The Role of the Physiotherapist in the Management of Hemophilia – Defining a New Normal
Historically, the role of physiotherapy in hemophiliacs was primarily to assist patients who developed severe hemophilic arthropathies resulting from recurrent untreated or inadequately treated bleeding. Today, it has also shifted to prevention as such, although it still plays a role in significant joint bleeding or when a hemophiliac needs to undergo surgery.
Proactive Role of Physiotherapy in the New Era of Hemophilia Treatment
Hemophilia is an X-linked inherited disorder characterized primarily by recurrent bleeding into muscles and joints, leading to decreased mobility, pain, and lower quality of life. In addition to replacement therapy with missing clotting factor concentrates, supportive therapy, where physiotherapy plays a significant role, is also very important.
In recent years, there has been a significant shift in the treatment of hemophilia. Some even speak of a new era offering minimal bleeding episodes or even being completely bleed-free. This also brings a challenge to move physiotherapy into a proactive area rather than reacting to bleeding.
Possible Roles of the Physiotherapist in Multidisciplinary Care
The role of the physiotherapist within a multidisciplinary team caring for the patient is quite broad. It includes mainly the differential diagnosis of musculoskeletal bleeding, support for physical activity even at a higher level, rehabilitation to maximize physical potential, assessment and treatment of other musculoskeletal problems not related to bleeding, fall prevention in older patients, and, very importantly, long-term and ideally lifelong supervision of joint and muscle health.
Supporting hemophiliacs in physical activity will lead to an overall sense of better health and improved treatment outcomes. There is hope that physical activity could become one of the key parameters for the success of hemophilia treatment in the future.
The goal should be to inform patients as much as possible about options for safe physical activity, reconcile patients' expectations with their possibilities, and enable greater social engagement. It is very important for the physiotherapist to create a care plan for the patient in collaboration with the patient and to support care focused on the specific needs of the individual.
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Source: Wells A. J., Stephensen D. The role of the physiotherapist in the management of people with haemophilia: defining the new normal. Br J Hosp Med 2020 Aug 2; 81 (8): 1–8, doi: 10.12968/hmed.2020.0016.
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