Implementation and assessment of a self- and community-based rehabilitation program in patients with hemophilia from Côte d’Ivoire

Introduction In resource-constrained countries, very few patients with hemophilia (PWH) have access to clotting factor concentrate (CFC) treatment, resulting in an increased rate of musculoskeletal (MSK) complications. Physiotherapy actively contributes to preventing MSK complications because it helps to minimize joint damage and reduce pain. Our study sought to implement and assess the impact of a 20-week self-and community-based rehabilitation (CBR) program on the joint and functional status of Ivoirian PWHs and to determine its feasibility. Methods Fifty participants underwent a clinical and functional baseline assessment with the identification of joints’ functional defects and allowed the initiation of an individualized exercise program that comprised exercises to improve strength, joint mobility, and proprioception. Hemophilia Joint Health Score (HJHS), 2-minute walking test (2MWT), timed up and go (TUG), goniometry and maximal isometric voluntary contractions using the MicroFET2 were performed at baseline (T1) and at week 20 (T2). A logbook was also provided to assess program adherence. Results At T2, there was a significant improvement in both the 2MWT and TUG tests. The HJHS-total score decreased significantly from 23.6 ± 14.2 at T1 to 20.4 ± 13 at T2. In addition, a significant moderate improvement in joint health was found in the left elbow, right knee, and right ankle, with elements correlating with joint function responsible for these improvements. A strong adherence to the program was also observed, with 94% of participants reporting regular exercise performance, along with a high degree of satisfaction. Conclusions The program revealed encouraging results and is meant to be the first step towards a more ambitious project that could be extended to other developing countries. Self- based and CBR programs are inexpensive and remain efficient treatment options designed to minimize the detrimental effects of joint and muscle bleedings and, increase the functional independence and quality of life of PWHs with limited access to CFC and physiotherapy.