Telerehabilitation Safe, Effective for Severe Hemophilia

A telerehabilitation program, wherein physical therapy exercises were delivered to patients by a professional via video calls, was deemed safe and effective at improving the physical condition of people with severe hemophilia, according to a small study in Chile.

Patients reported a high degree of satisfaction with the intervention, noting that having a physical therapist who specialized in the rehabilitation of people with hemophilia helped them trust the professional and improved their adherence to the program.

The study, “Safety and effectiveness of telerehabilitation program in people with severe haemophilia in Chile. A qualitative study,” was published in Musculoskeletal Science and Practice.

Hemophilia is a genetic blood disorder caused by deficiencies in specific clotting factors, leading to symptoms such as easy and excessive bleeding and bruising.

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These repeated episodes of bleeding and inflammation can cause irreversible damage to certain joints, most notably the knee, ankle, and elbow, leading to a reduced range of motion, chronic joint pain, and a lower quality of life.

Physiotherapy is commonly prescribed to hemophilia patients as a way to manage pain, prevent further joint damage, and improve their range of motion and overall function. While it’s usually conducted in person at specialized clinics, the COVID-19 pandemic disrupted physiotherapy management in several countries.

Telehealth, or telemedicine, uses technology such as telephones and computers to deliver care to patients without requiring them to come to the clinics. It allows patients to access care from their home or office and to be treated in a more timely manner.

Telerehabilitation comparable to in-person care

Telerehabilitation, in particular, where physical therapy or other rehabilitation methods are delivered remotely, has been deemed comparable to in-person rehabilitation in a number of conditions. However, whether hemophilia patients also see this as a useful, safe, and effective approach hasn’t been known.

Researchers at the University of Chile evaluated feedback from 12 men with severe hemophilia who enrolled in a telerehabilitation program developed by a physical therapist who specialized in the disease. The program was launched in Chile in June 2020, a few months after the COVID-19 pandemic hit the country.

Each week, patients joined a 30-minute video session wherein their exercises were supervised by a professional and conducted two additional home sessions without supervision.  The classes occurred on the same days as their prophylactic treatment.

The training focused on muscular strength using a free weight or resistance band, as well as balance training and education to promote physical activity at home. The difficulty of the exercises was increased every two weeks.

To assess the patients’ satisfaction with the program, participants were interviewed in focus groups by two independent physical therapists who hadn’t participated in the telerehabilitation.

Interviews were conducted remotely in two groups, one including patients 35 years and younger and another with patients older than 35. Those who agreed to be interviewed had completed an average of 10 sessions.

In the interview, researchers assessed the overall experience with telerehabilitation and the use of technologies followed by their advantages and disadvantages. Finally, they evaluated patients’ perspectives on their outcomes after telerehabilitation, including the factors that may have affected it.

Tele- it like it is

Results showed patients valued the one-on-one training with a therapist who specialized in hemophilia rehabilitation, which contributed to trusting the professional more and their adherence to treatment. The physiotherapist having knowledge about the risks, precautions, and safety of the exercises were also highly appreciated.

“It’s reassuring to have the chance to see a physiotherapist who’s knowledgeable about haemophilia, because I’ve seen other physiotherapists who don’ really know the disease and tell you to do exercises that aren’t good for you,” one patient said.

Among the advantages of telerehabilitation, participants noted the greater accessibility, particularly for those living in geographically isolated regions, or with tighter work schedules, as well as a potential reduction in their carbon footprint.

However, the lack of adequate equipment at home and direct supervision, the limited time of the sessions, as well as the physiotherapist not being able to make a thorough physical examination, prompted by the small screen and the low-resolution camera of their devices, were seen as disadvantages.

Some of the suggestions by patients to boost telerehabilitation included providing a basic equipment kit, such as elastic exercise bands, and a combination of individual and group online sessions.

All the patients reported improvements in their physical condition and a greater sense of well-being, and “expressed feeling taken care of by the health care system instead of being left alone,” the research team wrote.

Telerehabilitation was deemed as a “safe and effective intervention to improve physical condition,” the researchers wrote.

“Improving access to more difficult to reach areas already suffering from inequalities in healthcare access would further enhance the utility of telerehabilitation which may also enhance its support. The lack of face-to-face supervision and physical examination were perceived as the principal disadvantages,” they noted.