Efficacy and Safety of Manual Therapy in Haemophilic Ankle Arthropathy: A Randomised Crossover Clinical Trial.

BACKGROUND

Recurrent haemarthrosis leads to progressive and degenerative joint damage in patients with haemophilia from an early age. Haemophilic arthropathy is characterised by chronic pain, restricted range of motion, proprioceptive deficits, and structural alterations. The aim of this study was to evaluate the effectiveness of a manual therapy protocol in patients with haemophilic ankle arthropathy.

METHODS

A randomised, crossover, double-blind clinical trial was conducted. Thirteen patients with haemophilia were allocated to two sequences: A-B (intervention phase followed by placebo control) and B-A (placebo control followed by intervention). The intervention comprised joint mobilisation techniques, high-velocity low-amplitude manipulations, and myofascial release. In the placebo control condition, a simulated protocol was applied, consisting of intermittent contact and light pressure. Both conditions involved three physiotherapy sessions, delivered once weekly over three consecutive weeks. Outcome measures included functional capacity (2-Minute Walk Test), pain intensity (visual analogue scale), range of motion (goniometer), pressure pain threshold (algometer), joint status (Haemophilia Joint Health Score), kinesiophobia (Tampa Scale of Kinesiophobia), and postural stability (pressure platform). Following a four-week washout period, participants crossed over to the alternate condition.

RESULTS

No participants experienced ankle haemarthrosis or other adverse events during the intervention, confirming the safety of the protocol. Significant time*sequence interactions (p < 0.05) with high post hoc power (≥0.80) were observed for functional capacity, range of motion, and joint status. A significant sequence effect was also found for most clinical outcomes, with no evidence of a carry-over effect.

CONCLUSIONS

This manual therapy protocol might be safe for patients with haemophilia. The physiotherapy intervention demonstrated improvements in functionality, range of motion, and joint status in individuals with haemophilic ankle arthropathy.