Eficacia de una intervención de fisioterapia mediante visualización de movimiento en el abordaje del dolor en pacientes con artropatía hemofílicaestudio clínico aleatorio multicéntrico

Abstract

Pain is one of the main clinical manifestations in haemophilia patients, affecting their quality of life. The aim of this Doctoral Thesis was to analyse the efficacy of a Physiotherapy intervention through the application of movement visualization in patients with congenital coagulopathies and haemophilic arthropathy in their pain experience, and its implication in their quality of life. To achieve this, five research studies were carried out. Firstly, two observational studies were carried out regarding pain and quality of life in haemophilia patients in Spain and their relationship with various clinical and psychosocial factors. Once the results of these were obtained, a cohort study was implemented on the immediate effect of a 15-minute visualization of movement intervention. Finally, two non-randomised pilot studies were completed on the effectiveness of a 28-day programme of 15-minute per day of movement visualization. The treatment applied in the experimental studies consisted of 15 minutes of immersive movement visualization. The video was recorded in first person with 180° video to enhance the patients' immersion. This video presented an extension movement of the target joint of the study (knee or ankle). The results showed how pain intensity in patients with haemophilic arthropathy correlates with anxiety, catastrophizing and degree of kinesiophobia. On the other hand, these psychosocial factors influenced the pain experience of patients with haemophilic arthropathy, affecting their quality of life. Concerning the immersive visualization therapy of 180º movement using virtual reality in patients with haemophilic arthropathy, it has been confirmed to be safe for not causing hemarthrosis. In addition, this approach has the potential to activate the anterior rectus quadriceps. On the other side, this intervention maintained for 28 days is able to improve joint status, pressure pain threshold and mobility in patients with haemophilic ankle arthropathy. This intervention can also improve the intensity of joint pain in patients with haemophilic arthropathy of the knee. It may also improve joint status and quadriceps muscle strength in these patients. In conclusion, 180º immersive movement visualization using virtual reality is a safe and effective intervention in pain management in patients with haemophilic arthropathy.