Comparison of Efficiency of Closed Kinetic Chain Exercises versus Proprioceptive Exercises in Improving Balance and Gait in Hemophilia: Protocol for a Randomized Controlled Trial (Preprint)

BACKGROUND Inherited bleeding disorders are characterized by prolonged bleeding due to protein deficiencies involved in blood clotting, with hemophilia A and hemophilia B being the most common types. The severity of bleeding in people with hemophilia (PwH) varies on the level of deficient factor and treatment includes coagulation factor concentrates, nonreplacement preparations, gene therapies and physiotherapy methods. Thus, bleeding is prevented, symptoms are reduced and quality of life is improved. OBJECTIVE The aim is to investigate the effects of closed kinetic chain exercises and proprioceptive exercise training on improving balance and walking in PwH. METHODS This study is planned a 3-arm, parallel-group randomized controlled trial. The study will include 63 PWH aged between 13 and 25 years who attend meet the inclusion criteria. The primary outcome measures are medio-lateral swing, anterior-posterior swing, walking speed and hemophilia joint health score. Secondary outcome measures are kinematic assessment of gait, one-leg stand test, 6-Minute Walk Distance (6 MWD) test, proprioception assessment and Hemophilia Functional Independence Score. Participants will be evaluated with Biodex Balance System for postural sway, 10-meters walking test for gait speed, Hemophilia Joint Health Score for joint health, Kinovea 2D motion analysis for kinematic evaluation of gait, one leg stand test for balance measurement, 6 MWD for functional capacity, digital goniometer for proprioception, Functional Independence Score in Hemophilia for functional independence. Participants will be randomly assigned to a closed kinetic chain group, a proprioceptive group, or a controlled group. Following randomization, all participants in exercise training groups will receive a 30-minute education session on joint protection techniques and energy conservation prior to the first exercise session. Closed kinetic chain exercises will include progressive lower limb exercises duration of approximately 45 minutes each session. Proprioceptive exercise training will focus on vibration training, reposition exercises and proprioception exercises will be given to increase proprioceptive input on same duration as the other group. The control group will receive no interventions. All participants will undergo 24 exercise sessions (2 days a week for 12 weeks). After the treatment, the initial measurements will be repeated. RESULTS The study have began in September 2023 and scheduled to be completed in January 2025. CONCLUSIONS The study will investigate the effects of two different exercise on functional parameters in PWH. The effects of different exercise protocols on parameters such as postural sway, walking speed, joint health will be evaluated. It is predicted that both exercise methods may have positive effects on balance and gait. CLINICALTRIAL Clinical Trials.gov NCT05879549