Functional and Gait Analysis in Spanish Children with haemophilia

Abstract

Introduction: In the haemophilic patient, musculoskeletal injuries mainly affect the load‐bearing joints, causing impairments in the mobility and gait. The Timed Up And Go (TUG) is a simple to perform test to assess mobility and lower extremity function. Moreover, the Harmonic Ratio (HR) is an accelerometry based measure used to quantify the walking smoothness. The objective of this study is to determine differences in the mobility and gait characteristics in a group of children with haemophilia (HG) compared with a control group (CG).

Methods: A total of 31 children with haemophilia [21 severe and 10 mild; age: 10.90 ± 1.27 years old; IMC: 18.75 ± 3.73 kg m−2; HJHS in lower limbs: 3.81 ± 2.98 points] and 27 control children [Age: 11.33 ± 1.27 years old; IMC: 18.24 ± 3.29 kg m−2] were included in the study. TUG test measures the time to rise from an arm chair, walk 3 m to a line, turn around, walk back to the chair and sit down again (2 trials). The X16‐mini accelerometer (Gulf Coast Data Concepts, LLC) was used to evaluate the HR. Children walked 30 m (3 trials) in a straight line at preferred speed with the X16‐mini placed at L3/L4 vertebrae using a belt. HR of Vertical (V), Anterior Posterior (AP) and Medial Lateral (ML) data as well as the velocity of the gait was analysed. T‐test or Wilcoxon test (depending on the normality) was used to evaluate between‐group differences.

Results: TUG test times are higher in the HG (4.37 ± 0.31) than in the CG (4.29 ± 0.68) but the differences are not significant (P = 0.51). Moreover, in the gait analysis the HG has obtained lower ratios (less walking smoothness) than the CG in the HR_V (2.93 ± 0.69 vs 2.97 ± 0.62; P = 0.82), HR_AP (2.68 ± 0.48 vs 3.15 ± 0.70; P < 0.01) and HR_ML (1.95 ± 0.37 vs 2.19 ± 0.47; P = 0.04) components and a slower gait speed (m/sec) (1.36 ± 0.19 vs 1.53 ± 0.24; P = 0.01).

Discussion/Conclusion: Results obtained in TUG test and HR analysis identified changes in gait pattern in children with haemophilia compared with their counterparts. In addition to the factor replacement therapy, exercise and physical therapy programs are needed to improve musculoskeletal status of young people with haemophilia.