Publication: Eficacia de una intervención de fisioterapia mediante restricción de flujo sanguíneo en la mejora de la fuerza muscular de pacientes con artropatía hemofílica : estudio clínico aleatorio multicéntrico
Authors
Villalón González-Conejero, María del Mar
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Escuela Internacional de Doctorado
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Cuesta Barriuso, Rubén ; López Pina, José Antonio ; Pérez Llanes, Raúl
Publisher
Universidad de Murcia
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DOI
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info:eu-repo/semantics/doctoralThesis
Description
Abstract
Introducción y objetivos. La artropatía hemofílica constituye una de las principales complicaciones musculoesqueléticas en personas con hemofilia y se asocia a dolor crónico, pérdida de movilidad y deterioro progresivo de la función muscular, especialmente a nivel de la rodilla. El fortalecimiento del cuádriceps es un objetivo terapéutico prioritario en esta población; sin embargo, el entrenamiento con cargas elevadas puede no ser tolerado debido al riesgo articular. En este contexto, el entrenamiento de fuerza de baja carga combinado con restricción del flujo sanguíneo (blood flow restriction, BFR) se ha propuesto como una alternativa potencialmente segura y eficaz. El objetivo general de esta tesis doctoral fue analizar la seguridad y la eficacia del entrenamiento de fuerza con BFR aplicado al miembro inferior sobre la fuerza y activación muscular, el dolor, el rango de movimiento, la funcionalidad y la calidad de vida en personas adultas con artropatía hemofílica.
Metodología. Se desarrolló un proyecto de investigación estructurado en tres fases complementarias. En la fase 1, se realizó un estudio observacional de casos y controles para caracterizar las diferencias neuromusculares y de dolor entre personas con artropatía hemofílica de rodilla y sujetos sanos. En la fase 2, se llevó a cabo un estudio piloto aleatorizado para evaluar la seguridad y viabilidad de un programa de ejercicio de baja intensidad con BFR aplicado al miembro inferior. En la fase 3, se realizó un ensayo clínico aleatorizado para analizar la eficacia de un programa de entrenamiento con BFR de cuatro semanas de duración, enfocado a la rodilla. Las principales variables evaluadas incluyeron fuerza y activación muscular, umbral de dolor a la presión, intensidad del dolor, rango de movimiento, funcionalidad y calidad de vida relacionada con la salud.
Resultados. En el estudio observacional, las personas con artropatía hemofílica de rodilla presentaron una disminución significativa de la fuerza del cuádriceps, un menor umbral de dolor a la presión y una mayor fatigabilidad neuromuscular en comparación con sujetos sanos, sin diferencias significativas en la activación electromiográfica. El estudio piloto confirmó que el entrenamiento con BFR fue seguro y bien tolerado, sin aparición de hemartrosis ni eventos adversos clínicamente relevantes, y mostró mejoras en la fuerza del cuádriceps frente al grupo control, así como mejoras intragrupo en la fuerza del gastrocnemio y una reducción del dolor
articular. En el ensayo clínico aleatorizado, el programa de entrenamiento con BFR confirmó su seguridad y produjo incrementos significativos en la fuerza y activación electromiográfica del cuádriceps, mejoras en el umbral de dolor a la presión y en el rango de movimiento de la rodilla, así como una mejora en los dominios físicos de la calidad de vida. No se observaron cambios significativos en la funcionalidad objetiva evaluada mediante el Timed Up and Go Test.
Conclusiones. Los resultados de esta tesis doctoral indican que el entrenamiento de fuerza de baja carga con restricción del flujo sanguíneo es una intervención segura y eficaz para mejorar la función neuromuscular, el dolor y la movilidad articular en adultos con artropatía hemofílica de rodilla, cuando se aplica dentro de programas estructurados y clínicamente supervisados.
Introduction and Objectives. Hemophilic arthropathy is one of the main musculoskeletal complications in people with hemophilia and is associated with chronic pain, loss of mobility, and progressive deterioration of muscle function, particularly at the knee joint. Quadriceps strengthening is a primary therapeutic objective in this population; however, high-load training may not be well tolerated due to joint risk. In this context, low-load strength training combined with blood flow restriction (BFR) has been proposed as a potentially safe and effective alternative. The general objective of this doctoral thesis was to analyze the safety and effectiveness of lower-limb strength training with BFR on muscle strength and activation, pain, range of motion, functionality, and health-related quality of life in adults with hemophilic arthropathy. Methodology. A research project structured into three complementary phases was developed. In Phase 1, an observational case-control study was conducted to characterize neuromuscular and pain-related differences between individuals with hemophilic knee arthropathy and healthy subjects. In Phase 2, a randomized pilot study was carried out to evaluate the safety and feasibility of a low-intensity exercise program with BFR applied to the lower limb. In Phase 3, a randomized clinical trial was conducted to analyze the effectiveness of a four-week BFR training program focused on the knee. The main outcome variables included muscle strength and activation, pressure pain threshold, pain intensity, range of motion, functionality, and health-related quality of life. Results. In the observational study, individuals with hemophilic knee arthropathy showed significantly reduced quadriceps strength, lower pressure pain thresholds, and greater neuromuscular fatigability compared to healthy subjects, with no significant differences in electromyographic activation. The pilot study confirmed that BFR training was safe and well tolerated, with no hemarthrosis or clinically relevant adverse events, and demonstrated improvements in quadriceps strength compared to the control group, as well as within-group improvements in gastrocnemius strength and reductions in joint pain. In the randomized clinical trial, the BFR training program confirmed its safety and produced significant increases in quadriceps strength and electromyographic activation, improvements in pressure pain threshold and knee range of motion, as well as improvements in the physical domains of quality of life. No significant changes were observed in objective functionality assessed by the Timed Up and Go Test. Conclusions. The results of this doctoral thesis indicate that low-load strength training with blood flow restriction is a safe and effective intervention to improve neuromuscular function, pain, and joint mobility in adults with hemophilic knee arthropathy when applied within structured and clinically supervised programs.
Introduction and Objectives. Hemophilic arthropathy is one of the main musculoskeletal complications in people with hemophilia and is associated with chronic pain, loss of mobility, and progressive deterioration of muscle function, particularly at the knee joint. Quadriceps strengthening is a primary therapeutic objective in this population; however, high-load training may not be well tolerated due to joint risk. In this context, low-load strength training combined with blood flow restriction (BFR) has been proposed as a potentially safe and effective alternative. The general objective of this doctoral thesis was to analyze the safety and effectiveness of lower-limb strength training with BFR on muscle strength and activation, pain, range of motion, functionality, and health-related quality of life in adults with hemophilic arthropathy. Methodology. A research project structured into three complementary phases was developed. In Phase 1, an observational case-control study was conducted to characterize neuromuscular and pain-related differences between individuals with hemophilic knee arthropathy and healthy subjects. In Phase 2, a randomized pilot study was carried out to evaluate the safety and feasibility of a low-intensity exercise program with BFR applied to the lower limb. In Phase 3, a randomized clinical trial was conducted to analyze the effectiveness of a four-week BFR training program focused on the knee. The main outcome variables included muscle strength and activation, pressure pain threshold, pain intensity, range of motion, functionality, and health-related quality of life. Results. In the observational study, individuals with hemophilic knee arthropathy showed significantly reduced quadriceps strength, lower pressure pain thresholds, and greater neuromuscular fatigability compared to healthy subjects, with no significant differences in electromyographic activation. The pilot study confirmed that BFR training was safe and well tolerated, with no hemarthrosis or clinically relevant adverse events, and demonstrated improvements in quadriceps strength compared to the control group, as well as within-group improvements in gastrocnemius strength and reductions in joint pain. In the randomized clinical trial, the BFR training program confirmed its safety and produced significant increases in quadriceps strength and electromyographic activation, improvements in pressure pain threshold and knee range of motion, as well as improvements in the physical domains of quality of life. No significant changes were observed in objective functionality assessed by the Timed Up and Go Test. Conclusions. The results of this doctoral thesis indicate that low-load strength training with blood flow restriction is a safe and effective intervention to improve neuromuscular function, pain, and joint mobility in adults with hemophilic knee arthropathy when applied within structured and clinically supervised programs.
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