Comparison of efficiency of closed kinetic chain exercises versus proprioceptive exercises in improving balance and gait in people with hemophilia

Introduction: Hemophilia is a hereditary bleeding disorder caused by a deficiency in clotting factors. The severity of the disease in individuals with hemophilia varies according to the level of the deficient factor. Bleeding in the musculoskeletal system is the most common type of bleeding, with 70–80% occurring in the joints. Intra-articular bleeding, known as hemarthrosis, initiates an inflammatory process in the synovial membrane, which may ultimately lead to cartilage damage. Due to the frequent occurrence of hemarthrosis in the lower extremity joints, changes in balance and gait parameters can be observed in individuals with hemophilia. Objective: The aim of this study was to investigate the effects of closed kinetic chain exercises (CKCE) and proprioceptive training approaches on improving balance and gait in individuals with hemophilia. Methods: Participants who met the inclusion criteria were randomly assigned to three groups. The first group received CKCE for 45 minutes, twice a week, over a 12-week period. The second group underwent proprioceptive exercises with the same frequency and duration. No intervention was applied to the third group. Postural sway was assessed using the Biodex Balance System, gait speed with the 10-Meter Walk Test (10MWT), and joint health with the Hemophilia Joint Health Score (HJHS). Additionally, single-leg stance test, proprioception assessments of the knee and ankle joints, the 6-Minute Walk Test (6MWT) for functional capacity, and the Hemophilia Functional Independence Score (FISH) for functional independence were used. All evaluations were repeated before and after the intervention period. Results: A total of 46 participants completed the study. Post-intervention, both exercise groups demonstrated significant improvements in single-leg postural sway parameters, 10MWT, HJHS, 6MWT, ankle proprioception and knee extension angle during mid-stance compared to the control group (p<0.05). Significant improvement in double-leg postural sway parameters was observed only in the CKCE group (p<0.05). A significant difference in FISH scores was found in favor of the proprioceptive exercise group (p<0.05). No significant changes were observed in knee proprioception assessments in either exercise group (p>0.05). Conclusion: Both CKCE and proprioceptive exercises demonstrated positive effects on balance and gait in individuals with hemophilia. These exercise approaches are reliable for reducing functional impairments in hemophilic individuals with lower extremity involvement.