title: Manual therapy in the treatment of ankle hemophilic arthropathy. A randomized pilot study.
abstract: OBJECTIVE
  Although physiotherapy has demonstrated effectiveness in preventing ankle arthropathy compared to prophylaxis treatment from early ages, there have been no conclusive studies examining physiotherapy intervention once hemophilic arthropathy of the ankle has been established. The aim of this study was to evaluate the effectiveness of two physiotherapy interventions, in patients with hemophilic arthropathy of the ankle that had not been operated on previously.
  
  
  METHODS
  Nine patients with hemophilia (mean age of 35.7 SD 11.9 years) were randomized to a mobilization group (n = 5) and manual therapy group (n = 4). The two physiotherapy interventions were: (1) passive mobilization and stretching; and (2) manual orthopaedic therapy, both with proprioception training. The study lasted for six weeks, with two sessions a week. Ankle mobility and pain perception, lower limb proprioception and quality of life were the outcome measures.
  
  
  RESULTS
  Both treatments improved all ankle movements (p < 0.05). The treatment with passive mobilizations also improved the perception of pain and quality of life. Six months later, both groups still had improved articular movement with the exception of plantar flexion and continued to perceive less pain.
  
  
  CONCLUSIONS
  Both physiotherapy interventions improved the range of movement and lessened pain in patients with ankle arthropathy. No haemarthrosis was recorded during treatment or during the follow-up period.
authors.affiliation: Grado de Fisioterapia, Departamento de Ciencias de la Salud, Facultad de Ciencias de la Salud, UCAM-Universidad Católica San Antonio , Murcia , Spain .
authors.forename: Rubén
authors.initials: R
authors.lastname: Cuesta-Barriuso
authors.forename: Antonia
authors.initials: A
authors.lastname: Gómez-Conesa
authors.forename: José-Antonio
authors.initials: JA
authors.lastname: López-Pina
mesh_terms: D000328:Adult; D000843:Ankle Joint / Q000503:physiopathology*; D018771:Arthralgia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D001696:Biomechanical Phenomena; D006467:Hemophilia A / Q000150:complications* / Q000175:diagnosis; D002836:Hemophilia B / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008349:Manipulation, Orthopedic; D008875:Middle Aged; D052580:Muscle Stretching Exercises; D010147:Pain Measurement; D058748:Pain Perception; D010865:Pilot Projects; D011434:Proprioception; D011788:Quality of Life; D016059:Range of Motion, Articular; D020127:Recovery of Function; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Ankle; hemophilia; joint disease; physiotherapy modalities