Postural stability is affected in older males with Haemophilia—a matched control study

Despite fall-related injuries having serious consequences for older haemophilic patients, few studies have investigated their postural stability and risk of falls. The aim was to examine postural stability, joint function and joint mobility in haemophiliacs and age-matched controls. Centre of pressure excursions in four 60 s balance conditions, two minute walk test, passive ankle and knee range of motion, Haemophilia Joint Health Score, and Haemophilia Early Arthropathy Detection with Ultrasound score were measured in eight men with haemophilia (people with heamophilia, PWH), and eight age-matched men without haemophilia (people without heamophilia, PWOH). PWH have significantly worse postural stability under physically perturbed conditions (p = 0.001–0.028, η2p = 0.19–0.34), reduced joint function (p = 0.001–0.010, d = 1.33–2.62) and mobility (p < 0.001–0.025, d = 1.01–4.61), and increased centre of pressure (CoP) velocity (p < 0.001–0.003) when compared to PWOH. Postural stability among PWH did not deteriorate with time standing, although significant decreases compared to PWOH across all time intervals were observed (Eyes Open Foam (EOF) CoP ellipse (time x group) p = 0.011, η2p = 0.28; path (time × group) p = 0.035, η2p = 0.21; EOF CoP antero-posterior (AP) (time × group) p = 0.021, η2p = 0.24). Joint function, mobility, and postural stability are reduced in PWH compared to PWOH, driven by differences in the CoP AP range. Dynamic tests incorporating physical perturbation may be more effective than static balance tests on a level surface, and longer period of time to assess postural stability may determine whether fatigue affects ability of PWH to maintain postural stability. Adoption of a possible ‘hip strategy’ by which to achieve balance suggests falls prevention programs need to focus on increasing hip strength and retraining ankle strategy movement to allow PWH to improve balance stability

Using theory of change to co-create a programme theory for a telerehabilitation intervention for pain management in people with haemophilia

Background Improved approaches for chronic pain management are a clinical and research priority for people with haemophilia (PWH). Involving people with lived experience in the design of a complex rehabilitation intervention strengthens the credibility and plausibility of the intervention, particularly in relation to rare disorders. Here we describe using a ‘Theory of Change’ (ToC) dialogue-based stakeholder process to create a programme theory for a telerehabilitation intervention. Methods An online workshop was convened and stakeholders received a briefing document in advance. Five stakeholders took part (3 PWH and 2 physiotherapists). At the workshop the group first agreed the overall aim of the intervention. Discussions then identified the resources, activities, barriers and enablers needed to achieve this outcome. All discussions were recorded and annotated by the workshop moderator. Behaviour change techniques were mapped for inclusion in the theory. Results A programme theory and narrative report were produced. All stakeholders reviewed these for clarity and to ensure a true refection of the workshop discussions. Agreement was based on how meaningful, well-defined, do-able, plausible, credible, and testable each component was. Stakeholders highlighted the importance of issues unique to PWH. Key components included the need for physiotherapists to be knowledgeable of the condition, a range of exercises that were inclusive of all abilities, and the need for people to feel safe and supported whilst taking part. Conclusions Co-developed theory based approaches to intervention design offer an inclusive and transparent way to develop novel and meaningful interventions for people with complex health conditions. The ToC is wholly transparent in its design and content. Together with the identified behaviour change techniques, the theory informs the protocol for a feasibility study evaluating a telerehabilitation intervention. Importantly, it allows the opportunity to revise, adapt and improve the programme theory for further implementation and evaluatio

Muscle strengthening intervention for boys with haemophilia: Developing and evaluating a best-practice exercise programme with boys, families and health-care professionals

Background: Muscle strengthening exercises have the potential to improve outcomes for boys with haemophilia, but it is unclear what types of exercise might be of benefit. We elicited the views of health-care professionals, boys and their families to create and assess a home-based muscle strengthening programme. Objective: To design and develop a muscle strengthening programme with health-care professionals aimed at improving musculoskeletal health, and refine the intervention by engaging boys with haemophilia and their families (Study 1). Following delivery, qualitatively evaluate the feasibility and acceptability of the exercise programme with the boys and the study's physiotherapists (Study 2). Design: A person-based approach was used for planning and designing the exercise programme, and evaluating it post-delivery. The following methods were utilized: modified nominal group technique (NGT) with health-care professionals; focus group with families; exit interviews with boys; and interviews with the study's physiotherapists. Results: Themes identified to design and develop the intervention included exercises to lower limb and foot, dosage, age accommodating, location, supervision and monitoring and incentivization. Programme refinements were carried out following engagement with the boys and families who commented on: dosage, location, supervision and incentivization. Following delivery, the boys and physiotherapists commented on progression and adaptation, physiotherapist contact, goal-setting, creating routines and identifying suitable timeframes, and a repeated theme of incentivization. Conclusions: An exercise intervention was designed and refined through engagement with boys and their families. Boys and physiotherapists involved in the intervention's delivery were consulted who found the exercises to be generally acceptable with some minor refinements necessary

Natural history of radiographic first metatarsophalangeal joint osteoarthritis: A nineteen‐year population‐based cohort study

Objective: To assess the long-term prevalence, natural history, progression and incidence of 73 radiographic first metatarsophalangeal joint (1st MTPJ) osteoarthritis (OA). Methods: A longitudinal, cohort design was used in which radiographic OA at the 1st MTPJ was 75 investigated in participants at year 6 (1995) and year 23 (2013-2015) from the Chingford 1000 76 Women study. Radiographic features of osteophytes (OPs) and/or joint space narrowing (JSN) at the 77 1st MTPJ were scored according to a validated foot atlas. Natural history was determined by the 78 change in prevalence, incidence, progression and worsening of OA in the 1st MTPJ. Results: Complete case matched foot radiographic data were available for 193 of the women 80 currently enrolled in the study, mean age: 75.7 years (SD: 5.2; range 69-90). At the level of the 1st 81 MTPJ, prevalence of OA at year 6 was 21.76% in the left and 24.35% in the right and at year 23 was 82 23.83% in the left and 32.64% in the right. Over the 19-year period, 13.5% of women developed 83 incident OA in the right 1st MTPJ and 8.3% in the left. Both progression and worsening of OA were 84 more evident for OPs and in the right 1st MTPJs. Conclusion: In this longest study of the natural history of radiographic 1st MTPJ OA to date, the 86 prevalence and incidence of 1st MTPJ OA increased over a 19-year period. Progression and/or 87 worsening of 1st MTPJ OA over time appears to be driven by OP development rather than JSN 88 suggestive of a biomechanical cause

Acceptability and feasibility of an isometric resistance exercise program for abdominal cancer surgery: An embedded qualitative study

Although it is recognized in the early stages of cancer recovery that changes in lifestyle including increases in physical activity improves physical function, there are no clear findings whether low versus moderate intensity activity or home or gym exercise offer optimal benefit. Isometric-resistance exercises can be carried out with very little equipment and space and can be performed while patients are bed-bound in hospital or at home. This embedded qualitative study, based in an English hospital trust providing specialist cancer care, was undertaken as a component of a feasibility trial to evaluate the acceptability and feasibility of an isometric-resistance exercise program and explore the suitability of functional assessments by drawing from the experiences of abdominal cancer patients following surgery. Telephone interviews were undertaken with 7 participants in the intervention group, and 8 interviews with the usual care group (n¼ 15). The gender composition consisted of 11 females and 4 males. Participants’ ages ranged from 27 to 84 (M¼ 60.07, SD ¼ 15.40). Interviews were conducted between August 2017 and May 2018, with audio files digitally recorded and data coded using thematic framework analysis. Our results show that blinding to intervention or usual care was a challenge, participants felt the intervention was safe and suitable aided by the assistance of a research nurse, yet, found the self-completion questionnaire tools hard to complete. Our study provides an insight of trial processes, participants’ adherence and completion of exercise interventions, and informs the design and conduct of larger RCTs based on the experiences of abdominal cancer surgery patients

Effects of pre- and post-operative resistance exercise interventions on recovery of physical function in patients undergoing abdominal surgery for cancer: A systematic review of randomised controlled trials

Objective: To systematically review the effects of pre- and post-operative resistance exercise training on the recovery of physical function in patients undergoing abdominal surgery for cancer. Data sources: A systematic review of English articles using Medline, PEDro, Cinahl and The Cochrane Library electronic databases was undertaken. Eligibility criteria for selecting studies: Studies were included if they used a randomised, quasi-randomised, or controlled trial study design and compared the effects of a muscle-strengthening exercise intervention (+/- other therapy) with a comparative non-exercise group; involved adult participants (≥18 years) who had elected to undergo abdominal surgery for cancer; and used muscle strength, physical function, self-reported functional ability, range of motion and/or a performance-based test as an outcome measure. Results: Following screening of titles and abstracts of the 588 publications retrieved from the initial search, 24 studies met the inclusion criteria and were accessed for review of the full-text version of the article and 2 eligible met the inclusion criteria and were included in the review. One exercise programme was undertaken pre-operatively and the other post-operatively, until discharge from hospital. There were no differences between groups in either study. Conclusion: The only two studies designed to determine whether pre- or post-operative resistance muscle-strengthening exercise programmes improved or negatively affected physical function outcomes in patients undergoing abdominal surgery for cancer provide inconclusive results. The exercise interventions of the included studies were performed for 5 and 8 session respectively

Risk Assessment for Supply Chain Meat Inspection of Danish Finisher Pigs

The food safety value of routine incision into the major mandibular lymph nodes and the heart was assessed in finisher pigs from integrated production systems in Denmark. A risk assessment was conducted following international guidelines as a joint effort between university, industry and veterinary services. It was concluded that omission of routine incisions into the mandibular lymph nodes and the heart was not associated with a significant increase in the risk for human health. The main reason is that Denmark is officially free from bovine tuberculosis since 29 years, and the pathogens causing granulomatous lymphadenitis and endocarditis are not likely to be food-borne. The new way of conducting meat inspection is called supply chain meat inspection - the Danish way. The system will gradually be implemented on all slaughterhouses in Denmark during 2009

Expert United Kingdom consensus on the preservation of joint health in people with moderate and severe haemophilia A: A modified Delphi panel

Aim: For people with haemophilia A (PwHA), bleeding in the joints leads to joint damage and haemophilia-related arthropathy, impacting range of motion and life expectancy. Existing guidelines for managing haemophilia A support healthcare professionals (HCPs) and PwHA in their efforts to preserve joint health. However, such guidance should be reviewed, considering emerging evidence and consensus as presented in this manuscript. Methods: Fifteen HCPs experienced in the management of PwHA in the UK participated in a three-round Delphi panel. Consensus was defined at ≥70% of panellists agreeing or disagreeing for Likert-scale questions, and ≥70% selecting the same option for multiple- or single-choice questions. Questions not reaching consensus were revised for the next round. Results: 26.8% (11/41), 44.8% (13/29) and 93.3% (14/15) of statements reached consensus in Rounds 1, 2 and 3, respectively. HCPs agreed that prophylaxis should be offered to patients with a baseline factor VIII (FVIII) level of ≤5 IU/dL and that, where there is no treatment burden, the aim of prophylaxis should be to achieve a trough FVIII level ≥15 IU/dL and maintain a longer period with FVIII levels of ≥20-30 IU/dL to provide better bleed protection. The aspirational goal for PwHA is to prevent all joint bleeds, which may be achieved by maintaining normalised (50-150 IU/dL) FVIII levels. Conclusion: The panel of experts were largely aligned on approaches to preserving joint health in PwHA, and this consensus may help guide HCPs

Expert United Kingdom consensus on the preservation of joint health in people with moderate and severe haemophilia A: A modified Delphi panel

\ua9 2024 The Authors. Haemophilia published by John Wiley &amp; Sons Ltd.Aim: For people with haemophilia A (PwHA), bleeding in the joints leads to joint damage and haemophilia-related arthropathy, impacting range of motion and life expectancy. Existing guidelines for managing haemophilia A support healthcare professionals (HCPs) and PwHA in their efforts to preserve joint health. However, such guidance should be reviewed, considering emerging evidence and consensus as presented in this manuscript. Methods: Fifteen HCPs experienced in the management of PwHA in the UK participated in a three-round Delphi panel. Consensus was defined at ≥70% of panellists agreeing or disagreeing for Likert-scale questions, and ≥70% selecting the same option for multiple- or single-choice questions. Questions not reaching consensus were revised for the next round. Results: 26.8% (11/41), 44.8% (13/29) and 93.3% (14/15) of statements reached consensus in Rounds 1, 2 and 3, respectively. HCPs agreed that prophylaxis should be offered to patients with a baseline factor VIII (FVIII) level of ≤5 IU/dL and that, where there is no treatment burden, the aim of prophylaxis should be to achieve a trough FVIII level ≥15 IU/dL and maintain a longer period with FVIII levels of ≥20–30 IU/dL to provide better bleed protection. The aspirational goal for PwHA is to prevent all joint bleeds, which may be achieved by maintaining normalised (50–150 IU/dL) FVIII levels. Conclusion: The panel of experts were largely aligned on approaches to preserving joint health in PwHA, and this consensus may help guide HCPs