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Pain: a neglected symptom in hemophilia. Ann Hematol 2023; 102:947-953. [PMID: 36820905 DOI: 10.1007/s00277-023-05134-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 02/08/2023] [Indexed: 02/24/2023]
Abstract
Repetitive bleeding attacks may cause joint pain and arthropathy in patients with hemophilia (PWH). Despite being a common symptom, pain is not a well-studied topic in this disease. The aim of this cross-sectional, observational study was to assess the frequency and intensity of pain and analyze the success rates ofpain treatment methods. Adult hemophilia patients were included in the study. The Multidimensional Hemophilia Pain Questionnaire (MHPQ) was used to assess pain. In addition to the MHPQ, demographic data were collected. Fifty adult hemophilia patients were included in the study. Thirty-one (62%) of the patients reported pain due to hemophilia in the last year. Twenty-six of them (81.2%) reported pain during bleeding attacks. The most successful pain coping strategy was clotting factor replacement. None of the participants used opioids or adjuvant analgesics. None of them used a physical therapy modality or interventional pain therapy method. While 67.6% of the patients were very dissatisfied or dissatisfied with their global pain treatment, only 16.1% of the patients were satisfied or very satisfied. Patients with higher pain during bleeding episodes were more likely to continue their prophylaxis. There was no significant difference between plasma-derived or recombinant-derived factor prophylaxis in terms of pain complaints. Pain is a frequent and important symptom of hemophilia, but most of the patients are not treated sufficiently. A multidisciplinary approach is needed to improve the life quality of the patients. In addition to successful bleeding prophylaxis, administration of a proper and adequate analgesic regimen and combined physical therapy modalities may decrease pain intensity and prevent the development of arthropathy.
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Moderate-intensity aerobic exercise vs desmopressin in adolescent males with mild hemophilia A: a randomized trial. Blood 2022; 140:1156-1166. [PMID: 35839450 DOI: 10.1182/blood.2022016146] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/28/2022] [Indexed: 11/20/2022] Open
Abstract
Persons with mild hemophilia A (HA) may use intranasal desmopressin prior to sports participation. Desmopressin is expensive and can cause vomiting, headache, palpitation, and occasionally seizures. Our group has previously documented a 2.3-fold increase in factor VIII activity (FVIII:C) in adolescents with mild HA after moderate-intensity aerobic exercise. Herein, we report principal findings of a randomized trial of intranasal desmopressin vs a standardized, moderate-intensity aerobic exercise regimen in adolescents with mild HA. Our primary objective was to compare the change in FVIII:C associated with these 2 interventions. We also examined changes in hemostatic parameters arising from their sequential administration. The study was conducted simultaneously at the Hospital for Sick Children, Canada, and Nationwide Children's Hospital, USA. Thirty-two eligible male adolescents (mean age ± standard deviation: 16.1 ± 2.6 years) with mild HA (mean baseline FVIII:C: 27.9% ± 18.4%) were randomized to 1 of 4 study arms (desmopressin followed by exercise, desmopressin alone, exercise followed by desmopressin, and exercise alone). Blood work was obtained at baseline and at 3 subsequent time-points. Participants randomized to exercise cycled on an ergometer for approximately 12 minutes, with the final 3 minutes at 85% of their predicted maximum heart rate. Standard weight-based dosing of desmopressin was used. Mean immediate increase in FVIII:C was 1.7-fold with exercise compared with 1.9-fold with desmopressin (noninferiority, P = .04). Exercise-induced improvement in hemostatic parameters including FVIII:C was brief compared with more sustained improvements seen with desmopressin. More than 60% of participants randomized to receive both exercise and desmopressin achieved normal (>50%) FVIII:C, 75 and 135 minutes into the study protocol.
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Hmida J, Hilberg T, Koob S, Marquardt N, Wirtz DC, Schildberg FA, Oldenburg J, Strauss AC. Peak pressure during gait in patients with severe haemophilia: A controlled cross-sectional study. Gait Posture 2022; 93:26-31. [PMID: 35051714 DOI: 10.1016/j.gaitpost.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/09/2021] [Accepted: 01/12/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients with severe haemophilia suffer from bleeding-related joint changes in which the ankle joint is most frequently affected. In the resulting gait changes, the forefoot is involved by reducing the foot pressure. However, it is unclear which changes in foot pressure are present in the individual's foot zones. RESEARCH QUESTION The aim of the study was to determine whether compensation mechanisms are present in the foot zones regarding the peak pressure under dynamic conditions and to identify possible underlying mechanisms for gait changes. METHODS In a controlled cross-sectional study, a pedobarography was performed during gait with a standardized speed (3 km/h) in patients with haemophilia (PwH;n = 40) and healthy controls (Con;n = 40). Pressure pain thresholds (PPT) were detected, and Haemophilia Joint Health Score (HJHS) was performed to determine the current joint status. RESULTS PwH showed a decreased peak pressure in metatarsals II-IV and heel compared to Con. Patients with major-affected ankle joints (determined with the HJHS) showed a decreased single-step length, stride-length and stride-time. Accordingly, the cadence was increased by 10 ± 11 steps/min in PwH compared to Con. Furthermore, PwH showed decreased ankle range of motion (ROM) in HJHS and an altered pain perception due to reduced PPT. SIGNIFICANCE PwH showed a changed gait pattern in peak pressure compared to Con. A restricted rolling behavior, which might be caused by movement restrictions and pain sensation, leads to reduced pressure in the center forefoot, resulting in a shorter stride-length. Future therapies should focus on maintaining joint mobility for better rolling behavior and improving ankle joints' stability to achieve a balanced load between the midfoot, heel, and forefoot. The use of insoles adapted to our data, based on group differences between PwH and Con, could be supportive in this case.
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Affiliation(s)
- Jamil Hmida
- University of Wuppertal, Department of Sports Medicine, Moritzstraße 14, 42117 Wuppertal, Germany.
| | - Thomas Hilberg
- University of Wuppertal, Department of Sports Medicine, Moritzstraße 14, 42117 Wuppertal, Germany
| | - Sebastian Koob
- University of Bonn, Department of Orthopaedics and Trauma Surgery, Venusberg Campus 1, 53127 Bonn, Germany
| | - Natascha Marquardt
- University of Bonn, Institute for Experimental Haematology and Transfusion Medicine, Venusberg Campus 1, 53127 Bonn, Germany
| | - Dieter C Wirtz
- University of Bonn, Department of Orthopaedics and Trauma Surgery, Venusberg Campus 1, 53127 Bonn, Germany
| | - Frank A Schildberg
- University of Bonn, Department of Orthopaedics and Trauma Surgery, Venusberg Campus 1, 53127 Bonn, Germany
| | - Johannes Oldenburg
- University of Bonn, Institute for Experimental Haematology and Transfusion Medicine, Venusberg Campus 1, 53127 Bonn, Germany
| | - Andreas C Strauss
- University of Bonn, Department of Orthopaedics and Trauma Surgery, Venusberg Campus 1, 53127 Bonn, Germany
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Stromer W, Pabinger I, Ay C, Crevenna R, Donnerer J, Feistritzer C, Hemberger S, Likar R, Sevelda F, Thom K, Wagner B, Streif W. Pain management in hemophilia: expert recommendations. Wien Klin Wochenschr 2021; 133:1042-1056. [PMID: 33661391 PMCID: PMC8500904 DOI: 10.1007/s00508-020-01798-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/11/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION As a typical consequence of bleeding into muscles and joints, patients with severe hemophilia suffer from acute and chronic pain. In spite of its high prevalence, pain in this patient group is not always sufficiently considered or treated in an effective manner. AIM The recommendations presented in this paper address possible improvements in pain management in hemophilia patients and particularities that have to be taken into account in this patient group. METHOD The manifold aspects of pain management in hemophilia patients were discussed within the framework of an expert meeting. Based on the available literature and the experts' clinical experience, the participants developed a set of recommendations presented in this paper. RESULTS Pain management in patients with hemophilia is often insufficient, a fact that not only influences the patients' quality of life but also implies the risk of difficult to manage chronic pain. Both the prevalent polypharmacy (due to comorbidities) as well as the underlying disease itself present special challenges to pain therapy in this patient group. The present review and recommendations are intended to support medical professionals in recognising the risks of pain chronicity, applying basic principles of multimodal pain therapy, including the options of psychological intervention and modalities of physical medicine in therapy concepts, and reaching a comprehensive understanding of the range of analgesic options available.
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Affiliation(s)
- Waltraud Stromer
- Department for Anaesthesia and General Intensive Care, Horn State Hospital, Spitalgasse 10, 3580, Horn, Austria
| | - Ingrid Pabinger
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna/Vienna General Hospital, Vienna, Austria
| | - Cihan Ay
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna/Vienna General Hospital, Vienna, Austria
| | - Richard Crevenna
- University Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna/Vienna General Hospital, Vienna, Austria
| | - Josef Donnerer
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Clemens Feistritzer
- University Hospital for Internal Medicine V/Haematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Sophie Hemberger
- University Department of Paediatric and Adolescent Medicine, Medical University of Vienna/Vienna General Hospital, Vienna, Austria
| | - Rudolf Likar
- Department for Anaesthesia and Intensive Care, State Hospital Klagenfurt am Woerthersee, Klagenfurt, Austria
- Wolfsberg State Hospital, Wolfsberg, Austria
- Palliative Care, Sigmund Freud University Vienna, Klagenfurt, Austria
| | - Florian Sevelda
- University Department of Orthopaedics and Trauma Surgery, Medical University of Vienna/Vienna General Hospital, Vienna, Austria
| | - Katharina Thom
- University Department of Paediatric and Adolescent Medicine, Medical University of Vienna/Vienna General Hospital, Vienna, Austria
| | - Barbara Wagner
- University Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna/Vienna General Hospital, Vienna, Austria
| | - Werner Streif
- Department of Pediatrics, Medical University of Innsbruck, Innrain 52, 6020, Innsbruck, Austria.
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Hmida J, Hilberg T, Krüger S, Jansen TR, Goldmann G, Oldenburg J, Wirtz DC, Strauss AC. Changes of static and dynamic spine alignment in patients with severe haemophilia. Haemophilia 2021; 27:e721-e729. [PMID: 34492141 DOI: 10.1111/hae.14406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/29/2021] [Accepted: 08/23/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Haemophilic arthropathy results in a restricted range of motion and pain that often affects gait. The effect of these gait changes on spinal posture has not been studied. AIM To evaluate whether the altered joint situation in patients with haemophilia (PwH) leads to compensatory mechanisms evident in the trunk and spine, considering static and dynamic conditions. METHODS PwH and healthy controls (20-65 years) were examined using rasterstereography in a controlled cohort study. Analysis was performed in static and dynamic conditions in regard to gait phases. Joint status was determined using the Haemophilia Joint Health Score (HJHS). RESULTS Static measurements showed no group differences in PwH (n = 40) compared to healthy controls (n = 40) except pelvic torsion (median [25%-quartile;75%-quartile]: -1.9[-3.2;.9]° vs. .5[-1.1;1.9]°; P = .007). In contrast, under dynamic conditions PwH showed significantly higher trunk inclination and lower apex lumbar lordosis in all gait phases. Additionally, pelvic torsion was increased in mid stance and terminal swing. Considering joint status, PwH had a higher global HJHS (23.5[13.0;30.0] vs. 3.0[1.0;5.0]; P<.001). A significant moderate correlation was shown between the HJHS mobility score and spine parameters (r = .228-.588; P<.05). CONCLUSION Degenerative joint changes in PwH lead to altered spine posture during gait. A reason could be the reduced mobility in the affected joint. Changes in spinal and pelvic posture lead to higher structural burdens; therefore, clinicians should focus on posture of spinal column during gait in daily treatment.
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Affiliation(s)
- Jamil Hmida
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Thomas Hilberg
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Steffen Krüger
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Tom R Jansen
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | - Georg Goldmann
- Institute for Experimental Haematology and Transfusion Medicine, University of Bonn, Bonn, Germany
| | - Johannes Oldenburg
- Institute for Experimental Haematology and Transfusion Medicine, University of Bonn, Bonn, Germany
| | - Dieter C Wirtz
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | - Andreas C Strauss
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
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Fouasson-Chailloux A, Maugars Y, Trossaert M, Rannou F, Menu P, Vinatier C, Guicheux J, Dauty M. Isokinetic knee strength deficit in patients with moderate haemophilia. Haemophilia 2021; 27:634-640. [PMID: 33595151 DOI: 10.1111/hae.14279] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/02/2021] [Accepted: 02/05/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Knee joint bleedings are responsible for quadriceps atrophy and strength deficit in patients with severe haemophilia. Little is known about patients with moderate haemophilia (PWMH). AIM To evaluate isokinetic quadriceps and hamstrings strength in PWMH and to assess correlation with radiological and clinical parameter. METHODS 18 PWMH aged 37.1 ± 11.4 and 18 healthy age-, weight- and height-matched controls performed a knee isokinetic test at 180°/s to assess quadriceps and hamstrings strength. In the PWMH group, knee Pettersson's score was pursued and Haemophilia Joint Health Score 2.1 (HJHS) was performed to determine unaffected knees (knee HJHS = 0) and affected ones (knee HJHS >0). RESULTS Affected knees had a decrease of quadriceps strength compared to controls, 1.26 ± 0.47 vs 1.64 ± 0.27 Nm/kg and a decrease of hamstring strength, 0.60 ± 0.29 vs 1.03 ± 0.21 Nm/kg, (P < 0.001). Unaffected knees also had a decrease of quadriceps strength compared to controls, 1.36 ± 0.31 vs 1.64 ± 0.27 Nm/kg and a decrease of hamstring strength, 0.69 ± 0.18 vs 1.03 ± 0.21 Nm/kg, (P < 0.001). The conventional hamstring-to-quadriceps ratio was significantly decreased in affected knees compared to controls, 0.46 ± 0.15 vs 0.64 ± 0.13 (P < 0.001) but also in unaffected knees, 0.53 ± 0.16 vs 0.64 ± 0.13 (P = 0.02).No correlation was found between strength and HJHS or Pettersson's score. CONCLUSION PWMH have a significant knee strength deficit, both on the quadriceps and the hamstrings, which is responsible for an important muscle imbalance.
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Affiliation(s)
- Alban Fouasson-Chailloux
- INSERM, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, France.,Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes, France.,Service de Médecine du Sport, CHU Nantes, Nantes, France.,Université de Nantes, UFR Odontologie, Nantes, France
| | - Yves Maugars
- INSERM, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, France.,Université de Nantes, UFR Odontologie, Nantes, France.,Service de Rhumatologie, CHU Nantes, Nantes, France
| | - Marc Trossaert
- Centre Régional de Traitement de l'Hémophilie, CHU Nantes, Nantes, France
| | - François Rannou
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpitaux Universitaires-Paris Centre, Groupe Hospitalier Cochin, Assistance Publique - Hôpitaux de Paris, France.,INSERM UMRS 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs, UFR Sciences Fondamentales et Biomédicales, Sorbonne Paris Cité, Paris, France
| | - Pierre Menu
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes, France.,Service de Médecine du Sport, CHU Nantes, Nantes, France
| | - Claire Vinatier
- INSERM, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, France.,Université de Nantes, UFR Odontologie, Nantes, France
| | - Jérôme Guicheux
- INSERM, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, France.,Université de Nantes, UFR Odontologie, Nantes, France.,CHU Nantes, PHU4 OTONN, Nantes, France
| | - Marc Dauty
- INSERM, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, France.,Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes, France.,Service de Médecine du Sport, CHU Nantes, Nantes, France.,Université de Nantes, UFR Odontologie, Nantes, France
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Tat NM, Can F, Sasmaz HI, Tat AM, Antmen AB. The effects of manual therapy on musculoskeletal system, functional level, joint health and kinesiophobia in young adults with severe haemophilia: A randomized pilot study. Haemophilia 2021; 27:e230-e238. [PMID: 33423376 DOI: 10.1111/hae.14031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The effects of manual therapy (MT) on joint health and functional level in haemophilic arthropathy (HA) have relatively under-explored. AIM To investigate the effects of MT in HA of lower limb joints on musculoskeletal system, functional level, Functional Independence Score in Hemophilia (FISH), Hemophilia Joint Health Score (HJHS) and kinesiophobia. METHODS Seventeen patients were randomized to the control group (CG = 9) and manual therapy group (MTG = 8). The number of haemarthrosis (NoH) was recorded from the diaries. Range of motion (ROM), strength and pain intensity were measured using goniometer, digital dynamometer and visual analogue scale, respectively. Joint health was evaluated with HJHS, functional independence with FISH, and kinesiophobia with Tampa Scale. Functional Reach (FR), Timed Up-Go (TUG) and 5-Times Sit-to-Stand (5*STS) tests were used to evaluate functional level. Home exercises were given to both groups. Additionally, myofascial release techniques and mobilizations were applied to MTG. Interventions were applied 3 d/weekly for 5 weeks. Assessments were performed at baseline and after treatment. RESULTS ROM, strength, activity pain, HJHS and FISH were improved in MTG (p˂0.05). Ankle NoH, 5*STS and FR were developed in both groups (p˂0.05), but kinesiophobia, TUG and knee NoH were not significant. Although improvements were observed in favour of MTG in HJHS, FR, activity pain and ankle strength/ROM (p˂0.05), no significant difference was found in FISH, kinesiophobia, TUG, 5*STS, resting pain and knee strength. CONCLUSION Reduction in ankle NoH indicated that both interventions were safe. The use of MT in HA of lower limb joints was an effective physiotherapy approach to improve functional level, joint health and functional independence.
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Affiliation(s)
- Necati Muhammed Tat
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Necmettin Erbakan University, Konya, Turkey
| | - Filiz Can
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Hatice Ilgen Sasmaz
- Department of Pediatric Hematology and Oncology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Ayse Merve Tat
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Necmettin Erbakan University, Konya, Turkey
| | - Ali Bulent Antmen
- Department of Pediatric Hematology and Oncology, Acıbadem University, Adana, Turkey
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Tijskens D, Lobet S, Eerdekens M, Peerlinck K, Hermans C, Van Damme A, Staes F, Deschamps K. Paediatric patients with blood-induced ankle joint arthritis demonstrate physiological foot joint mechanics and energetics during walking. Haemophilia 2020; 26:907-915. [PMID: 32770628 DOI: 10.1111/hae.14128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/18/2020] [Accepted: 07/24/2020] [Indexed: 11/29/2022]
Abstract
AIM To compare foot joint kinetics and energetics in male paediatric boys with and without blood-induced ankle joint destruction to these of matched control groups. METHODS A cross-sectional study was conducted in which 3D gait analysis data were collected from thirty-five male children (6-21 years) with severe or moderate haemophilia and twenty-six typically developing boys. Structural integrity of the tarsal foot joints of all haemophilic patients was assessed using the IPSG-MRI scale. All participants walked barefoot while adopting a physiological gait pattern. Three subgroups were created based on the IPSG-MRI scores: a group with no joint involvement (HealthyHaemo), with uni- or bilaterally involvement (PathoHaemo) and with only unilaterally involvement (Haemo_Unilateral_Patho). RESULTS The PathoHaemo group presented a significant lower Lisfranc peak dorsiflexion angular velocity (34.7°/s vs 71.4°/s, P = .000, Cohen d = 1.31) and a significantly higher Lisfranc peak plantarflexion angular velocity (-130.5°/s vs -51.8°/s, P = .000, Cohen d = 0.98) compared to the control group. The Haemo_Unilateral_Patho side had a significant higher Chopart peak dorsiflexion angular velocity compared to the Haemo_Unilateral_Healthy side (41.7°/s vs 31.9°/s, P = .002, Cohen d = 1.16). CONCLUSION No evidence for mild and severe gait deviations could be demonstrated. Internal moments, used as a surrogate measure of joint loading, quantified by the multi-segment foot model were found to be similar within the three subanalyses. We suggest that the ongoing musculoskeletal development in children compensates for structural damage to the ankle joint.
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Affiliation(s)
- Dorien Tijskens
- Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, KULeuven, Heverlee, Belgium
| | - Sébastien Lobet
- Service D'hématologie, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium.,Neuromusculoskeletal Lab (NMSK), Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Service de Médecine Physique et Réadaptation, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Maarten Eerdekens
- Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, KULeuven, Heverlee, Belgium
| | - Kathelijne Peerlinck
- Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology, KU Leuven, Leuven, Belgium
| | - Cédric Hermans
- Service D'hématologie, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - An Van Damme
- Service D'hématologie Pédiatrique, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Filip Staes
- Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, KULeuven, Heverlee, Belgium
| | - Kevin Deschamps
- Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, KULeuven, Brugge, Belgium.,Division of Podiatry, Institut D'enseignement Supérieur Parnasse Deux-Alice, Sint-Lambrechts-Woluwe, Belgium.,Department of Podiatry, Artevelde University College, Ghent, Belgium
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9
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Wagner B, Krüger S, Hilberg T, Ay C, Hasenoehrl T, Huber DFX, Crevenna R. The effect of resistance exercise on strength and safety outcome for people with haemophilia: A systematic review. Haemophilia 2020; 26:200-215. [PMID: 32091659 PMCID: PMC7155123 DOI: 10.1111/hae.13938] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/16/2020] [Accepted: 01/21/2020] [Indexed: 01/01/2023]
Abstract
Introduction Haemophilia is a congenital bleeding disorder with severe musculoskeletal complications. Resistance exercise is important to increase joint stability and to improve physical performance. Aim This review aimed to investigate the safety and efficacy of resistance exercise interventions on people with haemophilia (PwH) and evaluate whether the American College of Sports Medicine resistance exercise criteria for healthy adults are valid for this population. Methods A systematic search in literature was conducted, using the databases PubMed, MEDLiNE, CINAHL, SCOPUS, PEDro and Cochrane Library. Out of 2.440 studies published between 1960 and November 2019, 14 studies (9 randomized controlled trials, 1 controlled trial, 4 single‐group prospective studies) applying resistance exercise in juvenile and adult PwH corresponded to the inclusion criteria. Results Studies performed dynamic, isokinetic or a combination of isometric and dynamic resistance training. Most interventions were carried out in the context of a multimodal training. Resistance was provided using fixed and free weights, body weight, resistance bands and water resistance. Study protocols included clinical and home‐based settings. Several studies suggest that training intensities lower than those known to increase the strength of healthy people are effective in increasing the strength of PwH. Resistance exercise seems to be a safe intervention if it is adequately monitored, individually adapted and applied with sufficient factor therapy. Due to the heterogeneity of study designs, training interventions and outcome measures a meta‐analysis could not be performed. Conclusions Further studies of higher methodological quality are needed to determine the optimal types of exercise, optimal dosage and timing.
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Affiliation(s)
- Barbara Wagner
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Steffen Krüger
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Thomas Hilberg
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Cihan Ay
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Timothy Hasenoehrl
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Dominikus Franz-Xaver Huber
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
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Wagner B, Seuser A, Krüger S, Herzig ML, Hilberg T, Ay C, Hasenöhrl T, Crevenna R. Establishing an online physical exercise program for people with hemophilia. Wien Klin Wochenschr 2019; 131:558-566. [PMID: 31535221 PMCID: PMC6851214 DOI: 10.1007/s00508-019-01548-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 08/06/2019] [Accepted: 08/22/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Hemophilia is a congenital bleeding disorder with an estimated frequency of 1:10,000 births. Repeated joint bleeding is a hallmark of the disorder and leads to painful hemophilic arthropathy. Regular exercise can help improve joint stability and function, reduce the risk of injury and bleeding and improve physical fitness and quality of life. This method paper describes an online training concept aiming to offer access to appropriate exercise instructions for people with hemophilia who are not able to attend regular training at a hemophilia center. METHODS The online exercise program is accessible through the homepage of the Department of Physical Medicine, Rehabilitation and Occupational Medicine of the Medical University Vienna as well as through scanning a QR code printed on information material using a smart phone or tablet. RESULTS The program contains exercises to improve mobility, coordination, muscular strength and flexibility. A brief introduction is given by a hematologist, a pediatrician and a physiatrist. An introductory video informs about contraindications and essential precautions, such as medical attendance and sufficient factor therapy to consider before starting the training. Another video gives advice on the exercise composition. The demonstrated exercises are explained by a physician and are available for adults and children. To individualize training recommendations and offer further diagnostic tools and physical treatment options as necessary, the Department of Physical Medicine, Rehabilitation and Occupational Medicine of the Medical University of Vienna will establish consultation hours for people with hemophilia. CONCLUSION As hemophilia is an orphan disease, patients are mainly treated in specialized centers. For patients who live far from these centers or have limited access to a training there for other reasons, the physical medicine consultation hour and the implementation of online exercise instructions offer individually adapted exercise information for a regular home-based training to benefit from increased physical fitness and joint stability.
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Affiliation(s)
- Barbara Wagner
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Axel Seuser
- Practice for Rehabilitation, Prevention and Orthopedics, Hans-Böckler-Straße 19, 53225, Bonn, Germany
| | - Steffen Krüger
- Department of Sports Medicine, University of Wuppertal, Moritzstraße 14, 42117, Wuppertal, Germany
| | - Marie Luca Herzig
- Department of Sports Medicine, University of Wuppertal, Moritzstraße 14, 42117, Wuppertal, Germany
| | - Thomas Hilberg
- Department of Sports Medicine, University of Wuppertal, Moritzstraße 14, 42117, Wuppertal, Germany
| | - Cihan Ay
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Timothy Hasenöhrl
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Hilberg T. Programmed Sports Therapy (PST) in People with Haemophilia (PwH) "Sports Therapy Model for Rare Diseases". Orphanet J Rare Dis 2018; 13:38. [PMID: 29506547 PMCID: PMC5836382 DOI: 10.1186/s13023-018-0777-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 02/15/2018] [Indexed: 12/30/2022] Open
Abstract
Sports and exercise therapy becomes more and more integrated in the treatment plan of different diseases. Although the benefits of this therapy are of high quality evidence, e.g. in cardiovascular diseases, no concepts of sports therapy are available as a treatment option for rare diseases. During the last eighteen years, we analyzed the situation as well as necessity, and developed a model, contents and the concept of the “Programmed Sports Therapy (PST)” for the treatment of PwH (people with haemophilia) as our model of rare disease. Many studies have shown that motoric skills are depressed in PwH, and that this gap to healthy people increases during age. The only way to reduce this progression is an appropriate therapy, adapted to the necessities of PwH. In haemophilia, in particular, physio- and sports therapy treatments should go hand in hand, the first in the acute phase after bleeding, the second later, after the acute phase has finished. One model, which considers all the different challenges, can be the cogwheel model presented here. Since haemophilia is a rare disease, new training concepts are necessary because classical group therapies are often impossible. PST based on the combination of sports therapy camps together with a supervised autonomous home training helps to directly bring the training to the trainee, in order to enhance key competences and improve the individual situation in PwH, and perhaps in patients with other rare diseases. The experience and scientific data substantiate the success of “Programmed Sports Therapy (PST)” and even this can be a model for other rare diseases.
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Affiliation(s)
- Thomas Hilberg
- Department of Sports Medicine, University of Wuppertal, Pauluskirchstr. 7, D-42285, Wuppertal, Germany.
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12
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Runkel B, Von Mackensen S, Hilberg T. RCT - subjective physical performance and quality of life after a 6-month programmed sports therapy (PST) in patients with haemophilia. Haemophilia 2016; 23:144-151. [PMID: 27726259 DOI: 10.1111/hae.13079] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Musculoskeletal bleedings lead to limitations in the locomotor system and consequently, in health-related quality of life (HRQoL) in patients with haemophilia (PwH). Sports therapy is increasingly recommended to improve their physical performance. Until today, randomised controlled studies investigating changes in physical performance in PwH are rare. AIM This study investigates the impact of programmed sports therapy on the subjective physical performance and the HRQoL in PwH. METHODS A randomised controlled trial (RCT) was conducted with a training intervention for over 6 months. For this purpose, 64 PwH with moderate (n = 5) or severe (n = 59) haemophilia A (n = 57) or B (n = 7) were randomised into two groups - intervention (IG) or control group (CG). The HRQoL was assessed with the SF-36 questionnaire and the disease-specific Haem-A-QoL before and after the intervention. The subjective physical performance was tested by the HEP-Test-Q. RESULTS After the 6-month training intervention, PwH in the IG subjectively reported significant better 'endurance' (P = 0.000) in the HEP-Test-Q compared to the CG. In the SF-36, a significant difference in the domains 'general health perceptions' (P = 0.005) and 'mental health' (P = 0.001) was detected. The haemophilia-specific HRQoL questionnaire showed a significant improvement in the dimensions 'feeling' (P = 0.049), 'work' (P = 0.046) and 'family' (P = 0.040). CONCLUSION In the first RCT evaluating the impact of a 6-month training intervention on the subjective perception of PwH, an increase in subjective physical performance and some domains of HRQoL was demonstrated in the IG. Specific sports therapy should be included into the comprehensive treatment under supervision and monitoring by experienced staff.
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Affiliation(s)
- B Runkel
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - S Von Mackensen
- Institute of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - T Hilberg
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
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13
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Runkel B, Czepa D, Hilberg T. RCT of a 6-month programmed sports therapy (PST) in patients with haemophilia - Improvement of physical fitness. Haemophilia 2016; 22:765-71. [PMID: 27396815 DOI: 10.1111/hae.12957] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2016] [Indexed: 11/28/2022]
Abstract
UNLABELLED Physical fitness is of major importance for patients with haemophilia (PwH) but is highly influenced by bleeding episodes. Although some cohort studies describe an improvement of physical fitness after training intervention, randomized controlled studies (RCT) in PwH are still rare. AIM The aim of this study was to prove the enhancement of physical work capacity in PwH by programmed sports therapy (PST). METHODS This RCT includes a training period over six months. Sixty-four PwH with moderate (n = 5) to severe (n = 59) haemophilia A (n = 57) and B (n = 7) were randomized into two groups - training intervention group (IG) and control group (CG) by block randomization. Complex strength measurements, joint score, coordination check and a 12-min walking test were carried out before and after training intervention. RESULTS Significant differences were tested in M. triceps brachii (Δ+0.62 N kg(-1) ), biceps brachii (Δ+1.25 N kg(-1) ), latissimus dorsi (Δ+0.59 N kg(-1) ), rectus abdominis (Δ+0.51 N kg(-1) ), biceps femoris (right: Δ+0.68 N kg(-1) ; left: Δ+0.59 N kg(-1) ) and the quadriceps femoris (right: Δ+0.71 N kg(-1) ; left: Δ+0.55 N kg(-1) ) after intervention between the two groups (all p ≤ 0.003). Furthermore, an increase in distance (Δ+171.5 m) covered in the 12-min walking test (P = 0.011) was observed. Regarding one-leg stand, a significant improvement (P = 0.037) in the IG (Δ+2.2 s right leg) after intervention could be determined. CONCLUSION For the first time, a study with a corresponding number of adult PwH in a RCT-design showed that programmed sport therapy with specific instructions over 6 months has a positive effect on physical performance of PwH, independent of constitution and disease process.
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Affiliation(s)
- B Runkel
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany. ,
| | - D Czepa
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - T Hilberg
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
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14
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Krüger S, Weitz C, Runkel B, Hilberg T. Pain sensitivity in patients with haemophilia following moderate aerobic exercise intervention. Haemophilia 2016; 22:886-893. [DOI: 10.1111/hae.13016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2016] [Indexed: 12/29/2022]
Affiliation(s)
- S. Krüger
- Department of Sports Medicine; University of Wuppertal; Wuppertal Germany
| | - C. Weitz
- Department of Sports Medicine; University of Wuppertal; Wuppertal Germany
| | - B. Runkel
- Department of Sports Medicine; University of Wuppertal; Wuppertal Germany
| | - T. Hilberg
- Department of Sports Medicine; University of Wuppertal; Wuppertal Germany
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15
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Goto M, Takedani H, Nitta O, Kawama K. Joint Function and Arthropathy Severity in Patients with Hemophilia. JOURNAL OF THE JAPANESE PHYSICAL THERAPY ASSOCIATION 2016; 18:15-22. [PMID: 26733762 DOI: 10.1298/jjpta.vol18_003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The Arnold-Hilgartner classification is one of the most popular evaluation systems for the progression hemophilic arthropathy. A previous study reported an association between arthropathy severity and arc range of motion (ROM). However, associations between arthropathy severity and angular ROM and muscle strength remain unclear. AIM The purpose of this study was to clarify the association between joint function and arthropathy severity in hemophilia. METHODS We studied the knee, ankle, and elbow joints of 31 patients with hemophilia (PWH). The condition of the affected joints was evaluated on the basis of the interview data, joint function measurements, and roentgenography of the affected joints. In assessment of joint function, we evaluated knee strength (flexor, extensor) and grip strength as well as the passive ROM of the elbow, knee, and ankle. During the interview, all patients were asked about the history of intra-articular bleeding over the past year and pain. RESULTS As arthropathy severity worsened, knee flexor strength, knee extensor strength, grip strength, and ROM (elbow flexion, elbow extension, knee flexion, knee extension, and ankle extension) significantly decreased. Even patients with mild arthropathies experienced knee extensor weakness and extension limitation. In addition, joint function of severe ankle arthropathy was significantly related to the history of intra-articular bleeding and pain. CONCLUSION Our results suggest that physical therapy is necessary to improve joint function in PWH and mild or no arthropathy. Pain control and prophylactic hematological management are necessary for patients with severe arthropathy because intra-articular bleeding and pain significantly decrease joint function.
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Affiliation(s)
| | - Hideyuki Takedani
- IMSUT Hospital of the Institute of Medical Science, The University of Tokyo
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16
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Astermark J, Dolan G, Hilberg T, Jiménez-Yuste V, Laffan M, Lassila R, Lobet S, Martinoli C, Perno CF. Managing haemophilia for life: 4th Haemophilia Global Summit. Haemophilia 2015; 20 Suppl 5:1-20. [PMID: 24924596 DOI: 10.1111/hae.12468] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The 4th Haemophilia Global Summit was held in Potsdam, Germany, in September 2013 and brought together an international faculty of haemophilia experts and delegates from multidisciplinary backgrounds. The programme was designed by an independent Scientific Steering Committee of haemophilia experts and explored global perspectives in haemophilia care, discussing practical approaches to the optimal management of haemophilia now and in the future. The topics outlined in this supplement were selected by the Scientific Steering Committee for their relevance and potential to influence haemophilia care globally. In this supplement from the meeting, Jan Astermark reviews current understanding of risk factors for the development of inhibitory antibodies and discusses whether this risk can be modulated and minimized. Factors key to the improvement of joint health in people with haemophilia are explored, with Carlo Martinoli and Víctor Jiménez-Yuste discussing the utility of ultrasound for the early detection of haemophilic arthropathy. Other aspects of care necessary for the prevention and management of joint disease in people with haemophilia are outlined by Thomas Hilberg and Sébastian Lobet, who highlight the therapeutic benefits of physiotherapy and sports therapy. Riitta Lassila and Carlo-Federico Perno describe current knowledge surrounding the risk of transmission of infectious agents via clotting factor concentrates. Finally, different types of extended half-life technology are evaluated by Mike Laffan, with a focus on the practicalities and challenges associated with these products.
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Affiliation(s)
- J Astermark
- Department of Hematology and Vascular Disorders, Skåne University Hospital, Malmö/Lund, Sweden
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Brunner A, Stäuber F, Göhler S, Czepa D, Wendel M, Seuser A, Hilberg T. Impact of joint status on contraction steadiness of m. quadriceps femoris in people with severe haemophilia. Haemophilia 2014; 20:884-90. [DOI: 10.1111/hae.12493] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2014] [Indexed: 12/19/2022]
Affiliation(s)
- A. Brunner
- Department of Sports Medicine; University of Wuppertal; Wuppertal Germany
| | - F. Stäuber
- Department of Sports Medicine; University of Wuppertal; Wuppertal Germany
| | - S. Göhler
- Department of Sports Medicine; University of Wuppertal; Wuppertal Germany
| | - D. Czepa
- Department of Sports Medicine; University of Wuppertal; Wuppertal Germany
| | - M. Wendel
- Institute of Motion Analysis and Quality Control of the Locomotive System; Bonn Germany
| | - A. Seuser
- Institute of Motion Analysis and Quality Control of the Locomotive System; Bonn Germany
| | - T. Hilberg
- Department of Sports Medicine; University of Wuppertal; Wuppertal Germany
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18
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Stäuber F, Brunner A, Czepa D, Krüger S, Wendel M, Seuser A, Hilberg T, Göhler S. Altersabhängige Ansteuerung der Muskulatur im Stand bei Patienten mit Hämophilie. Hamostaseologie 2014; 34 Suppl 1:S36-42. [DOI: 10.5482/hamo-14-02-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 09/17/2014] [Indexed: 11/05/2022] Open
Abstract
SummaryThe haemophilic arthropathy affects the function of the knee joint muscles. The aim of this study was to investigate the myoelectrical signal of knee joint muscles in different age stages during upright standing. Surface EMG (SEMG) amplitudes of quadriceps, hamstrings and gastrocnemii were measured in 191 patients with severe haemophilia A (n=164) and B (n=27) while standing on an even surface. After an age-based classification of patients into the subgroups HA: 17–29 (n = 37), HB: 30–39 (n = 50), HC: 40–49 (n = 61), HD: 50–70 in years (n = 43) the clinical WFH score for the ankle and knee joint was determined. To normalize the SEMG values amplitude ratios (percentage of cumulated activity) were calculated with respect to the specific limb. With increasing age, the patient showed descriptively a deterioration of the joint situation. The extensors of the knee joint reached significantly higher absolute and percentage levels in the muscle activity with increasing age (p < 0.05). The absolute amplitude values of the Mm. gastrocnemii showed no differences in the age groups while the relative levels were decreased.The present study shows that patients with increasing age and degree of haemophilic arthro pathy deve lop a modified control strategy during upright standing, in the form of a shift from the plantar flexors to the extensors of the knee joint.
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Mohanty SS, Dash KK. Total knee arthroplasty in haemophilic arthropathy with severe flexion deformity and HIV-TB co-infection: a case report. Haemophilia 2013; 19:e259-61. [PMID: 23647666 DOI: 10.1111/hae.12157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2013] [Indexed: 12/31/2022]
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