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Williams CM, Welch JJ, Scheper M, Tofts L, Pacey V. Variability of joint hypermobility in children: a meta-analytic approach to set cut-off scores. Eur J Pediatr 2024; 183:3517-3529. [PMID: 38801562 PMCID: PMC11263245 DOI: 10.1007/s00431-024-05621-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/13/2024] [Accepted: 05/19/2024] [Indexed: 05/29/2024]
Abstract
Current international consensus of the appropriate Beighton score cut-off to define if a child has generalised joint hypermobile or not is based upon expert opinion. Our aim was to determine the prevalence of Beighton scores of children worldwide to provide a recommendation for establishing the Beighton score cut-off to identify generalised joint hypermobility in children. We used AMED, OVID Medline, Embase and CINAHL to find published articles from inception to April 2024 describing Beighton scores of children up to and including 18 years from the general population. We extracted study demographics including country of publication, total number of participants, summary data about the age and sex of participant, Beighton scores and any cut-off used where authors deemed children hypermobile and how many children were rated at the corresponding Beighton scores. There were 37 articles reporting on the prevalence or incidence of hypermobility at cut-off scores from 28,868 participants. Using the cut-off of ≥ 6 resulted in a prevalence of 6% for studies reporting male data and 13% for studies reporting female data. Limited data reporting availability precluded further sub-analysis at a Beighton score of ≥ 7, age, pubertal status and ethnicity. Conclusion: The working threshold for identifying generalised joint hypermobility in children should be a Beighton score of 6 or more. Our analysis also suggests a Beighton score of 7 or greater may be appropriate in childhood, particularly for females. What is Known: • The working threshold for identifying generalised joint hypermobility in children previously was set based on expert opinion. What is New: • The threshold to identify hypermobility in children should be at a minimum of ≥ 6 on the Beighton score.
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Affiliation(s)
- Cylie M Williams
- School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia.
| | - James J Welch
- Ablefeet, 16 Terrace Road, Walton-on-Thames, Surrey, KT12 2SB, UK
| | - Mark Scheper
- Research Center Innovations in Care, Data Supported Healthcare, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
- Department of Health Sciences, Faculty of Medicine, Health & Human Sciences, Macquarie University, North Ryde, NSW, 2113, Australia
- Institute for Communication, Media and Information Technology, Program Responsible AI, Rotterdam University of Applied Sciences Rotterdam, Rotterdam, The Netherlands
- Livinglab Responsible AI, Creating010, Rotterdam University of Applied Sciences Rotterdam, Rotterdam, The Netherlands
| | - Louise Tofts
- Department of Health Sciences, Faculty of Medicine, Health & Human Sciences, Macquarie University, North Ryde, NSW, 2113, Australia
| | - Verity Pacey
- School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia
- Department of Health Sciences, Faculty of Medicine, Health & Human Sciences, Macquarie University, North Ryde, NSW, 2113, Australia
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Anieto EM, Anieto IB, Ituen OA, Naidoo N, Ezema CI, Smits-Engelsman B. The relationship between kinaesthesia, motor performance, physical fitness and joint mobility in children living in Nigeria. BMC Pediatr 2023; 23:526. [PMID: 37872483 PMCID: PMC10591369 DOI: 10.1186/s12887-023-04348-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/04/2023] [Indexed: 10/25/2023] Open
Abstract
PURPOSE This study aimed to determine the relationship between kinaesthesia, motor performance, fitness, and joint mobility in children. METHODS A descriptive cross-sectional study was conducted involving children from two primary schools in the South-Eastern part of Nigeria. The Beighton criteria were used to measure joint mobility. Motor performance, fitness, and kinaesthesia were measured in all the children. Spearman's rank correlation was used to evaluate the relationship between the outcomes. RESULTS A total of 91 children (51.6% girls) participated in the study. The mean age of the children was 8.20 ± 1.98 years. Using a Beighton score of ≥ 6, Generalized Joint Hypermobility (GJH) was identified in a total of 35 (38.46%) children and was more prevalent in females (60.0%). Joint mobility had significant correlations with most fitness and motor performance items, but not kinaesthesia. Agility & power, and motor performance seem to be reduced if mobility is larger. Kinaesthesia was correlated with most fitness and motor performance items, indicating that better fitness and better motor performance cooccur with better kinaesthesia or vice versa. CONCLUSION Joint mobility may have a significant influence on fitness and motor performance in children. Hence, it may be useful for future studies to investigate how fitness and motor performance modulate the onset and progression of musculoskeletal symptoms in GJH.
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Affiliation(s)
- Ebuka Miracle Anieto
- Department of Physiotherapy and Paramedicine, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, G4 0BA, Glasgow, Scotland, U.K..
- Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Ijeoma Blessing Anieto
- Department of Gerontology, Faculty of Social Sciences, University of Southampton, Southampton, United Kingdom
| | - Oluwakemi Adebukola Ituen
- Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Niri Naidoo
- Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Charles I Ezema
- Department of Medical Rehabilitation, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Bouwien Smits-Engelsman
- Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Blajwajs L, Williams J, Timmons W, Sproule J. Hypermobility prevalence, measurements, and outcomes in childhood, adolescence, and emerging adulthood: a systematic review. Rheumatol Int 2023:10.1007/s00296-023-05338-x. [PMID: 37149553 DOI: 10.1007/s00296-023-05338-x] [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: 03/23/2023] [Accepted: 04/24/2023] [Indexed: 05/08/2023]
Abstract
General Joint Hypermobility (GJH) is a common condition found in 2-57% of the population. Of those with GJH, 10% suffer from accompanying physical and/or psychological symptoms. While the understanding of GJH in the general population is unfolding, its implication in a cohort of children, adolescents and young adults are not yet understood. This systematic review explored GJH's prevalence, tools to measure it, its physical and psychosocial symptoms, with a special interest in aesthetic sports. The CINHAL, MEDLINE, PsycINFO, SPORTDiscus and Scopus databases were searched for relevant studies. Inclusion criteria were (1) Age range of 5-24; (2) Participants had GJH; (3) A measurement for GJH; (4) Studies written in English language. Study screening for title, abstract and full text (when needed) and quality assessment were performed by two independent individuals. 107 studies were included in this review and were thematically grouped into six clusters expressing different foci: (1) GJH's Core Characteristics; (2) Orthopedic; (3) Physical Other; (4) Psychosocial; (5) Treatment and (6) Aesthetic Sports. The review revealed a growing interest in GJH in this cohort in the last decade, especially regarding non-musculoskeletal physical implications and psychosocial aspects. Prevalence varied between different ethnic groups and as a parameter of age, gender and measurement. The most widespread tool to measure GJH was the Beighton scale, with a cut-off varying between 4 and 7. Children show fewer, but similar GJH implication to those in the general population, however, more research on the topic is warranted, especially regarding psychosocial aspects and treatment.
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Affiliation(s)
- Liron Blajwajs
- Institute of Sport, Physical Education and Health Sciences, The University of Edinburgh, Edinburgh, UK.
| | - Joanne Williams
- Department of Clinical and Health Psychology, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Wendy Timmons
- Institute of Sport, Physical Education and Health Sciences, The University of Edinburgh, Edinburgh, UK
| | - John Sproule
- Institute of Sport, Physical Education and Health Sciences, The University of Edinburgh, Edinburgh, UK
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Ituen OA, Anieto EM, Ferguson G, Duysens J, Smits-Engelsman B. Prevalence and Demographic Distribution of Hypermobility in a Random Group of School-Aged Children in Nigeria. Healthcare (Basel) 2023; 11:healthcare11081092. [PMID: 37107926 PMCID: PMC10137997 DOI: 10.3390/healthcare11081092] [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: 02/14/2023] [Revised: 04/08/2023] [Accepted: 04/09/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The purpose of this study was to determine the prevalence of hypermobility in randomly selected healthy children, without previous trauma or disease process affecting the joints and whether other demographic variables (age, sex, BMI) had an impact on Beighton scores and range of motion (RoM) in children between 6 and 10 years of age. RESULTS 286 children were included; 27.3% of them had a Beighton score ≥7/9 and 72% would be classified hypermobile if we had used a Beighton cut-off score ≥4/9. Prevalence declined with increasing age. Girls were more often hypermobile (34%) than boys (20%) and this was mainly caused by increased RoM in the knees. Positive scores of finger items of the Beighton were more common than on the other items, leading to a high prevalence of peripheral hypermobility. Localized hypermobility was only found in the fifth MCP joint. A total of 15% of the children with normal mobility reached 20 excess degrees RoM of the left and right fifth MCP. Pain was present in 12 of the 239 children but was not linked to the level of mobility. CONCLUSION Hypermobility is the rule in this pain-free population of children with GJH.
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Affiliation(s)
| | - Ebuka Miracle Anieto
- Department of Health & Rehabilitation, University of Cape Town, Cape Town 7701, South Africa
- Department of Physiotherapy and Paramedicine, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Gillian Ferguson
- Department of Health & Rehabilitation, University of Cape Town, Cape Town 7701, South Africa
| | - Jacques Duysens
- Motor Control Laboratory, Movement Control and Neuroplasticity Research Group, KU Leuven, 3001 Leuven, Belgium
| | - Bouwien Smits-Engelsman
- Department of Health & Rehabilitation, University of Cape Town, Cape Town 7701, South Africa
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Developmental Coordination Disorder and Joint Hypermobility in Childhood: A Narrative Review. CHILDREN 2022; 9:children9071011. [PMID: 35883995 PMCID: PMC9317025 DOI: 10.3390/children9071011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022]
Abstract
Children with developmental coordination disorder (DCD) and joint hypermobility could present an overlap of symptoms and motor functional difficulties. The link between these two clinical conditions has not yet been clarified. Recent studies reported a high incidence (30–50%) of motor delay in children who are referred to hypermobility and of enhanced joint hypermobility in children with DCD. The aim of this study was to provide a critical review of the literature outlining the association between DCD or limited motor performance and joint hypermobility. Studies were eligible for inclusion if they were written in English and human-based. All the studies were first selected, looking for the presence of a clinical association between developmental coordination disorder or motor performance and hyperlaxity and reporting details of outcome. After a review of the full texts, 16 articles for a total of 1898 children met the inclusion criteria. In general, there was evidence of a higher incidence of motor delay or DCD in children who are referred to hypermobility and of enhanced joint hypermobility in children with DCD with similar range of functional difficulties. These results could influence the way to support children with rehabilitation and the type of intervention according to the prevalence of one of the two conditions.
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Yam TTT, Fong SSM. Y-Balance Test Performance and Leg Muscle Activations of Children with Developmental Coordination Disorder. J Mot Behav 2018; 51:385-393. [PMID: 30095371 DOI: 10.1080/00222895.2018.1485011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This study compared Lower Quarter Y-Balance Test (YBT-LQ) performance and leg muscle kinetics between children with and without developmental coordination disorder (DCD), and investigated the association between YBT-LQ performance and muscle kinetics in children with DCD. Forty-eight children with DCD and 51 children without DCD participated in the study. Leg muscle kinetics were measured using surface electromyography when performing YBT-LQ. Children with DCD exhibited an overall lower YBT-LQ scores than controls. They had a lower peak gastrocnemius medialis activation for YBT-LQ posteromedial direction and shorter duration for the muscle to reach peak torque for YBT-LQ anterior direction. No relationship was found between YBT-LQ performance and leg muscle activations in children with DCD. Children with DCD exhibited a less competent YBT-LQ performance with atypical neuromuscular control.
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Romeo DM, Velli C, Lucibello S, Ferrantini G, Leo G, Brogna C, Cota F, Ricci D, Gallini F, Romagnoli C, Vento G, Mercuri E. Joint Laxity in Preschool Children Born Preterm. J Pediatr 2018; 197:104-108. [PMID: 29650414 DOI: 10.1016/j.jpeds.2018.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 12/27/2017] [Accepted: 02/01/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To evaluate the prevalence of joint laxity in children born preterm assessed in the first 2 years, the relationship between joint laxity and motor performance at preschool age, and possible changes over time in a subgroup of children followed longitudinally. STUDY DESIGN The revised scale of Beighton Score was used to evaluate joint laxity in a population of 132 preschool children born preterm between 24 and 32 weeks of gestational age. All were assessed for joint laxity between 12 and 24 months of age. Children also performed the Movement Assessment Battery for Children-Second Edition between the age of 3 years and 6 months and 4 years; the age at onset of independent walking also was recorded. RESULTS The total Beighton Score ranged between 0 and 8. Twenty percent of the cohort showed joint laxity. No differences related to sex or gestational age were observed. Children born preterm with joint laxity achieved later independent walking and achieved lower scores on Movement Assessment Battery for Children-Second Edition than those without joint laxity. In 76 children born preterm, an assessment for joint laxity was repeated once between 25 and 36 months and again after >36 months. No statistically significant difference was observed between the 3 assessments. CONCLUSIONS The Beighton Score can be used to assess generalized joint laxity in children born preterm. As the presence of joint laxity influenced motor competences, the possibility to early identify these infants in the first 2 years is of interest to benefit from early intervention and potentially improve gross motor skills and coordination.
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Affiliation(s)
- Domenico M Romeo
- Pediatric Neurology Unit, Catholic University, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Chiara Velli
- Pediatric Neurology Unit, Catholic University, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Simona Lucibello
- Pediatric Neurology Unit, Catholic University, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Gloria Ferrantini
- Pediatric Neurology Unit, Catholic University, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Giuseppina Leo
- Pediatric Neurology Unit, Catholic University, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Claudia Brogna
- Pediatric Neurology Unit, Catholic University, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Francesco Cota
- Neonatal Intensive Care Unit, Catholic University, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Daniela Ricci
- National Centre of Services and Research for Prevention of Blindness and Rehabilitation of Visually Impaired, Rome, Italy
| | - Francesca Gallini
- Neonatal Intensive Care Unit, Catholic University, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Costantino Romagnoli
- Neonatal Intensive Care Unit, Catholic University, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Giovanni Vento
- Neonatal Intensive Care Unit, Catholic University, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Eugenio Mercuri
- Pediatric Neurology Unit, Catholic University, Fondazione Policlinico A. Gemelli, Rome, Italy
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