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Introduction: As a result of centralisation of haemophilia care to a limited number of intramural settings, many persons with haemophilia have to travel long distances to attend their haemophilia specialised treatment centre. However, regular physiotherapy treatment can be provided by primary care physiotherapists in the personʼs own region. Due to the rarity of the disease most primary care physiotherapists have limited experience with this population. This study aims to provide a clinical practice guideline for primary care physiotherapists working with persons with bleeding disorders. Method: A list of the most urgent key‐questions was derived from a previous study. Literature was summarised using the grading of recommendations assessment, development, and evaluation (GRADE) evidence‐to‐decision framework. Recommendations were drafted based on four 90 min consensus meetings with expert physiotherapists. Recommendations were finalised after feedback and >80% consensus of all stakeholders (including PWH, physiotherapists, haematologists and the corresponding societies). Results: A list of 82 recommendations was formulated to support primary care physiotherapists when treating a person with a bleeding disorder. These recommendations could be divided into 13 categories: two including recommendations on organisation of care, six on therapy for adult patients with bleeding disorders and five on therapy adaptations for paediatric care. Therapy recommendations included treatment after a joint‐ or muscle bleed, haemophilic arthropathy, chronic synovitis, non‐haemophilia related conditions and orthopaedic surgery. Conclusion: An evidence‐based practice guideline, based on current evidence from literature and clinical expertise, has been developed for primary care physiotherapists treating a person with haemophilia. To improve care, the recommendations should be implemented in daily practice. [ABSTRACT FROM AUTHOR]

We encourage therapists to critically examine their own practice, as well as asking centre directors and therapy managers to see the value of a well-defined physiotherapy service within haemophilia. GLO:EVW/01mar21:hae14150-fig-0001.jpg PHOTO (COLOR): 1 Recommendation for reviewing provision of a local haemophilia physiotherapy service gl It remains unclear if new treatments (EHL's, non-substitutive therapies) will considerably reduce the frequency of bleeding in patients treated. Acute pain significantly impacts quality of life and is greater when present on a backdrop of ongoing persistent pain.6 An increase in age is also associated with a decrease in quality of life predominantly related to haemophilia-specific MSK complications, that is, joint disease. [Extracted from the article]