Self-Myofascial Release Intervention and Mobile App in Patients With Hemophilic Ankle Arthropathy: Protocol for a Randomized Controlled Trial

Antonio Javier Meroño-Gallut, Rubén Cuesta-Barriuso, Raúl Pérez-Llanes, Elena Donoso-Úbeda, José-Antonio López-Pina, Antonio Javier Meroño-Gallut, Rubén Cuesta-Barriuso, Raúl Pérez-Llanes, Elena Donoso-Úbeda, José-Antonio López-Pina

Abstract

Background: Hemophilic ankle arthropathy is manifested by degenerative functional alterations and chronic pain. Myofascial release techniques are used to treat soft tissue adhesions, relieve pain, and reduce tissue sensitivity.

Objective: This study aims to evaluate the safety and efficacy of a protocol using self-myofascial release with a foam roller to be applied in patients with hemophilic ankle arthropathy.

Methods: Patients with ankle arthropathy (N=70) will be recruited, enrolled, and assigned to one of two groups-experimental or control-in a 1:1 allocation ratio. Patients will be recruited from 5 centers in different regions of Spain. Patient data will be collected at baseline, posttreatment, and follow-up. The primary outcome will be frequency of ankle joint bleeding (self-reported). The secondary outcomes will be ankle range of motion (measured with a digital goniometer); joint pain (measured with a visual analog scale and an algometer); joint status (measured using the Hemophilia Joint Health Score); muscle strength (measured with a dynamometer); functionality of lower limbs (measured using the 6-minute walking test); activity (self-reported); and muscle flexibility (measured using the fingertip-to-floor test). The treatment program includes 11 exercises that must be administered bilaterally. A mobile app will be developed where each patient will be able to observe the exercises to be carried out. Each session will last 15 minutes with 5 physiotherapy sessions per week for a period of 3 months. It is expected that patients with hemophilia who receive the foam roller intervention will show improvement in mobility, pain, and status of the ankle joint; muscle strength; and function in the lower extremities.

Results: The study has been approved by the institutional review board of the University of Murcia. Patient recruitment will begin in September 2020, and the intervention period will last until June 2021. Data collection will take place between September 2020 and October 2021.

Conclusions: This protocol describes a randomized clinical trial to examine the safety and efficacy of a self-myofascial release intervention using a foam roller in patients with hemophilic ankle arthropathy.

Trial registration: ClinicalTrials.gov NCT03914287; https://ichgcp.net/clinical-trials-registry/NCT03914287.

International registered report identifier (irrid): PRR1-10.2196/15612.

Keywords: Hemophilic arthropathy; ankle; functionality; joint pain; randomized clinical trial; self-myofascial release.

Conflict of interest statement

Conflicts of Interest: None declared.

©Antonio Javier Meroño-Gallut, Rubén Cuesta-Barriuso, Raúl Pérez-Llanes, Elena Donoso-Úbeda, José-Antonio López-Pina. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 31.07.2020.

References

    1. Gringeri A, Ewenstein B, Reininger A. The burden of bleeding in haemophilia: is one bleed too many? Haemophilia. 2014 Jul;20(4):459–63. doi: 10.1111/hae.12375.
    1. Valentino LA. Blood-induced joint disease: the pathophysiology of hemophilic arthropathy. J Thromb Haemost. 2010 Sep;8(9):1895–902. doi: 10.1111/j.1538-7836.2010.03962.x. doi: 10.1111/j.1538-7836.2010.03962.x.
    1. Gouw SC, Timmer MA, Srivastava A, de Kleijn P, Hilliard P, Peters M, Blanchette V, Fischer K. Measurement of joint health in persons with haemophilia: a systematic review of the measurement properties of haemophilia-specific instruments. Haemophilia. 2019 Jan;25(1):e1–e10. doi: 10.1111/hae.13631.
    1. Rodriguez-Merchan EC. Prevention of the musculoskeletal complications of hemophilia. Adv Prev Med. 2012;2012:201271. doi: 10.1155/2012/201271. doi: 10.1155/2012/201271.
    1. Manco-Johnson MJ, Abshire TC, Shapiro AD, Riske B, Hacker MR, Kilcoyne R, Ingram JD, Manco-Johnson ML, Funk S, Jacobson L, Valentino LA, Hoots WK, Buchanan GR, DiMichele D, Recht M, Brown D, Leissinger C, Bleak S, Cohen A, Mathew P, Matsunaga A, Medeiros D, Nugent D, Thomas GA, Thompson AA, McRedmond K, Soucie JM, Austin H, Evatt BL. Prophylaxis versus episodic treatment to prevent joint disease in boys with severe hemophilia. N Engl J Med. 2007 Aug 09;357(6):535–44. doi: 10.1056/NEJMoa067659.
    1. Holstein K, Klamroth R, Richards M, Carvalho M, Pérez-Garrido R, Gringeri A, European Haemophilia Therapy Standardization Board Pain management in patients with haemophilia: a European survey. Haemophilia. 2012 Sep;18(5):743–52. doi: 10.1111/j.1365-2516.2012.02808.x.
    1. Rodriguez-Merchan EC. Management of hemophilic arthropathy of the ankle. Cardiovasc Hematol Disord Drug Targets. 2017;17(2):111–118. doi: 10.2174/1871529X17666170908110758.
    1. Cuesta-Barriuso R, Gómez-Conesa A, López-Pina J. Effectiveness of two modalities of physiotherapy in the treatment of haemophilic arthropathy of the ankle: a randomized pilot study. Haemophilia. 2014 Jan;20(1):e71–8. doi: 10.1111/hae.12320.
    1. Mazloum V, Rahnama N, Khayambashi K. Effects of therapeutic exercise and hydrotherapy on pain severity and knee range of motion in patients with hemophilia: a randomized controlled trial. Int J Prev Med. 2014 Jan;5(1):83–8.
    1. Gomis M, González L, Querol F, Gallach JE, Toca-Herrera J. Effects of electrical stimulation on muscle trophism in patients with hemophilic arthropathy. Arch Phys Med Rehabil. 2009 Nov;90(11):1924–30. doi: 10.1016/j.apmr.2009.05.017.
    1. O’Connell JA. Bioelectric responsiveness of fascia: a model for understanding the effects of manipulation. Techniques in Orthopaedics. 2003;18(1):67–73. doi: 10.1097/00013611-200303000-00012.
    1. Tutusaus R, Potau JM. Sistema Fascial. Anatomía, valoración y tratamiento. Barcelona: Editorial Médica Panamericana SA; 2015.
    1. Donoso-Úbeda E, Meroño-Gallut J, López-Pina JA, Cuesta-Barriuso R. Safety and effectiveness of fascial therapy in adult patients with hemophilic arthropathy. A pilot study. Physiother Theory Pract. 2018 Oct;34(10):757–764. doi: 10.1080/09593985.2018.1425513.
    1. Donoso-Úbeda E, Meroño-Gallut J, López-Pina JA, Cuesta-Barriuso R. Safety of fascial therapy in adult patients with hemophilic arthropathy of ankle. A cohort study. Musculoskelet Sci Pract. 2018 Jun;35:90–94. doi: 10.1016/j.msksp.2018.03.003.
    1. Findlay T, Schleip R. Introduction. In: Findlay T, Schleip R, editors. Fascia Research: Basic Science and Implications for Conventional and Complementary Health Care. Munich: Elsevier; 2007. pp. 2–9.
    1. Bordoni B, Lintonbon D, Morabito B. Meaning of the solid and liquid fascia to reconsider the model of biotensegrity. Cureus. 2018 Jul 05;10(7):e2922. doi: 10.7759/cureus.2922.
    1. Castro-Sánchez AM, Matarán-Peñarrocha GA, Arroyo-Morales M, Saavedra-Hernández M, Fernández-Sola C, Moreno-Lorenzo C. Effects of myofascial release techniques on pain, physical function, and postural stability in patients with fibromyalgia: a randomized controlled trial. Clin Rehabil. 2011 Sep;25(9):800–13. doi: 10.1177/0269215511399476.
    1. Crane JD, Ogborn DI, Cupido C, Melov S, Hubbard A, Bourgeois JM, Tarnopolsky MA. Massage therapy attenuates inflammatory signaling after exercise-induced muscle damage. Sci Transl Med. 2012 Feb 01;4(119):119ra13. doi: 10.1126/scitranslmed.3002882.
    1. Paolini J. Review of myofascial release as an effective massage therapy technique. Athl Ther Today. 2009;14(5):30–34. doi: 10.1123/att.14.5.30.
    1. MacDonald GZ, Penney MDH, Mullaley ME, Cuconato AL, Drake CDJ, Behm DG, Button DC. An acute bout of self-myofascial release increases range of motion without a subsequent decrease in muscle activation or force. J Strength Cond Res. 2013 Mar;27(3):812–21. doi: 10.1519/JSC.0b013e31825c2bc1.
    1. Sullivan KM, Silvey DBJ, Button DC, Behm DG. Roller-massager application to the hamstrings increases sit-and-reach range of motion within five to ten seconds without performance impairments. Int J Sports Phys Ther. 2013 Jun;8(3):228–36.
    1. Cheatham SW, Kolber MJ, Cain M, Lee M. The effects of self-myofascial release using a foam roll or roller massager on joint range of motion, muscle recovery, and performance: a systematic review. Int J Sports Phys Ther. 2015 Nov;10(6):827–38.
    1. Škarabot J, Beardsley C, Štirn I. Comparing the effects of self-myofascial release with static stretching on ankle range-of-motion in adolescent athletes. Int J Sports Phys Ther. 2015 Apr;10(2):203–12.
    1. Kelly S, Beardsley C. Specific and cross-over effects of foam rolling on ankle dorsiflexion range of motion. Int J Sports Phys Ther. 2016 Aug;11(4):544–51.
    1. Cheatham SW, Kolber MJ. Does roller massage with a foam roll change pressure pain threshold of the ipsilateral lower extremity antagonist and contralateral muscle groups? an exploratory study. J Sport Rehabil. 2018 Mar 01;27(2):165–169. doi: 10.1123/jsr.2016-0196.
    1. Grabow L, Young JD, Alcock LR, Quigley PJ, Byrne JM, Granacher U, Škarabot J, Behm DG. Higher quadriceps roller massage forces do not amplify range-of-motion increases nor impair strength and jump performance. J Strength Cond Res. 2018 Nov;32(11):3059–3069. doi: 10.1519/JSC.0000000000001906.
    1. Okamoto T, Masuhara M, Ikuta K. Acute effects of self-myofascial release using a foam roller on arterial function. J Strength Cond Res. 2014 Jan;28(1):69–73. doi: 10.1519/JSC.0b013e31829480f5.
    1. Skou ST, Simonsen O, Rasmussen S. Examination of muscle strength and pressure pain thresholds in knee osteoarthritis: test-retest reliability and agreement. J Geriatr Phys Ther. 2015;38(3):141–7. doi: 10.1519/JPT.0000000000000028.
    1. Leffler A, Kosek E, Lerndal T, Nordmark B, Hansson P. Somatosensory perception and function of diffuse noxious inhibitory controls (DNIC) in patients suffering from rheumatoid arthritis. Eur J Pain. 2002;6(2):161–76. doi: 10.1053/eujp.2001.0313.
    1. Dhondt W, Willaeys T, Verbruggen LA, Oostendorp RA, Duquet W. Pain threshold in patients with rheumatoid arthritis and effect of manual oscillations. Scand J Rheumatol. 1999;28(2):88–93. doi: 10.1080/030097499442540.
    1. Pérez-Alenda S, Carrasco JJ, Megías-Vericat JE, Poveda JL, Bonanad S, Querol F. Quantification of physical activity in adult patients with haemophilic arthropathy in prophylaxis treatment using a fitness tracker. Haemophilia. 2018 Jan;24(1):e28–e32. doi: 10.1111/hae.13388.
    1. Fischer K, de Kleijn P. Using the Haemophilia Joint Health Score for assessment of teenagers and young adults: exploring reliability and validity. Haemophilia. 2013 Nov;19(6):944–50. doi: 10.1111/hae.12197.
    1. Balke B. A simple field test for the assessment of physical fitness. rep 63-6. Rep Civ Aeromed Res Inst US. 1963 Apr;:1–8.
    1. Douma-van Riet DCM, Engelbert RHH, van Genderen FR, Ter Horst-De Ronde MTM, de Goede-Bolder A, Hartman A. Physical fitness in children with haemophilia and the effect of overweight. Haemophilia. 2009 Mar;15(2):519–27. doi: 10.1111/j.1365-2516.2008.01928.x.
    1. Groen W, van der Net J, Lacatusu AM, Serban M, Helders PJM, Fischer K. Functional limitations in Romanian children with haemophilia: further testing of psychometric properties of the Paediatric Haemophilia Activities List. Haemophilia. 2013 May;19(3):e116–25. doi: 10.1111/hae.12090.
    1. Salim M, Brodin E, Spaals-Abrahamsson Y, Berntorp E, Zetterberg E. The effect of Nordic Walking on joint status, quality of life, physical ability, exercise capacity and pain in adult persons with haemophilia. Blood Coagul Fibrinolysis. 2016 Jun;27(4):467–72. doi: 10.1097/MBC.0000000000000554.
    1. Thornton J, Sabah S, Segaren N, Cullen N, Singh D, Goldberg A. Validated method for measuring functional range of motion in patients with ankle arthritis. Foot Ankle Int. 2016 Aug;37(8):868–73. doi: 10.1177/1071100716645391.
    1. van der Ploeg RJ, Fidler V, Oosterhuis HJ. Hand-held myometry: reference values. J Neurol Neurosurg Psychiatry. 1991 Mar;54(3):244–7. doi: 10.1136/jnnp.54.3.244.
    1. Perret C, Poiraudeau S, Fermanian J, Colau MM, Benhamou MA, Revel M. Validity, reliability, and responsiveness of the fingertip-to-floor test. Arch Phys Med Rehabil. 2001 Nov;82(11):1566–70. doi: 10.1053/apmr.2001.26064.

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