Truque-Díaz Carlos, Pérez-Llanes Raúl, Meroño-Gallut Javier, Cuesta-Barriuso Rubén, Donoso-Úbeda Elena
Faculty of Physiotherapy, Podiatry and Occupational Therapy, Catholic University San Antonio-UCAM, 30107 Murcia, Spain.
Department of Physiotherapy, Faculty of Medicine, University of Murcia, 30120 Murcia, Spain.
Healthcare (Basel). 2025 Sep 5;13(17):2228. doi: 10.3390/healthcare13172228.
Recurrent haemarthrosis leads to progressive and degenerative joint damage in patients with haemophilia from an early age. Haemophilic arthropathy is characterised by chronic pain, restricted range of motion, proprioceptive deficits, and structural alterations. The aim of this study was to evaluate the effectiveness of a manual therapy protocol in patients with haemophilic ankle arthropathy.
A randomised, crossover, double-blind clinical trial was conducted. Thirteen patients with haemophilia were allocated to two sequences: A-B (intervention phase followed by placebo control) and B-A (placebo control followed by intervention). The intervention comprised joint mobilisation techniques, high-velocity low-amplitude manipulations, and myofascial release. In the placebo control condition, a simulated protocol was applied, consisting of intermittent contact and light pressure. Both conditions involved three physiotherapy sessions, delivered once weekly over three consecutive weeks. Outcome measures included functional capacity (2-Minute Walk Test), pain intensity (visual analogue scale), range of motion (goniometer), pressure pain threshold (algometer), joint status (Haemophilia Joint Health Score), kinesiophobia (Tampa Scale of Kinesiophobia), and postural stability (pressure platform). Following a four-week washout period, participants crossed over to the alternate condition.
No participants experienced ankle haemarthrosis or other adverse events during the intervention, confirming the safety of the protocol. Significant time*sequence interactions ( < 0.05) with high post hoc power (≥0.80) were observed for functional capacity, range of motion, and joint status. A significant sequence effect was also found for most clinical outcomes, with no evidence of a carry-over effect.
This manual therapy protocol might be safe for patients with haemophilia. The physiotherapy intervention demonstrated improvements in functionality, range of motion, and joint status in individuals with haemophilic ankle arthropathy.
复发性关节积血会导致血友病患者从小就出现进行性和退行性关节损伤。血友病性关节病的特征是慢性疼痛、活动范围受限、本体感觉缺陷和结构改变。本研究的目的是评估手法治疗方案对血友病性踝关节病患者的有效性。
进行了一项随机、交叉、双盲临床试验。13名血友病患者被分配到两个序列：A - B（干预阶段后接安慰剂对照）和B - A（安慰剂对照后接干预）。干预包括关节松动技术、高速度低幅度手法操作和肌筋膜放松。在安慰剂对照条件下，应用了一个模拟方案，包括间歇性接触和轻压。两种情况都包括三次物理治疗，连续三周每周进行一次。结果测量包括功能能力（2分钟步行测试）、疼痛强度（视觉模拟量表）、活动范围（量角器）、压痛阈值（痛觉计）、关节状况（血友病关节健康评分）、运动恐惧（坦帕运动恐惧量表）和姿势稳定性（压力平台）。经过四周的洗脱期后，参与者交叉到另一种情况。
在干预期间，没有参与者经历踝关节积血或其他不良事件，证实了该方案的安全性。在功能能力、活动范围和关节状况方面观察到显著的时间*序列交互作用（<0.05），事后检验效能高（≥0.80）。在大多数临床结果中也发现了显著的序列效应，没有证据表明存在遗留效应。
这种手法治疗方案对血友病患者可能是安全的。物理治疗干预在血友病性踝关节病患者的功能、活动范围和关节状况方面显示出改善。
