The role of physical therapy and rehabilitation in the management of hemophilia in developing countries.

Without replacement therapy, patients with severe hemophilia (PWH) will have five damaged joints by the age of 20, which lead to limitation of activities and prevent normal participation in society. Of all PWH, 80% live in developing countries, where access to factor replacement is limited. Physiotherapy and rehabilitation help to prevent disabilities, stimulate activities and participation, and help to preserve autonomy. Rehabilitation should be organized by creating awareness that physiotherapy and rehabilitation (next to availability of safe clotting factor) are very important in developing countries. Locally available medical and social systems and materials should be used for both education and aids and adaptations. Trainers must be trained to develop local treatment protocols. PWH and their families need to be educated and trained to do exercises. Important treatment modalities are management of pain, active muscle strengthening exercises, combined measures and exercises to regain range of motion, training proprioception and coordination, functional training, and orthotics and shoe adaptations.