A clinical practice guideline for primary care physiotherapy in patients with haemophilia.

INTRODUCTION: As a result of centralisation of haemophilia care to a limited number of intramural settings, many persons with haemophilia have to travel long distances to attend their haemophilia specialised treatment centre. However, regular physiotherapy treatment can be provided by primary care physiotherapists in the person's own region. Due to the rarity of the disease most primary care physiotherapists have limited experience with this population. This study aims to provide a clinical practice guideline for primary care physiotherapists working with persons with bleeding disorders. METHOD: A list of the most urgent key-questions was derived from a previous study. Literature was summarised using the grading of recommendations assessment, development, and evaluation (GRADE) evidence-to-decision framework. Recommendations were drafted based on four 90 min consensus meetings with expert physiotherapists. Recommendations were finalised after feedback and >80% consensus of all stakeholders (including PWH, physiotherapists, haematologists and the corresponding societies). RESULTS: A list of 82 recommendations was formulated to support primary care physiotherapists when treating a person with a bleeding disorder. These recommendations could be divided into 13 categories: two including recommendations on organisation of care, six on therapy for adult patients with bleeding disorders and five on therapy adaptations for paediatric care. Therapy recommendations included treatment after a joint- or muscle bleed, haemophilic arthropathy, chronic synovitis, non-haemophilia related conditions and orthopaedic surgery. CONCLUSION: An evidence-based practice guideline, based on current evidence from literature and clinical expertise, has been developed for primary care physiotherapists treating a person with haemophilia. To improve care, the recommendations should be implemented in daily practice.

Extended Reference Values for the Muscle Power Sprint Test in 6- to 18-Year-Old Children.

PURPOSE: The first aim was to extend the reference values and curves of the Muscle Power Sprint Test (MPST) in children with typical development. The second aim was to examine test/retest and intertester reliability of the MPST. METHODS: A total of 683 children aged 6 to 18 years (mean = 11.9 ± 3.8 years) were tested on the MPST. Test/retest reliability was examined in 71 children and intertester reliability in 77 children. MPST scores were merged with existing values and transformed into height-related normative reference curves. RESULTS: Sex-specific MPST curves were generated for children aged 6 to 18 years. Test/retest reliability was good (intraclass correlation coefficient = 0.90) and intertester reliability was excellent (intraclass correlation coefficient = 0.97). CONCLUSIONS: New and more complete MPST normative reference values and curves for children from 6 to 18 years old are now available. The MPST is easy and reliably performed by clinicians.

Anaerobic performance in children with cerebral palsy compared to children with typical development.

PURPOSE: Using a locomotor-based field test of anaerobic performance, this study compared the anaerobic performance of children with spastic cerebral palsy (CP) who walk without support with that of peers who are typically developing. METHODS: The Muscle Power Sprint Test was performed by 159 children with CP (102 boys, mean age 9.7 ± 1.5 years; and 57 girls, mean age 9.5 ± 1.6 years) classified at Gross Motor Function Classification System level I (n = 115) or level II (n = 44) and 376 children with typical development (175 boys, mean age 8.9 ± 1.8 years; and 201 girls, mean age 9.0 ± 1.7 years). RESULTS: The anaerobic performance of the children with CP was lower than that of peers with typical development. CONCLUSIONS: The difference between the 2 groups increased with height, especially for the children with CP classified at Gross Motor Function Classification System level II. Children with CP appear to have impaired anaerobic performance.

Reference values for the muscle power sprint test in 6- to 12-year-old children.

PURPOSE: The aims of this study were (1) to develop centile reference values for anaerobic performance of Dutch children tested using the Muscle Power Sprint Test (MPST) and (2) to examine the test-retest reliability of the MPST. METHODS: Children who were developing typically (178 boys and 201 girls) and aged 6 to 12 years (mean = 8.9 years) were recruited. The MPST was administered to 379 children, and test-retest reliability was examined in 47 children. MPST scores were transformed into centile curves, which were created using generalized additive models for location, scale, and shape. RESULTS: Height-related reference curves were created for both genders. Excellent (intraclass correlation coefficient = 0.98) test-retest reliability was demonstrated. CONCLUSIONS: The reference values for the MPST of children who are developing typically and aged 6 to 12 years can serve as a clinical standard in pediatric physical therapy practice. The MPST is a reliable and practical method for determining anaerobic performance in children.