Benefits of physical activity self-monitoring in patients with haemophilia: a prospective study with one-year follow-up.

INTRODUCTION: Activity wristbands have been shown to be effective in relation to self-monitoring activity levels and increasing exercise adherence. However, previous reports have been based on short-term follow-ups in people with haemophilia (PWH). AIM: (1) To evaluate compliance with physical activity (PA) recommendations in PWH during a 1-year follow-up period using activity wristbands to record daily steps and intensity; (2) To determine the effect of PA self-monitoring on clinical outcomes. METHODS: A prospective observational study was conducted in 27 adults with severe haemophilia undergoing prophylactic treatment. The Fitbit Charge HR was used to track daily PA for an entire year. The participants were encouraged to try to reach a goal of 10,000 steps/day and to track their progress. The pre- and post-evaluation included quality of life (A36 Hemophilia-QoL Questionnaire), joint health (Haemophilia Joint Health Score), functionality (Timed Up and Go test), and muscle strength. RESULTS: A total of 323.63 (95%CI: 194-364) valid days (i.e., > 2000 steps) were recorded. The annual average number of steps per day taken by participants was 10,379. Sixteen (59%) PWH reached 10,000 steps/day at baseline and 17 (63%) at 1 year follow-up, with no significant differences (x2 = .33; p = .56). A statistically significant improvement was observed in daily moderate activity time (p = .012) and in the 'physical health' quality of life subscale (mean difference: 2.15 points; 95%CI: .64-3.65; p = .007). CONCLUSION: Our results suggest that patients with severe haemophilia who self-managed their PA can improve their long-term quality of life in the domain of physical health and also the daily time spent in moderate-intensity PA.

Psychological Health Among Older Adults During and After Quarantine: A Multi-Method Study.

OBJECTIVE: Depression among older adults is a growing problem. With aging being a risk factor for COVID-19 infection, depression in this population may have been exacerbated. This study aimed to describe experiences and changes in depressive symptoms and well-being of older adults during and after the COVID-19 first wave in Spain. METHODS: The study used a multi-method design. Participants self-reported depressive symptoms (Geriatric Depression Scale) and well-being (Cantril Ladder of Life). Participants were asked about changes in depressive symptoms or well-being during quarantine. If a change was perceived, they were asked to describe the change. In addition, the Patient Global Impression of Change scale was used. Both quantitative and qualitative analyses were performed on the data. RESULTS: 111 participants (mean age: 71±5 years; 76% women) completed the study. Sixty-three percent reported mild and 2% reported major depressive symptoms. Nearly half (47.7%) reported changes in depressive symptoms during the lockdown. While 37% reported feeling better during the lockdown, about 11% reported depressive symptoms were worse now compared with during the lockdown. 60% reported worsening well-being during the quarantining period. The qualitative analysis revealed 2 main themes: (1) psychological discomfort (mood deflection, fear/worries, and boredom/inactivity) and (2) social issues (inability to go out, missing family members and others). CONCLUSIONS: Worsening depressive symptoms and lowering of well-being were noticed in this sample of older adults during and post-COVID lockdowns. Evaluation of mental health in the primary care setting and providing referrals for mental health services is essential for older adults who experienced COVID-19-related lockdowns.

Patient, clinician, and performance-based measures provide different information about clinical symptoms in patients with severe knee osteoarthritis presenting with depressive symptoms: a cross-sectional study.

BACKGROUND AND PURPOSE: Clinical status of subjects with knee osteoarthritis (KOA) is influenced by a complex interaction of several biopsychosocial factors. The use of patient-reported measures (PROM) is considered the gold standard for their evaluation. However, considering that 1 in 5 subjects with KOA present with depressive symptoms, it is necessary to analyse how this psychological domain may influence the subjective perception of PROM. The objective was to study the impact that depressive symptoms have on functional outcome assessments, according to the degree of objectivity of diverse outcome measures. METHODS: Cross-sectional study. Subjects with severe KOA, verified with clinical and radiological symptoms, were assessed with patient-reported (Oxford Knee Score), clinician-reported (knee range of motion), and performance-based (Timed up and go test) measures. The existence of depressive symptoms was assessed with the Yesavage scale, and participants were classified for having no-, mild- or severe-symptoms. Linear correlations (r) and one-way analysis of variance compared groups (95% CI). RESULTS: 244 participants were analysed, of which 75 (30.7%) had depressive symptoms. These symptoms had an inverse moderate association with Oxford Knee Score (r = -0.387). However, the correlation with the Timed up and go test was low (r = 0.176), while there was no correlation with knee ROM (r = -0.087). CONCLUSIONS: This study supports that patient-reported questionnaires may offer biased information on the clinical status of patients with severe knee osteoarthritis who present with depressive symptoms. Consideration of such symptoms may be critical to ensure data collected to accurately reflect patients' capacities and perceptions.

Physical Therapists' Ethical and Moral Sensitivity: A STROBE-Compliant Cross-Sectional Study with a Special Focus on Gender Differences.

(1) Background: Healthcare professionals´ clinical practice, their care of patients and the clinical decision-making process may be influenced by ethical and moral sensitivity. However, such outcomes have been scarcely studied in physical therapists. This study aimed to explore ethical sensitivity and moral sensitivity in practicing physical therapists, and to compare both variables by gender. (2) Methods: Cross-sectional study. 75 physical therapists (58.7% women; average age = 34.56 (8.68) years) were asked to fill in questionnaires measuring ethical sensitivity (Ethical Sensitivity Scale Questionnaire) and moral sensitivity (Revised-Moral Sensitivity Questionnaire). (3) Results: The sample showed high ethical sensitivity (116.14 ± 15.87 over 140) and high moral sensitivity (40.58 ± 5.36 over 54). When comparing by gender, women reported significantly higher ethical sensitivity than men (p = 0.043), as well as higher scores in the following dimensions: Caring by connecting with others (p = 0.012) and Working with interpersonal and group differences (p = 0.028). However, no differences were found in moral sensitivity (p = 0.243). (4) Conclusion: Physical therapists showed high levels of ethical and moral sensitivity, whilst women reported higher ethical sensitivity than men. Understanding physical therapists´ ethical and moral sensitivity is essential to design and implement integrated education programs directed to improve the quality of care of patients in their daily clinical practice.

Effectiveness of physical exercise on postural balance in patients with haemophilia: A systematic review.

INTRODUCTION: Balance training is important to improve balance and to decrease the risk of falls in patients with haemophilia (PWH). AIM: To analyse the current knowledge about the effectiveness of physical exercise on postural balance in PWH. METHODS: A systematic search for clinical trials, published before November 2021, was conducted using the following electronic databases: PubMed/MEDLINE, Web of Science, Embase, Wiley Online Library and the Cochrane Central Register of Controlled Trials (CENTRAL). Two independent reviewers extracted the data and assessed the risk of bias. The certainty of the evidence was analyzed using GRADE. RESULTS: A total of ten studies involving 304 patients were included. The studies performed strength and balance exercises, and some included flexibility, mobilization, and/or aerobic exercises in their training programs. Postural balance was evaluated using a force platform and the one leg stand test was the most frequently used. Only five exercise programs achieved a significant increase in balance (pre-post) with a strength, postural balance, flexibility, and aerobic intervention. In general, the quality rate of the risk of bias was fair but the overall quality of the evidence across the studies was very low. CONCLUSION: Five studies showed that there is a positive change in balance after the intervention. However, there is currently an unclear demonstration of evidence for the use of physical exercises to improve postural balance in people with haemophilia. Further studies with a higher methodological quality are needed.

High-Intensity Interval and Resistance Training Improve Health Outcomes in Older Adults With Coronary Disease.

OBJECTIVE: Both high-intensity interval training (HIIT) and resistance exercises (R) are used in cardiac rehabilitation in patients with coronary artery disease (CAD). However, the combined effect of an HIIT + R exercise program in older adults with CAD is not well investigated. The study's purpose was to assess the changes in anthropometric parameters, physical activity, functional capacity, physiological parameters, and quality of life (QoL) in this population following a combined HIIT + R program. DESIGN: The study was a 2-group (n = 45 each) randomized controlled single-blinded trial. SETTING AND PARTICIPANTS: The study was done at a treatment clinic of a tertiary hospital. The mean age of participants was 69.23 ± 4.9 years. The HIIT + R group performed 8 sessions (1/wk) of HIIT + R training. The 30 minutes of the active exercise phase consisted of ten 3-minute bouts. Each bout comprised of 1 minute of high-intensity treadmill walking at 85% to 90% maximum heart rate (MHR), followed by a low-intensity walking at 60%-70% MHR, followed by low-to moderate-intensity resistance training. The Usual Care group underwent conventional medical treatment. MEASURES: Anthropometric measurements [weight, body mass index (BMI), waist circumference, body fat percentage, lean body mass], physical activity (International Physical Activity Questionnaire), functional capacity (Incremental Shuttle Walking Test), physiologic measurements (blood pressure, heart rate), and QoL (36-Item Short Form Health Survey) were measured pre- and postintervention. RESULTS: Significant group and time interaction were found for the participants in the HIIT + R Group for BMI (P = .001), body fat percentage (P = .001), waist circumference (P < .001), physical activity (P < .001), functional capacity (P < .001), and QoL (P = .001) compared with the UC Group. Significant improvement in systolic blood pressure (P = .001) was seen in the HIIT + R group. CONCLUSIONS AND IMPLICATIONS: A combined HIIT + R training protocol in older adults with CAD can be useful in producing desired health outcomes. Further evaluation of longer duration exercise programs with more frequent dosing needs to be evaluated for their benefits and sustainability.

Physiotherapy Students' Experiences about Ethical Situations Encountered in Clinical Practices.

(1) Background: It is important to explore the ethical situations that physiotherapy students encountered in their clinical practices. (2) Methods: Qualitative, explorative, descriptive study. The participants included third-year physiotherapy students. They had to write five narratives about ethical situations encountered in their clinical practices. Krippendorff's method for qualitative content analysis was used to cluster units within the data to identify emergent themes. The study protocol was approved by the authors' University Ethic Committee of Human Research (H1515588244257). (3) Result: 280 narratives were reported by 64 students (23.34 ± 4.20 years, 59% women). Eight categories were identified from the qualitative analysis of the data: (a) professional responsibility, (b) professional competence, (c), beneficence, (d) equality and justice, (e) autonomy, (f) confidentiality, (g) respect for privacy, and (h) sincerity. All participants were informed and provided written informed consent. (4) Conclusions: Ethical principles were frequently violated in physiotherapy. Experiences of physiotherapy students must be examined to tailor educational interventions prior to their initiation into practice. Ethics education is needed in workplaces and should be increased in basic education. Facilitating the ethical awareness of future physiotherapists is a challenge for university teachers who provide ethical competence training.

Safety, Fear and Neuromuscular Responses after a Resisted Knee Extension Performed to Failure in Patients with Severe Haemophilia.

BACKGROUND: low-moderate intensity strength training to failure increases strength and muscle hypertrophy in healthy people. However, no study assessed the safety and neuromuscular response of training to failure in people with severe haemophilia (PWH). The purpose of the study was to analyse neuromuscular responses, fear of movement, and possible adverse effects in PWH, after knee extensions to failure. METHODS: twelve severe PWH in prophylactic treatment performed knee extensions until failure at an intensity of five on the Borg CR10 scale. Normalised values of amplitude (nRMS) and neuromuscular fatigue were determined using surface electromyography for the rectus femoris, vastus medialis, and vastus lateralis. After the exercise, participants were asked about their perceived change in fear of movement, and to report any possible adverse effects. RESULTS: Patients reported no adverse effects or increased fear. The nRMS was maximal for all the muscles before failure, the median frequency decreased, and wavelet index increased during the repetitions. The vastus lateralis demonstrated a higher maximum nRMS threshold and earlier fatigue, albeit with a lower and more progressive overall fatigue. CONCLUSIONS: severe PWH with adequate prophylactic treatment can perform knee extensions to task failure using a moderate intensity, without increasing fear of movement, or adverse effects.

Clinical benefits of a Bayesian model for plasma-derived factor VIII/VWF after one year of pharmacokinetic-guided prophylaxis in severe/moderate hemophilia A patients.

INTRODUCTION: Individual pharmacokinetic (PK) profiling in hemophilia A (HA) helps to individualize prophylaxis using population PK models (popPK). A specific popPK model for plasma-derived factor VIII containing von-Willebrand Factor (pdFVIII/VWF) was developed. AIM: To compare standard versus PK-driven prophylaxis, using a generic or a specific popPK model for pdFVIII/VWF. MATERIALS AND METHODS: A prospective study conducted in HA patients in prophylaxis with pdFVIII/VWF (Fanhdi®) comparing three one-year study periods: (1) standard prophylaxis, (2) PK-guided prophylaxis using a generic pdFVIII popPK model which described FVIII activity irrespective of FVIII concentrate, and (3) PK-guided prophylaxis with specific pdFVIII/VWF popPK model. PK parameters analyzed were half-life, trough levels (TL) at 24, 48 and 72 h, and time to reach FVIII levels of 1, 2, 5% (T5%). Clinical outcomes were dose/kg, FVIII consumption, annualized bleeding rate (ABR), annualized joint bleeding rate (AJBR), spontaneous and traumatic bleeds. RESULTS: Of the 30 analyzed patients, 28 had severe HA and the median age was 31.2. Fifteen patient's prophylaxis doses were PK-adjusted. After the generic PK-guided prophylaxis period, younger patients showed more joint bleeds, a shorter half-life, and lower TL48, TL72 and T5%. Using the specific pdFVIII/VWF popPK model compared with standard prophylaxis, a lower spontaneous AJBR was observed in the entire cohort and in patients aged >15 years. Additionally, lower spontaneous ABR was reported in patients aged ≤15 years comparing specific and generic models. CONCLUSIONS: PK-guided prophylaxis with a specific pdFVIII/VWF popPK model allowed treatment individualization and improved bleeding control in routine clinical practice, especially in younger patients with short pdFVIII/VWF half-lives.

EMG, Rate of Perceived Exertion, Pain, Tolerability and Possible Adverse Effects of a Knee Extensor Exercise with Progressive Elastic Resistance in Patients with Severe Haemophilia.

In people with haemophilia (PWH), elastic band training is considered an optimal option, even though the literature is scarce. The aim was to evaluate normalized electromyographic amplitude (nEMG), rate of perceived exertion (RPE), pain, tolerability, and possible adverse effects during the knee extension exercise using multiple elastic resistance intensities in PWH. During a single session, 14 severe PWH undergoing prophylactic treatment performed knee extensions without resistance and with different intensity levels of elastic resistance. nEMG was measured for the knee extensors and participants rated their RPE, tolerability and pain intensity after each condition. Patients had to report the possible adverse effects after the session. In most of the cases, an nEMG increase is only evidenced after increasing the resistance by two to three levels. Significant associations were found between RPE and the nEMG (ρ = 0.61), as well as between the elastic resistance level and nEMG (ρ = 0.69) and RPE (ρ = 0.71). All conditions were generally tolerated, without increased pain, and no adverse effects were reported. A wide variety of elastic resistance intensities during the knee extension are safe, tolerated, and do not increase knee pain in the majority of severe PWH undergoing prophylactic treatment.