Multimodal Telerehabilitation Versus Face-to-Face Care for Adults With Hemophilia and Chronic Pain

Hemophilia is an inherited bleeding disorder that is commonly associated with chronic joint pain, reduced physical function, and decreased quality of life. Pain science education combined with exercise therapy has shown beneficial effects in people with chronic musculoskeletal pain; however, its effectiveness in people with hemophilia remains largely unknown. Telerehabilitation may improve access to rehabilitation by reducing geographical and transportation barriers, but its effectiveness compared with face-to-face delivery has not been established in this population. This randomized controlled non-inferiority trial will compare a 6-week multimodal telerehabilitation program consisting of pain science education and therapeutic exercise with an equivalent face-to-face program in adults with hemophilia and chronic pain. Participants will be randomly assigned to one of the two interventions. Clinical outcomes will be assessed before and after the intervention by an assessor blinded to group allocation. The study aims to determine whether telerehabilitation provides clinical outcomes that are not inferior to those achieved with conventional face-to-face rehabilitation.

Inclusion Criteria: Male adults aged 18 to 60 years. Diagnosis of hemophilia A or hemophilia B. Chronic pain, defined as pain occurring every day for at least 3 months or on at least half of the days during the previous 6 months. Pain involving the elbow, knee, or ankle. Receiving prophylactic clotting factor replacement therapy at least three times per week. Current medical referral for physical therapy. Residence in the Metropolitan Region of Chile. Ability to understand study procedures and provide written informed consent. Exclusion Criteria: Inability to understand study instructions or provide informed consent. Neurological disorders affecting the central nervous system (e.g., stroke). Current participation in alternative therapies for pain management. Previous participation in a pain neuroscience education program. Orthopedic surgery or major musculoskeletal trauma within the previous 12 months.