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Lee S, Bourque J, Noël L, Hazel E, Ramsay E, Bélice R, Robbins S. Psychometric properties of the Mini-Balance Evaluation Systems Test and physical function measures in patients with Ehlers-Danlos syndrome/hypermobility spectrum disorders. Disabil Rehabil 2024:1-6. [PMID: 38828687 DOI: 10.1080/09638288.2024.2361137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/23/2024] [Indexed: 06/05/2024]
Abstract
PURPOSE Ehlers-Danlos syndrome (EDS) and hypermobility spectrum disorders (HSD) are associated with impairments in balance and physical function. However, the psychometric properties of relevant outcome measures remain largely unexplored. The objectives of this study were to evaluate the construct validity of the Mini-Balance Evaluation Systems Test (Mini-BESTest) alongside the test-retest reliability of the Mini-BESTest, Six Minute Walk Test (6MWT), and Lower Extremity Functional Scale (LEFS) in patients with the hypermobility subtype of EDS (hEDS) and HSD. MATERIALS AND METHODS Participants with hEDS/HSD (n = 20) attended two visits scheduled one to two weeks apart. The construct validity of the Mini-BESTest was determined through Pearson correlations between force plate balance measures, 6MWT, and LEFS. Test-retest reliability of the measures was evaluated through intraclass correlation coefficients (ICC). Minimal detectable change values with 95% confidence (MDC95) were also calculated. RESULTS Mini-BESTest demonstrated significant correlations with force plate measures, 6MWT, and LEFS (r = -0.41 to 0.66). Test-retest reliability was excellent for the Mini-BESTest, 6MWT, and LEFS (ICC = 0.91 to 0.96). MDC95 was 4 for the Mini-BESTest, 77 m for the 6MWT, and 11 for the LEFS. CONCLUSION The Mini-BESTest is valid and reliable for assessing balance and mobility in patients with hEDS/HSD.IMPLICATIONS FOR REHABILITATIONThe Mini Balance Evaluation Systems Test (Mini-BESTest) is valid in capturing aspects of balance and physical function in patients with hypermobile Ehlers-Danlos syndrome or hypermobility spectrum disorders.However, the Mini-BESTest may show a potential ceiling effect for high functioning patients in this population.The Mini-BESTest, 6 Minute Walk Test, and the Lower Extremity Functional Scale also show excellent test-retest reliability in this population.The Minimal Detectable Change with 95% confidence intervals is 4 for the Mini-BESTest, 77 m for the 6 Minute Walk Test, and 11 for the Lower Extremity Functional Scale in this population.
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Affiliation(s)
- Soomin Lee
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Jonathan Bourque
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Laurence Noël
- Lethbridge-Layton-MacKay Rehabilitation Centre, Montreal, Quebec, Canada
| | - Elizabeth Hazel
- Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Emma Ramsay
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Raphaël Bélice
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Shawn Robbins
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Centre for Interdisciplinary Research in Rehabilitation, Lethbridge-Layton-MacKay Rehabilitation Centre, Montreal, Quebec, Canada
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Garreth Brittain M, Flanagan S, Foreman L, Teran-Wodzinski P. Physical therapy interventions in generalized hypermobility spectrum disorder and hypermobile Ehlers-Danlos syndrome: a scoping review. Disabil Rehabil 2024; 46:1936-1953. [PMID: 37231592 DOI: 10.1080/09638288.2023.2216028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 05/13/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE Physical therapy (PT) plays a central role in treating individuals with Generalized Hypermobility Spectrum Disorder (G-HSD) and Hypermobile Ehlers-Danlos Syndrome (hEDS). However, there is limited research describing these individuals' PT management. This review aims to systematically map the evidence on PT interventions to treat this patient population. METHODS A systematic literature search of PubMed, CINAHL, and Embase from January 2000 to April 2023 was performed. After the screening process, studies were appraised and classified based on the type of PT interventions used. Five reviewers independently assessed the articles. RESULTS The search produced 757 articles. Twenty-eight met the inclusion criteria. The studies included 630 participants, mostly female, with a mean age of 26.2 (ranging from 2 to 69). The PT interventions used were therapeutic exercise, patient instruction, motor function training, adaptive equipment, manual therapy, and functional training. CONCLUSIONS The evidence indicates that therapeutic exercise and motor function training are efficacious methods to treat individuals with G-HSD and hEDS. There is also weak evidence for using adaptive equipment, patient instruction, manual therapy, and functional training. Recent studies emphasize multidisciplinary care and understanding of the psychological impact of G-HSD/hEDS. Additional research is needed to determine the effectiveness and dosage of PT interventions.
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Affiliation(s)
- Mackenzie Garreth Brittain
- School of Physical Therapy and Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Sarah Flanagan
- School of Physical Therapy and Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Lindsey Foreman
- School of Physical Therapy and Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Patricia Teran-Wodzinski
- School of Physical Therapy and Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
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Benistan K, Foy M, Gillas F, Genet F, Kane M, Barbot F, Vaugier I, Bonnyaud C, Gader N. Effects of compression garments on balance in hypermobile Ehlers-Danlos syndrome: a randomized controlled trial. Disabil Rehabil 2024; 46:1841-1850. [PMID: 37194618 DOI: 10.1080/09638288.2023.2209742] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 04/28/2023] [Indexed: 05/18/2023]
Abstract
PURPOSE To evaluate the immediate and 4-week effects of compression garments (CG) on balance using a force platform during 8 different visual, static, and dynamic conditions in hypermobile Ehlers-Danlos Syndrome (hEDS) patients. METHODS Thirty-six participants were randomly assigned to a group: physiotherapy alone (PT, n = 19) or physiotherapy and daily CG wearing for 4 weeks (PT + CG, n = 17). Both attended 12 physiotherapy sessions (strengthening, proprioception, and balance exercises) for 4 weeks. Primary outcome: sway velocity of the centre of pressure (COP) measured before, immediately with the CG, and at 4 weeks. Secondary outcomes: ellipse area, Romberg quotient, and pain. RESULTS Sway velocity in dynamic conditions decreased immediately with the CG. After 4 weeks of intervention, sway velocity (95% CI 4.36-39.23, effect size 0.93) and area (95% CI 146-3274, effect size 0.45) on the laterally oscillating platform with eyes-closed improved more in the PT + CG group than the PT group. Romberg quotient on foam cushion improved more in the PT + CG than the PT group. Pain decreased in both groups after 4 weeks with no between-group difference. CONCLUSION CG combined with physiotherapy improved dynamic balance measured with COP variables significantly more than physiotherapy alone in people with hEDS. TRIAL REGISTRATION NCT03359135.
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Affiliation(s)
- Karelle Benistan
- AP-HP, Hôpital Raymond Poincaré, Centre de référence des syndromes d'Ehlers-Danlos non vasculaires, Université Paris Saclay, Garches, France
- UMR1179 INSERM, UFR Simone Veil-Santé, Versailles, France
| | - Malika Foy
- AP-HP, Hôpital Raymond Poincaré, Centre de référence des syndromes d'Ehlers-Danlos non vasculaires, Université Paris Saclay, Garches, France
| | - Fabrice Gillas
- AP-HP, Hôpital Raymond Poincaré, Centre de référence des syndromes d'Ehlers-Danlos non vasculaires, Université Paris Saclay, Garches, France
| | - François Genet
- UMR1179 INSERM, UFR Simone Veil-Santé, Versailles, France
- AP-HP, Hôpital Raymond-Poincaré, Service de médecine physique et de réadaptation, Université Paris Saclay, Garches, France
| | - Maimouna Kane
- AP-HP, Hôpital Raymond Poincaré, Centre d'investigation Clinique, Garches, France
| | - Frédéric Barbot
- AP-HP, Hôpital Raymond Poincaré, Centre d'investigation Clinique, Garches, France
| | - Isabelle Vaugier
- AP-HP, Hôpital Raymond Poincaré, Centre d'investigation Clinique, Garches, France
| | - Céline Bonnyaud
- AP-HP, Hôpital Raymond Poincaré, Laboratoire d'analyse du mouvement, Université Paris-Saclay, Garches
- Université de Versailles Saint Quentin en Yvelines, ERPHAN, Versailles, France
| | - Nadra Gader
- AP-HP, Hôpital Raymond Poincaré, Centre de référence des syndromes d'Ehlers-Danlos non vasculaires, Université Paris Saclay, Garches, France
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Börsch N, Mücke M, Maier A, Conrad R, Pantel JT, Sellin J, Mani K, Chopra P. Treating pain in patients with Ehlers-Danlos syndrome : Multidisciplinary management of a multisystemic disease. Schmerz 2024; 38:12-18. [PMID: 38189943 DOI: 10.1007/s00482-023-00778-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND The clinical picture of people with Ehlers-Danlos syndromes (EDS) is complex and involves a variety of potential causes of pain. This poses major challenges to patients and healthcare professionals alike in terms of diagnosis and management of the condition. OBJECTIVES The aim of the article was to provide an overview of the specific pain management needs of patients with EDS and address their background. MATERIAL AND METHODS A selective literature search was performed to highlight the current state of research on pain management in EDS patients. RESULTS Affected patients require multimodal pain management considering their individual needs, disease-specific features, and comorbidities. CONCLUSION Medical awareness and evidence need to be further improved to enhance the medical care situation of these patients with complex needs.
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Affiliation(s)
- Natalie Börsch
- Institute for Digitalization and General Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany.
- Center for Rare Diseases (ZSEA), Medical Faculty, RWTH Aachen University, Aachen, Germany.
| | - Martin Mücke
- Institute for Digitalization and General Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Center for Rare Diseases (ZSEA), Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Andrea Maier
- Department of Neurology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Muenster, Muenster, Germany
| | - Jean Tori Pantel
- Institute for Digitalization and General Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Center for Rare Diseases (ZSEA), Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Julia Sellin
- Institute for Digitalization and General Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Center for Rare Diseases (ZSEA), Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Kyros Mani
- Institute for Digitalization and General Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Center for Rare Diseases (ZSEA), Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Pradeep Chopra
- Center for Complex Conditions, Brown Medical School, Providence, RI, USA
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Ramírez-Paesano C, Rodiera Clarens C, Sharp Segovia A, Coila Bustinza A, Rodiera Olive J, Juanola Galceran A. Perioperative opioid-minimization approach as a useful protocol in the management of patients with Ehlers-Danlos syndrome-hypermobility type, craniocervical instability and severe chronic pain who are to undergo occipito-cervical fixation. Orphanet J Rare Dis 2023; 18:214. [PMID: 37491286 PMCID: PMC10369693 DOI: 10.1186/s13023-023-02829-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/12/2023] [Indexed: 07/27/2023] Open
Abstract
Patients suffering from connective tissue disorders like Ehlers-Danlos syndrome hypermobility type/joint hypermobility syndrome (EDS-HT/JHS) may be affected by craniocervical instability (CCI). These patients experience myalgic encephalomyelitis, chronic fatigue, depression, extreme occipital-cervical pain, and severe widespread pain that is difficult to relieve with opioids. This complex and painful condition can be explained by the development of chronic neuroinflammation, opioid-induced hyperalgesia, and central sensitization. Given the challenges in treating such severe physical pain, we evaluated all the analgesic methods previously used in the perioperative setting, and updated information was presented. It covers important physiopathological aspects for the perioperative care of patients with EDS-HT/JHS and CCI undergoing occipital-cervical/thoracic fixation/fusion. Moreover, a change of paradigm from the current opioid-based management of anesthesia/analgesia in these patients to the perioperative opioid minimization strategies used by the authors was analyzed and proposed as follow-up considerations from our previous case series. These strategies are based on total-intravenous opioid-free anesthesia, multimodal analgesia, and a postoperative combination of anti-hyperalgesic coadjuvants (lidocaine, ketamine, and dexmedetomidine) with an opioid-sparing effect.
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Affiliation(s)
- Carlos Ramírez-Paesano
- Servei Central d'Anestesiología (Anestalia), Centro Médico Teknon, Grupo Quironsalud, Carrer Vilana 12, 08022, Barcelona, Spain.
| | - Claudia Rodiera Clarens
- Servei Central d'Anestesiología (Anestalia), Centro Médico Teknon, Grupo Quironsalud, Carrer Vilana 12, 08022, Barcelona, Spain
| | - Allan Sharp Segovia
- Servei Central d'Anestesiología (Anestalia), Centro Médico Teknon, Grupo Quironsalud, Carrer Vilana 12, 08022, Barcelona, Spain
| | - Alan Coila Bustinza
- Servei Central d'Anestesiología (Anestalia), Centro Médico Teknon, Grupo Quironsalud, Carrer Vilana 12, 08022, Barcelona, Spain
| | - Josep Rodiera Olive
- Servei Central d'Anestesiología (Anestalia), Centro Médico Teknon, Grupo Quironsalud, Carrer Vilana 12, 08022, Barcelona, Spain
| | - Albert Juanola Galceran
- Servei Central d'Anestesiología (Anestalia), Centro Médico Teknon, Grupo Quironsalud, Carrer Vilana 12, 08022, Barcelona, Spain
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Guerrieri V, Polizzi A, Caliogna L, Brancato AM, Bassotti A, Torriani C, Jannelli E, Mosconi M, Grassi FA, Pasta G. Pain in Ehlers-Danlos Syndrome: A Non-Diagnostic Disabling Symptom? Healthcare (Basel) 2023; 11:healthcare11070936. [PMID: 37046863 PMCID: PMC10094213 DOI: 10.3390/healthcare11070936] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/18/2023] [Accepted: 03/23/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Ehlers-Danlos syndrome (EDS) is a phenotypically and genetically heterogeneous group of connective tissue disorders. Currently, diagnosis of EDS is based on a series of clinical and genetic tools. On the other hand, the hypermobile form has not yet been characterized from a genetic point of view: it is considered a part of a continuous spectrum of phenotypes, ranging from isolated non syndromic joint hypermobility, through to the recently defined hypermobility spectrum disorders (HSD). The aim of this study is to characterize the pain symptom that is not considered among the diagnostic criteria but is relevant to what concerns the quality of life of patients with EDS. (2) Methods: A review of the literature was performed on two medical electronic databases (PubMed and Embase) on 20 December 2022. Study selection and data extraction were achieved independently by two authors and the following inclusion criteria were determined a priori: published in the English language and published between 2000 and 2022. (3) Results: There were fifty eligible studies obtained at the end of the search and screen process. Pain is one of the most common symptoms found in Ehlers-Danlos (ED) patients. Different causes seem to be recognized in different phases of the syndrome. (4) Conclusions: Pain is a nonspecific symptom and cannot be considered among the diagnostic criteria, but it is a negative predictive factor in the quality of life of patients with EDS. Therefore, proper evaluation and treatment is mandatory.
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Affiliation(s)
- Viviana Guerrieri
- Department of Othopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy
| | - Alberto Polizzi
- Department of Othopaedics and Traumatology, Fondazione Poliambulanza Istituto Ospedaliero, 25124 Brescia, Italy
| | - Laura Caliogna
- Department of Othopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy
| | - Alice Maria Brancato
- Department of Othopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy
| | - Alessandra Bassotti
- Regional Center of Ehlers-Danlos Syndrome, IRCCS Ca'Granda Foundation Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Camilla Torriani
- Department of Othopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy
| | - Eugenio Jannelli
- Department of Othopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy
| | - Mario Mosconi
- Department of Othopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy
| | - Federico Alberto Grassi
- Department of Othopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy
| | - Gianluigi Pasta
- Department of Othopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy
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Henriksen P, Junge T, Bojsen-Møller J, Juul-Kristensen B, Thorlund JB. Supervised, Heavy Resistance Training Is Tolerated and Potentially Beneficial in Women with Knee Pain and Knee Joint Hypermobility: A Case Series. TRANSLATIONAL SPORTS MEDICINE 2022; 2022:8367134. [PMID: 38655168 PMCID: PMC11022762 DOI: 10.1155/2022/8367134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/28/2022] [Accepted: 12/08/2022] [Indexed: 04/26/2024]
Abstract
Introduction Adults with generalised joint hypermobility including knee joint hypermobility (GJHk) report more knee joint symptoms when compared to adults without GJHk. There is no consensus on best practice for symptom management. For instance, controversy exists regarding the appropriateness and safety of heavy resistance training as an intervention for this specific group. This case series aims to describe a supervised, progressive heavy resistance training program in adults with GJHk and knee pain, the tolerability of the intervention, and the outcomes of knee pain, knee-related quality of life, muscle strength, proprioception, and patellar tendon stiffness through a 12-week period. Materials and Methods Adults with GJHk and knee pain were recruited to perform supervised, progressive heavy resistance training twice a week for 12 weeks. The main outcome was the tolerability of the intervention. Secondary outcomes were knee pain during a self-nominated activity (VASNA); Knee injury and Osteoarthritis Outcome Score (KOOS); Tampa Scale of Kinesiophobia (TSK); maximal quadriceps voluntary isometric contraction and rate of torque development; 5 repetition maximum strength in five different leg exercises; single leg hop for distance; knee proprioception and patellar tendon stiffness. Results In total, 16 women (24.2 years, SD 2.5) completed at least 21/24 training sessions. No major adverse events were observed. On average, VASNA decreased by 32.5 mm (95% CI 21.4-43.6), in addition to improvements in KOOS and TSK scores. These improvements were supported by an increase in all measures of lower extremity muscle strength, knee proprioception, and patellar tendon stiffness. Conclusion Supervised heavy resistance training seems to be well tolerated and potentially beneficial in young women with GJHk and knee pain.
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Affiliation(s)
- Peter Henriksen
- Health Sciences Research Centre, UCL University College, Odense, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Tina Junge
- Health Sciences Research Centre, UCL University College, Odense, Denmark
| | - Jens Bojsen-Møller
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jonas Bloch Thorlund
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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8
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Chen H, Zeng X, Xie Z, Ma L, Zhong G, Li L, Huang W, Zhang Y. Kinematic alterations of the ankle in subjects with generalized joint hypermobility compared with the controls: A cross-sectional study. J Orthop Surg (Hong Kong) 2022; 30:10225536221125951. [PMID: 36113013 DOI: 10.1177/10225536221125951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Generalized joint hypermobility (GJH) is a hereditary connective tissue disease in which the range of motion (ROM) of multiple joints exceeds the normal range, and the ROM varies with age, gender, and ethnicity. At present, the six-degree-of-freedom (6-DOF) of ankle kinematics among people with GJH have not been studied. To investigate the kinematic characteristics in the ankle during treadmill gait of university students with generalized joint hypermobility compared to normal participants. We hypothesized that compared to the participants in the control group, those with GJH would exhibit kinematic characteristics of poorer active motion stability in the ankle during treadmill gait. METHODS Healthy university student volunteers aged 18-24 (excluding those with a history of ankle trauma, etc.) were recruited and divided into a control group (50 volunteers) and a GJH group (Beighton score ≥4, 50 volunteers). Data of the 6-DOF kinematics of ankle was collected using a 3D gait analysis system. Variables were evaluated using independent t-tests and Wilcoxon signed-rank tests. RESULTS In the proximal/distal parameter, proximal displacement was significantly increased in the GJH group compared with the control group during 4-9% and 96-97% of the gait phase (loading response and terminal swing phase), with an increase of (0.1-0.2 cm, p < .05). Regarding the proximal/distal, internal/external, plantarflexion/dorsiflexion, and anterior/posterior parameters, the participants with GJH exhibited greater ROM than those in the control group throughout the gait cycle (0.24 ± 0.22 cm vs. 0.19 ± 0.15 cm, p = 0.047, 5.56 ± 2.90° vs. 4.48 ± 3.30°, p = .020, 23.05 ± 5.75° vs. 20.36 ± 4.91°, p < .001, 0.65 ± 0.30 cm vs. 0.55 ± 0.27 cm, p = .018). However, ROM of inversion/eversion translation was found to be decreased in the GJH group compared to the control group (8.92 ± 1.59° vs. 9.47 ± 1.37°, p = .009). In addition, there was no statistical difference between the GJH group and the control group in ROM of medial/lateral translation (0.05 ± 0.06 cm vs. 0.04 ± 0.05 cm, p = .131). CONCLUSION Our results confirm that our hypothesis is not valid. Although there were a few differences in each gait parameter of the ankle between the GJH group and the control group, the difference was not significant. These results indicate that the presence of GJH has less effect on ankle kinematics and enhance our knowledge of the relationship between GJH and 6-DOF of ankle kinematics.
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Affiliation(s)
- Haobin Chen
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiaolong Zeng
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Zhenyan Xie
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Limin Ma
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guoqing Zhong
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Liping Li
- Shantou University Medical College, Shantou, China
| | - Wenhan Huang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yu Zhang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Rationale and Feasibility of Resistance Training in hEDS/HSD: A Narrative Review. J Funct Morphol Kinesiol 2022; 7:jfmk7030061. [PMID: 35997377 PMCID: PMC9397026 DOI: 10.3390/jfmk7030061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022] Open
Abstract
Hypermobile Ehlers-Danlos Syndrome (hEDS) and hypermobility spectrum disorder (HSD) are genetic conditions characterized by increased joint hypermobility, often in the presence of other signs or symptoms if syndromic. This hypermobility can result in significant pain and ultimately decreased participation in recreational or competitive activity. Rehabilitation of patients with hEDS/HSD is not well understood, particularly since presentation can be relatively heterogenous. Regardless, more research is needed, particularly regarding resistance training, to allow patients with hEDS/HSD to participate in the activities they enjoy. The purpose of this narrative review is to provide an overview of the clinical features displayed by those with hEDS/HSD that have been found to be improved with resistance training in other populations, and to present the current evidence for resistance training in all types of study designs, ranging from case studies to randomized controlled trials.
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10
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Long M, Kiru L, Kassam J, Strutton PH, Alexander CM. An investigation of the control of quadriceps in people who are hypermobile; a case control design. Do the results impact our choice of exercise for people with symptomatic hypermobility? BMC Musculoskelet Disord 2022; 23:607. [PMID: 35739514 PMCID: PMC9219138 DOI: 10.1186/s12891-022-05540-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background People with symptomatic hypermobility have altered proprioception however, the origin of this is unclear and needs further investigation to target rehabilitation appropriately. The objective of this investigation was to explore the corticospinal and reflex control of quadriceps and see if it differed between three groups of people: those who have symptomatic hypermobility, asymptomatic hypermobility and normal flexibility. Methods Using Transcranial Magnetic Stimulation (TMS) and electrical stimulation of peripheral nerves, motor evoked potentials (MEPs) and Hoffman (H) reflexes of quadriceps were evoked in the three groups of people. The threshold and latency of MEPs and the slope of the input–output curves and the amplitude of MEPs and H reflexes were compared across the groups. Results The slope of the input–output curve created from MEPs as a result of TMS was steeper in people with symptomatic hypermobility when compared to asymptomatic and normally flexible people (p = 0.04). There were no other differences between the groups. Conclusion Corticospinal excitability and the excitability at the motoneurone pool are not likely candidates for the origin of proprioceptive loss in people with symptomatic hypermobility. This is discussed in the light of other work to suggest the receptor sitting in hypermobile connective tissue is a likely candidate. This suggests that treatment aimed at improving receptor responsiveness through increasing muscle tone, may be an effective rehabilitation strategy.
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Affiliation(s)
- Michael Long
- MSk Lab, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Louise Kiru
- MSk Lab, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jamila Kassam
- MSk Lab, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Paul H Strutton
- MSk Lab, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Caroline M Alexander
- MSk Lab, Department of Surgery and Cancer, Imperial College London, London, UK. .,Department of Therapies, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK.
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11
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Buryk-Iggers S, Mittal N, Santa Mina D, Adams SC, Englesakis M, Rachinsky M, Lopez-Hernandez L, Hussey L, McGillis L, McLean L, Laflamme C, Rozenberg D, Clarke H. Exercise and Rehabilitation in People With Ehlers-Danlos Syndrome: A Systematic Review. Arch Rehabil Res Clin Transl 2022; 4:100189. [PMID: 35756986 PMCID: PMC9214343 DOI: 10.1016/j.arrct.2022.100189] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective To conduct a systematic review examining the effect of exercise and rehabilitation in people with Ehlers-Danlos syndrome (EDS). Data Sources The following databases were systematically searched: MEDLINE, MEDLINE In-Process/ePubs, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, and Cumulative Index to Nursing and Allied Health. The final time point captured by the search is November 27, 2020. Study Selection Eligible study designs included case-control, case-series, prospective cohort, retrospective cohort, and intervention studies of structured exercise or rehabilitation interventions. Eligible populations included adults (18 years or older) with EDS (all subtypes) and hypermobility spectrum disorders. The search was restricted to articles published in English. Data Extraction Data were extracted by 2 independent reviewers. Risk of bias was assessed using the Physiotherapy Evidence Database (PEDro) scale for randomized controlled trials (RCTs) and Risk Of Bias In Nonrandomized Studies of Interventions (ROBINS-I) for non-RCTs. Reporting quality of RCTs was assessed using the Consolidated Standards for Reporting of Trials statement with the harms extension. Reporting was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Data Synthesis The search yielded 10 eligible studies including 330 participants. The study designs included 5 RCTs, 1 cohort, 2 single-arm interventions, 1 retrospective, and 1 feasibility study. All studies showed some improvement in a physical and/or psychological outcome after the intervention period. One adverse event (nonserious) potentially related to the intervention was reported. Of the 5 RCTs, 2 were rated as high quality with low risk of bias using PEDro, and the majority of non-RCTs were rated as critical risk of bias by ROBINS-I. Conclusions The results suggest that exercise and rehabilitation may be beneficial for various physical and psychological outcomes. Adequately powered and rigorous RCTs of exercise and rehabilitation interventions for people with EDS are needed.
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Key Words
- 6MWT, 6-minute walk test
- AIMS-2, Arthritis Impact Measurement Scales-2
- CONSORT, Consolidated Standards for Reporting of Trials
- EDS, Ehlers-Danlos syndrome
- Ehlers-Danlos Syndrome
- Exercise
- HADS, Hospital and Anxiety Depression Scale
- HSD, hypermobility spectrum disorders
- Joint instability
- PEDro, Physiotherapy Evidence Database
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- QOL, quality of life
- RCT, randomized control trial
- ROBINS-I, Risk Of Bias In Nonrandomized Studies of Interventions
- Rehabilitation
- SF-36, Short Form-36
- VAS, visual analog scale
- hEDS, hypermobile EDS
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Affiliation(s)
- Stephanie Buryk-Iggers
- Department of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
- GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada
| | - Nimish Mittal
- Department of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
- GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Santa Mina
- Department of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
- GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada
| | - Scott C. Adams
- Department of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
- Department of Cardiology, Toronto General Hospital Research Institute, Toronto, Ontario, Canada
- Ted Rogers Cardiotoxicity Prevention Program, Peter Munk Cardiac Centre, Toronto, Ontario, Canada
| | - Marina Englesakis
- Library and Information Services Toronto General Hospital, Toronto, Ontario, Canada
| | - Maxim Rachinsky
- GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada
| | - Laura Lopez-Hernandez
- GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada
| | - Laura Hussey
- GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada
| | - Laura McGillis
- GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada
| | - Lianne McLean
- GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada
| | - Camille Laflamme
- GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Dmitry Rozenberg
- Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Respirology, Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - Hance Clarke
- GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada
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12
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Masterclass: Hypermobility and hypermobility related disorders. Musculoskelet Sci Pract 2022; 57:102465. [PMID: 34808594 DOI: 10.1016/j.msksp.2021.102465] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 08/27/2021] [Accepted: 10/10/2021] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Hypermobile joints display a range of movement that is considered excessive, taking into consideration the age, gender and ethnic background of the individual. Joint hypermobility may present in a single joint, a few joints or in multiple joints and may be congenital or acquired with training, disease or injury. Hypermobile joints may be asymptomatic or may be associated with pain, fatigue, multisystemic complaints and significant disability. Furthermore, joint hypermobility may be a sign of an underlying hereditary disorder of connective tissue. PURPOSE This masterclass aims to provides a state-of-the-art review of the aetiology, epidemiology, clinical presentation, assessment and management of joint hypermobility and hypermobility related disorders using an evidence based and biopsychosocial approach. The new framework for classifying the spectrum of joint hypermobility disorders along with new diagnostic criteria for the hypermobile Ehlers Danlos syndrome, published by an international consortium of clinical experts and researchers in 2017 is integrated into the paper. IMPLICATIONS FOR PRACTICE People with joint hypermobility related disorders present to healthcare professionals with a wide range of symptoms which extend beyond the musculoskeletal system. Early recognition and treatment are key to effective management. A biopsychosocial and patient empowerment approach to functional restoration is recommended.
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13
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Bates AV, McGregor AH, Alexander CM. Prolonged standing behaviour in people with joint hypermobility syndrome. BMC Musculoskelet Disord 2021; 22:1005. [PMID: 34852804 PMCID: PMC8638551 DOI: 10.1186/s12891-021-04744-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 09/28/2021] [Indexed: 11/22/2022] Open
Abstract
Background Joint Hypermobility Syndrome (JHS) is a rare Heritable Disorder of Connective tissue characterised by generalised joint laxity and chronic widespread pain. Joint Hypermobility Syndrome has a large impact on patients’ day to day activities, and many complain of symptoms when standing for prolonged periods. This study investigates whether people with JHS exhibit the same behaviours to deal with the effects of prolonged standing as people with equal hypermobility and no pain, and people with normal flexibility and no pain. Methods Twenty three people with JHS, 22 people with Generalised Joint Hypermobility (GJH), and 22 people with normal flexibility (NF) were asked to stand for a maximum of 15 min across two force-plates. Fidgets were counted and quantified using a cumulative sum algorithm and sway parameters of the quiet standing periods between fidgets were calculated. Results Average standing time for participants with JHS was 7.35 min and none stood for the full 15 min. All participants with GJH and NF completed 15 min of standing. There were no differences in fidgeting behaviour between any groups. There was a difference in anteroposterior sway (p = .029) during the quiet standing periods. Conclusion There is no evidence to suggest people with JHS exhibit different fidgeting behaviour. Increased anteroposterior-sway may suggest a muscle weakness and strengthening muscles around the ankle may reduce postural sway and potentially improve the ability to stand for prolonged periods.
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Affiliation(s)
| | - Alison H McGregor
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Caroline M Alexander
- Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Therapies, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, W6 8RF, UK
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14
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Mailloux Z, Grady-Dominguez P, Petersen J, Parham LD, Roley SS, Bundy A, Schaaf RC. Evaluation in Ayres Sensory Integration® (EASI) Vestibular and Proprioceptive Tests: Construct Validity and Internal Reliability. Am J Occup Ther 2021; 75:23070. [PMID: 34792540 DOI: 10.5014/ajot.2021.043166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Vestibular and proprioceptive functions play a critical role in occupational performance and participation. Assessment of these functions in a reliable and valid manner is part of a comprehensive assessment in the Ayres Sensory Integration® frame of reference, commonly applied in pediatric occupational therapy. OBJECTIVE To report on reliability and validity of six tests of vestibular and proprioceptive functions of the Evaluation in Ayres Sensory Integration (EASI). DESIGN We used Rasch analyses to examine and modify the number of items and scoring categories on the six tests and known-groups analysis to examine group differences. We evaluated internal consistency using Cronbach's α and Rasch person reliability. PARTICIPANTS The sample contained typically developing children (n = 150) and children with sensory integration concerns (n = 84); all participated voluntarily. Outcomes and Measures: The EASI is used to measure sensory and motor functions in children ages 3 to 12 yr. The six tests of vestibular and proprioceptive functions were analyzed in this study. RESULTS Data from >96% of items conformed to the expectations of the model. We found statistically significant group differences (ps < .001-.128; ds = 0.20-1.31), with the typically developing children group scoring significantly higher on all but one test, and moderate to strong evidence of internal consistency (Rasch person-reliability indices ≥ 0.80; strata > 3) for five of six tests. CONCLUSIONS AND RELEVANCE The EASI vestibular and proprioceptive tests have strong construct validity and internal reliability, indicating that they are psychometrically sound clinical measures. What This Article Adds: The development of occupational therapy assessments with strong psychometric properties, such as the EASI tests of vestibular and proprioceptive functions, enhances clinical practice and research by elucidating the factors affecting participation in accurate and dependable ways so that occupational therapy interventions can be focused and effective.
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Affiliation(s)
- Zoe Mailloux
- Zoe Mailloux, OTD, OTR/L, FAOTA, is Adjunct Associate Professor, Department of Occupational Therapy, College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA;
| | - Patricia Grady-Dominguez
- Patricia Grady-Dominguez, MS, OTR/L, is PhD Candidate, Department of Occupational Therapy, Colorado State University, Fort Collins
| | - Jennifer Petersen
- Jennifer Petersen, OTD, OTR/L, is Assistant Professor, Department of Occupational Therapy, St. Ambrose University, Davenport, IA
| | - L Diane Parham
- L. Diane Parham, PhD, OTR/L, FAOTA, is Professor, Occupational Therapy Graduate Program, University of New Mexico, Albuquerque
| | - Susanne Smith Roley
- Susanne Smith Roley, OTD, OTR/L, FAOTA, is Cofounder, Collaborative for Leadership in Ayres Sensory Integration (CLASI), Aliso Viejo, CA
| | - Anita Bundy
- Anita Bundy, ScD, OTR/L, FAOTA, is Professor and Department Head, Department of Occupational Therapy, Colorado State University, Fort Collins
| | - Roseann C Schaaf
- Roseann C. Schaaf, PhD, OTR/L, FAOTA, is Professor, Department of Occupational Therapy, College of Rehabilitation Sciences and Director, Jefferson Autism Center of Excellence, Thomas Jefferson University, Philadelphia, PA
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15
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Caliogna L, Guerrieri V, Annunziata S, Bina V, Brancato AM, Castelli A, Jannelli E, Ivone A, Grassi FA, Mosconi M, Pasta G. Biomarkers for Ehlers-Danlos Syndromes: There Is a Role? Int J Mol Sci 2021; 22:ijms221810149. [PMID: 34576312 PMCID: PMC8469247 DOI: 10.3390/ijms221810149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 02/05/2023] Open
Abstract
Ehlers-Danlos syndromes (EDS) are an inherited heterogeneous group of connective tissue disorders characterized by an abnormal collagen synthesis affecting skin, ligaments, joints, blood vessels, and other organs. It is one of the oldest known causes of bruising and bleeding, and it was described first by Hippocrates in 400 BC. In the last years, multiple gene variants involved in the pathogenesis of specific EDS subtypes have been identified; moreover, new clinical diagnostic criteria have been established. New classification models have also been studied in order to differentiate overlapping conditions. Moreover, EDS shares many characteristics with other similar disorders. Although distinguishing between these seemingly identical conditions is difficult, it is essential in ensuring proper patient care. Currently, there are many genetic and molecular studies underway to clarify the etiology of some variants of EDS. However, the genetic basis of the hypermobile type of EDS (hEDS) is still unknown. In this review, we focused on the study of two of the most common forms of EDS—classic and hypermobile—by trying to identify possible biomarkers that could be of great help to confirm patients’ diagnosis and their follow up.
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Affiliation(s)
- Laura Caliogna
- Orthopedic and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (L.C.); (V.G.); (A.M.B.); (A.C.); (E.J.); (A.I.); (F.A.G.); (M.M.); (G.P.)
| | - Viviana Guerrieri
- Orthopedic and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (L.C.); (V.G.); (A.M.B.); (A.C.); (E.J.); (A.I.); (F.A.G.); (M.M.); (G.P.)
| | - Salvatore Annunziata
- Orthopedic and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (L.C.); (V.G.); (A.M.B.); (A.C.); (E.J.); (A.I.); (F.A.G.); (M.M.); (G.P.)
- Correspondence: ; Fax: +39-0382-502806
| | - Valentina Bina
- Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Alice Maria Brancato
- Orthopedic and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (L.C.); (V.G.); (A.M.B.); (A.C.); (E.J.); (A.I.); (F.A.G.); (M.M.); (G.P.)
| | - Alberto Castelli
- Orthopedic and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (L.C.); (V.G.); (A.M.B.); (A.C.); (E.J.); (A.I.); (F.A.G.); (M.M.); (G.P.)
| | - Eugenio Jannelli
- Orthopedic and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (L.C.); (V.G.); (A.M.B.); (A.C.); (E.J.); (A.I.); (F.A.G.); (M.M.); (G.P.)
| | - Alessandro Ivone
- Orthopedic and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (L.C.); (V.G.); (A.M.B.); (A.C.); (E.J.); (A.I.); (F.A.G.); (M.M.); (G.P.)
| | - Federico Alberto Grassi
- Orthopedic and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (L.C.); (V.G.); (A.M.B.); (A.C.); (E.J.); (A.I.); (F.A.G.); (M.M.); (G.P.)
| | - Mario Mosconi
- Orthopedic and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (L.C.); (V.G.); (A.M.B.); (A.C.); (E.J.); (A.I.); (F.A.G.); (M.M.); (G.P.)
| | - Gianluigi Pasta
- Orthopedic and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (L.C.); (V.G.); (A.M.B.); (A.C.); (E.J.); (A.I.); (F.A.G.); (M.M.); (G.P.)
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16
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Levine D, Work B, McDonald S, Harty N, Mabe C, Powell A, Sanford G. Occupational Therapy Interventions for Clients with Ehlers-Danlos Syndrome (EDS) in the Presence of Postural Orthostatic Tachycardia Syndrome (POTS). Occup Ther Health Care 2021; 36:253-270. [PMID: 34520307 DOI: 10.1080/07380577.2021.1975200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Postural orthostatic tachycardia syndrome (POTS) is often seen in clients with Ehlers-Danlos syndrome (EDS), primarily hypermobile EDS. Research has shown clients with EDS and POTS may experience limitations affecting not only their physical function, but also their social, emotional, and mental well-being. Using a client-centered approach, occupational therapy practitioners assess health, well-being, symptomatology (fatigue, muscle pain, dizziness, etc.), participation and engagement in occupation, and provide interventions to improve quality of life. This paper will address occupational therapy interventions to treat common symptomatology for clients with EDS in the presence of POTS, including environmental modifications, use of adaptive equipment and orthoses, exercise and fall prevention, energy conservation and pacing, sleep hygiene, and routine and habit development to promote optimal engagement in meaningful occupations.
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Affiliation(s)
- David Levine
- Department of Physical Therapy, The University of Tennessee at Chattanooga, Chattanooga, TN, USA
| | - Brittany Work
- Department of Occupational Therapy, The University of Tennessee at Chattanooga, Chattanooga, TN, USA
| | - Susan McDonald
- Department of Occupational Therapy, The University of Tennessee at Chattanooga, Chattanooga, TN, USA
| | - Nicole Harty
- Department of Occupational Therapy, The University of Tennessee at Chattanooga, Chattanooga, TN, USA
| | - Carolee Mabe
- Department of Occupational Therapy, The University of Tennessee at Chattanooga, Chattanooga, TN, USA
| | - Alison Powell
- Department of Occupational Therapy, The University of Tennessee at Chattanooga, Chattanooga, TN, USA
| | - Graceline Sanford
- Department of Occupational Therapy, The University of Tennessee at Chattanooga, Chattanooga, TN, USA
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17
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Clayton HA, 't Hart BM, Henriques DYP. Sensing hand position in Ehlers-Danlos syndrome. Somatosens Mot Res 2021; 38:303-314. [PMID: 34503384 DOI: 10.1080/08990220.2021.1973403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To explore the effect of joint hypermobility on acuity, and precision, of hand proprioception. MATERIALS AND METHODS We compared proprioceptive acuity, and precision, between EDS patients and controls. We then measured any changes in their estimates of hand position after participants adapted their reaches in response to altered visual feedback of their hand. The Beighton Scale was used to quantify the magnitude of joint hypermobility. RESULTS There were no differences between the groups in the accuracy of estimates of hand location, nor in the visually induced changes in hand location. However, EDS patients' estimates were less precise when based purely on proprioception and could be partially predicted by Beighton score. CONCLUSIONS EDS patients are less precise at estimating their hand's location when only afferent information is available, but the presence of efferent signalling may reduce this imprecision. Those who are more hypermobile are more likely to be imprecise.
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Affiliation(s)
- Holly A Clayton
- Department of Psychology, York University, Toronto, Canada.,Centre for Vision Research, York University, Toronto, Canada
| | | | - Denise Y P Henriques
- Department of Psychology, York University, Toronto, Canada.,Centre for Vision Research, York University, Toronto, Canada.,School of Kinesiology and Health Sciences, York University, Toronto, Canada
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18
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Chohan K, Mittal N, McGillis L, Lopez-Hernandez L, Camacho E, Rachinsky M, Mina DS, Reid WD, Ryan CM, Champagne KA, Orchanian-Cheff A, Clarke H, Rozenberg D. A review of respiratory manifestations and their management in Ehlers-Danlos syndromes and hypermobility spectrum disorders. Chron Respir Dis 2021; 18:14799731211025313. [PMID: 34291699 PMCID: PMC8312172 DOI: 10.1177/14799731211025313] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Ehlers-Danlos Syndromes (EDS) and Hypermobility Spectrum Disorders (HSD) are a heterogeneous group of heritable genetic connective tissue disorders with multiple characteristics including joint hypermobility, tissue fragility, and multiple organ dysfunction. Respiratory manifestations have been described in EDS patients, but have not been systematically characterized. A narrative review was undertaken to describe the respiratory presentations and management strategies of individuals with EDS and HSD. METHODS A broad literature search of Medline, Embase, Cochrane Database of Systematic Reviews, and Cochrane CENTRAL was undertaken from inception to November 2020 of all study types, evaluating EDS/ HSD and pulmonary conditions. This narrative review was limited to adult patients and publications in English. RESULTS Respiratory manifestations have generally been described in hypermobile EDS (hEDS), classical and vascular EDS subtypes. Depending on EDS subtype, they may include but are not limited to dyspnea, dysphonia, asthma, sleep apnea, and reduced respiratory muscle function, with hemothorax and pneumothorax often observed with vascular EDS. Respiratory manifestations in HSD have been less frequently characterized in the literature, but exertional dyspnea is the more common symptom described. Respiratory symptoms in EDS can have an adverse impact on quality of life. The respiratory management of EDS patients has followed standard approaches with thoracotomy tubes and pleurodesis for pleural manifestations, vocal cord strengthening exercises, continuous positive pressure support for sleep apnea, and exercise training. Reduced respiratory muscle function in hEDS patients responds to inspiratory muscle training. CONCLUSION Respiratory symptoms and manifestations are described in EDS and HSD, and have generally been managed using conservative non-surgical strategies. Research into the prevalence, incidence and specific respiratory management strategies in EDS and HSD is needed to mitigate some of the associated morbidity.
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Affiliation(s)
- Karan Chohan
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nimish Mittal
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada.,KITE-Toronto Rehab-University Health Network, Toronto, Ontario, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada.,Department of Anaesthesia and Pain Management, University of Toronto, Toronto, Ontario, Canada
| | - Laura McGillis
- GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada
| | - Laura Lopez-Hernandez
- GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada
| | - Encarna Camacho
- GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada.,Division of Respirology, University Health Network, Toronto, Ontario, Canada
| | - Maxim Rachinsky
- GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada
| | - Daniel Santa Mina
- GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada.,Department of Anaesthesia and Pain Management, University of Toronto, Toronto, Ontario, Canada
| | - W Darlene Reid
- KITE-Toronto Rehab-University Health Network, Toronto, Ontario, Canada.,Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Clodagh Mai Ryan
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,KITE-Toronto Rehab-University Health Network, Toronto, Ontario, Canada.,Division of Respirology, University Health Network, Toronto, Ontario, Canada
| | | | - Ani Orchanian-Cheff
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Hance Clarke
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada.,Department of Anaesthesia and Pain Management, University of Toronto, Toronto, Ontario, Canada
| | - Dmitry Rozenberg
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada.,Division of Respirology, University Health Network, Toronto, Ontario, Canada
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19
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Reychler G, De Backer MM, Piraux E, Poncin W, Caty G. Physical therapy treatment of hypermobile Ehlers-Danlos syndrome: A systematic review. Am J Med Genet A 2021; 185:2986-2994. [PMID: 34145717 DOI: 10.1002/ajmg.a.62393] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/17/2021] [Accepted: 05/11/2021] [Indexed: 12/30/2022]
Abstract
Physiotherapy techniques are regularly prescribed in the hypermobile type Ehlers-Danlos syndrome (hEDS) and they are appreciated by the patients. The objective of this systematic review was to investigate the effect of the different physiotherapy techniques related to the children and adult patients with hEDS. PubMed, SPORTDiscus, Cochrane Library, PEDro, Scopus, and Embase databases were analyzed from inception to April 2020. Characteristics of the studies (authors), patients (sample size, sex, age, Beighton score), and nonpharmacological treatment (length of the program, number of session, duration of the session, and type of intervention), and the results with the dropout rate were extracted. From the 1045 retrieved references, 6 randomized controlled trial with a sample size ranging from 20 to 57 patients were included in the systematic review. There was a huge heterogeneity in the interventions. The durations of the program were from 4 to 8 weeks. Pain or proprioception demonstrated significant improvements in the intervention group regardless of the type of intervention. A benefit of the inspiratory muscle training was observed on functional exercise capacity. The quality of life was systematically improved. Physiotherapy benefits on proprioception and pain in patients with hEDS even if robust randomized control studies are missing.
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Affiliation(s)
- Gregory Reychler
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Brussels, Belgium.,Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Secteur de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Maya-Mafalda De Backer
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Brussels, Belgium.,Secteur de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Elise Piraux
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Brussels, Belgium.,Secteur de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - William Poncin
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Brussels, Belgium.,Secteur de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Gilles Caty
- Service de Médecine Physique, Cliniques universitaires Saint-Luc, Brussels, Belgium
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Jung KS, Jung JH, Shin HS, Park JY, In TS, Cho HY. The Effects of Taping Combined with Wrist Stabilization Exercise on Pain, Disability, and Quality of Life in Postpartum Women with Wrist Pain: A Randomized Controlled Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073564. [PMID: 33808137 PMCID: PMC8037921 DOI: 10.3390/ijerph18073564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to evaluate the effects of wrist stabilization exercise combined with taping on wrist pain, disability, and quality of life in postpartum women with wrist pain. Forty-five patients with wrist pain were recruited and randomly divided into three groups: wrist stabilization exercise + taping therapy (WSE + TT) group (n = 15), wrist stabilization exercise (WSE) group (n = 15), and control group (n = 15). The WSE + TT and WSE groups performed wrist stabilization exercises for 40 min (once a day, five times a week for eight weeks), and the control group performed passive range of motion (P-ROM) exercise for the same amount of time. Additionally, the WSE + TT group attached taping to the wrist and forearm during the training period. The visual analogue scale (VAS) was used to assess pain level of the wrist. The Disabilities of the Arm, Shoulder and Hand (DASH) and the Short Form-36 (SF-36) were used to evaluate the degree of wrist disability and quality of life, respectively. The WSE + TT group showed a significant decrease in wrist pain and functional disability compared to two groups (p < 0.05). Significant improvement in the SF-36 score was observed in the WSE + TT and WSE groups compared to that in the control group (p < 0.05). However, there was no significant difference between the WSE + TT and WSE groups in the SF-36. Our findings indicate that wrist stabilization exercise combined with taping is beneficial and effective in managing wrist pain and disability in postpartum women with wrist pain.
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Affiliation(s)
- Kyoung-Sim Jung
- Department of Physical Therapy, Gimcheon University, Gimcheon 39528, Korea;
| | - Jin-Hwa Jung
- Department of Occupational Therapy, Semyung University, Jecheon 27136, Korea;
| | - Hyung-Soo Shin
- Department of Physical Therapy, Kyungwoon University, Gumi 39160, Korea; (H.-S.S.); (J.-Y.P.)
| | - Jae-Young Park
- Department of Physical Therapy, Kyungwoon University, Gumi 39160, Korea; (H.-S.S.); (J.-Y.P.)
| | - Tae-Sung In
- Department of Physical Therapy, Gimcheon University, Gimcheon 39528, Korea;
- Correspondence: (T.-S.I.); (H.-Y.C.)
| | - Hwi-Young Cho
- Department of Physical Therapy, College of Health Science, Gachon University, Incheon 21936, Korea
- Correspondence: (T.-S.I.); (H.-Y.C.)
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21
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Luder G, Aeberli D, Mebes CM, Haupt-Bertschy B, Baeyens JP, Verra ML. Effect of resistance training on muscle properties and function in women with generalized joint hypermobility: a single-blind pragmatic randomized controlled trial. BMC Sports Sci Med Rehabil 2021; 13:10. [PMID: 33557909 PMCID: PMC7871640 DOI: 10.1186/s13102-021-00238-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 01/27/2021] [Indexed: 01/23/2023]
Abstract
Background Generalized joint hypermobility is defined as an excessive range of motion in several joints. Having joint hypermobility is not a pathology, but when associated with pain and other symptoms, it might affect health and function. Evidence for physiotherapy management is sparse and resistance training might be a possible intervention. Thus, the effects of 12-week resistance-training on muscle properties and function in women with generalized joint hypermobility were evaluated. Methods In this single-blind randomized controlled trial women between 20 and 40 years with generalized joint hypermobility (Beighton score at least 6/9) were included. Participants were randomly allocated to 12-week resistance training twice weekly (experimental) or no lifestyle change (control). Resistance training focused on leg and trunk muscles. Primary outcome was muscle strength; additional outcomes included muscle properties, like muscle mass and density, functional activities, pain and disability. Training adherence and adverse events were recorded. Results Of 51 participating women 27 were randomised to training and 24 into the control group. In each group 11 women had joint hypermobility syndrome, fulfilling the Brighton criteria, while 24 (89%) in the training group and 21 (88%) in the control group mentioned any pain. The mean strength of knee extensors varied in the training group from 0.63 (sd 0.16) N/bm before training to 0.64 (sd 0.17) N/bm after training and in the control group from 0.53 (sd 0.14) N/bm to 0.54 (sd 0.15) N/bm. For this and all other outcome measures, no significant differences between the groups due to the intervention were found, with many variables showing high standard deviations. Adherence to the training was good with 63% of participants performing more than 80% of sessions. One adverse event occurred during training, which was not clearly associated to the training. Four participants had to stop the training early. Conclusions No improvement in strength or muscle mass by self-guided resistance training was found. Low resistance levels, as well as the choice of outcome measures were possible reasons. A more individualized and better guided training might be important. However, program adherence was good with few side effects or problems triggered by the resistance training. Trial registration This trial was prospectively registered in the ISRCTN registry (www.isrctn.com, BMC, Springer Nature) on July 16, 2013 as ISRCTN90224545. The first participant was enrolled at October 25, 2013. Supplementary Information The online version contains supplementary material available at 10.1186/s13102-021-00238-8.
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Affiliation(s)
- Gere Luder
- Department of Physiotherapy, Bern University Hospital, Insel Group, CH-3010, Bern, Switzerland. .,Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.
| | - Daniel Aeberli
- Department of Rheumatology, Clinical Immunology and Allergology, Bern University Hospital and University of Bern, CH-3010, Bern, Switzerland
| | - Christine Mueller Mebes
- Department of Physiotherapy, Bern University Hospital, Insel Group, CH-3010, Bern, Switzerland
| | - Bettina Haupt-Bertschy
- Department of Physiotherapy, Bern University Hospital, Insel Group, CH-3010, Bern, Switzerland
| | - Jean-Pierre Baeyens
- Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - Martin L Verra
- Department of Physiotherapy, Bern University Hospital, Insel Group, CH-3010, Bern, Switzerland
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22
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Casanova EL, Baeza-Velasco C, Buchanan CB, Casanova MF. The Relationship between Autism and Ehlers-Danlos Syndromes/Hypermobility Spectrum Disorders. J Pers Med 2020; 10:E260. [PMID: 33271870 PMCID: PMC7711487 DOI: 10.3390/jpm10040260] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 11/29/2020] [Accepted: 11/29/2020] [Indexed: 12/12/2022] Open
Abstract
Considerable interest has arisen concerning the relationship between hereditary connective tissue disorders such as the Ehlers-Danlos syndromes (EDS)/hypermobility spectrum disorders (HSD) and autism, both in terms of their comorbidity as well as co-occurrence within the same families. This paper reviews our current state of knowledge, as well as highlighting unanswered questions concerning this remarkable patient group, which we hope will attract further scientific interest in coming years. In particular, patients themselves are demanding more research into this growing area of interest, although science has been slow to answer that call. Here, we address the overlap between these two spectrum conditions, including neurobehavioral, psychiatric, and neurological commonalities, shared peripheral neuropathies and neuropathologies, and similar autonomic and immune dysregulation. Together, these data highlight the potential relatedness of these two conditions and suggest that EDS/HSD may represent a subtype of autism.
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Affiliation(s)
- Emily L. Casanova
- School of Medicine Greenville, University of South Carolina, Greenville, SC 29615, USA;
| | - Carolina Baeza-Velasco
- Laboratory of Psychopathology and Health Processes, University of Paris, 92100 Boulogne Billancourt, France;
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, 34000 Montpellier, France
| | | | - Manuel F. Casanova
- School of Medicine Greenville, University of South Carolina, Greenville, SC 29615, USA;
- Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, KY 40292, USA
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23
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Bitterman A, Clancy D. The management of pain and hypermobility in Ehlers-Danlos syndrome. Comment on "Pain in Ehlers-Danlos syndrome" by Benistan et al. Joint Bone Spine. 2020;87:199-201. Joint Bone Spine 2020; 88:105089. [PMID: 33130233 DOI: 10.1016/j.jbspin.2020.105089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 09/15/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Adam Bitterman
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Dillon Clancy
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, United States.
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24
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Feldman ECH, Hivick DP, Slepian PM, Tran ST, Chopra P, Greenley RN. Pain Symptomatology and Management in Pediatric Ehlers-Danlos Syndrome: A Review. CHILDREN-BASEL 2020; 7:children7090146. [PMID: 32967103 PMCID: PMC7552757 DOI: 10.3390/children7090146] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 12/12/2022]
Abstract
Ehlers-Danlos syndromes (EDS) are a group of connective tissue disorders that manifest with hyperextensibility of joints and skin, and general tissue fragility. While not a major criterion for clinical diagnosis, pain is a frequently endorsed symptom across subtypes of EDS. As such, the present review aims to summarize research to date on pain characteristics and management, and the relationship between such pain symptomatology and quality of life in pediatric EDS. Characteristics of pain, including theorized etiology, relative intensity and extent of pain are described, as well as descriptions of frequently endorsed pain sites (musculoskeletal, and non-musculoskeletal). Interventions related to the management of musculoskeletal (e.g., pharmaceutical intervention, physical therapy) and non-musculoskeletal pain (e.g., pharmaceutical and psychological interventions) are discussed, highlighting the need for additional research related to pediatric pain management in the context of hypermobility syndromes. In addition, the relationship between pain in pediatric EDS and quality of life is described. Finally, limitations of literature to date are described and recommendations for future lines of research are outlined.
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Affiliation(s)
- Estée C. H. Feldman
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA;
- Correspondence:
| | - Daniel P. Hivick
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA;
| | - P. Maxwell Slepian
- Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada;
| | - Susan T. Tran
- Department of Psychology, DePaul University, Chicago, IL 60614, USA;
| | - Pradeep Chopra
- Alpert Medical School, Brown University, Providence, RI 02903, USA;
| | - Rachel Neff Greenley
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA;
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25
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Psychosocial Influence of Ehlers-Danlos Syndrome in Daily Life of Patients: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176425. [PMID: 32899328 PMCID: PMC7503231 DOI: 10.3390/ijerph17176425] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/29/2020] [Accepted: 08/31/2020] [Indexed: 12/28/2022]
Abstract
(1) Background: Ehlers–Danlos syndrome is a heterogeneous group of connective tissue disorders causing pain, fatigue, and disabilities; it has several implications for patients who suffer from this disease. The major clinical manifestations of EDS include joint hypermobility, skin hyperextensibility, and generalized connective tissue fragility. This research aims to explore their perceptions and experiences about the phycological and social spheres. (2) Methods: Semistructured interviews were carried out. Participants were encouraged to talk about issues related to their disease by asking open-ended questions in one to one interview. The interview guide included questions to identify the syndrome’s influence on the social and psychological life of patients All interviews were audio recorded, fully transcribed, and analyzed using the phenomenological theoretical framework. The method of analysis was the thematic interpreting of perspectives and approaches. (3) Results: 31 individuals were proposed to participate in this study. Five patients refused to participate, so a total of 26 interviews were performed. Six themes ((1) Pain and its consequences on a daily basis; (2) The need to name the problem: the diagnosis; (3) Restructuring leisure and social relationships; (4) Limitations due to economic conditions; (5) Psychological impact of the disease situation; (6) Professional limitations) and four subthemes ((1) The value of partner support; (2) The weather influence on social plans; (3) Physical exercise and illness; (4) Support groups) emerged from the data. (4) Conclusions: This study revealed the impact of the syndrome on the social and daily life of patients, and not only in a physical level, but also in a psychological and social approach. These findings allow healthcare providers to know more about this disease in order to support and give advice to patients about the changes they will have to make.
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26
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van Meulenbroek T, Huijnen IPJ, Simons LE, Conijn AEA, Engelbert RHH, Verbunt JA. Exploring the underlying mechanism of pain-related disability in hypermobile adolescents with chronic musculoskeletal pain. Scand J Pain 2020; 21:22-31. [PMID: 32862151 DOI: 10.1515/sjpain-2020-0023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 07/12/2020] [Indexed: 01/27/2023]
Abstract
OBJECTIVES A significant proportion of adolescents with chronic musculoskeletal pain (CMP) experience difficulties in physical functioning, mood and social functioning, contributing to diminished quality of life. Generalized joint hypermobility (GJH) is a risk factor for developing CMP with a striking 35-48% of patients with CMP reporting GJH. In case GJH occurs with one or more musculoskeletal manifestations such as chronic pain, trauma, disturbed proprioception and joint instability, it is referred to as generalized hypermobility spectrum disorder (G-HSD). Similar characteristics have been reported in children and adolescents with the hypermobile Ehlers-Danlos Syndrome (hEDS). In the management of CMP, a biopsychosocial approach is recommended as several studies have confirmed the impact of psychosocial factors in the development and maintenance of CMP. The fear-avoidance model (FAM) is a cognitive-behavioural framework that describes the role of pain-related fear as a determinant of CMP-related disability. CONTENT Pubmed was used to identify existing relevant literature focussing on chronic musculoskeletal pain, generalized joint hypermobility, pain-related fear and disability. Relevant articles were cross-referenced to identify articles possibly missed during the primary screening. In this paper the current state of scientific evidence is presented for each individual component of the FAM in hypermobile adolescents with and without CMP. Based on this overview, the FAM is proposed explaining a possible underlying mechanism in the relations between GJH, pain-related fear and disability. SUMMARY AND OUTLOOK It is assumed that GJH seems to make you more vulnerable for injury and experiencing more frequent musculoskeletal pain. But in addition, a vulnerability for heightened pain-related fear is proposed as an underlying mechanism explaining the relationship between GJH and disability. Further scientific confirmation of this applied FAM is warranted to further unravel the underlying mechanism.In explaining disability in individuals with G-HSD/hEDS, it is important to focus on both the physical components related to joint hypermobility, in tandem with the psychological components such as pain-related fear, catastrophizing thoughts and generalized anxiety.
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Affiliation(s)
- Thijs van Meulenbroek
- Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands.,and Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Maastricht, The Netherlands
| | - Ivan P J Huijnen
- Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands.,and Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Maastricht, The Netherlands
| | - Laura E Simons
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Arnoud E A Conijn
- Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Raoul H H Engelbert
- Department of Rehabilitation, Amsterdam University Medical Centers, University of Amsterdam, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Department of Pediatrics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands; and ACHIEVE, Centre for Applied Research, Faculty of Health, University of Applied Sciences Amsterdam,The Netherlands
| | - Jeanine A Verbunt
- Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands.,and Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Maastricht, The Netherlands
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Mitchell UH, Owen PJ, Rantalainen T, Belavý DL. Increased Joint Mobility Is Associated With Impaired Transversus Abdominis Contraction. J Strength Cond Res 2020; 36:2472-2478. [PMID: 32796412 DOI: 10.1519/jsc.0000000000003752] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Mitchell, UH, Owen, PJ, Rantalainen, T, and Belavý, DL. Increased joint mobility is associated with impaired transversus abdominis contraction. J Strength Cond Res XX(X): 000-000, 2020-Increased joint mobility is a risk factor for joint injury, but muscle function may be able to compensate for it. Current evidence suggests reduced force production capacity in people with hypermobility. However, little is known about the lumbar spine. The purpose of this cross-sectional study was to assess whether there was a link between joint mobility and transverse abdominis and multifidus muscles contraction, muscles ascribed a core-stability role. Using a modified quantitative version of the Beighton scale (BOM score), we measured joint mobility of 30 middle-aged individuals without low back pain. These scores were correlated with magnetic resonance imaging-derived measures of transverse abdominis and multifidus muscle contraction during a spinal loading maneuver. The level of significance was set for p ≤ 0.05. The results showed greater joint mobility (a higher BOM score) correlated (r = 0.468; p = 0.009) with reduced transversus abdominis (TrA) shortening during contraction (i.e., less muscle shortening in people with greater joint mobility). The trunk subdomain score exhibited a correlation of 0.354 with TrA length change, but this did not reach statistical significance (p = 0.055). The subdomains of the BOM score did not correlate significantly with each other (p ≥ 0.097). No association was seen between multifidus contraction and joint mobility. The results suggest that greater general joint mobility is associated with impaired contraction of the TrA muscle. This should be considered when coaching athletes or treating patients with (functional) spinal instability. The quantitative approach we developed to measure joint mobility could be used in the future studies of global flexibility.
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Affiliation(s)
- Ulrike H Mitchell
- Department of Exercise Sciences, Brigham Young University, Provo, Utah
| | - Patrick J Owen
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
| | - Timo Rantalainen
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia.,Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Daniel L Belavý
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
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Palmer S, Davey I, Oliver L, Preece A, Sowerby L, House S. The effectiveness of conservative interventions for the management of syndromic hypermobility: a systematic literature review. Clin Rheumatol 2020; 40:1113-1129. [PMID: 32681365 PMCID: PMC7895781 DOI: 10.1007/s10067-020-05284-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/03/2020] [Accepted: 07/08/2020] [Indexed: 12/13/2022]
Abstract
Introduction ‘Syndromic hypermobility’ encompasses heritable connective tissue disorders such as hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders which are characterised by excessive joint range of motion and pain. Conservative interventions such as exercise are the cornerstone of management, yet their effectiveness is unclear. Aim To systematically appraise the effectiveness of conservative management for people with syndromic hypermobility. Method A systematic online database search was conducted (AMED, BND, CINAHL Plus, MEDLINE, PEDro, PsychINFO and SportDiscus). Potential articles were assessed for eligibility by two researchers against the following criteria: adults and children with a hEDS/HSD diagnosis (or equivalent diagnosis using specific criteria); non-pharmacological or non-surgical interventions; outcomes related to pain, physical function, psychological well-being or quality of life. Controlled trials and cohort studies were included. Critical Appraisal Skills Programme checklists were used to assess methodological quality. Results Eleven studies were included, comprising eight controlled trials and three cohort studies. All studies investigated interventions that had exercise as the primary component. Three small controlled studies demonstrated superior effects of conservative management relative to a control group. However, those studies only focused on a single area of the body, only recruited women, and had no long-term follow-up. All studies reported improvements in a wide range of outcomes over time. Conclusion Controlled trial evidence for the superiority of conservative management over comparators is weak. There is some evidence that people improve over time. Robust randomised controlled trial research of the long-term effectiveness of ‘whole-body’ (rather than individual joints or body areas) conservative management is required.Key Points • Conservative management is the cornerstone of management of syndromic hypermobility. • The review found that evidence for the effectiveness of conservative management relative to no treatment or other conservative comparators was weak. • However, there was consistent evidence for effectiveness from pre- to post-treatment. • Further robust randomised controlled trial evidence is required. |
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Affiliation(s)
- Shea Palmer
- Department of Allied Health Professions, Faculty of Health & Applied Sciences, University of the West of England, Blackberry Hill, Bristol, BS16 1DD, UK.
| | - Indi Davey
- Department of Allied Health Professions, Faculty of Health & Applied Sciences, University of the West of England, Blackberry Hill, Bristol, BS16 1DD, UK
| | - Laura Oliver
- Department of Allied Health Professions, Faculty of Health & Applied Sciences, University of the West of England, Blackberry Hill, Bristol, BS16 1DD, UK
| | - Amara Preece
- Department of Allied Health Professions, Faculty of Health & Applied Sciences, University of the West of England, Blackberry Hill, Bristol, BS16 1DD, UK
| | - Laura Sowerby
- Department of Allied Health Professions, Faculty of Health & Applied Sciences, University of the West of England, Blackberry Hill, Bristol, BS16 1DD, UK
| | - Sophie House
- Department of Allied Health Professions, Faculty of Health & Applied Sciences, University of the West of England, Blackberry Hill, Bristol, BS16 1DD, UK
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30
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Custom-Made Foot Orthoses Reduce Pain and Fatigue in Patients with Ehlers-Danlos Syndrome. A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041359. [PMID: 32093191 PMCID: PMC7068607 DOI: 10.3390/ijerph17041359] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 12/31/2022]
Abstract
Background: Pain and fatigue are major clinical manifestations in patients with Ehlers-Danlos Syndrome (EDS). The aim of this study is to measure change of the effects of custom-made foot orthotics on some manifestations related to EDS, such as foot pain, foot functionality, fatigue, and quality of life. Methods: Thirty-six patients with EDS wore foot orthoses for three months. Foot pain, foot-related disability, foot functionality, fatigue, and quality of life were measured using the 11-point Numeric Rating Scale, the Manchester Foot Pain and Disability Index, the Foot Function Index, the Fatigue Severity Score, and the 12-Item Short Form Health Survey questionnaires, respectively, at the beginning and after 3 months. Results: Participants demonstrated significantly improved foot pain (p = 0.002), disability related to foot pain (p < 0.001), foot functionality (p = 0.001), fatigue (p < 0.007), and mental health-related quality of life (p = 0.016). The physical health-related quality of life did not show significant changes. Conclusions: The use of custom-made foot orthoses help in the management of the symptoms by participants. This study could contribute to the foot specialists being considered as an additional member in multidisciplinary teams that are trying to develop an approach for patients with EDS.
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Bénistan K, Martinez V. Pain in hypermobile Ehlers‐Danlos syndrome: New insights using new criteria. Am J Med Genet A 2019; 179:1226-1234. [DOI: 10.1002/ajmg.a.61175] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/22/2019] [Accepted: 04/07/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Karelle Bénistan
- Centre de référence des syndromes d'Ehlers‐Danlos non vasculairesHôpital Raymond Poincaré, Garches, Assistance Publique Hôpitaux de Paris Garches France
| | - Valeria Martinez
- Département d'anesthésie et consultation douleurHôpital Raymond Poincaré, Garches, Assistance Publique Hôpitaux de Paris Garches France
- Centre d'Evaluation et de Traitement de la Douleur, F‐92100 FranceINSERM, U‐987, Hôpital Ambroise Paré Boulogne‐Billancourt France
- Université Versailles Saint‐Quentin Montigny‐Le‐Bretonneux France
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Palmer S, Bridgeman K, Di Pierro I, Jones R, Phillips C, Wilson M. The views of people with joint hypermobility syndrome on its impact, management and the use of patient-reported outcome measures. A thematic analysis of open-ended questionnaire responses. Musculoskeletal Care 2019; 17:183-193. [PMID: 30793827 DOI: 10.1002/msc.1387] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 01/07/2019] [Accepted: 01/07/2019] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Joint hypermobility syndrome (JHS) has been reported to have widespread impacts on people with the condition. However, our understanding of those impacts is still developing and we do not know if they can be captured effectively using patient-reported outcome measures. The aim of the present study was to explore written qualitative comments from previously administered questionnaires, to identify the impacts of JHS and any issues related to using patient-reported outcome measures to assess those impacts. METHODS Previous research administered a draft condition-specific questionnaire and Short Form-36 questionnaire to adult members of a patient organization in the UK, incorporating an open text box for further comments. Those comments were transcribed, anonymized and analysed using thematic analysis. A coding list, themes and subthemes were developed through double coding, parallel independent analysis and consensus. RESULTS A total of 393 of 614 eligible questionnaires (64%) contained qualitative comments and were analysed (mean respondent age 41 years, mean Bristol Impact of Hypermobility questionnaire score 228/360, 95% women). Three main themes were identified: (a) "Impacts of living with JHS"; (b) "Management strategies for JHS"; and (c) "Measurement and research into JHS". Participants highlighted a range of impacts of JHS, incorporating physical, social and psychological domains. Respondents described difficult journeys to diagnosis, and feeling unsupported and misunderstood by their peers and healthcare professionals. They detailed helpful strategies for managing their condition and provided useful comments on using questionnaires to assess JHS. CONCLUSIONS The study yielded valuable findings that can be used to directly inform the assessment and management of JHS.
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Affiliation(s)
- Shea Palmer
- Department of Allied Health Professions, Faculty of Health & Applied Sciences, University of the West of England, Bristol, UK
| | - Keely Bridgeman
- Department of Allied Health Professions, Faculty of Health & Applied Sciences, University of the West of England, Bristol, UK
| | - Isabelle Di Pierro
- Department of Allied Health Professions, Faculty of Health & Applied Sciences, University of the West of England, Bristol, UK
| | - Rosanna Jones
- Department of Allied Health Professions, Faculty of Health & Applied Sciences, University of the West of England, Bristol, UK
| | - Caitlin Phillips
- Department of Allied Health Professions, Faculty of Health & Applied Sciences, University of the West of England, Bristol, UK
| | - Megan Wilson
- Department of Allied Health Professions, Faculty of Health & Applied Sciences, University of the West of England, Bristol, UK
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Daman M, Shiravani F, Hemmati L, Taghizadeh S. The effect of combined exercise therapy on knee proprioception, pain intensity and quality of life in patients with hypermobility syndrome: A randomized clinical trial. J Bodyw Mov Ther 2019; 23:202-205. [DOI: 10.1016/j.jbmt.2017.12.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 11/06/2017] [Accepted: 12/12/2017] [Indexed: 11/16/2022]
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Abstract
Chronic musculoskeletal pain (CMP) is one of the main reasons for referral to a pediatric rheumatologist and is the third most common cause of chronic pain in children and adolescents. Causes of CMP include amplified musculoskeletal pain, benign limb pain of childhood, hypermobility, overuse syndromes, and back pain. CMP can negatively affect physical, social, academic, and psychological function so it is essential that clinicians know how to diagnose and treat these conditions. This article provides an overview of the epidemiology and impact of CMP, the steps in a comprehensive pain assessment, and the management of the most common CMPs.
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Affiliation(s)
- Jennifer E Weiss
- Pediatric Rheumatology, Seton Hall School of Medicine, Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, NJ 07601, USA.
| | - Jennifer N Stinson
- Research Institute, Child Health Evaluative Sciences, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
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Chan C, Hopper L, Zhang F, Pacey V, Nicholson LL. The prevalence of generalized and syndromic hypermobility in elite Australian dancers. Phys Ther Sport 2018; 32:15-21. [PMID: 29655088 DOI: 10.1016/j.ptsp.2018.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 02/08/2018] [Accepted: 02/21/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To determine the prevalence of Generalized Joint Hypermobility (GJH) and Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome-Hypermobility Type (JHS/EDS-HT) among dancers using established validated measures. DESIGN Observational Cohort Study. SETTING Laboratory. PARTICIPANTS 85 dancers from two dance institutions. MAIN OUTCOME MEASURES GJH was determined using the Beighton score (cut-point ≥5/9) and the Lower Limb Assessment Scale (LLAS) (cut-point ≥7/12). Presence of JHS/EDS-HT was assessed using the Brighton and Villefranche criteria. Paired sample t-test was performed to compare LLAS side-to-side scores, and percentage disagreements calculated to determine differences between the two GJH and the two JHS/EDS-HT measures. RESULTS 72% of dancers met the Beighton cut-point for GJH, while 38% and 42% met the LLAS cut-point on the left and right respectively. The proportion of dancers identified with GJH was different when assessed using the Beighton compared to the left and right LLAS (both p < 0.001), a disagreement of 48% and 46% respectively, with Beighton classifying more participants as having GJH. The Villefranche identified more dancers with JHS/EDS-HT than the Brighton (84% vs 31%, p < 0.001), with 54% disagreement. CONCLUSIONS High prevalence of generalized and syndromic hypermobility was found regardless of the criteria used. A higher Beighton cut-point, e.g. ≥6/9, to identify true GJH amongst dancers maybe warranted.
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Affiliation(s)
- Cliffton Chan
- The University of Sydney, Discipline of Biomedical Science, Sydney Medical School, New South Wales, Australia. 75 East St, Lidcombe, New South Wales, 1825, Australia.
| | - Luke Hopper
- Western Australian Academy of Performing Arts, Edith Cowan University, Perth, Australia. 1/2 Bradford St, Menora, Western Australia, 6050, Australia.
| | - Feili Zhang
- The University of Sydney, Discipline of Physiotherapy, Faculty of Health Sciences, New South Wales, Australia. 75 East St, Lidcombe, New South Wales, 1825, Australia.
| | - Verity Pacey
- Macquarie University, Department of Health Professions, Faculty of Medicine and Health Sciences, New South Wales, Australia. 75 Talavera Rd, Macquarie, New South Wales, 2109, Australia.
| | - Leslie L Nicholson
- The University of Sydney, Discipline of Biomedical Science, Sydney Medical School, New South Wales, Australia. 75 East St, Lidcombe, New South Wales, 1825, Australia.
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Palmer S, Cramp F, Clark E, Lewis R, Brookes S, Hollingworth W, Welton N, Thom H, Terry R, Rimes KA, Horwood J. The feasibility of a randomised controlled trial of physiotherapy for adults with joint hypermobility syndrome. Health Technol Assess 2018; 20:1-264. [PMID: 27365226 DOI: 10.3310/hta20470] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Joint hypermobility syndrome (JHS) is a heritable disorder associated with laxity and pain in multiple joints. Physiotherapy is the mainstay of treatment, but there is little research investigating its clinical effectiveness. OBJECTIVES To develop a comprehensive physiotherapy intervention for adults with JHS; to pilot the intervention; and to conduct a pilot randomised controlled trial (RCT) to determine the feasibility of conducting a future definitive RCT. DESIGN Patients' and health professionals' perspectives on physiotherapy for JHS were explored in focus groups (stage 1). A working group of patient research partners, clinicians and researchers used this information to develop the physiotherapy intervention. This was piloted and refined on the basis of patients' and physiotherapists' feedback (stage 2). A parallel two-arm pilot RCT compared 'advice' with 'advice and physiotherapy' (stage 3). Random allocation was via an automated randomisation service, devised specifically for the study. Owing to the nature of the interventions, it was not possible to blind clinicians or patients to treatment allocation. SETTING Stage 1 - focus groups were conducted in four UK locations. Stages 2 and 3 - piloting of the intervention and the pilot RCT were conducted in two UK secondary care NHS trusts. PARTICIPANTS Stage 1 - patient focus group participants (n = 25, three men) were aged > 18 years, had a JHS diagnosis and had received physiotherapy within the preceding 12 months. The health professional focus group participants (n = 16, three men; 14 physiotherapists, two podiatrists) had experience of managing JHS. Stage 2 - patient participants (n = 8) were aged > 18 years, had a JHS diagnosis and no other musculoskeletal conditions causing pain. Stage 3 - patient participants for the pilot RCT (n = 29) were as for stage 2 but the lower age limit was 16 years. INTERVENTION For the pilot RCT (stage 3) the advice intervention was a one-off session, supplemented by advice booklets. All participants could ask questions specific to their circumstances and receive tailored advice. Participants were randomly allocated to 'advice' (no further advice or physiotherapy) or 'advice and physiotherapy' (an additional six 30-minute sessions over 4 months). The physiotherapy intervention was supported by a patient handbook and was delivered on a one-to-one patient-therapist basis. It aimed to increase patients' physical activity through developing knowledge, understanding and skills to better manage their condition. MAIN OUTCOME MEASURES Data from patient and health professional focus groups formed the main outcome from stage 1. Patient and physiotherapist interview data also formed a major component of stages 2 and 3. The primary outcome in stage 3 related to the feasibility of a future definitive RCT [number of referrals, recruitment and retention rates, and an estimate of the value of information (VOI) of a future RCT]. Secondary outcomes included clinical measures (physical function, pain, global status, self-reported joint count, quality of life, exercise self-efficacy and adverse events) and resource use (to estimate cost-effectiveness). Outcomes were recorded at baseline, 4 months and 7 months. RESULTS Stage 1 - JHS is complex and unpredictable. Physiotherapists should take a long-term holistic approach rather than treating acutely painful joints in isolation. Stage 2 - a user-informed physiotherapy intervention was developed and evaluated positively. Stage 3 - recruitment to the pilot RCT was challenging, primarily because of a perceived lack of equipoise between advice and physiotherapy. The qualitative evaluation provided very clear guidance to inform a future RCT, including enhancement of the advice intervention. Some patients reported that the advice intervention was useful and the physiotherapy intervention was again evaluated very positively. The rate of return of questionnaires was low in the advice group but reasonable in the physiotherapy group. The physiotherapy intervention showed evidence of promise in terms of primary and secondary clinical outcomes. The advice arm experienced more adverse events. The VOI analysis indicated the potential for high value from a future RCT. Such a trial should form the basis of future research efforts. CONCLUSION A future definitive RCT of physiotherapy for JHS seems feasible, although the advice intervention should be made more robust to address perceived equipoise and subsequent attrition. TRIAL REGISTRATION Current Controlled Trials ISRCTN29874209. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 47. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Shea Palmer
- Department of Allied Health Professions, University of the West of England, Bristol, UK
| | - Fiona Cramp
- Department of Allied Health Professions, University of the West of England, Bristol, UK
| | - Emma Clark
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | | | - Sara Brookes
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | | | - Nicky Welton
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Howard Thom
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Rohini Terry
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Katharine A Rimes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jeremy Horwood
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
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Miglis MG, Schultz B, Muppidi S. Postural tachycardia in hypermobile Ehlers-Danlos syndrome: A distinct subtype? Auton Neurosci 2017; 208:146-149. [DOI: 10.1016/j.autneu.2017.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/08/2017] [Accepted: 10/01/2017] [Indexed: 11/30/2022]
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Palmer S, Manns S, Cramp F, Lewis R, Clark EM. Test-retest reliability and smallest detectable change of the Bristol Impact of Hypermobility (BIoH) questionnaire. Musculoskelet Sci Pract 2017; 32:64-69. [PMID: 28881227 DOI: 10.1016/j.msksp.2017.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/26/2017] [Accepted: 08/21/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The Bristol Impact of Hypermobility (BIoH) questionnaire is a patient-reported outcome measure developed in conjunction with adults with Joint Hypermobility Syndrome (JHS). It has demonstrated strong concurrent validity with the Short Form-36 (SF-36) physical component score but other psychometric properties have yet to be established. This study aimed to determine its test-retest reliability and smallest detectable change (SDC). DESIGN A test-retest reliability study. SETTING Participants were recruited from the Hypermobility Syndromes Association, a patient organisation in the United Kingdom. PATIENTS Recruitment packs were sent to 1080 adults who had given permission to be contacted about research. MAIN OUTCOME MEASURES BIoH and SF-36 questionnaires were administered at baseline and repeated two weeks later. An 11-point global rating of change scale (-5 to +5) was also administered at two weeks. Test-retest analysis and calculation of the SDC was conducted on 'stable' patients (defined as global rating of change -1 to +1). RESULTS 462 responses were received. 233 patients reported a 'stable' condition and were included in analysis (95% women; mean (SD) age 44.5 (13.9) years; BIoH score 223.6 (54.0)). The BIoH questionnaire demonstrated excellent test-retest reliability (ICC 0.923, 95% CI 0.900-0.940). The SDC was 42 points (equivalent to 19% of the mean baseline score). The SF-36 physical and mental component scores demonstrated poorer test-retest reliability and larger SDCs (as a proportion of the mean baseline scores). CONCLUSION The results provide further evidence of the potential of the BIoH questionnaire to underpin research and clinical practice for people with JHS.
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Affiliation(s)
- S Palmer
- Department of Allied Health Professions, University of the West of England, Bristol, BS16 1DD, UK.
| | - S Manns
- Department of Allied Health Professions, University of the West of England, Bristol, BS16 1DD, UK
| | - F Cramp
- Department of Allied Health Professions, University of the West of England, Bristol, BS16 1DD, UK
| | - R Lewis
- Department of Physiotherapy, North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB, UK
| | - E M Clark
- Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB, UK
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Simmonds JV, Herbland A, Hakim A, Ninis N, Lever W, Aziz Q, Cairns M. Exercise beliefs and behaviours of individuals with Joint Hypermobility syndrome/Ehlers-Danlos syndrome - hypermobility type. Disabil Rehabil 2017; 41:445-455. [PMID: 29125009 DOI: 10.1080/09638288.2017.1398278] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To explore exercise beliefs and behaviours of individuals with Joint Hypermobility syndrome/Ehlers-Danlos syndrome - hypermobility type and to explore patient experiences of physiotherapy. METHODS A cross sectional questionnaire survey design was used to collect quantitative and qualitative data from adult members of the Hypermobility Syndromes Association and Ehlers-Danlos Syndrome Support UK. Descriptive and inferential statistics were used to analyse the data. Qualitative data was analysed thematically. RESULTS 946 questionnaires were returned and analysed. Participants who received exercise advice from a physiotherapist were 1.75 more likely to report high volumes of weekly exercise (odds ratio [OR] = 1.75, 95% confidence interval [CI] = 1.30-2.36, p < 0.001) than those with no advice. Participants who believed that exercise is important for long-term management were 2.76 times more likely to report a high volume of weekly exercise compared to the participants who did not hold this belief (OR = 2.76, 95% CI = 1.38-5.50, p = 0.004). Three themes emerged regarding experience of physiotherapy; physiotherapist as a partner, communication - knowledge, experience and safety. CONCLUSION Pain, fatigue and fear are common barriers to exercise. Advice from a physiotherapist and beliefs about the benefits of exercise influenced the reported exercise behaviours of individuals with Ehlers-Danlos syndrome - hypermobility type in this survey. Implications for rehabilitation Exercise is a cornerstone of treatment for Ehlers-Danlos syndrome/Ehlers-Danlos syndrome - hypermobility type. Pain, fatigue and fear of injury are frequently reported barriers to exercise. Advice from physiotherapists may significantly influence exercise behaviour. Physiotherapists with condition specific knowledge and good verbal and non-verbal communication facilitate a positive therapeutic experience.
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Affiliation(s)
- Jane V Simmonds
- a Great Ormond Street Institute of Child Health , University College London , London , UK.,b Hospital of St. John and St Elizabeth , London , UK
| | - Anthony Herbland
- c School of Health and Social Work , University of Hertfordshire , Hatfield , UK
| | - Alan Hakim
- b Hospital of St. John and St Elizabeth , London , UK
| | - Nelly Ninis
- d Imperial College Healthcare NHS Trust, Paediatrics , St. Mary's Hospital , London , UK
| | - William Lever
- e Department of Pathology , Cambridge University , Cambridge , UK
| | - Qasim Aziz
- c School of Health and Social Work , University of Hertfordshire , Hatfield , UK.,f Neurogastroenterology , Queen Mary University of London , London , UK
| | - Mindy Cairns
- c School of Health and Social Work , University of Hertfordshire , Hatfield , UK.,g Physiocare , Twyford , UK
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Engelbert RHH, Juul-Kristensen B, Pacey V, de Wandele I, Smeenk S, Woinarosky N, Sabo S, Scheper MC, Russek L, Simmonds JV. The evidence-based rationale for physical therapy treatment of children, adolescents, and adults diagnosed with joint hypermobility syndrome/hypermobile Ehlers Danlos syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2017; 175:158-167. [PMID: 28306230 DOI: 10.1002/ajmg.c.31545] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
New insights into the phenotype of Joint Hypermobility Syndrome (JHS) and Ehlers-Danlos Syndrome-hypermobile type (hEDS) have raised many issues in relation to classification, diagnosis, assessment, and treatment. Within the multidisciplinary team, physical therapy plays a central role in management of individuals with hypermobility related disorders. However, many physical therapists are not familiar with the diagnostic criteria, prevalence, common clinical presentation, and management. This guideline aims to provide practitioners with the state of the art regarding the assessment and management of children, adolescents, and adults with JHS/hEDS. Due to the complexity of the symptoms in the profile of JHS/hEDS, the International Classification of Functioning, Disability and Health (ICF) is adopted as a central framework whereby the umbrella term of disability is used to encompass functions, activities and participation, as well as environmental and personal factors. The current evidence-based literature regarding the management of JHS/hEDS is limited in size and quality and there is insufficient research exploring the clinical outcomes of a number of interventions. Multicenter randomized controlled trials are warranted to assess the clinical and cost-effectiveness of interventions for children and adults. Until further multicenter trials are conducted, clinical decision-making should be based on theoretical and the current limited research evidence. For all individuals diagnosed with JHS/hEDS, international consensus and combined efforts to identify risk profiles would create a better understanding of the pathological mechanisms and the potential for optimizing health care for affected individuals. © 2017 Wiley Periodicals, Inc.
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Effects of spinal stabilization exercises in women with benign joint hypermobility syndrome: a randomized controlled trial. Rheumatol Int 2017; 37:1461-1468. [DOI: 10.1007/s00296-017-3713-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 03/23/2017] [Indexed: 01/23/2023]
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Fagevik Olsén M, Brunnegård S, Sjöström S, Biörserud C, Kjellby-Wendt G. Increased joint pain after massive weight loss: is there an association with joint hypermobility? Surg Obes Relat Dis 2017; 13:877-881. [PMID: 28274706 DOI: 10.1016/j.soard.2017.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 11/23/2016] [Accepted: 01/06/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Obesity is associated with an increased risk of pain in weight-bearing joints. Although pain often decreases after obesity surgery, this is the reverse for some patients. Hypermobility is described as an excessive range of motion in joints and has been suggested to be a possible cause of joint pain. It is not known whether there is an association between increased joint pain after weight loss and hypermobility. OBJECTIVES The objective of this study was to investigate whether there is an association between hypermobility and increased joint pain after massive weight loss. SETTING University hospital, Sweden. METHODS A survey including a screening questionnaire about hypermobility and questions about joint pain was sent to 149 people who had previously undergone bariatric surgery. Ninety-three people (72 women and 21 men) completed the questionnaire. RESULTS Nineteen of the respondents fulfilled the criteria for hypermobility. There were no significant differences between the groups with and without hypermobility regarding pain in weight-bearing joints before or after surgery. There was a significant difference between the groups with increased or novel pain in the ankles, shoulders, hands, and feet (P<.05) after the weight loss. Furthermore, the patients with hypermobility had increased or novel pain in a significantly higher number of weight-bearing joints, other joints, and joints in total (P< .05). CONCLUSION Even with a small sample size, a tendency can be seen for people with hypermobility to experience increased joint pain after weight loss compared with those without hypermobility.
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Affiliation(s)
- Monika Fagevik Olsén
- Department of Physical Therapy, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Department of Surgery, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
| | - Sofie Brunnegård
- Department of Physical Therapy, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Sofia Sjöström
- Department of Physical Therapy, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Christina Biörserud
- Department of Surgery, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Gunilla Kjellby-Wendt
- Department of Physical Therapy, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
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Chopra P, Tinkle B, Hamonet C, Brock I, Gompel A, Bulbena A, Francomano C. Pain management in the Ehlers-Danlos syndromes. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2017; 175:212-219. [DOI: 10.1002/ajmg.c.31554] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Blokland D, Thijs KM, Backx FJG, Goedhart EA, Huisstede BMA. No Effect of Generalized Joint Hypermobility on Injury Risk in Elite Female Soccer Players: A Prospective Cohort Study. Am J Sports Med 2017; 45:286-293. [PMID: 28146401 DOI: 10.1177/0363546516676051] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although it has been suggested that generalized joint hypermobility (GJH) is a risk factor for injury in soccer players, it remains unclear whether this applies to elite female soccer players. PURPOSE To investigate whether GJH is a risk factor for injury in elite female soccer players. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Elite female soccer players in the Netherlands were screened at the start of the 2014-2015 competitive season. GJH was assessed using the Beighton score. Soccer injuries and soccer exposure were registered throughout the entire season. Poisson regression was performed to calculate incidence risk ratios (IRRs) using different cutoff points of the Beighton score (≥3, ≥4, and ≥5) to indicate GJH. RESULTS Of the 114 players included in the study, 20 were classified as hypermobile (Beighton score ≥4). The mean (±SD) injury incidence per player was 8.40 ± 9.17 injuries/1000 hours of soccer, with no significant difference between hypermobile and nonhypermobile players. GJH was not a risk factor for injuries when using Beighton score cutoff points of ≥3 (IRR = 1.06 [95% CI, 0.74-1.50]; P = .762), ≥4 (IRR = 1.10 [95% CI, 0.72-1.68]; P = .662), or ≥5 (IRR = 1.15 [95% CI, 0.68-1.95]; P = .602). Similarly, GJH was not a significant risk factor for thigh, knee, or ankle injuries evaluated separately. CONCLUSION This study indicates that GJH is not a risk factor for injuries in elite female soccer players, irrespective of Beighton score cutoff point. Hypermobile players at this elite level might have improved their active stability and/or used braces to compensate for joint laxity.
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Affiliation(s)
- Donna Blokland
- Rudolf Magnus Institute of Neurosciences, Department of Rehabilitation, Physical Therapy & Sports, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Karin M Thijs
- Rudolf Magnus Institute of Neurosciences, Department of Rehabilitation, Physical Therapy & Sports, University Medical Center Utrecht, Utrecht, the Netherlands.,FIFA Medical Center, Royal Netherlands Football Association, Zeist, the Netherlands
| | - Frank J G Backx
- Rudolf Magnus Institute of Neurosciences, Department of Rehabilitation, Physical Therapy & Sports, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Edwin A Goedhart
- FIFA Medical Center, Royal Netherlands Football Association, Zeist, the Netherlands
| | - Bionka M A Huisstede
- Rudolf Magnus Institute of Neurosciences, Department of Rehabilitation, Physical Therapy & Sports, University Medical Center Utrecht, Utrecht, the Netherlands
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Postural balance control in women with generalized joint laxity. Turk J Phys Med Rehabil 2017; 63:259-265. [PMID: 31453463 DOI: 10.5606/tftrd.2017.160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/07/2016] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to investigate the potential relationship between joint laxity and postural balance by using tetra-ataxiometric posturography (Tetrax®). Patients and methods A total of 69 healthy volunteers were included in the study and classified into three groups based on their hypermobility severity determined with Beighton-Horan hypermobility index scores. Of those, 29 participants were non-hypermobile, 13 participants were mildly hypermobile and remaining 27 patients had severe hypermobility. Postural control of the participants was evaluated by using the Tetrax® device in eight different positions. The stability index, Fourier index, weight distribution index, and synchronization index scores of each participant were recorded. Results We found that the participants with severe hypermobility exhibited significantly higher stability index scores while the position of the head is extended and rotated right. The weight distribution index on elastic surfaces was impaired in non-hypermobile and severely hypermobile participants. We observed that the Fourier Index scores were higher at a higher-medium frequency (0.5-1 Hz) in participants with severe hypermobility. There was no difference between the groups in terms of synchronization index scores. Conclusion These findings suggest that severely hypermobile individuals have a decreased postural stability in head-extended and head- rotated positions when compared to individuals who are non-hypermobile. This increased instability may lead to an increased risk of musculoskeletal injuries, especially in sports that require extension and rotation movements of the head.
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Wang W, Wang B, Xu J, Bian Z, Yao J, Gong X, Zhang Y, Zhang H, Zhou S, Jiang Y, Zeng B, Chen J, Yao W, Zhang L, Zhu L, Chen Y, Ni F, Ding S, Lu L. Limb Dysdifferentiation. Plast Reconstr Surg 2017. [DOI: 10.1007/978-981-10-5101-2_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Castori M. Pain in Ehlers-Danlos syndromes: manifestations, therapeutic strategies and future perspectives. Expert Opin Orphan Drugs 2016. [DOI: 10.1080/21678707.2016.1238302] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Report of Societies. Scott Med J 2016. [DOI: 10.1177/003693300505000416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Scheper M, Rombaut L, de Vries J, De Wandele I, van der Esch M, Visser B, Malfait F, Calders P, Engelbert R. The association between muscle strength and activity limitations in patients with the hypermobility type of Ehlers-Danlos syndrome: the impact of proprioception. Disabil Rehabil 2016; 39:1391-1397. [PMID: 27339264 DOI: 10.1080/09638288.2016.1196396] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE The patients diagnosed with Ehlers-Danlos Syndrome Hypermobility Type (EDS-HT) are characterized by pain, proprioceptive inacuity, muscle weakness, potentially leading to activity limitations. In EDS-HT, a direct relationship between muscle strength, proprioception and activity limitations has never been studied. The objective of the study was to establish the association between muscle strength and activity limitations and the impact of proprioception on this association in EDS-HT patients. METHODS Twenty-four EDS-HT patients were compared with 24 controls. Activity limitations were quantified by Health Assessment Questionnaire (HAQ), Six-Minute Walk test (6MWT) and 30-s chair-rise test (30CRT). Muscle strength was quantified by handheld dynamometry. Proprioception was quantified by movement detection paradigm. In analyses, the association between muscle strength and activity limitations was controlled for proprioception and confounders. RESULTS Muscle strength was associated with 30CRT (r = 0.67, p = <0.001), 6MWT (r = 0.58, p = <0.001) and HAQ (r = 0.63, p= <0.001). Proprioception was associated with 30CRT (r = 0.55, p < 0.001), 6MWT (r = 0.40, p = <0.05) and HAQ (r = 0.46, p < 0.05). Muscle strength was found to be associated with activity limitations, however, proprioceptive inacuity confounded this association. CONCLUSIONS Muscle strength is associated with activity limitations in EDS-HT patients. Joint proprioception is of influence on this association and should be considered in the development of new treatment strategies for patients with EDS-HT. Implications for rehabilitation Reducing activity limitations by enhancing muscle strength is frequently applied in the treatment of EDS-HT patients. Although evidence regarding treatment efficacy is scarce, the current paper confirms the rationality that muscle strength is an important factor in the occurrence of activity limitations in EDS-HT patients. Although muscle strength is the most dominant factor that is associated with activity limitations, this association is confounded by proprioception. In contrast to common belief proprioception was not directly associated with activity limitations but confounded this association. Controlling muscle strength on the bases of proprioceptive input may be more important for reducing activity limitations than just enhancing sheer muscle strength.
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Affiliation(s)
- Mark Scheper
- a Faculty of Health, ACHIEVE , Center for Applied Research, University of Applied Sciences Amsterdam , Amsterdam , The Netherlands.,b Department of Rehabilitation , Academic Medical Centre, University of Amsterdam , Amsterdam , The Netherlands
| | - Lies Rombaut
- c Department of Rehabilitation Sciences and Physiotherapy , Ghent University , Ghent , Belgium
| | - Janneke de Vries
- a Faculty of Health, ACHIEVE , Center for Applied Research, University of Applied Sciences Amsterdam , Amsterdam , The Netherlands.,b Department of Rehabilitation , Academic Medical Centre, University of Amsterdam , Amsterdam , The Netherlands
| | - Inge De Wandele
- c Department of Rehabilitation Sciences and Physiotherapy , Ghent University , Ghent , Belgium
| | - Martin van der Esch
- a Faculty of Health, ACHIEVE , Center for Applied Research, University of Applied Sciences Amsterdam , Amsterdam , The Netherlands.,d Reade, Amsterdam Rehabilitation Research Centre , Amsterdam , The Netherlands
| | - Bart Visser
- a Faculty of Health, ACHIEVE , Center for Applied Research, University of Applied Sciences Amsterdam , Amsterdam , The Netherlands
| | | | - Patrick Calders
- c Department of Rehabilitation Sciences and Physiotherapy , Ghent University , Ghent , Belgium
| | - Raoul Engelbert
- a Faculty of Health, ACHIEVE , Center for Applied Research, University of Applied Sciences Amsterdam , Amsterdam , The Netherlands.,b Department of Rehabilitation , Academic Medical Centre, University of Amsterdam , Amsterdam , The Netherlands
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Bovet C, Carlson M, Taylor M. Quality of life, unmet needs, and iatrogenic injuries in rehabilitation of patients with Ehlers-Danlos Syndrome hypermobility type/Joint Hypermobility Syndrome. Am J Med Genet A 2016; 170:2044-51. [DOI: 10.1002/ajmg.a.37774] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 05/11/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Claire Bovet
- University of Colorado Denver; Adult Medical Genetics Program; University of Colorado Denver; Aurora Colorado
| | - Matthew Carlson
- Physical Therapy Program; University of Colorado Denver; Aurora Colorado
| | - Matthew Taylor
- University of Colorado Denver; Adult Medical Genetics Program; University of Colorado Denver; Aurora Colorado
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