The role of the physiotherapist in hemophilia care is expanding and irreplaceable − what it entails and how it changes with treatment advances?
In the team cooperation in caring for patients with hemophilia, the physiotherapist plays a very important role, which is expanding with today's comprehensive approach to treating this condition. The reason is that even in the era of modern treatment availability, many hemophilia patients have various musculoskeletal complications. A team of authors, preferentially physiotherapists, recently published a paper pondering whether the advent of new drugs will also change the position of physiotherapy in the care of patients with hemophilia.
Physiotherapist as an Assistant and Advisor in Prevention, Treatment, and Education
Physiotherapy traditionally plays a very important role in preventing joint damage, which is a central concern in this bleeding disorder. It is also an essential part of caring for already damaged joints, in terms of preserving their functionality or even improving joint health. This also applies to joint care after acute bleeding. Lastly, the physiotherapist is important as an assistant and advisor in incorporating rational physical activity into the everyday lives of hemophilia patients, ensuring it is safe in terms of bleeding risk and effective in protecting joints. Thus, the educational role of the physiotherapist for hemophilia patients of different ages is also significant.
Individual Approach Depending on Current Treatment Options and Patient Expectations
For all these reasons, it remains very important that a hemophilia patient of any severity has direct access to an experienced physiotherapist within multidisciplinary care. The care provided by the physiotherapist must be personalized to meet the individual needs of the patient.
The goal of modern hemophilia treatment is to reduce bleeding, both spontaneous and traumatic. The ideal state from this perspective is achieving a so-called zero bleeding state (zero bleed). New drugs offer various possibilities for achieving bleeding protection − improving trough levels or, in the case of non-factor therapies, providing non-peaking stable protection, which has its positives and negatives regarding physical activity. Ongoing collaboration between the physiotherapist and hematologist is therefore very necessary. Discussions should also cover the significance of other achieved pharmacokinetic variables in the treatment with extended half-life factors (which is crucial with modified coagulation factor IX concentrates, but also important with modified factor VIII molecules) or the expected level of protection in patients treated with non-factor therapy, for instance. This can significantly help the physiotherapist in applying a personalized approach depending on patient expectations and treatment options.
Mutually Effective Collaboration among Experts Ultimately Benefits the Hemophilia Patient
The authors also emphasize the need for continuous team collaboration, the impact of understanding modern hemophilia treatment principles on the competence of the physiotherapist in a multidisciplinary team, and also educating local physiotherapists where the patient resides. On the other hand, precise assessment of joint status by an experienced physiotherapist can serve as a critical basis for the hematologist to possibly adjust treatment to better protect joint health or support physical activity in these patients.
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Source: Lobet S., Timmer M., Königs C. et al. The role of physiotherapy in the new treatment landscape for haemophilia. J Clin Med 2021 Jun 26; 10 (13): 2822, doi: 10.3390/jcm10132822.
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