Multimodal Telerehabilitation Versus Face-to-Face Care for Adults With Hemophilia and Chronic Pain
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: other, Exercise.
- Who it may be relevant to
- Registry conditions: Hemophilia, Chronic Pain. Basic parameters: 18 years — 60 years · Male.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- Chile
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Official title
Effects of a Multimodal Telerehabilitation Intervention Versus Face-to-Face Care in Adults With Hemophilia and Chronic Pain: A Randomized Controlled Non-Inferiority Trial
Overview
Hemophilia is an inherited bleeding disorder that is commonly associated with chronic joint pain, reduced physical function, and decreased quality of life. Pain science education combined with exercise therapy has shown beneficial effects in people with chronic musculoskeletal pain; however, its effectiveness in people with hemophilia remains largely unknown. Telerehabilitation may improve access to rehabilitation by reducing geographical and transportation barriers, but its effectiveness compared with face-to-face delivery has not been established in this population. This randomized controlled non-inferiority trial will compare a 6-week multimodal telerehabilitation program consisting of pain science education and therapeutic exercise with an equivalent face-to-face program in adults with hemophilia and chronic pain. Participants will be randomly assigned to one of the two interventions. Clinical outcomes will be assessed before and after the intervention by an assessor blinded to group allocation. The study aims to determine whether telerehabilitation provides clinical outcomes that are not inferior to those achieved with conventional face-to-face rehabilitation.
Detailed description
Chronic pain affects nearly half of adults with hemophilia and is associated with impaired physical function, kinesiophobia, reduced self-efficacy, and poorer quality of life. Recurrent joint bleeding and hemophilic arthropathy contribute to persistent pain and disability, highlighting the need for accessible and effective rehabilitation strategies.
Pain science education (PSE) is an educational intervention designed to improve understanding of the biological and psychosocial mechanisms underlying persistent pain, reduce pain-related threat, and promote adaptive health behaviors. When combined with exercise therapy, PSE has demonstrated beneficial effects in individuals with chronic musculoskeletal disorders. However, evidence supporting its use in people with hemophilia is scarce.
Telerehabilitation has emerged as a promising strategy to improve access to rehabilitation services by reducing travel burden and geographical barriers while maintaining treatment adherence. Although previous studies suggest that telerehabilitation may provide outcomes comparable to conventional rehabilitation in several musculoskeletal conditions, no randomized controlled trial has compared multimodal pain science education plus exercise delivered by telerehabilitation with an equivalent face-to-face program in adults with hemophilia and chronic pain.
This study is a single-center, randomized, assessor-blinded, parallel-group non-inferiority trial. Participants will be randomly allocated (1:1) to receive either a 6-week telerehabilitation program or an equivalent face-to-face program. Both groups will receive the same educational content and exercise protocol, differing only in the mode of delivery.
The primary objective is to determine whether multimodal telerehabilitation is non-inferior to face-to-face rehabilitation in reducing pain intensity and improving pain sensitivity. Secondary objectives include evaluating changes in kinesiophobia, self-efficacy, joint health, functional performance, and patient-perceived improvement.
The results of this trial will provide evidence regarding the effectiveness of multimodal telerehabilitation for adults with hemophilia and may support the implementation of accessible rehabilitation models in clinical practice.
Interventions
- Behavioral other
A standardized pain neuroscience education program delivered once weekly for 6 weeks. Educational sessions focus on the neurobiology and neurophysiology of pain, pain modulation, central sensitization, the influence of cognitive and emotional factors on pain, and strategies to promote adaptive self-management and behavior change. The educational content is identical in both study arms and differs only in the mode of delivery (telerehabilitation or face-to-face). - Other Exercise
A standardized supervised exercise program delivered once weekly for 6 weeks. Each session includes a warm-up, joint mobility exercises, stretching, and progressive strengthening exercises for major muscle groups. Exercise intensity is progressively increased according to participants' perceived exertion using the Borg CR10 scale. The exercise protocol is identical in both study arms and differs only in the mode of delivery.
Primary outcome measures
- Pain Intensity [Time frame: Baseline and immediately after the 6-week intervention.]
Secondary outcome measures (4)
- Kinesiophobia [Time frame: Baseline and immediately after the 6-week intervention.]
- Pain Self-Efficacy [Time frame: Baseline and immediately after the 6-week intervention.]
- Functional Performance [Time frame: Baseline and immediately after the 6-week intervention]
- Pressure Pain Threshold [Time frame: Baseline and immediately after the 6-week intervention.]
Eligibility criteria
Inclusion criteria
Male adults aged 18 to 60 years. Diagnosis of hemophilia A or hemophilia B. Chronic pain, defined as pain occurring every day for at least 3 months or on at least half of the days during the previous 6 months.
Pain involving the elbow, knee, or ankle. Receiving prophylactic clotting factor replacement therapy at least three times per week.
Current medical referral for physical therapy. Residence in the Metropolitan Region of Chile. Ability to understand study procedures and provide written informed consent.
Exclusion criteria
Inability to understand study instructions or provide written informed consent. Neurological disorders affecting the central nervous system (e.g., stroke). Current participation in alternative therapies for pain management. Previous participation in a pain neuroscience education program. Orthopedic surgery or major musculoskeletal trauma within the previous 12 months.
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Allocation
- Randomized
- Model
- Parallel assignment
- Masking
- Single blind
- Primary purpose
- Treatment
Study locations
Chile · 1 center
- Department of Physical Therapy, Faculty of Medicine, University of Chile — Santiago
Identifiers
NCT: NCT07682519 · UI-001/25