Randomized Clinical Trial to Evaluate the Effect of Two Physical Therapy Programs in Musculoskeletal Dysfunction in Subjects with Sickle Cell Disease

Sickle cell disease is a genetic disease that results in sickling of red blood cells, triggering phenomena of vaso-occlusion, pain and organ damage. Bone involvement is the most common clinical manifestation, and may cause chronic and progressive disorders such as avascular necrosis of the femoral head and spine damage, which in turn leads to disturbances in gait and activity and function limitation due to pain. There are few studies in the literature on the role of physiotherapy as a resource capable of preventing and treating disorders of the locomotor system of sickle cell disease patients. The aim of this study was to evaluate and compare the effect of two physical therapy programs for patients with sickle cell disease to decrease musculoskeletal pain in the hip and lower back and increase the functionality of these patients. One of the programs was conventional physical therapy in the soil compared with a protocol of exercises performed in a swimming pool. The study began with an evaluation of the volunteers the from functional scales (Scale LEFS – Lower Extremity Functional Scale; Lequesne’s Algofunctional Questionnaire and Oswestry Disability Index), measuring the range of motion (ROM) in flexion and extension of the trunk, flexion, extension, adduction and abduction of the hip, the assessment of muscle strength (MS) of the trunk flexors and extensors, flexors, extensors, adductors and hip abductors through load cell and surface electromyography (SEMG) of iliocostalis, dorsal longissimus, gluteus maximus, gluteus medius and tensor fasciae latae. The final sample consisted of 10 volunteers, randomized to two different groups: aquatic physiotherapy (AP) and conventional physiotherapy (CP). The AP group was composed of five volunteers with a median age of 42 (25-67) years. The CP group consisted of five volunteers with a median age of 49 (43-59) years. After randomization, subjects from both groups underwent intervention for twelve week, with two sessions per week, totaling 24 sessions. At the end of the intervention, patients were reassessed for comparison of pre-and post-intervention results. For statistical analysis ANOVA was used for repeated measures with transformation stations. Significance was established at the 5% level (p<0.05). Both programs lead to statistically significant improvement after the intervention for the variables Lequesne index (p=0.0217), Oswestry Disability Index (p=0.0112), trunk extension ROM (p=0.0320), ROM trunk flexion (p=0,0459) and MS extension (p=0.0062) and abduction (p=0.0257) of the hip. The variables Scale LEFS, trunk flexion ROM, ROM of flexion, extension, adduction and hip abduction, extension of MS trunk, MS flexion and hip adduction and all SEMG variables showed no statistically significant difference. However no difference was detected between aquatic or conventional physiotherapy. These results suggest that physical therapy seems to be a resource capable of preventing and treating musculoskeletal dysfunctions of patients with sickle cell disease, regardless of the technique used.

Keywords: Sickle cell disease, physical therapy, aquatic therapy.