1. New Methods of Physiotherapy
in Patients with Advanced Haemophilic Arthropathy
Janusz Zawilski1, Adrian Dudek1,2, Krystyna Zawilska1
1The Diagnostic and Treatment Centre INTERLAB, 2Department of Spondyloorthopaedics
and Biomechanics of the Spine, W. Dega University Hospital, Poznan University of Medical Sciences,
Poznan, Poland
OBJECTIVES
METHODS
Five subjects, aged from 32 to 42 years, with severe haemophilia A or B attended physiotherapy in an outpatient ambulatory setting over a 3-month period.
The following types of therapy were used:
-  AlterG anti-gravity treadmill
- Deep Penetrating Electro-magnetic Stimulation (Salus Talent)
- Manual therapy
-  Proprioception exercises -
Outcome Measures:
- Haemophilia Joint Health Score (HJHS)
- Visual Analog Scale (VAS) 
- Timed Up and Go Test (TUG Test) 
Analyses were performed on patient level (ΔHJHS total score).
Advanced arthropathy mainly of the knee, hip or ankle joint occurs even in young adults with haemophilia, if they have not been properly treated. It has been proved that physical training increases isometric muscular strength and proprioceptive performance in these patients.
Some new methods of physiotherapy, recently introduced, might improve the results of haemophilic artropathy treatment.
The aim of this study was to present the new methods of physiotherapy process and their effects in patients with advanced haemophilic arthropathy.
Walking on AlterG anti-gravity treadmill
RESULTS
Deep penetrating electromagnetic stimulation (Salus Talent) therapy
Patient
HJHS
total
Swelling of joints
(HJHS)
Strength of the muscles (HJHS)
TUG
VAS
Before
physioth.
After A 51 35 7 1 2 25 19 5 3 B 55 45 6 4 27 C 40 30 23 15 D 32 21
 14 E
 32 20
Mean
Δ (%)
35,6
32,2 
-10
2,6
-48
1,4
- 65
25,2
17,4
 - 31
4,6
3,2
-31
Strength of the muscles acting on the joints improved, swelling of joints diminished and the level of pain decreased. An improvement of the dynamic and static balance was found as well. The range of motion did not change.
Physiotherapy process did not provoked bleeding episodes in patients included to the study.
Walking on AlterG anti-gravidy treadmill
HJHS -Haemophilia Joint Health Score; TUG – TimeUp and Go test (s); VAS – Visual Analogue Scale of pain assessment
CONCLUSIONS
References
Fisher K, De Kleijn P. Using haemophilia Joint Health Score for assessment of teenagers and young adults: exploring reliability and validity. Haemophilia 2013; 19:
Feldman BM, Funk SM, Bergstrom BM, et al. Validation of a new pediatric joint scoring system from the international haemophilia prophylaxis study group: validity of the haemophilia joint health score (HJHS) Arthritis Care Res. 2011; 68:
Soucie JM, et al. Range of motion measurements: reference values and a database for comparison studies. Haemophilia 2011;17:
Podsiadlo D, Richardson S. The Timed Up & Go: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991; 39:142-8.
Carlsson AM. Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain 1983;16:
Kuijlaars I, Timmer M, Schutgens R, et al. Factors associated with long-term changes in joint health of patients with hemophilia. Haemophilia 2017; 23: 11 (084).
New methods of  physiotherapy including AlterG anti-gravity treadmill, and deep penetrating electromagnetic stimulation (Salus Talent) :  allow to improve the muscle strength and the overall posture causing less strain on joints, diminish the swelling,  decrease the level of pain, and improve  the dynamic and static balance.