Author Names
Cuestra-Barriuso R, Pérez-Llanes R, López-Pina J A, Donoso-Úbeda E, Meroño-Gallut
Reviewer Name
Razan Mazin Fayyad, SPT
Reviewer Affiliation(s)
Duke University School of Medicine, Doctor of Physical Therapy Division
Paper Abstract
Purpose: To evaluate the effectiveness of manual therapy in reducing the frequency of clinical hemarthrosis, increasing range of motion and improving the perception of disability in the upper limbs in patients with hemophilic elbow arthropathy. Materials and methods: Sixty-nine patients were randomized into experimental (N1⁄435) and control group (N1⁄434). The outcome measures were: frequency of clinical hemarthrosis, the elbow range of motion and the perception of disability in the upper limbs (DASH questionnaire). The intervention included one 50 min weekly session, for three weeks, of upper limb fascial therapy according to our treatment protocol. Results: There were differences (p < 0.001) in the repeated measures analysis for frequency of elbow clinical hemarthrosis (F1⁄420.64) and range of motion in flexion (F1⁄417.37) and extension (F1⁄421.71). No differences were found in the overall perceived disability (F1⁄40.91; p 1⁄4 .37). We found group interaction with the (p<0.001) in the frequency of elbow clinical hemarthrosis, range of motion and overall perceived disability. Conclusions: Manual therapy is safe in patients with hemophilia and elbow arthropathy. Fascial therapy reduces the frequency of hemarthrosis, increases the range of motion and improves the perceived disability in the upper limbs.
NIH Risk of Bias Tool
Quality Assessment of Controlled Intervention Studies
- Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT
- Yes
- Was the method of randomization adequate (i.e., use of randomly generated assignment)?
- Yes
- Was the treatment allocation concealed (so that assignments could not be predicted)?
- Yes
- Were study participants and providers blinded to treatment group assignment?
- Yes
- Were the people assessing the outcomes blinded to the participants’ group assignments?
- Yes
- Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?
- Yes
- Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?
- Yes
- Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
- Yes
- Was there high adherence to the intervention protocols for each treatment group?
- Yes
- Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
- Yes
- Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?
- Yes
- Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?
- Yes
- Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
- Yes
- Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?
- Yes
Key Finding #1
Manual therapy can significantly reduce the frequency of clinical hemarthrosis in patients with hemophilic elbow arthropathy
Key Finding #2
Patients who received manual therapy also showed significant improvements in range of motion and perceived disability compared to the control group
Key Finding #3
The study suggests that manual therapy can be an effective non-pharmacological intervention to reduce the frequency of hemarthrosis and improve joint function and quality of life in patients with hemophilic elbow arthropathy
Please provide your summary of the paper
Hemophilic elbow arthropathy causes specific functional alternations that with time lead to ROM restrictions in elbow flexion, extension, periarticular muscle hypotrophy, and chronic pain. Recurring hemarthrosis and its long-term effects on joints cause chronic pain, severe joint damage, disability, and a decrease in quality of life. There are a limited number of treatments. Of those, manual therapy using joint traction achieved improvements in range of motion and perceived pain in patients with hemophilic elbow arthropathy. With that, this study aims to evaluate the effectiveness of a manual therapy intervention in reducing the frequency of hemarthrosis, increasing range of motion and improving the perceived disability in the upper limbs in adult patients with hemophilia and elbow arthropathy. Sixty-nine patients were randomized into either the experimental or control group. The experimental group received a fascial therapy-based manual therapy intervention while the patients in the control group did not receive any treatment and were asked to continue with their usual routines. The frequency of clinical hemarthrosis, the elbow range of motion and the perception of disability in the upper limbs were the outcomes measured. The results showed that manual therapy was effective in reducing the frequency of clinical hemarthrosis and improving the range of motion and perceived disability in patients with this condition.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
This study showed how the addition of fascial therapy-based manual therapy significantly reduced the frequency of clinical hemarthrosis and improved the range of motion and perceived disability in these patients. This study recruited a significant number of patients with hemophilic elbow arthropathy. The evaluation of the effects of manual therapy on upper limb functionality was crucial in better understanding the relationship between the intervention and upper limb functionality. The paper discusses several limitations of the study, including the use of goniometric evaluation to measure elbow ROM and the hemarthrosis evaluation method. Other instruments such as the isokinetic dynamometer could provide more exact values. Although the study did not have any events of clinical hemarthrosis, subclinical hemarthrosis should be considered and identified through an ultrasound evaluation, something that should be incorporated into the study design. With that, further research is needed to confirm the findings and determine the long-term effects of manual therapy on hemophilic elbow arthropathy.
