Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.
Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
Haemophilia. 2022 May;28(3):497-504. doi: 10.1111/hae.14517. Epub 2022 Feb 24.
It is unknown whether altered neural control is associated with clinical outcomes in people with haemophilic arthropathy (PWHA). The dynamic motor control index during walking (Walk-DMC) is a summary metric of neural control.
The primary aim of this study was to apply the Walk-DMC to assess if people diagnosed with haemophilic arthropathy have impaired neural control of gait and investigate the association of Walk-DMC with pain and joint impairment.
The Walk-DMC was assessed using surface electromyography in 11 leg muscles. Twenty-two PWHA and 15 healthy subjects walked on a 30-m walkway at 1 m/s. In addition, pain (visual analogue scale), knee flexion contracture (degrees) and joint impairment (Haemophilia Joint Health Score, HJHS) were assessed. The clinical outcomes were correlated with the Walk-DMC. Multiple regression analysis was performed to predict the Walk-DMC using the clinical outcomes.
In 13 PWHA the Walk-DMC was beyond the normal range (80-120 pts). PWHA with an altered Walk-DMC showed more years with arthropathy, more pain, higher knee flexion contracture and a higher HJHS score (P < .05, effect size > .8). Significant negative moderate associations between Walk-DMC and pain, knee flexion contracture and HJHS were found (P < .05). The model that best predicted the Walk-DMC was the pain with knee flexion contracture (R = .44; P = .004).
PWHA with abnormal neural control of gait also has more years with arthropathy, more pain, and more impaired joints. Our results indicate an association between the Walk-DMC index and joint damage, specifically with pain in combination with knee flexion contracture.
尚不清楚神经控制的改变是否与血友病性关节病（PWHAs）患者的临床结局相关。步行时的动态运动控制指数（Walk-DMC）是神经控制的综合指标。
本研究的主要目的是应用 Walk-DMC 评估 PWHAs 是否存在步态神经控制受损，并探讨 Walk-DMC 与疼痛和关节损伤的关系。
使用表面肌电图评估 11 条腿部肌肉的 Walk-DMC。22 名 PWHAs 和 15 名健康受试者以 1m/s 的速度在 30m 步行道上行走。此外，还评估了疼痛（视觉模拟评分）、膝关节屈曲挛缩（度）和关节损伤（血友病关节健康评分，HJHS）。将临床结果与 Walk-DMC 相关联。使用多元回归分析，根据临床结果预测 Walk-DMC。
在 13 名 PWHAs 中，Walk-DMC 超出正常范围（80-120 分）。Walk-DMC 异常的 PWHAs 具有更长的关节病病史、更多的疼痛、更高的膝关节屈曲挛缩和更高的 HJHS 评分（P<.05，效应量>.8）。Walk-DMC 与疼痛、膝关节屈曲挛缩和 HJHS 之间存在显著的负中度关联（P<.05）。预测 Walk-DMC 的最佳模型是疼痛与膝关节屈曲挛缩（R =.44；P =.004）。
步态神经控制异常的 PWHAs 也具有更长的关节病病史、更多的疼痛和更多受损的关节。我们的结果表明，Walk-DMC 指数与关节损伤之间存在关联，特别是与疼痛结合膝关节屈曲挛缩。
