Effectiveness of manual theraphy on lower extremity jointarthropathy in patients with hemophilia

The aim of this study was to investigate the effects of manual therapy in addition to home exercise program on hemophilia functional independence level, joint health, kinesiophobia, functional level, range of motion, muscle strength and pain level in hemophilic individuals with lower extremity joint arthropathy. Hemophilic arthropathy was developed in at least one of the lower extremity joints and aged between 18-30 years 17 severe type hemophilic men were participated in the study. The participants were divided into two groups as Home Exercise Group (HEG) and Manual Therapy Group (MTG) by randomization method. While the HEG was performed the exercise program at home, in addition to the same HEG manual therapy were applied to the MTG by the same physiotherapist 3 days a week for 1 hour. Both groups were followed for a total of 5 weeks and pre-treatment evaluations were repeated post-treatment. The joint health of the hemophilics in both groups were evaluated with Hemophilia Joint Health Score (HJHS), their kinesiophobia level were evaluated with Tampa Kinesophobia Scale, their functionality with the Functional Independence Score in Hemophilia (FISH). In addition, Functional Reach, Timed Up and Go and 5 Times Sit-to- Stand tests were used for functional level. The range of motion was evaluated with a goniometer, muscle strength was measured with a digital dynamometer and pain level was assessed with a Visual Analogue Scale (VAS). Number of hemarthrosis decreased in both groups. Significant improvements in range of motion, muscle strength, activity VAS, HJHS and FISH were found in the MTG after treatment (p˂0.05). There was also significant improvement in Functional Reach and 5 Times Sit-to-Stand tests results in both groups (p˂0.05), while there was no change in Timed Up and Go Test and Tampa Kinesiophobia Scale results (p>0.05). In the comparison between the groups, significant differences were found in favor of the MTG in the HJHS-index joint and total HJHS, Functional Reach Test, Activity VAS, knee extension range of motion, and muscle strength of ankle dorsi and plantar flexors (p˂0.05). No significant difference was found between the groups in FISH, Tampa Kinesophobia Scale, Timed Up and Go and 5 Times Sit-to-Stand tests, resting VAS, knee flexion range of motion and knee extensor and flexor muscle strength (p>0.05). As a result of the study, it was shown that manual therapy applied to patients with hemophilic arthropathy was especially effective in improving joint health, knee extension range of motion, activity VAS, ankle muscle strength and functional level. According to these results, manual therapy which is not commonly used in the physiotherapy and rehabilitation program of the patients with hemophilic arthropathy has a special importance and therefore it is necessary to use it in the physiotheraphy and rehabilitation of the hemophilics.