Nathalie Anne Roussel’s research while affiliated with University of Antwerp and other places

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Publications (12)


Figure 2 Example of the smartphone application screen.
Inclusion and exclusion criteria
Schedule of enrolment, interventions and assessments in accordance with the SPIRIT 2013 guidelines
Technology supported High Intensity Training in chronic non-specific low back pain (the Techno-HIT trial): study protocol of a randomised controlled trial
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October 2024

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63 Reads

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1 Citation

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Karin Coninx

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Chronic low back pain (CLBP) is one of the most common chronic musculoskeletal disorders worldwide. Guidelines recommend exercise therapy (ET) in CLBP management, but more research is needed to investigate specific ET modalities and their underlying mechanisms. The primary goal of this study is to evaluate the short-term and long-term effectiveness of a time-contingent individualised high-intensity training (HIT) protocol on disability compared with a time-contingent moderate-intensity training (MIT) as used in usual care, in persons with severely disabling CLBP. Additionally, the effectiveness on central effects, the added value of prolonged training at home and technology support, and the cost-effectiveness are evaluated. In this randomised controlled trial, CLBP patients will be randomly divided into three groups of 56 participants. Group 1, ‘TechnoHIT’, receives HIT with technology-support in the home-phase. Group 2, ‘HIT’, receives HIT without technology support. Group 3, ‘MIT’, receives MIT, reflecting training intensity as used in usual care. The primary outcome is patient-reported disability, measured by the Modified Oswestry Disability Index. Secondary outcomes include quantitative sensory testing, psychosocial factors, broad physical fitness, quality of life, cost-effectiveness, adherence and usability of technology. Trial registration number NCT06491121.

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Joint status, pain and quality of life in elderly people with haemophilia: A case‐control study

October 2023

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48 Reads

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3 Citations

Haemophilia

Introduction Elderly people with haemophilia (PwH) develop haemophilic arthropathy, pain, and reduced health‐related quality of life (HR‐QoL). The condition of elderly mild haemophilia patients have rarely been evaluated. This study aimed to compare joint status, pain, and HR‐QoL between elderly with mild, moderate/severe haemophilia and healthy elderlies. Methods Knee/ankle abnormalities were assessed by ultrasound (HEAD‐US) and physical examination (HJHS 2.1). Pain severity and pain interference were investigated using the Brief Pain Inventory. Pressure pain thresholds (PPTs) were obtained at knees/ankles and forehead. Functional limitations were evaluated using the 2‐Minute‐Walking‐Test, Timed‐Up‐and‐Go and HAL. The EQ‐5D‐5L questionnaire evaluated HR‐QoL. Healthy controls (HCs) and elderly individuals with moderate/severe and mild haemophilia were compared using Kruskal–Wallis and Mann–Whitney U tests. Results From the 46 elderly PwH approached, 40 individuals (≥60 years) with haemophilia A/B (17 moderate/severe; 23 mild) and 20 age‐matched HCs were recruited. Moderate/severe PwH displayed worse joint status, lower PPTs, and poorer HR‐QoL than mild PwH and HCs ( p ‐value = .010–<.001). HEAD‐US abnormalities were observed in 100% of knees and 94% of ankles in moderate/severe PwH, versus 50% of knees and 61% of ankles in mild PwH. Pain was reported by 80% and 57% of moderate/severe and mild PwH, respectively. Low PPTs, functional limitations, and poor HR‐QoL scores were likewise observed in some mild PwH, yet without significantly differing from HCs. Conclusion This study highlights poor joint/functional status, pain, and HR‐QoL outcomes in elderly with moderate/severe haemophilia. A few mild haemophilia subjects presented joint abnormalities, pain, functional limitations, and poor HR‐QoL, without significantly differing from HCs. Highlights Elderly individuals with mild haemophilia have not yet been extensively studied, whereas moderate/severe haemophilia individuals have proven to suffer from haemophilic arthropathy, pain, and poor health‐related quality of life (HR‐QoL). Using a case‐control design, joint status, pain, and HR‐QoL outcomes were examined in elderly haemophilia individuals and compared with those of healthy controls (HCs). Elderly moderate/severe haemophilia individuals exhibited worse joint status, increased joint pain sensitivity, and reduced HR‐QoL compared with both mild haemophilia subjects and HCs. A subset of mild haemophilia subjects exhibited poor joint status, pain, and HR‐QoL outcomes, without any differences noted when compared with HCs.


Prevalence and perceptions of pain in people with haemophilia: A UK study

September 2023

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35 Reads

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6 Citations

Haemophilia

Introduction: Joint bleeds in haemophilia cause destruction of articular structures, impaired function and pain. Up to 70% of people with haemophilia (PWH) report chronic pain. Little is known about the pain experiences in PWH in the UK. Aim: To identify prevalence and perceptions of pain among PWH living in the UK. Methods: A cross-sectional, non-interventional survey study conducted among PWH (all severities). The survey incorporated elements from validated tools (EQ-5D; EQ-VAS) and was distributed via participating treatment centres. Results: Five hundred and ninety-nine PWH responded, 91% aged > 18. 81% used factor prophylactically or on demand. More pain was reported by those treated on demand versus prophylaxis particularly in those who reported daily pain. 65% reported 'problem joints' based on individual impact rather than medically defined 'target joints', 2/3 reported multiple joint issues. The ankle was most commonly affected. 59% reported frequent pain, with 56% aware of pain constantly or most of the time and were more likely to report less favourable EQ-5D or EQ-VAS scores (p < .001). Pain frequency/awareness was consistent across all severities. Most discussed pain with care teams, 31% only when asked; 25% did not discuss it. Pain discussions resulted in physiotherapy referral (63%) analgesia prescription (48%), and a minority specialist pain referral (9%). Most felt well supported with regard to their pain, but 70% reported learning to live with it. Conclusion: Pain affects PWH of all ages and severities even in a well-resourced country significantly impacting quality of life. Clinicians must be more aware of chronic pain in PWH. Biopsychosocial approaches to pain assessment and management are recommended.


Clinical reasoning process on the application of the IASP clinical criteria and grading system for nociplastic pain in PwH.
Demographic, anthropometric and clinical characteristics of the participants.
Cont.
The Classification of Suspected Predominant Nociplastic Pain in People with Moderate and Severe Haemophilia: A Secondary Exploratory Study

September 2023

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56 Reads

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2 Citations

In people with haemophilia (PwH), joint pain is a major comorbidity that is often overlooked and under-treated. It is believed that, to ensure the most successful outcome, pain management should be tailored to the predominant pain phenotype (i.e., nociceptive, neuropathic and nociplastic). The 2021 clinical criteria and grading system for nociplastic pain, established by the International Association for the Study of Pain (IASP), emphasize the necessity of early-stage identification and predominant pain type classification. Consistent with findings in other chronic musculoskeletal pain conditions, studies suggest that a subgroup of PwH suffers from nociplastic pain, i.e., pain arising from altered nociception rather than structural damage, but this has not yet been explored in PwH. This study aimed to identify PwH with “unlikely”, “possible” and “probable” nociplastic pain and investigate differences in anthropometric, demographic and clinical characteristics and psychological factors between subgroups of PwH and healthy individuals.: The IASP clinical criteria and grading system were used to classify pain types in adult men with moderate or severe haemophilia recruited from two Belgian haemophilia treatment centres. Statistical analyses were applied to study between-subgroup differences. Of 94 PwH, 80 PwH (85%) were classified with “unlikely” and 14 (15%) with “at least possible” nociplastic pain (including 5 PwH (5%) with “possible” and 9 PwH (10%) with “probable” nociplastic pain). PwH in both the “unlikely” and “at least possible” nociplastic pain groups showed significantly higher levels of unhelpful psychological factors compared to healthy individuals. Additionally, age may partially account for the observed differences in body height and psychological factors. Larger sample sizes may be needed to detect more subtle between-group differences. study confirmed the presence of nociplastic pain in haemophilia, categorising a notable subgroup as individuals who experience at least possible nociplastic pain. These exploratory insights may provide a starting point for future studies and the development of more effective and tailored pain management.


Associations between psychological factors, pressure pain thresholds and conditioned pain modulation and disability in (sub)-acute low back pain: a three-month follow-up study

February 2023

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92 Reads

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4 Citations

The Journal of manual & manipulative therapy

Background: The clinical presentation and pain experience of patients with (sub)-acute low back pain ((S)ALBP) can strongly vary in clinical practice. However, despite growing evidence that psychological factors are associated with disability in chronic pain conditions including low back pain, studies examining the influence of psychological factors, quantitative sensory testing (QST) (i.e. pressure pain thresholds (PPTs)) and conditioned pain modulation (CPM) on future disability are still lacking in (S)ALBP. Objective: This prospective cohort study aims to determine associations between baseline psychological factors, PPTs and CPM in (S)ALBP and disability after 3 months. Methods: Fifty-two patients with (S)ALBP underwent a baseline PPT evaluation in rest and during a CPM protocol. Patients were asked to fill in self-report questionnaires: the Visual Analogue Scale (VAS), the Quebec Back Pain Disability Scale (QBPDS), the Pain Catastrophizing Scale (PCS), the Tampa Scale for Kinesiophobia (TSK) and the Illness Perception Questionnaire - Brief version (IPQ-B). At 3-month follow-up, participants were asked to fill in the QBPDS again. Multiple linear regression analysis was conducted to determine associations between baseline factors and disability at follow-up. Results: Thirty-eight patients participated at follow-up. Because of the multicollinearity issue, the TSK score was selected for analyses and the PCS and IPQ-B score were excluded from the model. No significant associations between baseline factors and disability at follow-up were found. Conclusion: Neither baseline psychological factors nor PPTs or CPM in (S)ALBP were significantly associated with disability after 3 months. Our multiple linear regression analysis was likely underpowered to detect significant associations.


Discordance between joint pain and imagery severity in the ankle joint and contributors of lower limb activity limitations in adults with haemophilia: A cross-sectional study

January 2023

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38 Reads

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5 Citations

Haemophilia

Introduction: People with haemophilia (PwH) suffer from knee and ankle joint pain, but the association with structural damage remains underexplored. They report activity limitations but it is unclear which factors contribute to lower limb activity limitations (LL-AL). Aims: This study aimed (i) to analyse the association between ankle joint pain and structure and (ii) explore the contribution of haemophilia-related, individual and psychological factors to LL-AL in PwH. Methods: This study included 104 moderate/severe PwH. Ankle pain intensity was assessed with a numeric rating scale and pain sensitivity with algometry (pressure pain threshold (PPTA )). Ankle structure was assessed with MRI (IPSG-MRI) and ultrasound (HEAD-US), joint health with the Haemophilia Joint Health Score (HJHS). The HAL-LOWCOM subscore evaluated LL-AL. A Spearman correlation analysed the correlation between ankle pain and structure. The contribution of haemophilia-related factors (joint health, overall pain (Brief Pain Inventory-Pain Severity (BPI-PS)), functional status (2-Minute-Walking-Distance, Timed Up and Go); individual factors (age, BMI) and psychological factors (fear and avoidance beliefs over physical activity (FABQ-PA) and work (FABQ-Work), anxiety and depression) to LL-AL was explored using a regression analysis. Results: Only low correlations were found between ankle pain intensity and structure (IPSG-MRI, HEAD-US). PPTA was unrelated to structure. Altogether, HJHS, overall pain (BPI-PS), FABQ-Work and age explained 69% of HAL-LOWCOM variance, with 65% explained by the combination of HJHS and BPI-PS. Conclusion: No meaningful associations were found between ankle pain and structural damage, suggesting that other factors may contribute to PwH's ankle pain. In contrast, mainly haemophilia-related factors explained LL-AL variance.


Pain interferes with daily activities, emotions and sleep in adults with severe, moderate and mild haemophilia: A national cross‐sectional survey

January 2023

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49 Reads

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7 Citations

Haemophilia

Introduction: Pain is a major issue in people with haemophilia (PwH). Few studies comprehensively assessed pain in PwH using a biopsychosocial framework and studies in mild PwH are lacking. Aim: To assess pain prevalence, pain interference and their relationship with health-related quality of life (HR-QoL) in male adults with haemophilia. Methods: A survey was initiated by the Belgian national member organisation. Pain in the last 24 h, pain severity (BPI-PS) and pain interference (BPI-PI) scores were obtained with the Brief Pain Inventory short-form (BPI). HR-QoL was evaluated with the EQ-5D-3L, giving the health utility index (EQ-HUI). Associations between EQ-HUI, BPI-PS and BPI-PI were analysed using Pearson's correlation test. A multiple regression analysed the relationship between HR-QoL and BPI-PS, with age and haemophilia severity as confounding factors. Results: Within 185 respondents (97, 31 and 57 respectively severe, moderate and mild PwH), 67% (118/177) reported pain. In severe, moderate and mild PwH, respectively 86% (79/92), 71% (22/31) and 32% (17/54) reported pain. Median [IQR] BPI-PS, BPI-PI and EQ-HUI scores were respectively 1.5 [.0; 4.0], 1.6 [.0; 3.6] and .81 [.69; 1.00]. PwH reported pain interference with general activity (56% (99/176)), psychosocial factors such as mood (53% (93/175)), and sleep (51% (90/177)). Moderate correlations were found between EQ-HUI, BPI-PS and BPI-PI. After adjusting for age and haemophilia severity, BPI-PS explained 14% of HR-QoL variance. Conclusions: Pain is a major issue amongst PwH, including people with mild haemophilia. Pain interferes with activities, emotions, sleep and HR-QoL, arguing for a comprehensive biopsychosocial approach of pain.


Improved quality of physiotherapy care in patients with Whiplash-Associated Disorders: results based on 16 years of routinely collected data. Frontiers in Pain Research 2022;3.929385

August 2022

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119 Reads

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1 Citation

Frontiers in Pain Research

Quality improvement is now a central tenet in physiotherapy care, and quality indicators (QIs), as measurable elements of care, have been applied to analyze and evaluate the quality of physiotherapy care over the past two decades. QIs, based on Donabedian’s model of quality of care, provide a foundation for measuring (improvements in) quality of physiotherapy care, providing insight into the many remaining evidentiary gaps concerning diagnostics, prognostics and treatment, as well as patient-related outcome measures. In this overview we provide a synthesis of four recently published articles from our project group on the topic of quantitative measures of quality improvement in physiotherapy care, in this context specifically focused on patients with WAD in primary care physiotherapy. A set of process and outcome QIs (n=28) was developed for patients with WAD and linked to a database consisting of routinely collected data (RCD) on patients with WAD collected over a 16-year period. The QIs were then embedded per step of the clinical reasoning process: (a) administration (n=2); (b) history taking (n=7); (c) objectives of examination (n=1); (d) clinical examination (n=5); (e) analysis and conclusion (n=1); (f) treatment plan (n=3); (g) treatment (n=2); (h) evaluation (n=5); and (i) discharge (n=2). QIs were expressed as percentages, allowing target performance levels to be defined ≥70% or ≤30%, depending on whether the desired performance required an initially high or low QI score. Using RCD data on primary care patients with WAD (N=810) and a set of QIs, we found that the quality of physiotherapy care has improved substantially over a 16-year period. This conclusion was based on QIs meeting predetermined performance targets of ≥70% or ≤30%. Twenty-three indicators met the target criterium of ≥70% and three indicators ≤30%. Our recommended set of QIs, embedded in a clinical reasoning process for patients with WAD, can now be used as a basis for the development of a validated QI set that effectively measures quality (improvement) of primary care physiotherapy in patients with WAD.


Prevalence of pain in adult patients with moderate to severe haemophilia: a systematic review

March 2022

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68 Reads

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7 Citations

Objectives: Patients with haemophilia (PwH) often suffer from joint pain due to repetitive haemarthroses and resulting arthropathy. Literature focuses so far on pain causes, diagnosis or treatment. A summary of prevalence rates, providing facts on the absolute occurrence of pain, is not sufficiently described so far. This review aimed to explore and systematically review different pain conditions, focussing on prevalence rates of pain in adult PwH. Methods: A review of English articles using PubMed and Web of Science was conducted in February 2020. The search strategy included patients with haemophilia A or B suffering from pain. The articles were selected based on defined PICOS-selection criteria. Results: Out of 606 identified articles, 13 studies matched the given eligibility criteria and indicated pain prevalence rates. The weighted mean (WM) for the prevalence rate (varying timeframes) for chronic pain was 40% whereas for point prevalence the rate was WM=75%. Regarding pain intensity, findings of the EQ-5D-3L revealed moderate pain to be more present (61.0%) compared to extreme (11.6%). The main problem was the inconsistency of the definition of both acute and chronic pain as well as for prevalence types. Conclusions: Pain is a major problem in patients with haemophilia. Pain therapy should be carried out taking into account the difference between bleeding-related or arthropathy-related causes of pain. In addition, the intensity and duration of pain should be recorded consistently to better monitor therapy and allow comparison with existing data.


Gaining more insight into ankle pain in haemophilia: A study exploring pain, structural and functional evaluation of the ankle joint

March 2022

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71 Reads

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14 Citations

Haemophilia

Introduction: Ankle arthropathy is highly prevalent among people with haemophilia (PwH), even with prophylaxis, and leads to pain and disability. Mechanisms and consequences of painful symptoms related to ankle arthropathy have not been extensively studied. Methods: A consecutive sample of 30 adult PwH was included (60 ankles). Ankle structure was assessed with magnetic resonance imaging (IPSG-MRI) and ultrasound (HEAD-US). The HJHS 2.1 assessed function of ankles and knees. Physical functioning was assessed with the Timed Up and Go test, the 2-Minute Walking Test and activity limitations with the HAL questionnaire. Health-related quality of life was evaluated using the EQ-5D-5L questionnaire. Overall pain severity was examined using the Brief Pain Inventory questionnaire and ankle pain intensity with a visual analogue scale. Pressure pain thresholds with an algometer assessed pain sensitivity. Spearman correlations were used to calculate interrelations between joint structure, function and pain. Results: Twenty-five PwH (83%) reported ≥1 painful joint, with 67% reporting the ankle as most painful joint. MRI-confirmed abnormalities were seen in 76% of talocrural and 55% of subtalar joints. HEAD-US abnormalities were seen in 93% of the ankles. A large variation was seen in pain sensitivity at the ankle. While moderate to high correlations were observed between ankle structure and HJHS, no meaningful correlations were found between MRI-scores and pain intensity or sensitivity. Conclusions: Structural joint damage is present in many ankles but is not related to pain in PwH. Further studies should consider somatosensory nervous system dysfunction in PwH as contributing factor to painful ankle arthropathy.


Citations (10)


... Third, the relatively limited sample size represents an additional weakness, as it reduces the statistical power and validity of the results. However, despite these limitations, this pilot clinical trial serves as a valuable stepping stone toward a larger randomized clinical controlled trial, which aims to provide more robust evidence regarding the effectiveness of the intervention [53]. ...

Reference:

High-Intensity Training Telerehabilitation for Persons with Chronic Low Back Pain: A Pilot Clinical Trial
Technology supported High Intensity Training in chronic non-specific low back pain (the Techno-HIT trial): study protocol of a randomised controlled trial

... Treatment decision making is mainly guided by clinical characteristics like the bleeding frequency, presence of inhibitors, problems with venous access, etc., as well as economic considerations. Ideally, vulnerability to develop haemophilic arthropathy (HA) should also be taken into account, as joint damage is heterogenic even in patients with a similar bleeding pattern [3], and the subsequent limitations severely impact quality of life [4]. However, at present, we are unable to predict who will develop a rapidly progressive arthropathy. ...

Joint status, pain and quality of life in elderly people with haemophilia: A case‐control study
  • Citing Article
  • October 2023

Haemophilia

... In the US, the prevalence of haemophilia A at birth has been reported to be 17.9 per 100,000 among males, whereas it has been reported to be 19.1 and 24.6 per 100,000 in Canada and the UK, respectively [3,4]. People living with haemophilia experience frequent episodes of bleeding, particularly in joints and muscles, causing destruction of articular structures, impaired function and pain [1,5,6]. Additionally, haemophilia impacts life expectancy and can result in comorbidities such as cardiovascular and metabolic disease, renal disease, and cancer [1,3]. ...

Prevalence and perceptions of pain in people with haemophilia: A UK study
  • Citing Article
  • September 2023

Haemophilia

... (30,53) and Foubert et al. (54). to assess and interpret this step by using the individual A C C E P T E D questions of the central sensitization index (CSI) part A. This questionnaire, in which every item is scored from zero (never) to four (always), is found to be reliable (55). ...

The Classification of Suspected Predominant Nociplastic Pain in People with Moderate and Severe Haemophilia: A Secondary Exploratory Study

... Our findings are consistent with previous studies, further validating the association between ACEs and body pain. Previous research by Foubert's and Kerker's teams have indicated that ACEs significantly increase the risk of mental health disorders, such as depression and anxiety [23,24]. Individuals experiencing these disorders often perceive pain as more intense due to heightened attention to pain sensation [25]. ...

Associations between psychological factors, pressure pain thresholds and conditioned pain modulation and disability in (sub)-acute low back pain: a three-month follow-up study
  • Citing Article
  • February 2023

The Journal of manual & manipulative therapy

... Expectedly, pain would correlate with both function and HR-QoL and, to a lesser extent, joint status, as previously reported in adult PwH. 9 ...

Discordance between joint pain and imagery severity in the ankle joint and contributors of lower limb activity limitations in adults with haemophilia: A cross-sectional study
  • Citing Article
  • January 2023

Haemophilia

... Faced with this clinical situation, which goes beyond the tissue damage itself, a truly biopsychosocial approach is necessary for the approach to these patients. 10 Occupational therapy is defined as the therapeutic use of activities A recent review has shown the absence of evidence of the efficacy of occupational therapy in the management of patients with haemophilia, providing lines of work for its implementation in the improvement of activities of daily living and the multidisciplinary treatment of these patients. 12 The aim was to identify the best predictive model for performing ...

Pain interferes with daily activities, emotions and sleep in adults with severe, moderate and mild haemophilia: A national cross‐sectional survey
  • Citing Article
  • January 2023

Haemophilia

... Patients with haemophilia (PwH) often suffer from chronic pain due to arthropathic changes known as haemophilic arthropathy (HA) that manifest as a result of recurrent bleeding episodes. [1][2][3] The ankle represents the most prevalent joint to show signs of manifest HA and the most common source of joint-related pain. 4,5 HA can be defined as a joint pathology that entails an inflammatory as well as a degenerative component. ...

Prevalence of pain in adult patients with moderate to severe haemophilia: a systematic review
  • Citing Article
  • March 2022

... This is because the relation between the presence of hemosiderin and the chronicity of joint bleeds has not been fully explored [10,17,28,29]. We focused on ankle joints as these are the most common location of bleeding episodes and of subclinical bleeds in young PWH; moreover, the involvement of the ankle joint affects significantly gait and posture [30,31]. ...

Gaining more insight into ankle pain in haemophilia: A study exploring pain, structural and functional evaluation of the ankle joint
  • Citing Article
  • March 2022

Haemophilia

... pain levels or kinesiophobia. Notably, those participants who demonstrated improvements also resumed physical activity following PRP injection, potentially contributing to their positive outcomes (29). Emphasizing the significance of integrating tailored, progressive rehabilitation or fitness programs alongside PRP injection to potentially enhance outcomes warrants consideration. ...

High Intensity Training Is an Effective Modality to Improve Long-Term Disability and Exercise Capacity in Chronic Nonspecific Low Back Pain: A Randomized Controlled Trial