Effect of Electrical Stimulation of the Quadriceps Muscles in the Management of Haemophilic Knee Arthropathy

Background Hemarthrosis is the most common disabling manifestation of haemophilia, and recurrent knee bleeding leads to haemophilic arthropathy with pain, muscle wasting, and functional limitation. Evidence on the added benefit of electrical stimulation (ES) in conjunction with therapeutic exercise for haemophilic knee arthropathy is limited, particularly in low-resource settings. So, this study was planned to evaluate the effect of quadriceps ES as an adjunct to isometric quadriceps exercise (IQE) on pain, muscle strength, muscle bulk, bleeding events, and functional status in patients with haemophilic knee arthropathy. Methods This quasi-experimental study was conducted at Dhaka Medical College Hospital from October 2021 to September 2022. Patients aged 12-41 years with mild-moderate haemophilia and mild-moderate haemophilic knee arthropathy were assigned purposively to Group A (ES + IQE; n = 25) or Group B (IQE alone; n = 26). IQE was prescribed twice daily for six months. Group A additionally received quadriceps ES (50 Hz, 15 minutes) twice weekly for the first three months. Outcomes (pain by visual analogue scale (VAS), muscle power by Medical Research Council (MRC) scale, muscle bulk by mid-thigh circumference, bleeding events, and functional outcome by Bangla validated Western Ontario and McMaster Osteoarthritis (WOMAC)) were assessed monthly for six months. Results Baseline characteristics were comparable between the groups. From the third follow-up onward, Group A showed significantly lower pain scores compared with Group B (VAS: 4.08 ± 0.64 vs 4.87 ± 0.86; p-value: 0.002), which remained significant at the sixth follow-up (4.00 ± 0.76 vs 4.69 ± 0.92; p-value: 0.006). Muscle strength improved significantly in Group A, with 52.0% achieving MRC grade 5 compared with 15.4% in Group B at the third follow-up (p-value: 0.006). Muscle bulk was also significantly greater in Group A from the third follow-up (34.89 ± 4.35 cm vs 31.42 ± 3.48 cm; p-value: 0.011). Functional outcomes improved significantly in the intervention group, with lower WOMAC total scores from the second follow-up (38.84 ± 5.15 vs 44.62 ± 4.67; p-value: 0.008) and highly significant differences by the sixth follow-up (p-value: <0.001). Bleeding events were infrequent and did not differ significantly between the groups during the follow-up period. Conclusions Quadriceps ES combined with IQE provides superior pain relief, strength gains, muscle bulk, and functional improvement, without increasing bleeding risk, in mild-to-moderate haemophilic knee arthropathy.