Joint evaluation instruments for children and adults with haemophilia

With the heightened interest in protocols to prevent or treat complications of haemophilia related to recurrent haemarthroses, there is a need for sen sitive joint-evaluation tools. The World Federation of Haemophilia (WFH) Ph ysical Joint Examination instrument, which was developed for persons with h aemophilia worldwide, is not sensitive enough to detect early structural or functional abnormalities. Therefore, we have expanded the WFH instrument t o detect more subtle abnormalities of joint structure and function, and in addition! developed a new scale specifically tailored to the dynamic growth and gait development of children. We compared the original and three new i nstruments in 43 children with haemophilia. The three new scales all showed better correlation with the WFH pain instrument than did the original WFH physical examination instrument (P < 0.01 for each of the new instruments v s. P>0.05 for the WFH instrument). In addition, results of the new child ph ysical examination instrument best conformed to a normal distribution (P = 0.35) and this instrument had better overall statistical performance. This instrument should be studied further in prospective, longitudinal clinical trials of young children.