Investigation of effectiveness of manual therapy and strengthening exercises in physiotherapy and rehabilitasyon of hemophilic arthropathy of the elbow

The aim of this study was to investigate the effects of strengthening exercises and manual therapy on bleeding frequency, pain, range of motion (ROM), muscle strength, arm circumference, joint health, functionality and quality of life in the physiotherapy and rehabilitation (PTR) of hemophilic arthropathy of the elbow. Seventeen adolescent and young adult hemophilic individuals aged 12-35 years with elbow arthropathy were included in the study. The individuals were divided into the two groups via simple randomisation as Manuel Therapy and Exercise Group (MTEG) and Home Exercise Group (HEG). The individuals in HEG were given strengthening exercises as a home program. Those in the MTEG were applied manual therapy by the physiotherapist and were given supervised strengthening exercises. All treatments were performed 3 times a week for 5 weeks totally 15 sessions. Frequency of bleeding was evaluated with number of bleeding in the last 5 weeks. Numerical Pain Scale was used for activity and resting pain. Range of motion (ROM) and muscle strength were measured with universal goniometer and digital dynamometer, respectively. The Quick-DASH questionnaire and Oxford Elbow Score (OES) were used for the functionality of the upper extremity and quality of life, respectively. The joint health status was evaluated with Hemophilia Joint Health Score-Elbow Point (HJHS-EP) and Hospital for Special Surgery-Elbow Scoring System (HSS-ESS). Evaluations were made by the same physiotherapist before and after treatment. As a result, frequency of bleeding was significantly reduced in MTEG (p<0.05). Activity pain was significantly reduced in both groups (p<0.05) but the decrease in MTEG was higher. All of the elbow ROMs were significantly increased in MTEG compared to HEG (p<0.05). In muscle strength measurements, there was a significant increase in MTEG for more muscle groups (p<0.05). HJHS-EP decreased in both groups whereas only the decrease in MTEG was significant (p<0.001) and reduction in MTEG was significantly higher than in HEG (p<0.05). HSS-ESS and Q-DASH were significantly improved only in MTEG (p<0.05). Total OES score significantly ameliorated in both groups (p<0.05). According to normative values, the most losses were in flexion and pronation angles. The correlation analysis between Q-DASH and ROMs showed a strong correlation only between pronation angle and Q-DASH (r=-0.704, p=0.000). According to these results, manual therapy and supervised strengthening exercises in the PTR of hemophilic arthropathy of the elbow decreased the severity of arthropathy and increased functionality without causing any complications. It was thought that home exercises should be recommended for hemophiliacs with elbow arthropathy who cannot reach the PTR. Key Words: Hemophilia, arthropathy, elbow joint, manual therapy, exercise.