Physiotherapy interventions for pain management in haemophilia: A systematic review.

Chronic musculoskeletal pain affects roughly 35%-50% of people with haemophilia, but there are no established guidelines for treating it with physiotherapy. This systematic review searched five databases plus trial registries and grey literature, identifying nine trials with a combined 235 participants that tested various physiotherapy interventions for pain, quality of life, and function. Because the trials differed too much in design and interventions, the authors could not pool results into a meta-analysis, and instead described findings study by study. All nine trials had an overall risk of bias and low methodological quality.

Comparisons of physiotherapy interventions against no treatment generally showed no clear benefit for pain intensity or quality of life, with one exception, a hydrotherapy versus land-based exercise study, that showed a positive effect on pain but was rated very low quality using the GRADE system. Head-to-head comparisons between physiotherapy interventions also showed no clear advantage of one over another for pain, quality of life, or function, though laser therapy combined with exercise and hydrotherapy showed some positive pain effects without clear functional benefit.

If you live with haemophilia, chronic joint or muscle pain is common, affecting an estimated 35%-50% of people with the condition. This review looked at whether physiotherapy treatments help with that pain.

Researchers combed through five medical databases along with trial registries and other sources, and found nine studies covering 235 participants in total that tested different physiotherapy approaches. The honest answer right now is that we don't have strong evidence either way. Most studies comparing physiotherapy treatments to no treatment found no clear improvement in pain or quality of life.

One small study looking at hydrotherapy (exercise in water) versus land-based exercise did show a positive effect on pain, but the evidence behind it was rated very low quality, meaning it's hard to trust the result. Studies comparing different physiotherapy treatments against each other also didn't show one being clearly better than another, though laser therapy combined with exercise and hydrotherapy showed some positive signs for pain, without clear improvement in physical function.

All the included studies had weaknesses in how they were designed and carried out, so these findings should be viewed cautiously rather than as settled answers.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This systematic review synthesised nine trials (n=235) evaluating physiotherapy interventions for pain, quality of life, and function in people with haemophilia. Searches spanned AMED, CINAHL, EMBASE, MEDLINE, and PEDro, along with trial registries, grey literature, and hand searching.

Critical appraisal found that all included studies carried an overall risk of bias and low methodological quality, and substantial heterogeneity across interventions and outcome measures precluded meta-analysis, limiting the review to a narrative synthesis. Comparisons of physiotherapy versus no intervention showed no clear beneficial effect on pain intensity or quality of life across most studies. One trial comparing hydrotherapy against land-based exercise reported a positive effect on pain intensity, but GRADE assessment rated this evidence as very low certainty.

Head-to-head comparisons between physiotherapy modalities found no clear superiority for pain, quality of life, or function, although laser therapy combined with exercise and hydrotherapy showed some positive effects on pain intensity without corresponding functional gains. Overall, the evidence base for physiotherapy in managing chronic pain in haemophilia remains limited and of low certainty, with the authors calling for better-designed trials with more rigorous methodology and patient involvement to clarify efficacy.