Fabian Tomschi

Introduction: Radiosynoviorthesis (RSO) may alleviate pain and clinical symptoms in people with haemophilia (PwH), however, controlled longitudinal data on these outcomes remain limited. Aim: To evaluate the effects of RSO on pain, joint health, swelling, and treatment satisfaction over twelve months. Methods: Patients with an indication for RSO ( n = 30) and patients without indication ( n = 33) were examined for subjective joint‐related pain (NRS), pressure pain thresholds (PPT), the Haemophilia Joint Health Score (HJHS), and joint swelling at baseline and three, six, and twelve months post‐RSO. RSO‐treated joints (J‐RSO, n = 33) were compared to the corresponding contralateral joint (J‐CL, n = 33), and joints of control PwH without RSO (J‐Con, n = 33). Results: RSO was administered in 9 elbows, 6 knees, and 18 ankles. Over the twelve‐month follow‐up, no significant time x joint group interaction was observed for NRS between J‐RSO and J‐Con ( p = 0.092) or J‐CL ( p = 0.096). However, from baseline to three months, reduction in NRS was significantly more pronounced in J‐RSO compared to control joints. No significant differences in longitudinal changes were observed for PPT or HJHS. Swelling was significantly reduced in J‐RSO at three and six months (each p = 0.037), without significant differences compared to control joints. At twelve months, the majority of RSO‐treated patients (78.8%) reported treatment satisfaction. Conclusion: RSO was associated with a greater early reduction in subjective joint‐related pain. Over the twelve‐month follow‐up, this gradually decreased, resulting in no significant difference in overall pain trajectory. Swelling decreased for six months only in J‐RSO, while PPT and HJHS showed no significant improvements in J‐RSO.

Background: Competitive esports involve prolonged sedentary behavior combined with high cognitive and emotional demands, potentially influencing acute physiological responses. However, evidence regarding acute cardiovascular, autonomic, and endocrine responses to competitive gaming remains inconsistent and methodologically heterogeneous. Methods: In this randomized controlled crossover study, sixteen healthy male EA Sports FC players completed a one-hour competitive gaming session and a control condition (documentary viewing). Heart rate (HR), root mean square of successive differences (RMSSD) and standard deviation of NN-intervals (SDNN) for heart rate variability (HRV) were recorded continuously. Peripheral and central blood pressure, pulse wave velocity (PWV) and salivary cortisol were assessed at baseline, post-session, and after 15 min of rest. Linear mixed-effects models examined the effects of condition, time, and their interaction while accounting for period and sequence effects. Results: RMSSD ( p = 0.005, ηₚ² = 0.13) and SDNN ( p = 0.040, ηₚ² = 0.08) showed a significant Condition x Time interaction, with an increase in the control condition, whereas no significant temporal changes were observed during gaming. No significant Condition x Time interactions were observed for HR, PWV, peripheral and central blood pressure. Salivary cortisol decreased over time in both conditions ( p < 0.001, ηₚ² = 0.33) without condition-specific effects ( p = 0.765). Conclusion: In this laboratory setting, no significant condition specific temporal changes in acute hemodynamic or cortisol responses were detected during competitive gaming compared with passive documentary viewing. The observed differences in cardiac autonomic regulation were primarily driven by an increase in HRV during the control condition, whereas no significant temporal changes in HRV were observed during gaming. Trial registration: The study was preregistered in the German Clinical Trials Registry on 05 June 2024 (ID: DRKS00034399).

Background: Pressure pain threshold (PPT) testing is a widely used quantitative sensory testing method to assess mechanical pain sensitivity. While reference values for PPT at articular-/joint-related and osseous landmarks are available, data on measurement reliability remain limited. This study aimed to determine the intra- and inter-rater reliability of PPT measurements and to report the standard error of measurement (SEM) for joint PPT. Methods: Healthy participants aged 18–40 years were included in a two-part study. In Part A ( N = 40), intra-rater reliability was assessed through three repeated PPT measurements by the same examiner. In Part B ( N = 40), inter-rater reliability was evaluated with two different examiners. PPT was measured at joints (elbow, knee, ankle) and reference landmarks (sternum, forehead) using a digital algometer. ICCs (2,k model) and SEM were calculated for each landmark. Results: Intra-rater reliability was excellent at all landmarks (ICCs ≥ 0.926) except the elbow with a good reliability (ICC = 0.848). Inter-rater reliability was excellent at the sternum (ICC = 0.950) and good at the ankle, knee, elbow, and forehead (ICCs ≥ 0.813). SEM values varied across landmarks, with lowest values observed at reference landmarks sites (e.g., sternum and forehead). ICCs are similar between sexes. Conclusions: PPT measurements at articular (joints) and bony reference landmarks show good to excellent reliability. These findings support the use of joint PPT in standardized pain sensitivity assessments and provide a basis for clinical and research applications. However, findings are limited to pain-free participants and should be replicated in broader populations.

Background: While specific types of exercise (e.g., core exercise) are recommended for the management of chronic low back pain (CLBP), little is known of the effects of whole-body strength training (WBST) on pain outcomes. Objective: This randomized controlled trial investigated the effects of a WBST program on pain intensity, pain sensitivity, and core strength in CLBP patients. Methods: 45 Patients were assigned to an intervention group (IG) or active control group (CG). The IG completed 12 weeks of WBST (45 min/week) plus group training (45 min/week), while the CG only performed the group training. Pain intensity (numeric rating scale, NRS, 0–10), lumbar pressure pain thresholds (PPT, N/cm ² ), and isometric trunk flexion/extension strength (kg) were assessed baseline (T0), post-intervention (T1), and follow-up (T2, NRS only). Results: 32 Patients finished the intervention and were analyzed. For PPT, an interaction effect for ‘time’ × ‘group’ was observed (p = 0.048) and the IG showed improvements in PPT (T0 = 38.2 ± 21.1; T1 = 48.1 ± 29.1), while the CG showed no change. A main effect ‘time’ (p < 0.001) and no interaction effect (p = 0.737) was observed for NRS. In the IG, NRS was lower at T1 and T2 compared to T0 (T0 = 5.0 ± 1.7; T1 = 3.8 ± 1.7; T2 = 3.8 ± 1.5), while no difference was found in the CG. For core extension and flexion strength, main effects ‘time’ (p ≤ 0.001) and no interaction effects (p > 0.071) were observed, while strength increased only in the IG (extension: T0 = 60.0 ± 23.7; T1 = 74.4 ± 28.9; flexion: T0 = 40.3 ± 16.9; T1 = 48.5 ± 19.2). PPT correlated positively with trunk strength (r = 0.320–0.621). Conclusion: WBST combined with group exercise improves lumbar pain sensitivity in CLBP patients and might therefore be considered as an efficient training option within rehabilitation programs.

Background/Objectives: Haemophilia-related bleedings primarily affect the musculoskeletal system, and functional tests are used in clinical management. Yet, fine motor skills of the upper extremities have not been evaluated in adult persons with haemophilia (PwH). The Moberg Pick-Up Test (MPUT) assesses fine motor skills but has only been psychometrically evaluated in other cohorts. This study aims to examine its psychometric properties in PwH. Methods: A total of 40 moderate or severe PwH A or B were included. The MPUT, consisting of three trials, was conducted twice by rater A and once by rater B. The best performance per hand of each MPUT was used. Subjective hand function (Duruöz Hand Index (DHI) and numeric rating scale (NRS)), elbow joint status (Haemophilia Joint Health Score (HJHS)), pain (NRS), and wrist range of motion (ROM) were utilised for convergent validity evaluation. Inter-rater and test–retest reliability were determined through intraclass correlation coefficients (ICCs) for raw and log10-transformed data. Results: Inter-rater and test–retest reliability demonstrated moderate-to-excellent ICCs for both data types (ICC range: 0.624–0.918). The DHI correlated moderately with the average MPUT score of both hands (r = 0.410; p = 0.016). Left-hand MPUT scores did not correlate with left elbow HJHS scores, whereas right-hand MPUT scores correlated with right elbow HJHS scores (r = 0.396, p = 0.018). Subjective left-hand function (NRS) correlated with the results of the MPUT (r = 0.433; p = 0.009). Conclusions: The MPUT is a reliable and partially valid tool and can be useful to assess fine motor skills in PwH.

Introduction: Sufficient sleep is essential for maintaining both physical and mental health, yet data on sleep health among persons with haemophilia (PwH) remain limited. Aim: This study aimed to assess sleep in PwH compared to healthy controls (Con) and identify factors associated with impaired sleep quality (SQual) in PwH. Methods: 100 PwH A or B and 100 Con participated. Sleep metrics were assessed using the German sleep questionnaire (Schlaffragebogen B revised), comparing SQual, trouble falling asleep (TFA), trouble staying asleep (TSA), feeling of being restored after sleep (RAS), and sleep quantity (SQuan) between groups. Additionally, variables potentially associated with SQual in PwH, i.e. age, BMI, current pain (NRS _now ), pain over four weeks (NRS‐4w), joint health (Haemophilia Joint Health Score (HJHS)), and quality of life (QoL), were analysed using a multiple regression model. Results: Age‐adjusted comparisons revealed significantly worse SQual ( p < 0.001) and RAS ( p = 0.037) in PwH compared to Con, with no significant differences in TFA, TSA, and SQuan. Regression analysis identified only NRS‐4w ( p = 0.012) and QoL ( p = 0.008) as significant predictors of worse SQual in PwH ( R ² = 0.17), while age, BMI, and HJHS had no significant effect. Conclusion: PwH exhibit poorer SQual and RAS compared to Con, with pain and diminished QoL being key factors contributing to impaired SQual. Other sleep indices such as TFA, TSA and SQuan were unaltered. Given the adverse health impacts of poor SQual and its association with pain, integrating sleep assessment into routine care may enhance patient outcomes.

Background: Persons with hemophilia (PwH) develop arthropathic changes due to recurrent hemarthroses. This study aimed to comprehensively investigate structural knee joint alterations in PwH, extended beyond synovitis and osteochondral abnormalities, and to compare findings with healthy controls (Con). Methods: Bilateral knee ultrasound examinations were performed in 36 male PwH (severe A: 30, B: 2; moderate A: 3, B: 1; mean age: 47.1 ± 12.0) and 39 age-matched Con (mean age: 47.7 ± 12.8). A total of 26 landmarks and tissues, including synovium, osteophytes, ligaments, tendons, and bursae, were assessed quantitatively or semi-quantitatively. Clinical joint status was classified using the Hemophilia Joint Health Score, distinguishing between minorly (PwH-MI) and majorly (PwH-MA) affected joints. Results: Synovium, osteophytes, ligaments, and bursae showed more pronounced alterations in PwH compared to Con. While the iliotibial band was slightly thicker in PwH (p = 0.023), the popliteus tendon (p = 0.001) and patellar tendon at the tibial insertion were significantly thinner. PwH-MA showed significant changes at all landmarks (p < 0.001), while PwH-MI demonstrated differences only in the lateral knee joint synovium (p = 0.006) compared to Con. Osteophytes and synovium were significantly thicker in PwH-MA than in PwH-MI. Conclusion: The findings highlight the importance of assessing periarticular structures in PwH, as changes may contribute to functional impairments such as gait deviations. Further research is required to clarify the clinical implications.