Balance, strength and related falls risk factors in people with haemophilia and other bleeding disorders (PWH), and feasibility of a targeted home exercise program to improve balance.

Health professionals working with people with haemophilia and other bleeding disorders (PWH) report a concern that patients appear to be at increased risk of falls and serious injuries from falls. However, to date there is no published research about falls risk in samples of adult haemophilia patients or any research quantifying the extent of balance dysfunction in PWH. Therefore this project aims to: - Determine which measures of balance performance are most useful in identifying balance impairment in PWH in comparison to healthy age and gender matched controls; - Evaluate the association between balance performance and falls risk; - Evaluate the association between balance performance and falls efficacy (confidence in mobility); and - Evaluate the feasibility and effectiveness of a tailored home exercise program in improving balance and related outcomes for PWH. Thirty adults with haemophilia or other bleeding disorders and 30 age and gender matched healthy adults will be recruited. All participants will undergo a baseline assessment of laboratory measures of balance, clinical measures of balance, falls risk, falls efficacy, activity level, pain, disease severity and health related quality of life. Following the initial assessment the participants from the haemophilia group will be provided with an individually tailored balance and strengthening home exercise program from a physiotherapist, based on the results of the initial assessment. The participants will be required to undertake the home exercise program for four months, during which time they will receive two visits from the physiotherapist, who will review them and provide any support required. At the end of the four month program the participants from the haemophilia group will undergo the baseline assessment again in order to evaluate their progress. This pilot work will be useful to inform health care providers, and PWH, about the magnitude of the problem of balance dysfunction, what methods are most appropriate to identify this risk, and whether standard balance training exercises will be useful in this group. If successful, further studies will be required with a large sample to evaluate whether this approach can reduce falls in this group.