The use of physiotherapy in hemophilia treatment centers across the United States varies greatly, according to a new study published in Haemophilia. The authors propose that gaps in care may be addressed using approaches such as salary support, funded education, more collaboration between physiotherapists specializing in bleeding disorders in different regions, and advocacy for insurance coverage.

Physiotherapy is an integral part of hemophilia treatment. Physiotherapists can provide musculoskeletal evaluation, treatment, and education. However, the practice patterns and utilization of physiotherapists affiliated with hemophilia treatment centers are unclear.

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Here, a team of researchers led by Tyler W. Buckner, MD, from the University of Colorado School of Medicine Hemophilia and Thrombosis Center in Aurora conducted a survey among physiotherapists to evaluate their utilization, role responsibilities, and practice patterns at hemophilia treatment centers and identify any gaps in utilization and role responsibilities.

The unvalidated survey was developed by a multidisciplinary team of hemophilia experts; it was completed by 59 physiotherapists across the United States.

The results showed that physiotherapists working at least 10 hours per week were more likely to provide nutrition and surgical options education to their patients. Similarly, those who billed insurance companies for their services were more likely to provide education regarding surgical options.

Almost all physiotherapists (95%) evaluated and felt comfortable treating pain, and a little more than half (58%) used a formal pain measurement tool. They were more likely to do so if they were billing an insurance company for their services. 

The top 5 nonpharmacologic treatment options that physiotherapists recommended to manage pain were splints or braces, aquatic therapy, orthotics, surgery, and yoga.

Based on the findings of this study, the authors’ recommendations included: “Ensure uniquely trained and skilled [hemophilia treatment center physical therapists] are utilized as core members of the [hemophilia treatment center] treatment team,” and “Supporting [physical therapist] access to specialized educational opportunities to advance expertise in the care of [people with bleeding disorders].”


Newman JR, Durben N, Baumann K, et al. Physical therapy within US HTCs: a multicentre survey of utilization, practice patterns and pain management approaches. Haemophilia. Published online February 13, 2022. doi:10.1111/hae.14501