effectiveness of myofascial therapy (MFT) along with traditional physiotherapy and intermittent prophylaxis on short-term improvement of joint health in hemophilic arthropathy: a randomized control trial

BACKGROUND

Myofascial therapy (MFT) works on biomechanical soft tissue loading principles aimed to reduce pain, improve tissue mobility and function.

AIM

To find effectiveness of MFT and traditional physiotherapy with intermittent prophylaxis on short-term improvement of joint health in hemophilic arthropathy.

RESEARCH DESIGN AND METHODS

Thirty-one patients with Hemophilia A and joint arthropathy (elbows and/or knees) were randomly divided into MFT group (MFT  +  traditional physiotherapy) and control group (traditional physiotherapy). Both groups received four physiotherapy sessions per week for three weeks and FVIII prophylaxis twice weekly. Haemophilia Joint Health Score (HJHS), Functional Independence Scoring for Haemophilia (FISH), and Range of Motion (ROM) were assessed on Day 0, 10, 21.

RESULTS

MFT group demonstrated a significant improvement in their overall HJHS scores (p = 0.016, d = 0.93) and HJHS knee joint scores (p = 0.007, d = 0.57) compared to control group participants. ROM increased substantially in MFT group relative to control group (18.97%; 10.10% improvement in knee and elbow ROM, respectively, vs 9.49%; 1.25%). There was an improvement in FISH scores in both groups, with a slightly greater improvement in control group (13.68% vs 11.08%).

CONCLUSIONS

MFT is effective and feasible in short-term improvement of joint health in Hemophilia A patients with elbow and knee arthropathy.

Effects of resistance training on muscle strength in adults with haemophilia: A systematic review and meta-analysis

INTRODUCTION

Although resistance training is frequently prescribed for people with haemophilia (PWH), no previous meta-analyses have quantified the effect of this intervention on muscle strength, nor the implications of the intervention's modality and duration.

AIM

(1) To determine the effects of resistance training on muscle strength in adults with haemophilia; (2) To determine the most effective duration and modality among the exercise protocols.

METHODS

A systematic search from inception until 28 November 2023 was conducted in PubMed, Embase, Web of Science, CENTRAL and CINAHL databases. We included randomised controlled trials or before-after studies that involved resistance training without other physiotherapy co-interventions. Study selection, data extraction and risk of bias assessment were independently performed by two reviewers. Disagreements were resolved in consultation with a third author. The level of evidence was determined according to the GRADE methodology.

RESULTS

Seven studies were included. Measurements of knee extensor strength and elbow extensor strength were included in the meta-analysis. Subgroup analysis showed significant effects for both elastic resistance protocols (SMD: 0.54; 95% CI: 0.02-1.07) and conventional training (isometric and weight-based equipment) (SMD: 0.88; 95% CI: 0.50-1.25), demonstrating small and moderate effect sizes respectively. Additionally, both protocols of duration 5-7 weeks (SMD: 1.16, 95% CI: 0.63-1.69) as well as those of duration ≥8 weeks (SMD: 0.57, 95% CI: 0.20-0.94) showed a significant difference.

CONCLUSION

Resistance training is effective in improving muscle strength of the knee and elbow extensors in PWH. Both elastic resistance and conventional training show benefits.

Efficacy of rehabilitation interventions on functioning in patients with hemophilic arthropathy: A systematic review with meta-analysis

BACKGROUND

Hemophilic arthropathy is a detrimental condition that crucially affects functional outcomes in hemophilic patients. In recent years, due to the advances in systemic therapies, growing attention has been raised in the rehabilitation field in order to improve functional outcomes of hemophilic patients. However, the optimal rehabilitation modalities in these patients are far from being fully characterized.

OBJECTIVE

The present study aimed to assess the effects of different rehabilitation interventions on physical functioning and health-related quality of life of hemophilic arthropathic patients.

METHODS

The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Five databases were systematically searched for randomized controlled trials (RCTs) published until June 22nd, 2023. The selection criteria included adult patients with hemophilia A and B receiving rehabilitation interventions. The outcomes were muscle strength, physical function, pain intensity, physical performance, and health-related quality of life.

RESULTS

Out of 1,743 identified records, 17 studies were included in the qualitative synthesis. Rehabilitation interventions were categorized into exercise intervention, fascial therapy, and multimodal intervention. The findings suggested positive outcomes in terms of muscle modifications, range of motion improvements, joint health enhancements, pain intensity reduction, and quality of life improvements. More in detail, meta-analyses showed significant improvements in pain intensity [ES: -1.10 cm (-1.37, -0.82), p< 0.00001], joint health [ES: -1.10 (-1.38, -0.82), p< 0.00001], In accordance, exercise interventions showed significant benefits in terms of joint health [ES: -2.54 (-3.25, -1.83), p< 0.00001)] and quality of life [ES: 1.17 (0.48, 1.86), p< 0.0000)].

CONCLUSION

Rehabilitation interventions have a positive impact on functional outcomes and health-related quality of life of hemophilic arthropathic patients. Further studies are needed to better elucidate the role of a comprehensive intervention combining different rehabilitation approaches to treat hemophilic arthropathy.