Physical Activity in Adolescents with Haemophilia

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Introduction

Welcome to this online wiki resource which will focus on ‘The Role of a Physiotherapist in Promotion and Management of Physical Activity in Adolescents with Haemophilia.’ This wiki has been designed as learning resource for final year physiotherapy students and newly qualified physiotherapists. It is an online self-study module and should take approximately 10 hours to complete.

There are various treatments and concerns associated with paediatric haemophilia, the background will include a brief introduction to haemophilia and its medical management. As this resource will focus solely on the physiotherapists role in physical activity, aspects not directly related to the scope of this wiki may not be fully explained in detail. Therefore, any red hyperlinks will offer further information, should the reader require, when clicked on. Additionally, the learner will be orientated to further reading, should they wish to do so, throughout the module.

The Physiotherapists role in treating and managing adolescents with haemophilia is extremely important, and recent developments within the profession have increased its value (Buzzard and Beeton 2008). One of the key interventions involved in its treatment is promotion of physical activity (REF).

Definition of PE and how it is important in general pop as well as PWH

Although various studies have described the benefits of engaging in physical activity for PWH, results from research conducted in the USA among adolescent haemophilia patients have demonstrated a lack of knowledge concerning the role of physical activity in managing their condition (Nazzaro et al. 2006). This suggests that more work must be done to promote physical activity and emphasize its positive role in enhancing the lives of haemophilia sufferers (Negrier et al. 2013).

Physical activity promotion for health exists worldwide (Heath et al. 2012). The benefits of such in the general population are widely known, providing health improvements along with the potential for enhancing disease outcomes (WHO 2015). Although many studies have reported the benefits of participation in physical activity for PWH, researchers in the USA have identified a lack of knowledge among
young haemophilia patients (aged 13–18 years) as to the role of exercise in the management of their condition.

The promotion of exercise in children with haemophilia (CwH) is of particular importance due to recent advances in care over the past 40 years (Manco-Johnson et al. 2003). This has seen changes in exercise prescription; as is it now believed to be a crucial modality and understood it will not attribute to bleeds, as previously believed (REF).

As physiotherapists, we have an obligation and responsibility to actively promote physical activity in this population, as well as educating the individuals correctly in self-management of their life-long conditions, the intention being to maximize quality of life (REF).

The wiki is organised under three main sections, ‘Background of Haemophilia’, ‘Physiotherapist’s Role’ and ‘Benefits of Physical Activity’

Useful advice to be considered whilst undertaking the wiki: ensure you take regular screen breaks, complete all tasks, use further reading to expand knowledge and understanding, be aware of posture. (Insert pic of ideal posture) 

Aims and Objectives

The aims of this wiki are as follows:

• To present a learning resource for final year physiotherapy students and newly qualified graduates which aims to develop their knowledge and understanding of the management of adolescents with haemophilia.

• To introduce final year physiotherapy students and newly qualified graduates to the skills, competencies and resources which can be utilised within their clinical practice in order to offer more effective and comprehensive management of adolescents with haemophilia.

Throughout this learning resource various tasks and activities have been encouraged to engage the learner. These have been developed considering different learning styles (VARK xxxx)

Learning Outcomes:

The following learning outcomes have been constructed using the levels determined by Bloom’s Taxonomy to facilitate learning development (Bloom et al. 1956).

Through completion of this learning module and related tasks, final year physiotherapy students and newly qualified physiotherapy graduates will be able to:

• Summarise the characteristics and underlying pathophysiology of haemophilia including explanation of different types.
• Critically reflect on the challenges and considerations associated with treating an adolescent with haemophilia.
• Using the biopsychosocial model, evaluate the physical, spiritual and emotional needs which must be considered when treating an adolescent with haemophilia.
• Critically appraise the evidence base surrounding physical activity in an adolescent with haemophilia.

Blooms Taxonomy, shown to the right, demonstrates a hierarchy of learning of which this wiki aims to encompass various levels of throughout. The identified learning aims have been constructed to suit this learning theory. (Insert pic of blooms taxonomy)

The Role of The Physiotherapist

Education

Below is a mind map which explains the advice that should be given to patients regarding physical activity. More detail on each is presented in the bullet points below.

The physiotherapist has a crucial role in educating patients regarding physical activity, exercise prescription and selecting particular activities (Heijnen 1993).

It is important to inform patients/relatives/peers that the benefits derived from physical activity can actually help to prevent joint damage and functional impairment (Buzzard 1997).

Individuals who exercise frequently actually exhibit fewer bleeds (Tinktinsky et al 2002).

You should inform patients that just as with healthy individuals, exercise also improves psychosocial factors (Negrier et al. 2008).

The physiotherapist should assist and advise patients on developing an individually tailored physical activity programme (Wittmeier and Mulder 2007).

You must educate the patients regarding protective equipment and timing of prophylaxis administration that is appropriate to their chosen sport or activity (McGee et al 2015; The World Federation of Hemophilia 2015).

The encouragement of the use of protective equipment (e.g. splints, braces) during activity especially if the patients has a target joint, or no clotting factor given prior to activity (Philpott et al. 2010).

Depending on the patients severity of their condition high contact and collision sports such as football, hockey, rugby, boxing, and wrestling are usually best avoided (The World Federation of Haemophilia 2015).

It is important to address the added benefits of physical activity during puberty in adolescents. Regular physical activity participation during puberty, enhances lean tissue mass, fitness and strength and decreases fat mass (Ara et al. 2004).

Physiotherapists should try to encourage non-contact sports such as swimming, walking, cycling, golf, archery, badminton, rowing and sailing (The World Federation of Haemophilia 2015).

It is paramount for physiotherapists to advise patients on the importance of gradually re-introducing activity after a bleed to minimise the chance of a re-ocurring bleed (The World Federation of Haemophilia 2015).

Give advice on appropriate forms of physical activity specific to that patient and their individual preferences, interests and needs (The World Federation of Hemophilia 2015).

Advice on amount of physical activity is no different to national guidelines for healthy individuals. Young people between the ages of 13-18 should participate in a minimum of 60 minutes of daily activity (Department of Health 2011).

It is advised that school personnel should be educated regarding suitable activities for the child, immediate care in case of a bleed, and modifications in activities that may be needed after bleeds (The World Federation of Hemophilia 2015).�

References

References will automatically be added here, see adding references tutorial.