Proof of concept and feasibility of a blended physiotherapy intervention for persons with haemophilic arthropathy

• Published in: Haemophilia : the official journal of the World Federation of Hemophilia 2023-01, Vol.29 (1), p.290-307
• Main Authors: Timmer, Merel A., Kuijlaars, Isolde A. R., Kloek, Corelien, Kleijn, Piet, Schutgens, Roger E. G., Veenhof, Cindy, Pisters, Martijn F.
• Format: Article
• Language: English
• Subjects: Arthritis; blended care; Exercise; e‐health; Feasibility Studies; haemophilia; Hemophilia; Hemophilia A - complications; Hemophilia A - therapy; Hemorrhage; Humans; Middle Aged; Original; Physical activity; Physical fitness; Physical therapy; Physical Therapy Modalities; Physical training; physiotherapy
• ISSN: 1351-8216; 1365-2516
• DOI: 10.1111/hae.14690

Background Regular physiotherapy with a physiotherapist experienced in the field is not feasible for many patients with haemophilia. We, therefore, developed a blended physiotherapy intervention for persons with haemophilic arthropathy (HA) (e‐Exercise HA), integrating face‐to‐face physiotherapy with a smartphone application. Aim The aim of the study was to determine proof of concept of e‐ Exercise HA and to evaluate feasibility. Methods Proof of concept was evaluated by a single‐case multiple baseline design. Physical activity (PA) was measured with an accelerometer during a baseline, intervention and post‐intervention phase and analysed using visual inspection and a single case randomisation test. Changes in limitations in activities (Haemophilia Activities List [HAL]) and a General Perceived Effect (GPE) were evaluated between baseline (T0), post‐intervention (T1) and 3 months post‐intervention (T2) using Wilcoxson signed rank test. Feasibility was evaluated by the number of adverse events, attended sessions and open‐ended questions. Results Nine patients with HA (90% severe, median age 57.5 (quartiles 50.5–63.3) and median HJHS 32 (quartiles 22–36)) were included. PA increased in two patients. HAL increased mean 15 (SD 9) points (p = .001) at T1, and decrease to mean +8 points (SD 7) (p = .012) at T2 compared to T0. At T1 and T2 8/9 participants scored a GPE > 3. Median 5 (range 4–7) face‐to‐face sessions were attended and a median 8 out of 12 information modules were viewed. No intervention‐related bleeds were reported. Conclusion A blended physiotherapy intervention is feasible for persons with HA and the first indication of the effectiveness of the intervention in decreasing limitations in activities was observed.