Comparative Effect of Ultrasound and Infrared on Pain, Range of Motion and Joint Health in Patients with Hemophilia A: A Randomized Clinical Trial

Abstract

Background: Hemophilia A is an inherited bleeding disorder characterized by factor VIII deficiency that frequently leads to recurrent hemarthrosis, resulting in joint pain, swelling, and progressive musculoskeletal dysfunction. Physiotherapy plays an important role in managing hemophilic arthropathy; however, evidence comparing the effectiveness of different therapeutic modalities remains limited. Objective: To compare the effects of therapeutic ultrasound and infrared therapy, combined with conventional physiotherapy, on pain, swelling, range of motion, and joint health in patients with Hemophilia A experiencing hemarthrosis. Methods: A randomized clinical trial was conducted involving 30 male patients with Hemophilia A recruited from a specialized hemophilia care center. Participants were randomly assigned to an ultrasound group (n = 15) or an infrared therapy group (n = 15). Both groups received conventional physiotherapy consisting of range-of-motion exercises, isometric strengthening, and stretching for four sessions per week over four weeks. Outcome measures included the Numerical Pain Rating Scale (NPRS), Hemophilia Joint Health Score (HJHS), joint swelling measured by circumferential tape measurement, and joint range of motion assessed using a goniometer. Non-parametric statistical analyses were performed using Mann–Whitney U and Wilcoxon signed-rank tests with significance set at p < 0.05. Results: Both treatment groups demonstrated improvements in pain, swelling, and joint mobility after intervention. The ultrasound group showed greater reductions in severe pain (93.3% to 0%), higher rates of swelling resolution (73.3% reporting no swelling), and significantly greater improvement in flexion limitation compared with the infrared group (p = 0.011). Improvements in extension range of motion and muscle atrophy were observed in both groups but were not statistically different. Conclusion: Therapeutic ultrasound demonstrated superior effectiveness compared with infrared therapy in reducing pain, resolving swelling, and improving joint mobility in patients with Hemophilia A with hemarthrosis, supporting its use as a preferred adjunct modality in physiotherapy-based rehabilitation