Outcome of a combined physiotherapy and podiatry haemophilia clinic: patient perceptions and the effect on ankle bleeds and joint health

Charlene Dodd; Alis Trivelli; David Stephensen; Gillian Evans; Miranda Foord

doi:10.17225/jhp00153

Abstract

Abstract Background

The ankle joint is the most common site of bleeding for people with haemophilia (PWH) in the developed world. Recent surveys suggest that PWH do not always have access to non-surgical musculoskeletal interventions and that when provided; there is considerable heterogeneity in clinical practice.

Aims

To determine patient perceptions and the potential benefits of a new combined multidisciplinary physiotherapy-podiatry haemophilia clinic, and to observe the effect on frequency of bleeds and ankle joint Haemophilia Joint Health Scores (HJHS).

Materials and methods

PWH with a history of ankle bleeds, pain, foot and/or ankle deformities from a single UK haemophilia centre were referred to the clinic from December 2017 to December 2018. Pre- and post-intervention ankle joint HJHS data and ankle annualised joint bleed rate (AJBR) were collected together with a satisfaction questionnaire asking patients their views on the clinic's value, usefulness and their satisfaction after the initial appointment.

Results

Twenty-seven PWH (16 children and 11 adults) attended the clinic. All patients agreed or strongly agreed that they were satisfied with the new clinic. The combined multidisciplinary nature of the clinic meant that patients only needed to attend one appointment with the expertise of two professionals, rather than attending two separate appointments. All patients reported it “more useful to see the physiotherapist and podiatrist together”. There were no statistically significant differences in ankle AJBR or HJHS scores post-intervention compared to pre-intervention.

Conclusion

Establishing a multidisciplinary physiotherapy-podiatry clinic for PWH with a history of ankle bleeds, pain, foot and/or ankle deformities appears to increase patient satisfaction. We did not observe a significant change in ankle AJBR or ankle HJHS scores, suggesting they might not be sufficient to evaluate potential benefits to patients. A larger study incorporating validated tools, focusing on patient-reported foot function, pain, activity and quality of life is needed to confirm if there is any effect of a combined physiotherapy-podiatry intervention on ankle joint AJBR and function.

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References

1. Stephensen D, Tait R, Brodie N, et al. Changing patterns of bleeding in patients with severe haemophilia A. Haemophilia 2009; 15(6): 1210–14. doi: https://doi.org/10.1111/j.1365-2516.2008.01876.x.
2. Roosendaal G, Lafeber F. Pathogenesis of haemophilic arthropathy. Haemophilia 2006; 12(3): 117–21.
3. Mulder K, Katzerova M. Chronic sequels: Haemophilic arthropathy and exercise. In: Kleijn P, Mauser-Bunschoten E (ed.). Physiotherapy Management in Haemophilia. The Netherlands: HH Global; 2017.
4. Pasta G, Forsyth A, Merchan C, et al. Orthopaedic management of haemophilia arthropathy of the ankle. Haemophilia 2008; 14(3): 170–6. doi: https://doi.org/10.1111/j.1365-2516.2008.01720.x.
5. Brunel T, Lobet S, Deschamps K, et al. Reliability and clinical features associated with the IPSG MRI tibiotalar and subtalar joint scores in children, adolescents and young adults with haemophilia. Haemophilia 2018; 24(1): 141–48. doi: https://doi.org/10.1111/hae.13368.
6. De la Corte-Rodriguez H, Rodriguez-Merchan E, Alvarez-Roman M, Martin-Salces M, Jimenez-Yuste V. Hindfoot malalignment in adults with haemophilic ankle arthropathy: The importance of early detection and orthotic treatment. Haemophilia 2019; 25(3): 500–508. doi: https://doi.org/10.1111/hae.13680.
7. Colvin BT, Astermark J, Fischer K, et al.; Interdisciplinary Working Group. European principles of haemophilia care. Haemophilia 2008; 14(2): 361–74. doi: https://doi.org/10.1111/j.1365-2516.2007.01625.x.
8. NHS England. 2013/14 NHS Standard Contract for Haemophilia (All Ages). Section B Part 1 – Service Specifications. B05/S/a. Available from https://www.england.nhs.uk/wp-content/uploads/2013/06/b05-haemophilia.pdf (accessed 8 April 2020).
9. O’Mahony B, Savani L, O’Hara J, Bok A. Haemophilia care in Europe – a survey of 37 countries. Haemophilia 2017; 23(4): e259–e266. doi: https://doi.org/10.1111/hae.13263.
10. Stephensen D, de Kleijn P, Matlary R, et al. Scope of practice of haemophilia physiotherapists: a European survey. Haemophilia 2019; 25(3): 514–20. doi: https://doi.org/10.1111/hae.13727.
11. Conceição CSD, Gomes Neto M, Mendes SM, Sá KN, Baptista AF. Systematic review and meta-analysis of effects of foot orthoses on pain and disability in rheumatoid arthritis patients. Disabil Rehabil 2015; 37(14): 1209–13. doi: https://doi.org/10.3109/09638288.2014.961654.
12. Hennessy K, Woodburn J, Steultjens MP. Custom foot orthoses for rheumatoid arthritis: a systematic review. Arthritis Care Res (Hoboken) 2012; 64(3): 311–20. doi: https://doi.org/10.1002/acr.21559.
13. Gijon-Nogueron G, Ramos-Petersen L, Ortega-Avila AB, Morales-Asencio JM, Garcia-Mayor S. Effectiveness of foot orthoses in patients with rheumatoid arthritis related to disability and pain: a systematic review and meta-analysis. Qual Life Res 2018; 27(12): 3059–69. doi: https://doi.org/10.1007/s11136-018-1913-5.
14. Heijnen L, Roosendaal G, Heim M. Orthotics and rehabilitation for chronic hemophilic synovitis of the ankle. An overview. Clin Orthop Relat Res 1997; 343: 68–73.
15. Battistella L. Maintenance of musculoskeletal function in people with haemophilia. Haemophilia 1998; 4(2): 26–32.
16. Ribbans W, Rees J. Management of equinus contractures of the ankle in haemophilia. Haemophilia 1999; 5(1): 46–52.
17. Heijnen L, Heim M, In Der Maur H; World Federation of Hemophilia. Hemophilia. Manufactured shoes and orthopaedic shoes. Haemophilia 2000; 6(1): 4–6.
18. Lobet S, Detrembleur C, Lantin A, Haenecour L, Hermans C. Functional impact of custom-made foot orthoses in patients with haemophilic ankle arthropathy. Haemophilia 2012; 18(3): e227–35. doi: https://doi.org/10.1111/j.1365-2516.2011.02711.x.
19. Hawke F, Burns J. Understanding the nature and mechanism of foot pain. J Foot Ankle Res 2009; 2: 1. doi: https://doi.org/10.1186/1757-1146-2-1.
20. Gallagher KS, Godwin J, Hendry GJ, Steultjens M, Woodburn J. A protocol for a randomised controlled trial of prefabricated versus customised foot orthoses for people with rheumatoid arthritis: the FOCOS RA trial [Foot Orthoses - Customised v Off-the-Shelf in Rheumatoid Arthritis]. J Foot Ankle Res 2018; 31: 11–24. doi: https://doi.org/10.1186/s13047-018-0272-3.
21. Slattery M, Tinley P. The efficacy of functional foot orthoses in the control of pain in ankle joint disintegration in hemophilia. J Am Podiatr Med Assoc 2001; 91(5): 240–4.
22. Jorge Filho D, Battistella L, Lourenço C. Computerized pedobarography in the characterization of ankle-foot instabilities of haemophilic patients. Haemophilia 2006; 12(2): 140–6.
23. World Confederation for Physical Therapy. Policy statement: Description of physical therapy. 2017; Available from https://www.wcpt.org/policy/ps-descriptionPT (accessed 8 April 2020).
24. International Federation of Podiatrists. What is Podiatry. 2018. Available from https://www.fip-ifp.org/what-we-do/what-ispodiatry/ (accessed 8 April 2020).
25. South A, Short L, Richards M. Utility of a combined physiotherapy and podiatry clinic for adults and children with haemophilia. SessionB-27: Musculoskeletal free papers 02 / 12 FP 31. Haemophilia 2008; 14 Suppl 2: 1–157 (76). doi: https://doi.org/10.1111/j.1365-2516.2008.01725.x.
26. Feldman B, Funk S, Bergstrom B, et al. Validation of a new pediatric joint scoring system from the International Hemophilia Prophylaxis Study Group: validity of the hemophilia joint health score. Arthritis Care Res (Hoboken) 2011; 63(2): 223–30. doi: https://doi.org/10.1002/acr.20353.
27. Haemtrack. What is Haemtrack? Available from http://haemtrack.mdsas.com/#about (accessed 8 April 2020).
28. Rome K, Erikson K, Ng A, Gow P, Sahid H, Williams A. A new podiatry service for patients with arthritis. N Z Med J 2013; 126 (1370): 70–77.
29. Leung YY, Tam LS, Lee KW, Leung MH, Kun EW, Li EK. Involvement, satisfaction and unmet health care needs in patients with psoriatic arthritis. Rheumatology (Oxford) 2009; 48(1): 53–56. doi: https://doi.org/10.1093/rheumatology/ken410.
30. Albright TL, Parchman M, Burge SK; RRNeST Investigators. Predictors of self-care behavior in adults with type 2 diabetes: an RRNeST study. Fam Med 2001; 33(5): 354–60.
31. Dang B, Westbrook R, Black W, Rodriguez-Barradas M, Giordano T. Examining the link between patient satisfaction and adherence to HIV care: a structural equation model. PLoS ONE 2013; 8(1): e54729. doi: https://doi.org/10.1371/journal.pone.0054729.

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Authors

Charlene Dodd

charlene.dodd@nhs.net

Clinical Specialist Physiotherapist, Haemophilia and Thrombosis Centre, East Kent Hospitals University NHS Foundation Trust, UK
Alis Trivelli

Clinical Lead Podiatrist for Children, MSK Specialist Podiatrist, Queen Victoria Memorial Hospital, Kent Community Health NHS Foundation Trust, UK
David Stephensen

Physiotherapist, Haemophilia and Thrombosis Centre, East Kent Hospitals University NHS Foundation Trust, UK
Gillian Evans

Consultant Haematologist, Director of Kent Haemophilia and Thrombosis Centre, East Kent Hospitals University NHS Foundation Trust, UK
Miranda Foord

Podiatry Team Lead, Queen Victoria Memorial Hospital, Kent Community Health NHS Foundation Trust, UK