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Background: Hemophilia is characterized by degenerative joint damage. Patients with hemophilic arthropathy present joint damage, reduced range of motion, and decreased strength and functional capacity. Myofascial release therapy aims to decrease pain and improve tissue mobility and functionality., Objectives: To evaluate the safety and efficacy of myofascial release therapy in patients with hemophilic ankle arthropathy., Method: Single-blind randomized controlled trial. Fifty-eight adult patients with hemophilia were randomly allocated to the experimental group (myofascial release therapy with foam roller) or the control group (no intervention whatsoever). The daily home protocol of myofascial release therapy for the lower limbs using a foam roller lasted eight consecutive weeks. The primary variable was the safety of myofascial release therapy (weekly telephone follow-up). The secondary variables were pain intensity (visual analog scale), range of motion (goniometer), functional capacity ( 2-Minute Walk Test ) and muscle strength (dynamometer), at baseline and at 8 and 10 weeks., Results: During the experimental phase, none of the patients in the experimental group developed ankle hemarthrosis. There were statistically significant changes in time*group interaction in ankle dorsal flexion (F [1.75]  = 10.72; p  < .001), functional capacity (F [1.16]  = 5.24; p  = .009) and gastrocnemius strength (F [2]  = 26.01; p  < .001). The effect size of the changes after the intervention was medium-large in pain intensity (d = -1.77), functional capacity (d = 1.34) and gastrocnemius strength (d = 0.76)., Conclusion: Myofascial release therapy is a safe form of physical therapy for patients with hemophilia. Myofascial release therapy can effectively complement prophylactic pharmacological treatment in patients with hemophilic arthropathy, improving range of motion in dorsal flexion, functional capacity and gastrocnemius strength.

Objective: To evaluate the efficacy of immersive movement observation in adult patients with haemophilic ankle arthropathy., Design: Multicentre, single-blind, randomized clinical trial., Subjects: 48 patients with haemophilia., Methods: Patients were randomly allocated to 2 groups (180º immersive video-based visualization of movement and a control group with no intervention). Twenty-eight consecutive 15-min home sessions, 1 per day, of immersive visualization of ankle flexion-extension movement were carried out. Three evaluations were performed: pretreatment (T0), post-intervention (T1), and at 16 weeks' follow-up (T2). The primary variable was joint-pain intensity (visual analogue scale). The secondary variables were conditioned pain modulation (Conditioned Pain Modulation Index), pressure pain threshold (pressure algometer), range of motion (goniometry) and kinesiophobia (Tampa Scale of Kinesiophophia)., Results: There were intergroup differences in pain intensity (F = 37.14; p < 0.001), conditioned pain modulation (F = 5.40; p = 0.006), and dorsal (F = 19.17; p < 0.001) and plantar (F = 9.27; p<0.001) ankle flexion. More than 50% of experimental group patients exhibited changes exceeding the minimum detectable change in pain intensity (MDC = 0.43), and the pressure pain threshold in the extensor carpi radialis longus muscle (MDC = 1.34) and malleolus (MDC = 4.93)., Conclusions: 180º immersive video-based visualization of movement can improve the intensity of pain, conditioned pain modulation, and ankle range of motion in patients with haemophilic ankle arthropathy.

Background: Hemophilia is a congenital coagulopathy characterized by degenerative joint damage. Self-induced myofascial therapy aims to decrease pain and improve tissue mobility, functionality and proprioception., Aim: The aim of this study was to evaluate the safety and efficacy of self-induced myofascial release in patients with hemophilic knee arthropathy., Design: This is a randomized clinical study., Setting: This study was carried out in different patient associations., Population: Fifty-two patients with hemophilia were included in the study., Methods: Patients were randomized to the experimental group (daily home protocol of foam roller-based self-induced myofascial therapy for 8 weeks) or the control group (no intervention). The variables were the frequency of hemarthrosis (self-reporting), pain intensity (visual analog scale), range of motion (goniometry) and muscle strength (dynamometry). All variables were evaluated at baseline, post-treatment and after a 10-week follow-up., Results: The patients included in the experimental group showed significant improvements in terms of a decrease in frequency of hemarthrosis (mean difference [MD]=-0.61; 95% confidence interval [CI]: -0.81; -0.41) and pain intensity (MD=-0.33; 95% CI: -0.48, -0.18), increased range of motion (MD=0.88; 95% CI: 0.39; 1.37), strength in quadriceps (MD=0.88; 95% CI: 0.39; 1.37). (MD=12.39; 95% CI: 3.44; 21.34) and hamstrings (MD=7.85; 95% CI: 0.60; 15.11). There were intergroup differences in the frequency of hemarthrosis (F=14.51; P<0.001), pain intensity (F=9.14; P<0.001) and range of motion (F=13.58; P<0.001)., Conclusions: Self-induced myofascial therapy can be an effective complementary technique in the treatment of patients with hemophilic arthropathy. Self-induced myofascial therapy can reduce the frequency of knee hemarthrosis in patients with hemophilia. This technique can improve pain intensity and range of motion in patients with hemophilic knee arthropathy., Clinical Rehabilitation Impact: Hemophilic knee arthropathy is characterized by chronic pain, decreased range of motion, and periarticular muscle atrophy. Foam roller-based self-induced myofascial therapy can reduce the frequency of hemarthrosis and pain intensity and improve range of motion in patients with hemophilic arthropathy. Foam roller-based self-induced myofascial therapy is safe and effective in the treatment of patients with hemophilia. The inclusion of self-induced myofascial therapy exercises in the approach to degenerative joint pathologies may be an effective and safe treatment option.

Background: Patients with haemophilic arthropathy suffer chronic pain that affects and restricts their quality of life. Visualization of movement through immersive virtual reality is used for pain management., Aim: To evaluate the efficacy of 180-degree immersive VR motion visualization therapy in patients with haemophilic ankle arthropathy., Methods: Prospective, multicentre pilot study. Fifteen adult patients with bilateral haemophilic ankle arthropathy were recruited (mean age: 42.73 ± 12.36 years). The intervention lasted 4 weeks, with daily home sessions of 180-degree immersive motion visualization. The patients were given virtual reality glasses to use with their smartphones. From the YouTube mobile app® they accessed the recorded video with access from the He-Mirror App®. The study variables were joint state (Haemophilia Joint Health Score), pressure pain threshold (pressure algometer), muscle strength (dynamometry) and range of motion (goniometry). Three evaluations were performed: at baseline (T0), after the intervention (T1) and at the end of a 16-week follow-up period (T2)., Results: No patient developed ankle hemarthrosis during the experimental phase. In the repeated measures analysis we found statistically significant differences in joint state (F = 51.38; η 2 p = .63), pressure pain threshold of the lateral malleolus (F = 12.34; η 2 p = .29) and range of motion (F = 11.7; η 2 p = .28)., Conclusions: Therapy using immersive motion visualization does not cause hemarthrosis. This intervention can improve joint condition, pressure pain threshold and range of motion in patients with ankle arthropathy. Changes greater than the MDC were reported in more than 40% of patients for the variables pressure pain threshold, anterior tibialis strength and range of motion, which were considered clinically relevant., (© 2022 The Authors. Haemophilia published by John Wiley & Sons Ltd.)

Background: Prophylactic treatment is the gold standard in the treatment of patients with haemophilia. Prophylaxis with extended half-life (EHL) treatment has shown long-term safety and efficacy in patients with haemophilia., Aim: To evaluate the efficacy of prophylaxis with EHL treatment in the frequency of haemarthrosis and musculoskeletal health in adult patients with severe haemophilia A., Methods: Prospective cohort study. Forty-six patients with severe haemophilia A were recruited. The frequency of haemarthrosis (self-reports), joint condition (Haemophilia Joint Health Score), pain intensity (visual analogue scale), range of motion (goniometry), and strength (dynamometry) and muscle activation (surface electromyography) were evaluated. Three assessments were carried out: at baseline (T0), at 6 months (T1) and at 12 months following treatment (T2)., Results: There were significant changes in the within-subject effect in the frequency of haemarthrosis in elbow (F(1.05;96.20) = 3.95; P < .001) and knee (F(1.73;157.99) = 9.96; P < .001). Significant within-subject effect in elbow pain intensity (F(2;182) = 63.51; P < .001) was found. The mean values of the frequency haemarthrosis in elbow (from .66±1.01 to .04±.20) and knees (from .55±.68 to .33±.53) decrease after the period study. The intensity of elbow pain and (from 3.08±1.69 to 2.67±1.73), decrease after the 12-month follow-up period., Conclusions: Prophylaxis with extended half-life treatment reduces the frequency of haemarthrosis in elbow and knee in adult patients with haemophilia. EHL treatment reduces the intensity of elbow pain in patients with haemophilic arthropathy., (© 2022 The Authors. Haemophilia published by John Wiley & Sons Ltd.)

Purpose: To evaluate the effectiveness of manual therapy in reducing the frequency of clinical hemarthrosis, increasing range of motion and improving the perception of disability in the upper limbs in patients with hemophilic elbow arthropathy., Materials and Methods: Sixty-nine patients were randomized into experimental ( N  = 35) and control group ( N  = 34). The outcome measures were: frequency of clinical hemarthrosis, the elbow range of motion and the perception of disability in the upper limbs (DASH questionnaire). The intervention included one 50 min weekly session, for three weeks, of upper limb fascial therapy according to our treatment protocol., Results: There were differences ( p  < 0.001) in the repeated measures analysis for frequency of elbow clinical hemarthrosis ( F  = 20.64) and range of motion in flexion ( F  = 17.37) and extension ( F  = 21.71). No differences were found in the overall perceived disability ( F  = 0.91; p = .37). We found group interaction with the ( p  < 0.001) in the frequency of elbow clinical hemarthrosis, range of motion and overall perceived disability., Conclusions: Manual therapy is safe in patients with hemophilia and elbow arthropathy. Fascial therapy reduces the frequency of hemarthrosis, increases the range of motion and improves the perceived disability in the upper limbs. Trial registration number: id NCT03009591IMPLICATIONS FOR REHABILITATIONImpairments in the range of motion, pain and disability may occur in patients with hemophilic elbow arthropathy since early age.There is a need to validate safe and effectiveness protocols of rehabilitation to treat these patients.Prophylactic replacement is the most effective treatment for the prevention of hemarthrosis.Physiotherapists need to be trained in the specific management of patients with hemophilia.Manual therapy can be a safe and effective tool in the treatment of hemophilic arthropathy.

Objective: To evaluate the effect of fascial therapy on the perceived quality of life, pain intensity, and joint health in people with hemophilia., Design: Single-blind randomized controlled trial., Setting: Hemophilia Patient Associations., Participants: Patients with hemophilia (N=69) were randomly allocated to an experimental group (fascial therapy protocol) or to a control group (no intervention whatsoever)., Interventions: The fascial therapy intervention lasted 3 consecutive weeks with one 45-minute weekly session., Main Outcome Measures: The variables evaluated were perceived quality of life (Short Form Health Survey-36), pain intensity (visual analog scale) and joint health (Hemophilia Joint Health Score) at baseline and at 3 and 12 weeks., Results: The mean values of the physical (38.64±9.41 and 41.92±12.16) and mental (45.77±6.25 and 55.02±9.73) components of the Short Form Health Survey-36 improved after the intervention in the experimental group, as well as those for pain intensity and joint health (P<.001). There were differences (P<.001) in the intergroup effect in the physical role variables (F=49.22), emotional role (F=229.71), mental component (F=9.86), intensity of pain (F=24.74), and joint health (F=55.31)., Conclusions: A fascial therapy protocol for patients with hemophilic elbow arthropathy can improve their perceived quality of life. Elbow pain intensity improved in patients treated with fascial therapy. This technique can improve elbow joint health., (Copyright © 2022 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Haemophilic knee arthropathy presents functional and structural alterations and chronic pain. Self-induced myofascial release aims to treat fascial restrictions and improve functionality., Aim: This study investigated the safety and effectiveness of a self-induced myofascial release protocol in patients with haemophilic knee arthropathy., Methods: Twenty-five patients with bilateral haemophilic knee arthropathy were recruited (n = 50 knees). The patients followed an intervention protocol, with daily exercises for 8 weeks. The dependent variables were: safety of the technique (periodic telephone monitoring), joint state (Haemophilia Joint Health Score), pain intensity (visual analogue scale), pressure pain threshold (pressure dynamometer), range of motion (universal goniometer) and hamstring flexibility (Fingertip-To-Floor test). The resulting values were measured at baseline (T0) and after the intervention (T1). Paired t-test compared the means between the assessments. Effect size was obtained using Cohen's d mean difference formula. The minimum detectable change of each variable was calculated., Results: There were no cases of joint bleeding either during or after the procedure. The results showed improvements after the experimental period in joint state (Mean difference [MD]: 1.38; 95% confidence interval [95%CI]: .94;1.81), pain intensity (MD: 1.19; 95%CI: .70;1.67), pressure pain threshold (MD: -23.25; 95%CI: -26.25;-19.84), flexion (MD: -4.36; 95%CI: -5.70;-3.01), loss of extension (MD: 4.10; 95%CI: 3.01;5.18) and hamstring flexibility (MD: 3.54; 95%CI: 2.61;4.46)., Conclusions: Myofascial self-release using a foam roller is safe in patients with haemophilic knee arthropathy. A myofascial self-release protocol can improve perceived pain, range of motion and knee joint status, as well as hamstring flexibility in patients with haemophilic knee arthropathy., (© 2022 The Authors. Haemophilia published by John Wiley & Sons Ltd.)

Background: Hemophilic arthropathy is characterized by loss of function and chronic pain. Fascial therapy mobilizes the connective tissue and is thus involved in the condition of the injured fascial complex and the surrounding tissues. Objective: To evaluate the safety of a physiotherapy program using fascial therapy in patients with hemophilic elbow arthropathy. Methods: Fourteen adult patients with hemophilia were randomly assigned to a control group and an intervention group. The intervention consisted of three 45-min sessions of fascial therapy over a 3-week period. Assessment was carried out at baseline, after treatment, and at follow-up. The study variables were bleeding frequency using a self-registration of bleeding; joint pain using the visual analog scale; range of motion with a universal goniometer; and joint status assessed with Hemophilia Joint Health Score. Results: None of the patients developed joint bleeding during the experimental period. Joint pain in the experimental group decreased by 1.43 out of 2.43 (95% CI 0.52 to 2.33) and 2.14 out of 2.57 (95% CI 0.18 to 4.10) in right and left elbow, respectively, more than the control group by 3 weeks. Flexion increased by 3.57 degrees out of 129.14 (95% CI 5.48 to 1.65) in right elbow and joint condition improved by 1.14 points out of 6.0 (95% CI 0.01 to 2.26) more than the control group by 3 weeks. Conclusion: Fascial therapy does not appear to produce elbow hemarthrosis in patients with hemophilia. This treatment can improve joint pain, range of motion, and elbow status in patients with hemophilia.

Background: Chronic joint injury of the elbow joint is common in patients with hemophilia. Myofascial release is used for the management of pain and functionality in patients with chronic restrictions., Objective: To evaluate the effectiveness of myofascial release in patients with hemophilic elbow arthropathy., Methods: Sixty-nine patients with hemophilia took part in this randomized controlled trial. They were recruited from 10 hemophilia patient Associations. They were randomly allocated to experimental (n = 35) or control group (n = 34). The intervention consisted of three 50-min sessions of fascial therapy over a 3-week period. The intervention included 11 bilaterally administered maneuvers in both upper limbs (from shoulder girdle to forearm). The study variables were frequency of elbow bleeding (self-report), joint status (Hemophilia Joint Health Score), and joint pain (visual analog scale) at baseline, after the intervention, and at the 3-month follow-up., Results: There were significant changes (P < .001) in the repeated measures factor in the frequency of hemarthrosis (F = 20.64), joint status (F = 31.45), and perceived joint pain (F = 30.08). We found group interaction with the (P < .001) in the frequency of hemarthrosis (F = 21.57), joint status (F = 99.98), and perceived joint pain (F = 44.26). There were changes (P < .01) in the pairwise comparison analysis between the pretreatment assessment and the posttreatment and follow-up assessments., Conclusions: Myofascial release decreases frequency of elbow bleedings, and improved joint status and perception of elbow pain in patients with hemophilic elbow arthropathy. Myofascial release may be recommended to improve joint status and joint pain in patients with hemophilic elbow arthropathy., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)