St George's University of London and Kingston University, London, UK.
Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK.
Haemophilia. 2020 Jul;26(4):667-684. doi: 10.1111/hae.14030. Epub 2020 May 13.
Approximately 35%-50% of people with haemophilia (PWH) report living with chronic musculoskeletal pain. Although exercise based rehabilitation is effective for pain in other arthritises, there are no published guidelines for management of chronic pain in PWH. This review aims to evaluate and appraise the current evidence of effectiveness of physiotherapy interventions on (a) pain intensity, (b) quality of life (QoL) and (c) function in PWH.
A systematic review of five databases AMED and CINAHL, EMBASE and MEDLINE and PEDro, as well as trial registries, grey literature and hand searching key journals was completed. Included studies were critically appraised and evaluated for risk of bias. The GRADE approach was used to rate the quality of the evidence.
Nine trials consisting of 235 participants met the inclusion criteria. All studies had an overall risk of bias with low methodological quality. Meta-analysis was not possible due to heterogeneity across trials. Studies comparing a range of physiotherapy interventions against no intervention showed no clear beneficial effect on pain intensity or QoL. Only one study, investigating hydrotherapy or land-based exercise against control, showed positive effect for pain intensity, but rated very low on GRADE assessment. Studies comparing one physiotherapy intervention against another showed no clear benefit on pain intensity, QoL or function. LASER with exercise and hydrotherapy were shown to have some positive effects on pain intensity, but no clear benefit on function.
At present, there is limited evidence for the use of physiotherapy interventions in addressing the issue of pain in PWH. Better designed trials with higher quality and explicit methodology along with user involvement are needed to assess the efficacy of any proposed intervention.
约 35%-50%的血友病患者（PWH）报告存在慢性肌肉骨骼疼痛。尽管基于运动的康复对于其他关节炎的疼痛是有效的，但目前尚无针对 PWH 慢性疼痛管理的指南。本综述旨在评估和评价物理治疗干预对（a）疼痛强度、（b）生活质量（QoL）和（c）PWH 功能的有效性的现有证据。
对 AMED 和 CINAHL、EMBASE 和 MEDLINE 以及 PEDro 这五个数据库进行了系统综述，以及试验登记处、灰色文献和手检关键期刊。对纳入的研究进行了批判性评估，并对偏倚风险进行了评估。使用 GRADE 方法对证据质量进行评级。
共有 9 项试验（共 235 名参与者）符合纳入标准。所有研究均存在总体偏倚风险，方法学质量较低。由于试验之间存在异质性，因此无法进行荟萃分析。与无干预相比，比较各种物理治疗干预的研究并未显示对疼痛强度或 QoL 有明显的有益效果。只有一项研究（调查水疗或陆地运动与对照组相比）显示对疼痛强度有积极影响，但 GRADE 评估等级非常低。比较一种物理治疗干预与另一种干预的研究未显示对疼痛强度、QoL 或功能有明显的益处。激光联合运动和水疗显示出对疼痛强度有一定的积极影响，但对功能没有明显的益处。
目前，物理治疗干预在解决 PWH 疼痛问题方面的证据有限。需要设计更好、质量更高、方法更明确的试验，并考虑用户的参与，以评估任何拟议干预的疗效。
