Modern Physical Therapy for Hemophiliacs
Today's physical therapists working with hemophiliacs find themselves in a unique situation - far more effective treatments are available than in past years, leading to a better quality of life. However, it remains necessary to carefully consider what may still have harmful or positive effects on joint health. Dr. Sebastien Lobet from Cliniques universitaires Saint-Luc in Brussels reflected on joint health, sports, and physical therapy in relation to modern treatment for hemophiliacs during the 9th Hemophilia Academy, held online from October 5 to 7.
Is there an ideal approach?
More modern treatment modalities lead to expectations of lower annual bleeding rates and associated better joint health, or at least prevent further deterioration in cases of existing damage. With better therapy, many hemophiliacs can also be expected to engage in more physical activity, which could be harmful.
So, what is the ideal approach, or the ideal level of coagulation factor for safe sporting activities? Studies have shown that the highest risk of bleeding occurs with severe deficiency of coagulation factor VIII (FVIII), and each 1% increase in FVIII level reduces joint bleeding by 18%. An FVIII level ≥ 15% provides protection against most joint bleedings, including those resulting from physical activity.
On the other hand, an optimal prophylactic treatment strategy for physically active hemophiliacs has not yet been established, as it is a very individual matter reflecting current lifestyle. Not every prophylactic strategy meets expectations.
Improvement possibilities for prophylactic strategy
One possibility for improving strategy is the inclusion of long-acting factors – which can be used in various ways. One approach is to limit the burden of the number of injections given; however, this leads to longer dosing intervals and is more suitable for adult patients with predominantly sedentary lifestyles. Another option is to shorten the dosing interval and achieve higher minimum (trough) levels, which may suit younger and more active patients.
Another factor for improving strategy is to define physical activity according to bleeding risk categories (from low to increased), e.g., according to the Playing It Safe Physical Activity Ratings (NHF). Prophylaxis can then also be adjusted according to the type of physical activity. It has also been shown that factor level below the critical threshold is a more important indicator of bleeding risk than mild exposure to demanding activities. Thus, persistent good protection is key to protecting joints.
Education as the basis for correct practices
It is also essential not to forget the importance of proper execution of sports activities – good technique is safer and reduces the risk of trauma and bleeding. If physical activity is recommended by a physician, it is advisable to guide the individual in developing their skills under the supervision of a physical therapist or trainer.
In the case of an acute injury, proper treatment is crucial – e.g., according to the RRICE method: R (replacement – administration of coagulation factor), rest, ice, compression, elevation of the limb. In the case of existing joint damage, it is essential to perform mobilization under the supervision of an experienced specialist.
For improving physiotherapeutic care for hemophiliacs, further and ongoing education considering individualization of care is very necessary.
(eza)
Source: Lobet S. Physiotherapy, sports and haemophilia – pediatrics. 9th Hemophilia Academy, 2021 Oct 5. Available at: www.youtube.com/watch?v=DyUBYoWI3ew
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