| |

Received: 7 December 2018    Revised: 13 February 2019    Accepted: 13 February 2019

DOI: 10.1111/hae.13727

ORIGINAL ARTICLE

Scope of practice of haemophilia physiotherapists: A European

survey

David Stephensen1,2  | Piet de Kleijn3,4 | Ruth Elise D. Matlary5 | Marie Katzerova6 |

Paul McLaughlin7  | Aislin Ryan8 | Sebastien Lobet9,10,11  | on behalf of the EAHAD
Physiotherapists Committee

1
East Kent Hospitals University NHS Trust,
Canterbury, UK Introduction: European guidelines on the care of haemophilia recommend ready ac-
2
Royal London Hospital, Haemophilia cess to a range of services provided by a multidisciplinary team of specialists includ-
Centre, London, UK
ing physiotherapy. However, the scope of physiotherapy provided is unknown.
3
University Medical Center Utrecht, Van
Creveldkliniek, Utrecht, The Netherlands
Methods: The Physiotherapists Committee of the European Association for
4
Department of Rehabilitation, Physical Haemophilia and Allied Disorders (EAHAD) conducted a web‐based survey to quan-
Therapy Science and Sport, University tify the role and scope of practice of physiotherapists involved in haemophilia care.
Medical Center Utrecht, Utrecht, The
Netherlands The survey was sent to more than 200 physiotherapists registered on the EAHAD
5
Department of Clinical Service, Oslo database. Questions concerned their work practices including assessment and treat-
University Hospital, Rikshospitalet, Oslo,
ment activities and level of autonomy.
Norway
6
Department of Rehabilitation, University Results: Eighty physiotherapists from twenty‐four European countries responded.
Children's Hospital, Brno, Czech Republic Considerable heterogeneity exists in roles, responsibilities, and clinical practice of
7
Royal Free Hospital NHS Trust, Katharine
physiotherapists, particularly in access to and type of physiotherapy treatment pro-
Dormandy Haemophilia Centre and
Thrombosis Unit, London, UK vided, as well as the skill set and autonomy of physiotherapists to make independent
8
European Association for Haemophilia and assessment and treatment decisions.
Allied Disorders, Brussels, Belgium
9
Discussion: This pan‐European survey establishes a context to support physiother-
Secteur des Sciences de la Santé,
Institut de Recherche Expérimentale apy role development and professional identity. Key recommendations include the
et Clinique, Neuromusculoskeletal Lab following: (a) establishing a pan‐European network to support collaboration and edu-
(NMSK), Université catholique de Louvain,
Brussels, Belgium cation for physiotherapists working in haemophilia, (b) developing a core skills and
10
Service d'hématologie, Cliniques capability framework to ensure person‐centred approaches are central as well as
Universitaires Saint‐Luc, Brussels, Belgium
working in partnership with those with the condition to maximize early recovery,
11
Service de Médecine Physique et
Réadaptation, Cliniques Universitaires Saint‐ support self‐management and enablement in remaining active and independent, (c)
Luc, Brussels, Belgium regular training, standardized validation and maintenance of competency for assess-

Correspondence ment tools, (d) well‐designed randomized clinical studies with larger numbers of par-
David Stephensen, East Kent Hospitals ticipants from multiple sites should be the focus of future research.
University NHS Trust, Canterbury, UK.
Email: david.stephensen@nhs.net

1 |  I NTRO D U C TI O N muscular structures.1-3 Due to the complexity of managing haemo-

Haemophilia is an inherited disorder, characterized by repeated
bleeding into joints and muscles. The consequences of the disorder
are musculoskeletal (MSK); typified by a degenerative process of ir-
reversible changes to articular cartilage and other joint as well as
philia, European guidelines on the care of the condition recommend
that those with the disorder should have ready access to a range of
services provided by a multidisciplinary team of specialists including
availability of a physiotherapy service.4 However, a 2015 survey of
37 European countries by the European Haemophilia Consortium

Haemophilia. 2019;1–7. © 2019 John Wiley & Sons Ltd |  1

wileyonlinelibrary.com/journal/hae  
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2       STEPHENSEN et al.
found 30% of counties reported access to physiotherapy for people
5
with haemophilia was only sometimes available. It is recommended
that physiotherapy involvement begins at the time of diagnosis and
covers functional recovery after each musculoskeletal bleed, reha-
bilitation aspects on the aforementioned chronic aspects and on-
going MSK surveillance and prevention, continuing throughout an
individual's lifespan. Despite this recommendation there is a lack of
evidence based guidelines on the optimal role and work practices of
physiotherapists.
The World Health Organization defines rehabilitation as “a set
of measures that assist individuals, who experience or are likely
to experience disability, to achieve and maintain optimum func-
tioning in interaction with their environments.”6 Rehabilitation
goals include achieving prevention and slowing the rate of func-
tional loss, improving or restoring function, compensation for lost
function and maintaining current function. The ability to move is
an essential element of health and well‐being and central to what
7
it means to be healthy. Physiotherapy is directed towards the
movement needs and potential of individuals providing rehabili-
tation and services to develop, maintain and restore maximum
movement and functional ability and prevent MSK impairment
throughout the lifespan.
Although joint disease is the predominant feature of haemophilia,
it differs from other forms of arthritis in pathogenicity. Haemophilic
arthropathy has an onset early in life, is progressive, irreversible, and
involves multiple peripheral joints, weight bearing as well as non‐
weight bearing, leading to marked functional impairments.8,9 The
role of physiotherapy in haemophilia is described as: general health
prevention, rehabilitation following acute musculoskeletal bleeding,
maintenance of mobility and function to maximize physical activities
and participation in chronic situations as well as preoperative and
postoperative rehabilitation.10,11 How these roles are implemented
is likely to vary depending on the specific health care resources and
autonomy of physiotherapists in each country, as well as the haemo-
philia treatment centre (HTC).
In line with professional standards from the Chartered Society
of Physiotherapy, the Haemophilia Chartered Physiotherapists
Association in the United Kingdom has developed guidelines of
physiotherapy practice for people with haemophilia.12 Professional
autonomy for physiotherapists was established in the United
Kingdom in 1977 and enables health professionals to make indepen-
dent decisions regarding the management of a patient based on his/
her own professional knowledge and expertize and to manage his/
her practice independently according to the code of professional
conduct within the framework of health legislation. Policy state-
ments from the World Confederation for Physical Therapy (WCPT)
state that physiotherapists should have the freedom to exercise
their professional judgement and decision making, wherever they
practice, within the physiotherapist's knowledge, competence and
13
scope of practice. Physiotherapists should be able to act as first
contact practitioners without referral from another health profes-
sional. Despite these statements, the degree of autonomy of phys-
iotherapists varies internationally,13 due to the diverse codes of
professional conduct within the framework of health legislation in
respective countries.
Services provided by physiotherapists include examination and
assessment, evaluation, interventions and treatments, outcome
assessments, health promotion and prevention. A comprehensive
evaluation of the role and work practices of the haemophilia phys-
iotherapists across Europe has not been previously undertaken. In
2015, a Physiotherapists' Committee of the European Association
for Haemophilia and Allied Disorders (EAHAD) was established with
the aim of connecting physiotherapists working in this specialized
area and to facilitate the exchange of knowledge between them with
the end goal of improving the provision and quality of musculoskele-
tal care to patients with bleeding disorders throughout Europe.
The aim of the current survey is to document and quantify the
role and scope of practice of physiotherapists in European HTCs.
This information will be of value to establish European principles
of physiotherapy practice for people with haemophilia to support
professional education strategies and enhance self‐governance of
physiotherapists.
2 | M E TH O DS
The Physiotherapists Committee of EAHAD developed a web‐based
survey in English, including questions concerning respondents’ char-
acteristics, physiotherapy work practices including assessment and
treatment activities and level of autonomy. The survey was sent to
more than 208 physiotherapists across 31 European countries regis-
tered on the EAHAD database in March 2018. To reach physiothera-
pists not on the database, respondents were asked to forward the
survey to other health professionals in their HTCs to forward to their
colleagues to in turn forward to their physiotherapists. Two follow‐
up invitations to complete the survey were sent to those registered
on the EAHAD database.
Percentages were calculated per separate answer and are pro-
portional to the number of responses per question. This was re-
ported as descriptive statistics using Microsoft Excel. All responses
were incorporated in the analysis, including countries where a sin-
gle response was returned. For countries with two or more survey
respondents, results were differentiated to identify variation in
practice.
3 | R E S U LT S
3.1 | Characteristics of respondents
Eighty physiotherapists from 24 European countries responded to
the survey, with no response from seven countries (Table 1). Seventy
per cent of respondents were associated with a Haemophilia
Treatment Centre (HTC) and 50% worked at centres with at least
50 patients registered with severe haemophilia. Association with
a HTC was not comparable between countries, ranging from 0%
(Luxemburg) to 100% (Denmark, Ireland, Netherlands, Sweden,
STEPHENSEN et al. |
      3

TA B L E 1   Summary of countries surveyed and respondents

Number of certified
Number of people haemophilia treatment Number of haemophilia Number of physiother- Percentage of all
Country with haemophilia centres treatment centres apist respondents respondents (%)

Albania 306 0 1 1 1.23

Austria 798 2 13 — —
Azerbaijan 1304 0 0 — —
Belgium 1239 5 11 5 6.17
Croatia NR 1 2 1 1.23
Czech 1077 6 7 3 3.70
Republic
Denmark 523 0 3 2 2.47
Estonia 111 1 2 — —
Finland 247 4 5 1 1.23
France 7524 6 37 6 7.41
Georgia 323 1 5 1 1.23
Germany 4553 14 40 1 1.23
Ireland 844 4 4 3 3.70
Israel 700 0 1 1 1.23
Italy 5005 11 55 11 13.58
Lithuania 174 2 3 3 3.70
Luxembourg NR 0 0 2 2.47
Macedonia NR 1 1 — —
Netherlands NR 6 10 4 4.94
Norway 419 1 1 1 1.23
Poland 2869 1 11 — —
Romania 1825 3 11 1 1.23
Russia 7451 0 6 — —
Serbia 523 2 8 — —
Slovakia 599 2 4 1 1.23
Spain NR 3 38 1 1.23
Sweden 839 3 3 2 2.47
Switzerland 418 7 12 5 6.17
Turkey NR 5 18 7 8.64
Ukraine 2188 1 1 1 1.23
UK 8205 22 80 15 18.52

NR, Data Not Reported in Annual Global Survey.

Source of People with haemophilia statistics: World Federation of Haemophilia report on the Annual Global Survey 201731
Source of Haemophilia Treatment Centres: EUHANET www.euhanet.org32

Switzerland, and United Kingdom). Physiotherapists from Lithuania,
Luxemburg and Turkey were less likely to be working at a HTC than
their colleagues from other European countries.
Forty‐seven per cent of physiotherapists spent <5 hours per week
related to haemophilia care, with 25% allocating 5‐14 hours, 19%
15‐24 hours and 10% more than 25 hours per week. Physiotherapists
from Belgium, Czech Republic, France, Luxembourg and Turkey were
more likely to treat PWH for less than five hours per week. United
Kingdom was the only country to report physiotherapists who treated
PWH more than 24 hours per week (approximately more than 3 days
per week). Seventy‐eight per cent of all respondents treated persons
with conditions other than haemophilia as part of their routine work.
Orthopaedic/musculoskeletal and rheumatological conditions were
the most common. Others included, neurological, other paediatric
conditions, haematological, oncology, surgery and cardiorespiratory.
Eighty‐nine per cent of physiotherapists had a minimum university,
college or academy education. We did not ascertain if this was to de-
gree level of equivalent. Eleven per cent did not report their training.
Seventy‐four per cent reported receiving no education or training re-
lated to haemophilia during their primary physiotherapy qualification.
 |
4       STEPHENSEN et al.
3.2 | Access to physiotherapy
Seventy per cent of physiotherapists reported that PWH could not
receive physiotherapy treatment without a referral from a doctor. In
most cases, referral from a haematologist (75%), orthopaedic (51%)
or rehabilitation specialist (36%) was required. Fifty‐eight per cent
reported that people with haemophilia received unlimited treat-
ment free at the point of delivery. Twenty‐five per cent reported
that whilst people with haemophilia could access physiotherapy
at no cost, the number of treatments was limited. Fifteen per cent
reported that people with haemophilia were required to pay some
of the cost towards physiotherapy. Czech Republic, France, Ireland,
Spain and the United Kingdom reported unlimited cost‐free ac-
cess to physiotherapy for PWH, whilst Denmark and Luxembourg
reported cost‐free access for a restricted number of treatments.
Within‐country differences were seen for Italy, Switzerland and
Turkey. Belgium and Sweden were the only countries to report no
cost‐free access to physiotherapy for PWH, both reporting patients
paid part of the cost.
3.3 | Autonomy of physiotherapist
Ninety‐three per cent of physiotherapists make their own assess-
ment of a musculoskeletal problem and decide on the appropri-
ate physiotherapy treatment or rehabilitation. However, a third
reported that their assessment or physiotherapeutic treatment
decision required verification or confirmation from a medical doc-
tor. Denmark and the United Kingdom were the only countries
where all physiotherapists reported full autonomy for treatment
decisions. Some, but not all physiotherapists from Ireland, Spain
and Sweden reported a lack of autonomy for treatment decisions.
Belgium and Switzerland (60%), Italy (78%) and Luxembourg (100%)
reported the highest rates for verification of treatment by a medi-
cal doctor.
Clinical examination of joints and muscles
Haemophilia Joint Health Score (HJHS)
Clinical examination of posture, gait or function
Haemophilia Activities List (HAL)
Point-of-care ultrasound
Request imaging
Peadiatric Haemophilia Activities List (PedHAL)
FISH
Other haemophilia examinations/scores
0%
F I G U R E 1   Assessments utilized by physiotherapists for haemophilia care
TA B L E 2   Key recommendations to support physiotherapy role
development and professional identity
1. To establish a pan‐European network to support collaboration
and education for physiotherapists working in haemophilia
2. To develop a core skills framework to ensure to that person‐cen-
tred approaches are central to haemophilia care and working in
partnership with those with the condition to maximise early
recovery, support self‐management and enable people to stay
active and independent.
3. Regular training, standardized validation and maintenance of
competency for those using HJHS, and other tools are essential.
4. Further well‐designed randomized clinical studies with larger
numbers of participants from multiple sites should be the focus of
future research
3.4 | Assessment techniques and tools utilized by
physiotherapists for haemophilia care
Clinical examination of the musculoskeletal system including joint,
muscle, posture, gait and function were utilized by most physiother-
apists (Figure 1).
Of the standardized tools, as recommended by the World
Federation of Haemophilia, the Haemophilia Joint Health Score
(HJHS)14 was used most commonly (85%), the adult or paediatric
version of the Haemophilia Activities List (HAL)15,16 regularly (55%),
and the Functional Independence Score for Haemophilia (FISH)17
less (15%). Twenty‐six per cent reported independently using point‐
of‐care ultrasound and 25% reported being able to independently
request radiological imaging. The highest rates of point‐of‐care ul-
trasound use were reported by United Kingdom (67%) and French
physiotherapists (50%). Independence of radiological requesting
was only reported in the United Kingdom (47%) and Italy (50%).
Other reported assessment tools included quantitative as-
sessments of posture and balance using pressure mats and
20% 40% 60% 80% 100%
STEPHENSEN et al. |
      5

three‐dimension movement analysis, mobility with the timed up and
go test and two‐minute walk test and physical activity with acceler-
ometers. A range of patient self‐reported outcome questionnaires
are also used by some physiotherapists, including; Oxford Elbow
score, Oxford Knee Score, Foot and Ankle Ability Measure, EQ‐5D,
Musculoskeletal Health Questionnaire and CONFBAL scale (confi-
dence in balance/falls questionnaire).
3.5 | Treatment interventions utilized by
physiotherapists for haemophilia care
The most common treatments provided by physiotherapists as part
of their haemophilia practice were muscle strengthening (Figure 2),
education, joint range of motion techniques, soft‐tissue techniques,
taping and manual therapy (Figure 2). Less common modalities
were massage, electrotherapy, splinting, activity camps and ultra-
sound therapy. Laser and magnetic therapy, acupuncture and cryo-
therapy were used least; less than 10% of physiotherapists. Three
United Kingdom physiotherapists reported autonomy to prescribe
medication and perform intra‐articular joint injections. We did not
collect information on the training and further qualifications ob-
tained for providing treatment interventions under supervision or
autonomously.
3.6 | Learning and professional development of
physiotherapists
Physiotherapists employ a range of strategies to maintain their learn-
ing, competence and professional development with regard to hae-
mophilia. Attendance at congresses and conferences, as reported
by 74%, is most common. Workshop/course attendance, accessing
journal articles and literature and professional peer networks were
utilized by 45% of our respondents. Twenty‐one per cent maintained
their haemophilia knowledge through networking with their immedi-
ate haemophilia centre colleagues.
3.7 | National variations
In the United Kingdom, people with haemophilia had unlimited access,
free at the point‐of‐contact to specialist physiotherapists who had au-
tonomy to make independent assessment and treatment decisions.
In the Czech Republic, France, Ireland and Spain, patients had unlim-
ited access free at the point‐of‐contact to specialist physiotherapists
but the physiotherapists lacked full autonomy to make independent
assessment and treatment decisions. In Belgium, Luxembourg and
Switzerland, it was reported that people with haemophilia have re-
stricted access to specialist physiotherapists that also lacked full au-
tonomy to make independent assessment and treatment decisions.
4 | DISCUSSION AND RECOMMENDATIONS
Although the response rate to this survey was 38%, a limitation is
that half of respondents were from four countries; UK, Italy, Turkey
and France, and there was one respondent each from ten of the
countries. It is not known if the one respondent from those coun-
tries was representative of other physiotherapists. Nevertheless,
the spread of participants and their wide‐ranging responses provide
a comprehensive insight into the scope of practice of haemophilia
physiotherapists in Europe.
This survey emphasizes the considerable heterogeneity in roles,
responsibilities and clinical practice of physiotherapists in the care
of people with haemophilia across Europe. There is marked variabil-
ity in access to physiotherapy treatment along with the autonomy
of physiotherapists to make independent assessment and treat-
ment decisions due to the diverse codes of professional conduct

Muscle strengthening
Education
Active joint motion/ROM
Rehabilitation techniques
Physical therapy/kinesiotherapy
Soft tissue techniques
Taping
Manual therapy
Hydrotherapy/spa treatment
Massage
Electrotherapy
Summer/sports/activity camps
Splinting
Ultrasound therapy
Laser therapy
Acupuncture
Magnetic therapy
Cryotherapy
F I G U R E 2   Treatments utilized by
physiotherapists for haemophilia care 0% 20% 40% 60% 80% 100%
 |
6       STEPHENSEN et al.
within the framework of health legislation in respective countries.
13
Despite policy statements from the WCPT that physiotherapists
should have the freedom to exercise their professional judgement
and decision making, wherever they practice and act as first con-
tact practitioners without referral from another health profes-
sional, this is not the current practice in health care systems of all
European countries, where persons with haemophilia are involved.
Almost half of physiotherapists that responded to the survey spent
less than one half‐day per week managing a haemophilia caseload.
Haemophilia experience was not evaluated in this survey, but it
would be challenging to attain a wide breadth of knowledge, clinical
skills and experience of haemophilia care within this time allocation.
To address this, the EAHAD Physiotherapists group has established
a network of regional coordinators, in order to give any physiother-
apist, in any setting the possibility for professional feedback.
Physiotherapists in the United Kingdom are more likely to
be aligned to a Haemophilia Treatment Centre and spend more
hours treating people with the condition than their European col-
leagues. Physiotherapy for haemophilia in the United Kingdom is
well organized with scope of practice and standards defined by the
Haemophilia Chartered Physiotherapists Association. Established
more than 25 years ago, this national network supports collabora-
tion and education for physiotherapists working in haemophilia18
and could well serve as an example for other countries.
Surprisingly across all respondents, only two‐thirds of physiother-
apists reported autonomy of assessment and treatment. It is, however,
possible that rates of autonomy were underestimated and physiother-
apists are autonomous in some circumstances but not others. For ex-
ample, inpatient treatment may require strict referral but outpatient
treatment may not and vice versa. Survey responses suggest physio-
therapy assessment of people with haemophilia is focused on muscu-
loskeletal structure and the clinical examination of joints and muscles,
with the validated HJHS14 commonly utilized. In some European coun-
tries, physiotherapists have enhanced their scope of practice to include
requesting imaging and performing point‐of‐care ultrasound imaging.
We note that physiotherapists from Italy reported the ability to request
radiological imaging, but little autonomy with regard to physiothera-
peutic treatment. This could be misunderstanding of survey questions
or a foundation for greater professional autonomy. This extended scope
of practice, reflective of increased autonomy, should be encouraged.
The first recommendation of this survey is to establish a pan‐
European network to support collaboration and education for physio‐
therapists working in haemophilia (Table 2). Currently, education about
haemophilia is not included in undergraduate training; however, the
variety of assessment and treatment approaches reported in this
survey suggest that the condition could be used as a model for teach-
ing multi‐ and inter‐disciplinary management for health conditions
for physiotherapists and other healthcare professions. Supporting
opportunities for physiotherapists’ attendance at national and inter-
national meetings and workshops enabling formal education as well
as networking is essential to facilitate continued learning and skills
development. The second recommendation is the need to develop
a core skills framework to ensure that person‐centred approaches are
central to haemophilia care and working in partnership with those with
the condition to maximize early recovery, support self‐management and
enable people to stay active and independent (Table 2).
Function and the International Classification of Functioning,
Disability and Health (ICF)19 domains of activity and participation are
assessed to a lesser extent, as previously reported by de Kleijn et al in
2002.20 The patient‐reported questionnaires, HAL15 and its paediatric
version PedHAL16 are utilized by more than half of physiotherapists
but actual performance of functional physical tasks and activities is
under‐utilized. Performance and participation in activities as well as
clinical examinations of joint structure has the potential to improve
monitoring of musculoskeletal health and subsequent functional mod-
ifications. A wide range of additional patient‐reported questionnaires
as well as objective timed performance tests were reported. Many
tests and tools have not undergone validity and reliability testing in
people with haemophilia, which weakens their use as reassessment
tools. Furthermore, normative values are often unknown. A third rec-
ommendation of this survey is that regular training, standardized vali‐
dation and maintenance of competency for those using HJHS, and other
tools are essential (Table 2). Standardizing a core set of outcomes is
necessary whilst minimizing patient burden of multiple assessments.
Respondents reported a wide range of therapeutic treatments
utilized by physiotherapists and represent those described in a re-
cent review of advances in musculoskeletal physiotherapy.21 Muscle
strengthening, education and active joint motion were the most com-
mon modalities reported. It is reassuring to note the predominance of
active intervention with patient participation, rather than the passive
modalities of treatment. There is reasonable evidence emerging that
exercise via its effect on pain, joint range of motion (ROM), strength
and mobility can have a positive impact on maximizing mobility and
function, behaviour and quality of life in PWH.22-25 Similarly, man-
ual therapy—controlled use of manual force applied to articular and
soft‐tissue structures through mobilization and stretching to improve
biomechanical elasticity—shows some potential benefit, particularly
on pain.26-30 Unfortunately, studies demonstrating promising results
often used\were based on heterogeneous cohorts, few and low pow-
ered. Due to small numbers of studies and diversity of outcomes,
meta‐analysis and confirmation of efficacy has yet to be reported.
Whilst adequately powered studies are challenging due to the rarity of
the condition, the fourth recommendation of this survey is further well‐
designed randomized clinical studies with larger numbers of participants
from multiple sites should be the focus of future research (Table 2).21,23
This European survey establishes a context to support physiother-
apy role development and professional identity. The recently estab-
lished Physiotherapists' Committee of the European Association for
Haemophilia and Allied Disorders (EAHAD) would be the ideal network
to implement the recommendations. It should also be used to facilitate
the development of guidelines on scope of practice, establish core skills,
competency and educational frameworks for physiotherapists involved
in haemophilia care as well as strategies to improve the musculoskeletal
management of people with haemophilia. We recommend that a core
skills and capability framework include the standards expected of phys-
iotherapists in delivering a musculoskeletal service, and the knowledge,
STEPHENSEN et al.
skills and behaviours that practitioners need to develop and demonstrate.
It is important that any framework for a rare disease like haemophilia is
developed in partnership with patients to ensure a patient‐centred ap-
proach and professional organizations so that barriers such as lack of ac-
cess, time, autonomy, funding and training are addressed.
AC K N OW L E D G E M E N T S
DS, PdK, RM, MK, PMc, AR, SL designed the survey, analysed
data, interpreted the data and contributed to preparation of the
manuscript.
D I S C LO S U R E S
The authors stated that they had no interests which might be
perceived as posing a conflict or bias.
ORCID
David Stephensen  https://orcid.org/0000-0002-6175-3343
Paul McLaughlin  https://orcid.org/0000-0002-5962-7647
Sebastien Lobet  https://orcid.org/0000-0002-3829-6850
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How to cite this article: Stephensen D, de Kleijn P, Matlary
RED, et al; on behalf of the EAHAD Physiotherapists
Committee. Scope of practice of haemophilia
physiotherapists: A European survey. Haemophilia.
2019;00:1–7. https://doi.org/10.1111/hae.13727