Objective:
To investigate the effect of modified pull-up exercises on elbow range of motion (ROM) and function for people with arthropathy secondary to hemophilia and recurrent bleeding
Methods:
- A) Participants: Men above age 18 years with hemophilia, and greater than 5 degrees ROM loss due to arthropathy from recurrent joint bleeding
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B) Design and procedure: This pilot study was a prospective case series. Subjects were asked to perform a home exercise program consisting of modified pull ups three times per week for 8 weeks. Data was collected prior to start of program, at 3-5 weeks and at 8-10 weeks. Outcome measures included elbow ROM, pain, upper arm girth and activities of daily living (ADL) related reaching tasks. Information on how often the exercises were being performed, as well as episodes of bleeding was collected each week.
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C) Analyses: A paired t-test was used to compare pre and post intervention measurements.
Summary:
Ten subjects have been recruited with ages ranging from 26-45 years. All have severe hemophilia A. Six subjects have completed the 8 week program to date. Those who completed the program demonstrated a mean increase of 5.3° of elbow flexion ROM (p=0.007). There was a trend toward increase in supination ROM between the two time points (p=0.058). No significant difference was seen in pre and post measurements for extension and pronation ROM. The only ADL related reaching task that demonstrated change between the two time points was palm of hand to occiput. Distance between the palm of hand to the occiput decreased 2.2 inches (p=0.009). Only 2 of the 6 subjects reported having pain in their elbow prior to the start of the program and it was unchanged during the course of the study. Arm girth data only existed for 5 of the 6 subjects and was measured at 3-5 week and 8-10 weeks. There was a trend toward increase in upper arm girth (p=0.078). There have been three reported episodes of elbow bleeding; only one was attributed to the exercises according to subject’s report.
Conclusion:
Preliminary results suggest that an eight week exercise program consisting of modified pull- ups may increase elbow flexion ROM in men with elbow joint contracture due to recurrent joint bleeding from hemophilia. Continuation of this study as well as development of others is needed to further determine if strength training is beneficial to improving elbow movement and function in those with hemophilic arthropathy.