POCUS focus

Bleeding into the joints is a common ‘complication’ of having haemophilia. As any of us who have experienced this can attest to, it’s really not fun. Worse, it can cause long term damage to the joint.

It can sometimes be tricky to assess if joint pain is due to an active joint bleed or caused by underlying joint damage. Neither of these types of pain are nice, but identifying the cause is important in choosing the right course of action.

Sharing skills

In a paper recently published in The Journal of Haemophilia Practice, Karen Strike and her colleagues point out that haemophilia treatment centres around the world are increasingly adopting ‘point-of-care ultrasonography’ (or POCUS, which is a pretty cool acronym) to monitor joint health. POCUS can help healthcare professionals ensure they are obtaining the best possible outcomes for people with haemophilia – for example, by helping to determine whether the pain someone is experiencing is because of a joint bleed or underlying joint damage. However, it requires quite a bit of experience and technique to use it properly.

As it’s often physiotherapists in haemophilia treatment centres who use POCUS, Karen and her colleagues set out to see if there was any difference between the scans performed by a sonographer (a healthcare professional who specialises in using ultrasonic imaging devices) and scans performed by a physiotherapist. Excitingly, they found an excellent level of agreement between the sonographer and the physiotherapist. This suggests that after only a relatively short period of formal training, physiotherapists are capable of obtaining and interpreting ultrasound imagery of joint bleeds to the same degree of proficiency as a skilled sonographer.

Physio advocacy

Having the technology available to determine the presence of bleeding accurately means that people with haemophilia, and healthcare professionals themselves, can be confident about receiving and delivering optimal care, respectively. This is particularly important in a context where advances in treatment can mean symptoms are often subtler. Physiotherapists in haemophilia treatment centres regularly go above and beyond for their patients, so it’s wonderful to see this endorsement of yet another skill that they can bring to the management of our condition.

Patient advocacy groups need to ensure that they continue to campaign for the integration of physiotherapists into haemophilia treatment centres, and for physiotherapists to have access to the types of training that empowered the physiotherapist in this study to deliver quality point-of-care ultrasonography.


Further reading

Strike K, Chan AKC, Maly MR, Stein N, Farrell L, Solomon P. Point of care ultrasonography in patients with haemophilia and acute haemarthrosis: a physiotherapist and sonographer inter-professional agreement pilot study. J Haem Pract 2022; 9(1): 64-75. doi: 10.2478/jhp-2022-0008

About the author

Rich Gorman lives with severe haemophilia A. He works as a researcher at Brighton and Sussex Medical School.

Image: Shutterstock/Peter Porrini