Physiotherapy Home Exercise Program for Haemophiliacs

Abstract

Background: Regular physiotherapy can improve the stability and flexibility of joints and decrease the bleeding risk in patients with haemophilia. To reduce the appointments for the patients and to make exercising a part of daily live, an individualized home exercise program (HEP) was designed. Retrospectively the number of bleedings during the HEP was compared to number of bleedings before.

Method: 8 patients aged between 4 and 16 years with haemophilia A were evaluated. At start and after 13 month patients had a motion analysis via topographic ultrasound. According to the results and clinical findings an individualized HEP was created. Standardised scores for clinical evaluation and the patient based evaluation of exercises were designed. At every appointment exercises were individually adjusted.

Results: Patients exercised in median 1.7 times a week. No training related bleeds occurred. 7 of 8 patients showed reduced joint and/or muscle bleeds (p<0.02). Clinical scores raised slightly in every patient. However the second motion analysis of squat and gait showed a worsening in 7 of 8 patients (p>0.05).

Conclusion: A HEP can help to advance in physical fitness and coordination and may reduce bleeding tendency, but needs to be accomplished regularly. Patients are interested but the motivation to exercise at home is low. Disorders measured by motion analysis seem not to be sufficiently influenced by our surrogate training program.

Zusammenfassung

Hintergrund: Regelmäßige Physiotherapie kann die Stabilität und Mobilität der Gelenke verbessern und das Blutungsrisiko bei Patienten mit Hämophilie verringern. Um die Behandlungstermine der Patienten zu reduzieren und regelmäßiges Training in den Alltag zu integrieren, wurde ein individuelles Heimselbsttrainingsprogramm (HSP) entworfen. Retrospektiv wurde die Zahl der Blutungen während der Zeit des HSP mit der davor verglichen.

Methode: Bei 8 Patienten zwischen 4 und 16 Jahren mit Hämophilie A erfolgten zu Beginn und nach 13 Monaten eine Bewegungsanalyse mittels Ultraschalltopometrie. Anhand der Ergebnisse wurde ein individualisiertes HSP erstellt. Mit Hilfe standardisierter Untersuchungs und Fragebögen wurden die Übungen bei jeder Vorstellung individuell angepasst.

Ergebnisse: Die Patienten trainierten im Mittel 1,7-mal pro Woche. Trainingsbedingte Blutungen traten nicht auf. 7 von 8 Patienten zeigen eine Reduktion der Gelenk- und/oder Muskelblutungen (p<0,02). Die klinischen Scores besserten sich bei allen Patienten leicht. 7 von 8 Patienten verschlechterten sich in der zweiten Bewegungsanalyse im Gang und der Kniebeuge (p>0,05).

Schlussfolgerung: Ein HSP kann bei regelmäßiger Durchführung die körperliche Fitness und Koordination verbessern und die Blutungsneigung verringern. Die Patienten haben Interesse, jedoch fällt die dauerhafte Motivation zum Heimselbsttraining schwer. In der Bewegungsanalyse erfasste Störungen scheinen durch unser Surrogattraining nicht suffizient verbessert zu werden.

Key words

exercise program - haemophilia - children - motion analysis - physiotherapy - home exercise

Schlüsselwörter

Trainingsprogramm - Hämophilie - Kinder - Bewegungsanalyse - Physiotherapie - Heimtraining

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1 The first both authors (K. Pierstorff, A. Seuser) contributed equally.

Correspondence