Manual Therapy in the Treatment of Hemophilic Arthropathy of the Ankle

Investigación en Hemofilia y Fisioterapia

Status: Completed

Conditions: Hemophilia

Treatments: Other: Manual therapy

Study type: Interventional

Funder types: NETWORK

Identifiers

NCT05549843

He-AnklePilot

Details and patient eligibility

About

Introduction: Hemophilic ankle arthropathy is manifested by degenerative functional alterations (deficit of muscle strength, mobility and proprioception), intra-articular alterations and chronic pain. Manual therapy techniques are used to treat soft tissue adhesions, relieve pain and reduce tissue sensitivity.

Design. randomized pilot trial. Aimed: To evaluate the safety and effectiveness of a protocol by manual therapy techniques in patients with hemophilic ankle arthropathy.

Patients: 24 patients with ankle arthropathy will be recruited for inclusion in the study. Patients will be recruited in seven centers, from different regions of Spain.

Intervention: Each session will last approximately 50-60 minutes, with 1 physiotherapy session per week for a period of 3 weeks. Patients will be evaluated at baseline, after the intervention, and after a follow-up period of 3 weeks. The treatment program includes 10 exercises that must be administered bilaterally.

Measuring instruments and study variables: Visual Analog Scale and pressure algometer (joint pain); Leg motion (ankle range of motion); and Haemophilia Joint Health Score (joint health). At the same time, the study will allow to determine joint bleeding caused by applied physiotherapy treatment.

Expected results: To demonstrate the safety of this Physiotherapy technique in patients with hemophilia. Likewise, an improvement in ankle pain, joint motion, joint health and pressure pain threshold.

Enrollment: 24 patients

Sex: Male

Ages: 18 to 60 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Patients diagnosed with hemophilia A and B
• With severe (<1% FVIII/FIX) or moderate (1-5% FVIII/FIX) phenotype of hemophilia
• Over 18 years
• With medical diagnosis of ankle arthropathy and with clinical evaluation by Hemophilia Joint Health Score
• In prophylactic treatment with FVIII / FIX concentrates for coagulation

Exclusion criteria

• Patients with inhibitors (antibodies against FVIII or FIX)
• Patients with neurological or cognitive disorders that prevent the understanding of questionnaires and physical tests
• Failure to sign the informed consent document

Trial design

Primary purpose: Prevention

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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24 participants in 1 patient group

Hemophilia group

Experimental group

Description:

Intervention protocol: * Preparatory work: active mobilizations with the patient supine. * Global passive mobilization of the forefoot and midfoot. * Calcaneocuboid mobilization, functional and structural work of said joint. * Astragaloscaphoid mobilization, functional and structural work of said joint. * Talar manipulation dorsally. * Manipulation-tibial displacement: * Tibiotarsal decompression: 2 very gentle high-speed and short-course tibial-tarsal manipulations. * Plantar fascia induction for foot captors of the plantar fascia. * Tibiotarsal sustained traction technique (unwinding) * Sural triceps induction technique:

Treatment:

Other: Manual therapy