title: How do patients and professionals differentiate between intra-articular joint bleeds and acute flare-ups of arthropathy in patients with haemophilia?
abstract: BACKGROUND
  The overlap in symptoms between joint bleeds and flare-ups of haemophilia arthropathy (HA) creates difficulties in differentiating between the two conditions. Diagnosis of haemarthrosis is currently empirically made based upon clinical presentations. However, no standard diagnostic criteria are available. To offer appropriate treatment, rapid and accurate diagnosis is essential. Additionally, adequate differentiation can decrease health costs significantly.
  
  
  OBJECTIVE
  The aim of this study was to identify signs and symptoms to differentiate between an intra-articular joint bleed and an acute flare-up of HA in patients with haemophilia and make an initial proposal of items to include in a diagnostic criteria set.
  
  
  METHODS
  Six focus group interviews with a total of 13 patients and 15 professionals were carried out. The focus groups were structured following the Nominal Group Technique (NGT).
  
  
  RESULTS
  The most important signs and symptoms used to differentiate between joint bleeds and HA were (i) course of the symptoms, (ii) cause of the complaints, (iii) joint history, (iv) type of pain and (v) degree of impairments in range of motion.
  
  
  CONCLUSIONS
  This qualitative study provides insight into signs and symptoms that are currently used to differentiate between joint bleeds and flare-ups of HA. Results of this study can be used to develop a valid and standardized clinical diagnostic criteria set to differentiate between these two conditions. Further research is necessary to validate the signs and symptoms found in this study.
authors.affiliation: Van Creveldkliniek, University Medical Center Utrecht, Utrecht, the Netherlands.|Physical Therapy Research, Departement of Rehabilitation, Nursing Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: M A
authors.initials: MA
authors.lastname: Timmer
authors.affiliation: Physical Therapy Research, Departement of Rehabilitation, Nursing Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.|Center for Physical Therapy Research and Innovation in Primary Care, Leidsche Rijn Julius Health Care Center, Utrecht, the Netherlands.
authors.forename: M F
authors.initials: MF
authors.lastname: Pisters
authors.affiliation: Van Creveldkliniek, University Medical Center Utrecht, Utrecht, the Netherlands.|Physical Therapy Research, Departement of Rehabilitation, Nursing Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: de Kleijn
authors.affiliation: Physical Therapy Research, Departement of Rehabilitation, Nursing Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Veenhof
authors.affiliation: Departement of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: B A P
authors.initials: BA
authors.lastname: Laros-van Gorkom
authors.affiliation: Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: M J H A
authors.initials: MJ
authors.lastname: Kruip
authors.affiliation: Physical Therapy Research, Departement of Rehabilitation, Nursing Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.|Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.
authors.forename: R A
authors.initials: RA
authors.lastname: de Bie
authors.affiliation: Van Creveldkliniek, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: R E G
authors.initials: RE
authors.lastname: Schutgens
mesh_terms: D000328:Adult; D017144:Focus Groups; D006395:Hemarthrosis / Q000175:diagnosis*; D006467:Hemophilia A / Q000473:pathology*; D006801:Humans; D007407:Interviews as Topic; D007592:Joint Diseases / Q000175:diagnosis*; D007596:Joints / Q000503:physiopathology; D008875:Middle Aged; D009726:Nurses / Q000523:psychology; D010361:Patients / Q000523:psychology*; D010820:Physicians / Q000523:psychology*; D016059:Range of Motion, Articular
keywords: diagnosis; haemarthrosis; haemophilia; haemophilia arthropathy; symptoms