The Role of Physical and Rehabilitation Medicine in Preventing Musculoskeletal Complications in Pediatric Hemophilia
DOI:
https://doi.org/10.47134/inhis.v5i1.175Keywords:
Pediatric hemophilia, Musculoskeletal complications, Medical rehabilitationAbstract
Background: Pediatric hemophilia is a hereditary bleeding disorder that leads to progressive musculoskeletal complications due to recurrent hemarthrosis, thereby increasing the risk of long-term disability and reduced quality of life. Objective: To examine the role of medical rehabilitation in preventing musculoskeletal complications in pediatric hemophilia. Methods: This study was conducted as a narrative literature review by searching articles through PubMed, Scopus, and Google Scholar using keywords related to pediatric hemophilia, musculoskeletal complications, hemarthrosis, hemophilic arthropathy, and preventive rehabilitation and management. The selected literature included original research articles, clinical guidelines, and systematic reviews relevant to children and adolescent populations. A descriptive-synthesis approach was used to integrate findings related to musculoskeletal complications and phase-based preventive rehabilitation strategies. Results: Complications include hemarthrosis, chronic hemophilic synovitis, hemophilic arthropathy, joint deformities, and muscle hematomas, which contribute to decreased muscle strength, limited joint range of motion, chronic pain, activity restriction, and reduced quality of life. Preventive rehabilitation integrated with coagulation factor prophylaxis includes functional assessment (HJHS and FISH), the acute-phase RICE protocol, hydrotherapy, isometric strengthening exercises, range of motion exercises, joint protection education, and the use of orthoses and mobility aids. Conclusion: Medical rehabilitation represents an essential non-pharmacological prophylactic pillar in preventing musculoskeletal complications in pediatric hemophilia.
References
Ay, C., Mancuso, M. E., Matino, D., Strike, K., & Pasta, G. (2024). The haemophilia joint health score for the assessment of joint health in patients with haemophilia. Haemophilia : The Official Journal of the World Federation of Hemophilia, 30(6), 1265-1271. https://doi.org/10.1111/hae.15116
Azeredo-da-Silva, A. F., Zanotto, B. S., Kuwabara, Y. S., & Mata, V. E. (2023). Quality of life in children and adolescents with hemophilia A: A systematic review and meta-analysis. Research and Practice in Thrombosis and Haemostasis, 7(1), 100008. https://doi.org/10.1016/j.rpth.2022.100008
Berntorp, E., Fischer, K., Hart, D. P., Mancuso, M. E., Stephensen, D., Shapiro, A. D., & Blanchette, V. (2021). Haemophilia. Nature Reviews. Disease Primers, 7(1), 45. https://doi.org/10.1038/s41572-021-00278-x
Biasoli, C., Baldacci, E., Coppola, A., De Cristofaro, R., Di Minno, M. N. D., Lassandro, G., Linari, S., Mancuso, M. E., Napolitano, M., Pasta, G., & Rocino, A. (2022). Promoting physical activity in people with haemophilia: the MEMO (Movement for persons with haEMOphilia) expert consensus project. Blood Transfusion Trasfusione Del Sangue, 20(1), 66-77. https://doi.org/10.2450/2021.0138-21
Buckner, T. W., Sidonio, R. J., Witkop, M., Guelcher, C., Cutter, S., Iyer, N. N., & Cooper, D. L. (2019). Correlations between patient-reported outcomes and self-reported characteristics in adults with hemophilia B and caregivers of children with hemophilia B: analysis of the B-HERO-S study. Patient Related Outcome Measures, 10, 299-314. https://doi.org/10.2147/PROM.S219166
Budiarty, S., & Nafianti, S. (2020). Menilai Kualitas Hidup Anak Penyandang Hemofilia. Cermin Dunia Kedokteran, 47(8). https://doi.org/10.55175/cdk.v47i8.784
Chigbu, U. E., Atiku, S. O., & Du Plessis, C. C. (2023). The Science of Literature Reviews: Searching, Identifying, Selecting, and Synthesising. Publications, 11(1). https://doi.org/10.3390/publications11010002
Cruz-Montecinos, C., Pérez-Alenda, S., Querol, F., Cerda, M., & Maas, H. (2020). Changes in Muscle Activity Patterns and Joint Kinematics During Gait in Hemophilic Arthropathy. Frontiers in Physiology, Volume 10-2019.
de Kleijn, P., Duport, G., Jansone, K., Marinić, M., McLaughlin, P., Noone, D., Ramishvili, L., Tollwé, A., Stephensen, D., & Committee, the E. H. C. and E. P. (2022). European principles of care for physiotherapy provision for persons with inherited bleeding disorders: Perspectives of physiotherapists and patients. Haemophilia, 28(4), 649-655. https://doi.org/https://doi.org/10.1111/hae.14566
Din, S. (2021). “Level of Activity Limitation Due to Joints Pain among Hemophilia Patients.” Biomedical Journal of Scientific & Technical Research, 39. https://doi.org/10.26717/BJSTR.2021.39.006377
Federation, W., & Report, H. (2024). World Federation of Hemophilia Report on the Annual Global Survey 2024. 1-91.
Feldberg, G., Ricciardi, J. B. S., Zorzi, A. R., Colella, M. P., & Ozelo, M. C. (2021). Aquatic exercise in patients with haemophilia: Electromyographic and functional results from a prospective cohort study. Haemophilia, 27(2), e221-e229. https://doi.org/https://doi.org/10.1111/hae.14275
Fouda, R., Argueta, D. A., & Gupta, K. (2022). Pain in Hemophilia: Unexplored Role of Oxidative Stress. In Antioxidants (Vol. 11, Issue 6, p. 1113). https://doi.org/10.3390/antiox11061113
Goto, M., Takedani, H., Yokota, K., & Haga, N. (2020). Strategies to encourage physical activity in patients with hemophilia to improve quality of life. Journal of Blood Medicine, 7, 85-98. https://doi.org/10.2147/JBM.S84848
Gouw, S. C., Timmer, M. A., Srivastava, A., de Kleijn, P., Hilliard, P., Peters, M., Blanchette, V., & Fischer, K. (2019). Measurement of joint health in persons with haemophilia: A systematic review of the measurement properties of haemophilia-specific instruments. Haemophilia : The Official Journal of the World Federation of Hemophilia, 25(1), e1-e10. https://doi.org/10.1111/hae.13631
Gualtierotti, R., Piero, L., & Flora, S. (2021). Hemophilic arthropathy : Current knowledge and future perspectives. Journal of Thrombosis and Haemostasis, 19(9), 2112-2121. https://doi.org/10.1111/jth.15444
Gualtierotti, R., Solimeno, L. P., Peyvandi, F., Giachi, A., Arcudi, S., Ciavarella, A., & Siboni, S. M. (2024). Ultrasound evaluation of hemophilic arthropathy: a proposal of definitions in a changing landscape. Research and Practice in Thrombosis and Haemostasis, 8(1), 102314. https://doi.org/https://doi.org/10.1016/j.rpth.2023.102314
Kathy Mulder. (2016). Exercises for People with Hemophilia. World Federation of Hemophilia, 1(20), 1-91.
Kavia, A., Joshi, M., Mittal, S., & Banthia, P. (2021). Impact of Functional Disability on Quality of Life in Patients with Haemophilia : An Observational Study. Journal of Clinical and Diagnostic Research, 2(11834), 5-8. https://doi.org/10.7860/JCDR/2021/51441.15813
Kovač, K., Caktaš, I. L., Kalebota, N., & Perić, P. (2025). Hemophilic Arthropathy—Pathophysiology and Advances in Treatment. In Rheumato (Vol. 5, Issue 2, p. 5). https://doi.org/10.3390/rheumato5020005
López-Arroyo, J., Pérez-Zúñiga, J., Merino-Pasaye, L., Saavedra-González, A., Alcivar-Cedeño, L., Álvarez-Vera, J., Anaya-Cuellar, I., Arana-Luna, L., Ávila-Castro, D., Bates-Martín, R., Cesarman-Maus, G., Chávez-Aguilar, L., Peña-Celaya, J., Espitia-Ríos, M., Estrada-Domínguez, P., Fermín-Caminero, D., Flores-Patricio, W., García-Chávez, J., García-Lee, M., & Alvarado-Ibarra, M. (2021). Consensus on hemophilia in Mexico. Gaceta Medica de Mexico, 157. https://doi.org/10.24875/GMM.M21000463
Mannucci, P. M. (2020). Hemophilia therapy: the future has begun. Haematologica, 105(3), 545-553. https://doi.org/10.3324/haematol.2019.232132
Marchesini, E., Morfini, M., Valentino, L., & Morfini, M. (2021). Review Recent Advances in the Treatment of Hemophilia : A Review. Biologics: Targets and Therapy, 5475(221-235). https://doi.org/10.2147/BTT.S252580
Matuk-Villazon, O., Roberts, J. C., & Corrales-Medina, F. F. (2021). Hemophilia: The Past, the Present, and the Future. Pediatrics In Review, 42(12), 672-683. https://doi.org/10.1542/pir.2020-004143
Mazloum, V., Rahnama, N., & Khayambashi, K. (2014). Effects of therapeutic exercise and hydrotherapy on pain severity and knee range of motion in patients with hemophilia: a randomized controlled trial. International Journal of Preventive Medicine, 5(1), 83-88.
Nogami, K., & Shima, M. (2017). Pathogenesis and Treatment of Hemophilia. In Hematological Disorders in Children: Pathogenesis and Treatment (pp. 189-204). https://doi.org/10.1007/978-981-10-3886-0_9
Paredes, A. C., Costa, P., Almeida, A., & Pinto, P. R. (2020). A new measure to assess pain in people with haemophilia: The Multidimensional Haemophilia Pain Questionnaire (MHPQ). PloS One, 13(11), e0207939. https://doi.org/10.1371/journal.pone.0207939
Querol, F., Aznar, J. A., Haya, S., & Cid, A. (2002). Orthoses in haemophilia. Haemophilia, 8(3), 407-412. https://doi.org/https://doi.org/10.1046/j.1365-2516.2002.00637.x
Ray, A., Colville, J. G., Hartley, R., & Rowbotham, E. (2022). The musculoskeletal manifestations of haemophilia: a review of the imaging findings. Clinical Radiology, 77(10), 730-737. https://doi.org/10.1016/j.crad.2022.06.022
Rodriguez-Merchan, E. C. (2012). Prevention of the musculoskeletal complications of hemophilia. Advances in Preventive Medicine, 2012, 201271. https://doi.org/10.1155/2012/201271
Rodriguez-Merchan, E., Jimenez-Yuste, V., Aznar, J., Hedner, U., Knobe, K., Lee, C. A., Ljung, R., Querol, F., Santagostino, E., Valentino, L., & Caffarini, A. (2011). Joint protection in haemophilia. Haemophilia : The Official Journal of the World Federation of Hemophilia, 17 Suppl 2, 1-23. https://doi.org/10.1111/j.1365-2516.2011.02615.x
Samman, B. R., Alrumaih, E. T., A, A. L. A., Alrsheedi, M. M., Aldhafeeri, M. D., Alasiry, A. A., Alharbi, K. S., Alosaimi, B. S., Alotaibi, N. H., & Mohammed, A. (2020). an overview of hemophilia diagnosis and management in children : simple literature review. Pharmacophore, 11(6), 62-66.
Stromer, W., Pabinger, I., Ay, C., Crevenna, R., Donnerer, J., Feistritzer, C., Hemberger, S., Likar, R., Sevelda, F., Thom, K., Wagner, B., & Streif, W. (2021). Pain management in hemophilia: expert recommendations. Wiener Klinische Wochenschrift, 133(19-20), 1042-1056. https://doi.org/10.1007/s00508-020-01798-4
Tlacuilo-Parra, A., Villela-Rodriguez, J., Garibaldi-Covarrubias, R., Soto-Padilla, J., & Orozco-Alcala, J. (2010). Functional independence score in hemophilia: a cross-sectional study assessment of Mexican children. Pediatric Blood & Cancer, 54(3), 394-397. https://doi.org/10.1002/pbc.22291
Wagner, B., Seuser, A., Krüger, S., Luca, M., Thomas, H., Cihan, H., Hasenöhrl, T., & Crevenna, R. (2019). Establishing an online physical exercise program for people with hemophilia. Wiener Klinische Wochenschrift, 131(1), 558-566. https://doi.org/10.1007/s00508-019-01548-1
Wang, M., Álvarez-Román, M. T., Chowdary, P., Quon, D. V, & Schafer, K. (2016). Physical activity in individuals with haemophilia and experience with recombinant factor VIII Fc fusion protein and recombinant factor IX Fc fusion protein for the treatment of active patients: a literature review and case reports. Blood Coagulation & Fibrinolysis : An International Journal in Haemostasis and Thrombosis, 27(7), 737-744. https://doi.org/10.1097/MBC.0000000000000565
WFH Guidelines for the Management of Hemophilia. (2020). WFH, 4(1), 1-180.
Wyseure, T., Mosnier, L. O., & von Drygalski, A. (2016). Advances and challenges in hemophilic arthropathy. Seminars in Hematology, 53(1), 10-19. https://doi.org/10.1053/j.seminhematol.2015.10.005
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