Effects of Manual Therapy and Structured Exercises on Postural Balance and Walking Capacity in Adults With Haemophilia

INTRODUCTION: Haemophilic arthropathy (HA) impairs joint health, walking capacity, and postural balance in adults with haemophilia (AwH). Evidence regarding the combined effects of manual therapy and structured exercise on postural balance remains limited. AIM: To investigate the effects of manual therapy combined with structured exercise on joint health, activity-related pain, walking capacity, and static and dynamic balance in AwH. METHODS: This randomized controlled trial included 35 AwH (control group [CG], n = 17; physiotherapy group [PG], n = 18). The PG received manual therapy and supervised exercise twice weekly for six weeks, whereas the CG received routine care. Outcomes included the Hemophilia Joint Health Score (HJHS), Numeric Pain Scale (NPS), 6-Minute Walking Test (6MWT), and postural balance assessed using static stability and Limits of Stability (LoS) tests. Analyses were performed according to both intention-to-treat (ITT) and per-protocol (PP) principles. RESULTS: Groups were comparable at baseline (all p > 0.05). Following the intervention, the PG showed significant improvements in HJHS, NPS, 6MWT, and LoS (all p < 0.001), whereas no significant changes were observed in the CG. Repeated-measures ANOVA showed significantly greater improvements over time in the PG than in the CG for HJHS, NPS, 6MWT, and LoS, whereas static balance remained unchanged. CONCLUSION: Manual therapy combined with structured progressive exercise improves joint health, activity-related pain, walking capacity, and dynamic balance in AwH. These findings support the use of combined manual therapy and exercise as part of physiotherapy management for HA.