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Chuchin JD, Ornstein TJ. Fear avoidance, fear of falling, and pain disability in hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders. Disabil Rehabil 2024; 46:4234-4245. [PMID: 37843031 DOI: 10.1080/09638288.2023.2268520] [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: 09/26/2022] [Accepted: 10/04/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE Hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorders (HSD) are understudied conditions characterized by hallmark hypermobility and chronic pain. Disease manifestations lead to significant disability. Understanding predictors of disability, over and above the univariate construct of pain severity, is necessary to tailor treatment. Thus, the current study examined the impact of the Fear-Avoidance Model [FAM] on disability in hEDS/HSD. Fear of falling was included as a novel fear-avoidance factor impacting disability. METHODS A total of 168 individuals with hEDS/HSD answered a cross-sectional online survey regarding FAM constructs, fear of falling, disability, and clinical-demographic factors. A hierarchical regression analysis was used to assess whether FAM constructs and fear of falling significantly predicted disability, over and above pain severity and age. RESULTS Pain catastrophizing, anxiety, and fear of falling contributed significant unique predictive relations, above age and average pain severity. Pain severity and fear of falling were the strongest unique predictors of disability. CONCLUSIONS This is the first study to assess the relations among FAM constructs, pain severity, and disability in hEDS/HSD, and introduces fear of falling as a novel fear-avoidance factor specific to this population. Future research should apply these findings towards individualized interventions to improve disability in hEDS/HSD.
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Affiliation(s)
- Jessica D Chuchin
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Tisha J Ornstein
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
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Wang YT, Jahani S, Morel-Swols D, Kapely A, Rosen A, Forghani I. Patient experiences of receiving a diagnosis of hypermobile Ehlers-Danlos syndrome. Am J Med Genet A 2024; 194:e63613. [PMID: 38545882 DOI: 10.1002/ajmg.a.63613] [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: 09/20/2023] [Revised: 01/24/2024] [Accepted: 03/16/2024] [Indexed: 07/05/2024]
Abstract
Hypermobile Ehlers-Danlos syndrome (hEDS) presents with a wide range of clinical symptoms and comorbidities that impact quality of life. The diagnosis is challenging and often delayed due to the heterogeneity of the disease and lack of diagnostic biomarkers, which adds to the disease burden by affecting patients' psychosocial adaptation and overall well-being. Previous studies have revealed that healthcare professionals and the public have a limited understanding and familiarity with the condition, which leads to disapproval and skepticism that greatly impact patients' social spheres and welfare. While physical manifestations have been widely discussed, the psychosocial impact and the importance of receiving a diagnosis have not been fully studied in the current literature. This survey study investigated the impact of diagnosis in hEDS patients, selected from the University of Miami's hEDS registry. Survey questions were formulated based on clinical expertise and literature review. Descriptive statistics, Mann-Whitney test, and Spearman's correlation were used for data analysis. The median age at symptom presentation was 10 years, with a median gap of 4 years before the initial medical evaluation. On average, it took 10 years to receive a diagnosis of hEDS. Nearly all participants (95.2%) expressed receiving a diagnosis as "important" or "highly important," with 81.9% agreeing that it helped them cope with their condition better, 76.8% could better manage their symptoms, and felt more in control of their long-term care. Participants mostly had a positive emotional reaction and experienced an improvement in the support they were receiving from their caregivers and healthcare providers after receiving a diagnosis of hEDS. This study demonstrates that receiving a diagnosis could positively impact the patient's support, quality of care, and overall well-being.
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Affiliation(s)
- Yun-Ting Wang
- Department of Human Genetics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Shiva Jahani
- Department of learning sciences and educational Research, University of Central Florida, Orlando, Florida, USA
| | - Dayna Morel-Swols
- Department of Human Genetics, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Angelica Kapely
- Department of Human Genetics, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ami Rosen
- Department of Human Genetics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Irman Forghani
- Department of Human Genetics, Miller School of Medicine, University of Miami, Miami, Florida, USA
- Department of Oncology, Division of Clinical Genetics, Mount Sinai Medical Center at Florida, Miami, Florida, USA
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Halverson CME, Doyle TA, Vershaw S. Social media use by patients with hypermobile Ehlers-Danlos syndrome. Mol Genet Genomic Med 2024; 12:e2467. [PMID: 38860470 PMCID: PMC11165341 DOI: 10.1002/mgg3.2467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/25/2024] [Accepted: 05/07/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Patients with uncommon genetic conditions often face limited in-person resources for social and informational support. Hypermobile Ehlers-Danlos syndrome (hEDS) is a rare or underdiagnosed hereditary disorder of the connective tissue, and like those with similar diseases, patients with hEDS have begun to turn to social media in search of care and community. The aims of our study were to understand the usage habits and perceptions of utility of social media use for patients with hEDS in order to formulate suggestions for how clinicians may best engage these and similar patient populations about this topic. METHODS We conducted both a quantitative survey and qualitative interviews with patients who had received a robust clinical diagnosis of hEDS. RESULTS Twenty-four individuals completed the initial survey, and a subset of 21 of those participants completed an interview. Through thematic analysis, we identified four primary themes related to their experience with social media: (1) befriending others with their disease, (2) seeking and vetting information, (3) the risks and downsides of social media use, and (4) the desire for clinicians to discuss this topic with them. CONCLUSION We conclude by proposing five suggestions that emerge empirically from our data. These proposals will help clinicians engage their patients regarding social media use in order to promote its potential benefits and circumvent its potential harms as they pursue support for their hereditary condition.
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Affiliation(s)
- Colin M. E. Halverson
- Department of Medicine, Center for BioethicsIndiana University School of MedicineIndianapolisIndianaUSA
- Department of MedicineIndiana University School of MedicineIndianapolisIndianaUSA
- Department of AnthropologyIndiana UniversityIndianapolisIndianaUSA
- Regenstrief InstituteIndianapolisIndianaUSA
- Charles Warren Fairbanks Center for Medical EthicsIndianapolisIndianaUSA
| | - Tom A. Doyle
- Department of Medicine, Center for BioethicsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Samantha Vershaw
- Department of Medicine, Center for BioethicsIndiana University School of MedicineIndianapolisIndianaUSA
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Xu K, Li G, Wu Z, Zhang TJ, Wu N. Diagnosis and treatment of the Ehlers-Danlos syndromes in China: synopsis of the first guidelines. Orphanet J Rare Dis 2024; 19:194. [PMID: 38741208 DOI: 10.1186/s13023-024-03121-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/03/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The Ehlers-Danlos syndromes (EDS) are a group of rare hereditary connective tissue disorders. EDS is clinically and genetically heterogeneous and usually involves multiple systems. There are 14 subtypes of EDS with hallmark features including joint hypermobility, skin hyperextensibility, and tissue fragility. The clinical manifestations and their severity differ among the subtypes, encompassing recurrent joint dislocations, scoliosis, arterial aneurysm and dissection, and organ rupture. Challenges in diagnosis and management arise from the complexity of the disease, which is further complicated by its rarity. The development of clinical guidelines and implementation of coordinated multi-disciplinary team (MDT) approaches have emerged as global priorities. MAIN BODY Chinese Multi-Disciplinary Working Group on the Ehlers-Danlos Syndromes was therefore established. Healthcare professionals were recruited from 25 top hospitals across China. The experts are specialized in 24 fields, including genetics, vascular surgery, dermatology, and orthopedics, as well as nursing care, rehabilitation, psychology, and nutrition. Based on GRADE methodology, the Guidelines were written by the Group supervised by methodologists, following a systemic review of all 4453 articles in PubMed published before August 9, 2023, using the search term "Ehlers Danlos". A coordinated MDT approach for the diagnosis and management of EDS is highly recommended by the Group, along with 29 specific recommendations addressing key clinical questions. In addition to the treatment plan, the Guidelines also emphasize integrating support from nursing care, rehabilitation, psychology, and nutrition. This integration not only facilitates recovery in hospital settings, but most importantly, the transition from an illness-defined life to a more "normalized" life. CONCLUSION The first guidelines on EDS will shorten the diagnostic odyssey and solve the unmet medical needs of the patients. This article is a synopsis of the full guidelines.
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Affiliation(s)
- Kexin Xu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China
- Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, 100730, China
- Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, 100730, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Guozhuang Li
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China
- Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, 100730, China
- Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, 100730, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Zhihong Wu
- Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, 100730, China
- Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, 100730, China
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Terry Jianguo Zhang
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China.
- Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, 100730, China.
- Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, 100730, China.
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| | - Nan Wu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China.
- Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, 100730, China.
- Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, 100730, China.
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
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Glayzer JE, Bray BC, Kobak WH, Steffen AD, Schlaeger JM. Lack of Diversity in Research on Females with Ehlers-Danlos Syndromes: Recruitment Protocol for a Quantitative Online Survey. JMIR Res Protoc 2024; 13:e53646. [PMID: 38696252 PMCID: PMC11099804 DOI: 10.2196/53646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/22/2024] [Accepted: 03/13/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Ehlers-Danlos syndromes (EDS) are a group of connective tissue disorders caused by fragile lax collagen. Current EDS research lacks racial and ethnic diversity. The lack of diversity may be associated with the complexities of conducting a large international study on an underdiagnosed condition and a lack of EDS health care providers who diagnose and conduct research outside of the United States and Europe. Social media may be the key to recruiting a large diverse EDS sample. However, studies that have used social media to recruit have not been able to recruit diverse samples. OBJECTIVE This study aims to discuss challenges, strategies, outcomes, and lessons learned from using social media to recruit a large sample of females with EDS. METHODS Recruitment on social media for a cross-sectional survey examining dyspareunia (painful sexual intercourse) in females was examined. Inclusion criteria were (1) older than 18 years of age, (2) assigned female at birth, and (3) diagnosed with EDS. Recruitment took place on Facebook and Twitter (now X), from June 1 to June 25, 2019. RESULTS A total of 1178 females with EDS were recruited from Facebook (n=1174) and X (n=4). On Facebook, participants were recruited via support groups. A total of 166 EDS support groups were identified, 104 permitted the principal investigator to join, 90 approved posting, and the survey was posted in 54 groups. Among them, 30 of the support groups posted in were globally focused and not tied to any specific country or region, 21 were for people in the United States, and 3 were for people outside of the United States. Recruitment materials were posted on X with the hashtag #EDS. A total of 1599 people accessed the survey and 1178 people were eligible and consented. The average age of participants was 38.6 (SD 11.7) years. Participants were predominantly White (n=1063, 93%) and non-Hispanic (n=1046, 92%). Participants were recruited from 29 countries, with 900 (79%) from the United States and 124 (11%) from Great Britain. CONCLUSIONS Our recruitment method was successful at recruiting a large sample. The sample was predominantly White and from North America and Europe. More research needs to be conducted on how to recruit a diverse sample. Areas to investigate may include connecting with more support groups from outside the United States and Europe, researching which platforms are popular in different countries, and translating study materials into different languages. A larger obstacle to recruiting diverse samples may be the lack of health care providers that diagnose EDS outside the United States and Europe, making the pool of potential participants small. There needs to be more health care providers that diagnose and treat EDS in countries that are predominantly made up of people of color as well as research that specifically focuses on these populations. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/53646.
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Affiliation(s)
- Jennifer E Glayzer
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, United States
| | - Bethany C Bray
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL, United States
| | - William H Kobak
- Department of Obstetrics and Gynecology, College of Medicine, University of Illinois Chicago, Chicago, IL, United States
| | - Alana D Steffen
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, United States
| | - Judith M Schlaeger
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, United States
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Estrella E, Frazier PA. Healthcare experiences among adults with hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorder in the United States. Disabil Rehabil 2024; 46:731-740. [PMID: 36772820 DOI: 10.1080/09638288.2023.2176554] [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: 12/01/2022] [Revised: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE This cross-sectional mixed-method study examined healthcare experiences among individuals in the US with hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorder (HSD), genetic connective tissue disorders. We hypothesized that many individuals with these conditions would report low satisfaction with healthcare and low health-related quality of life, and that lower healthcare satisfaction would be related to lower health-related quality of life and self-efficacy for symptom management. METHODS Adults living in the US with hEDS or HSD (N= 2125) completed an online survey assessing satisfaction with healthcare, health-related quality of life, and symptom management self-efficacy. Qualitative data also were gathered on desired changes to improve healthcare. RESULTS Participants reported low satisfaction with healthcare and lower health-related quality of life and symptom management self-efficacy than norm groups. Lower satisfaction with healthcare was associated with lower health-related quality of life and lower symptom management self-efficacy, ps <.001. The most common desired change to improve healthcare was more knowledge about hEDS and HSD among healthcare professionals. CONCLUSIONS U.S. adults with joint hypermobility report negative healthcare experiences and poor health-related quality of life. Future research should explore ways to improve the healthcare experiences and quality of care for individuals with hEDS and HSD.Implications for RehabilitationIndividuals with hypermobility spectrum disorder (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS) score worse than the U.S. population on most health-related quality of life domains and symptom management self-efficacy.Individuals with HSD and hEDS report low levels of satisfaction with healthcare compared to norm groups.Participants particularly wanted to see improvements in the level of awareness and education about HSD and hEDS among healthcare professionals, provider attitudes about HSD and hEDS, and healthcare accessibility and convenience.Individuals who were less satisfied with their healthcare reported lower health-related quality of life and lower symptom management self-efficacy, underscoring the importance of improving healthcare experiences.
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Affiliation(s)
- Emma Estrella
- Department of Psychology, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Patricia A Frazier
- Department of Psychology, University of Minnesota Twin Cities, Minneapolis, MN, USA
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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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Guedry SE, Langley BO, Schaefer K, Hanes DA. Patient experience of chronic illness care and complementary integrative health use: a cross-sectional study of patients with hypermobility spectrum disorders (HSD) and Ehlers-Danlos syndromes (EDS). Disabil Rehabil 2023; 45:3549-3559. [PMID: 36222285 DOI: 10.1080/09638288.2022.2131003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 09/25/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE Hypermobility spectrum disorders (HSD) and Ehlers-Danlos syndromes (EDS) are frequently underdiagnosed, contributing to patient dissatisfaction in the healthcare system. This study evaluated the health service utilization, care, and subjective experiences of living with chronic illness among adults with HSD and EDS in the United States and Canada. METHODS This was an anonymous, web-based, cross-sectional healthcare survey. The survey obtained basic demographic information, the Patient Assessment of Chronic Illness Care (PACIC+), as well as responses to questions on the use of healthcare and integrative medicine. RESULTS A total of 353 surveys were received. The most common complementary therapies used were physical therapy (82%), massage (68%), yoga (58%), chiropractic (48%), and meditation (43%). Mean (SD) summary PACIC and PACIC 5 As scores were 2.16 (0.77) and 2.25 (0.83), respectively. Across all PACIC domains, mean scores of individuals whose typical doctor visit was 30 min or at least an hour were significantly higher than those of individuals who indicated typical visits of 15 min (all p < 0.0001 by one-way ANOVA). There was widespread agreement on the importance of patient-provider relationship and trust, physicians' understanding of the individual's complete medical history, and prioritization of physical and emotional safety (>95% agree or strongly agree to each). CONCLUSION Individuals with HSD or EDS report low satisfaction with chronic illness care and commonly seek out complementary and self-administered therapies, likely in an attempt to manage symptoms. Respondents reported a desire for greater time and attention from physicians. Results from this study could educate the healthcare community to improve support mechanisms for HSD and EDS populations.IMPLICATIONS FOR REHABILITATIONPatients with hypermobility spectrum disorders (HSD) or Ehlers-Danlos syndromes (EDS) express a desire for patient-centered care and peer support from other individuals with HSD or EDS.Individuals with HSD or EDS have typically seen multiple doctors for their condition and their satisfaction with chronic care, as measured by the Patient Assessment of Chronic Illness Care (PACIC+), is low.The use of various complementary and integrative health treatments, as well as specialized diets, is common in this population, and might be beneficial for symptom management.Healthcare delivery for HSD and EDS may require a multidisciplinary healthcare team, as complementary and self-care modalities are typically used in addition to physical therapy, pain medication, and other conventional care.
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Affiliation(s)
- Sara E Guedry
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | - Blake O Langley
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | | | - Douglas A Hanes
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
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Anderson LK, Lane KR. Clinical trajectory of hypermobile Ehlers-Danlos syndrome/hypermobility spectrum disorders in older adults. J Am Assoc Nurse Pract 2023; 35:605-612. [PMID: 37261967 DOI: 10.1097/jxx.0000000000000900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/28/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Research on hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorder (hEDS/HSD) has described its natural history and clinical course in children, adolescents, and young to middle-aged adults. However, more research is needed on the clinical trajectory of hEDS/HSD into older age. Therefore, clinicians, including nurse practitioners, know little about identifying older adults with undiagnosed hEDS/HSD. OBJECTIVE This review sought to identify studies regarding aging in hEDS/HSD. DATA SOURCES This scoping review included PubMed, Cumulative Index to Nursing and Allied Health Literature, and Scopus and found 15 studies that mentioned age or aging on the symptoms and health-related quality of life. CONCLUSIONS No study had a stated aim regarding aging in hEDS/HSD, but all studies corroborated earlier natural history studies describing the age-related trajectory of manifestations in younger people. Studies found that symptom progression was heterogeneous, multisystemic, and unpredictable. Studies also noted prolonged diagnosis delays and long symptom duration, but the impact of these factors on outcomes was unclear. The high variability in patient outcomes precludes the prediction of outcomes based on the included studies. The clinical impact of aging on hEDS/HSD remains mostly speculative. IMPLICATIONS FOR PRACTICE Nurse practitioners, especially those in primary care, should consider that older adults presenting with multimorbidity may have undiagnosed hEDS/HSD. More research is needed to identify symptom patterns and clinical history that may suggest an underlying connective tissue disorder.
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Affiliation(s)
- Linda K Anderson
- University of Missouri, Sinclair School of Nursing, Columbia, Missouri
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Willich L, Bohner L, Köppe J, Jackowski J, Hanisch M, Oelerich O. Prevalence and quality of temporomandibular disorders, chronic pain and psychological distress in patients with classical and hypermobile Ehlers-Danlos syndrome: an exploratory study. Orphanet J Rare Dis 2023; 18:294. [PMID: 37726791 PMCID: PMC10510186 DOI: 10.1186/s13023-023-02877-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/24/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND The Ehlers-Danlos syndromes are a group of clinically and genetically heterogeneous hereditary diseases affecting the connective tissue. They are characterized by hypermobility of the joints, hyperextensible skin and friable tissue. According to current classification, 13 subtypes can be distinguished, of which the hypermobile and the classical subtype are the most prevalent. This study aimed to evaluate patients with classical (cEDS) and hypermobile (hEDS) Ehlers-Danlos syndrome regarding temporomandibular disorder (TMD), chronic pain, and psychological distress. METHODS Support groups from Germany, Austria, and Switzerland were contacted, and social media were used to recruit participants. Free text questions, the German version of the Depression Anxiety and Stress Scale (DASS), and the German version of the Graded Chronic Pain Status (GCPS) were used. RESULTS 259 participants were included (230 hEDS/29 cEDS). At least 49.2% of the participants had painful or restricted jaw movements, and at least 84.9% had pain in the masticatory muscles, with 46.3% already having a diagnosed TMD. Multivariate analysis showed a significant correlation between TMJ involvement and chronic pain with a 2.5-fold higher risk of chronic pain with a diagnosed TMD. 22.8% of participants had a critical score for depression, 53.3% had a critical score for anxiety, and 34.0% had a critical score for stress. CONCLUSION There is a high prevalence of TMD problems and chronic pain in patients with cEDS and hEDS. The lack of knowledge about these problems can create psychological distress. More research is needed to provide adequate treatment for patients with EDS.
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Affiliation(s)
- Leon Willich
- Department of Prosthodontics, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W30, Münster, D-48149, Germany
| | - Lauren Bohner
- Department of Oral and Maxillofacial Surgery, University Hospital Münster, Münster, 48149, Germany
| | - Jeanette Köppe
- Institute of Biostatistics and Clinical Research, University of Münster, Schmeddingstraße 56, Münster, D- 48149, Germany
| | - Jochen Jackowski
- Department of Oral Surgery and Policlinical Ambulance, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 45, Witten, 58448, Germany
| | - Marcel Hanisch
- Department of Oral and Maxillofacial Surgery, University Hospital Münster, Münster, 48149, Germany.
- Department of Oral Surgery and Policlinical Ambulance, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 45, Witten, 58448, Germany.
| | - Ole Oelerich
- Department of Prosthodontics, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W30, Münster, D-48149, Germany.
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Dolsø M, Juul-Kristensen B, Skou ST, Søgaard K, Søndergaard J, Juhl CB, Liaghat B. Psychological factors and symptom duration are associated with exercise-based treatment effect in people with hypermobile shoulders: A secondary analysis of a randomised controlled trial. Musculoskelet Sci Pract 2023; 66:102798. [PMID: 37331257 DOI: 10.1016/j.msksp.2023.102798] [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] [Received: 01/12/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Shoulder symptoms are common in patients with hypermobility spectrum disorders (HSD), but few studies focus on identifying factors associated with treatment effects. AIM To identify baseline and clinical characteristics associated with a better outcome 16 weeks after starting an exercise-based treatment in patients with HSD and shoulder symptoms. DESIGN Exploratory secondary analysis of data from a randomised controlled trial. METHOD Self-reported treatment outcome was reported as change between baseline and follow-up after 16 weeks of high-load or low-load shoulder strengthening. Multiple linear and logistic regressions were used to investigate associations of patient expectations of treatment effect, self-efficacy, fear of movement, and symptom duration with change in shoulder function, shoulder pain, quality of life, and patient reported health change. All regression models were performed firstly with adjustments for covariates (age, sex, body mass index, hand dominance, treatment group, and baseline score of the outcome variable) and secondly with additional adjustments for exposure variables. RESULTS Expectations of complete recovery were associated with an increased odds of perceiving an important improvement in physical symptoms after a 16-week exercise-based treatment program. Higher self-efficacy at baseline seemed to be associated with improved shoulder function, shoulder pain and quality of life. A higher fear of movement seemed to be associated with increased shoulder pain and decreased quality of life. A longer symptom duration was associated with decreased quality of life. CONCLUSION Expectations of complete recovery, higher self-efficacy, lower fear of movement and shorter symptom duration seem to be important for better treatment outcomes.
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Affiliation(s)
- Morten Dolsø
- 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
| | - Søren T Skou
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Carsten Bogh Juhl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Denmark
| | - Behnam Liaghat
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Centre for Evidence-Based Orthopaedics (CEBO), Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark.
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12
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Labanca L, Brizola E, Luciani D, Luppi G, Sangiorgi L, Benedetti MG. Clinical-functional features of individuals with Osteogenesis Imperfecta and Ehlers-Danlos syndromes: A scoping review of assessment tools and ICF model. Musculoskelet Sci Pract 2023; 64:102742. [PMID: 36905741 DOI: 10.1016/j.msksp.2023.102742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/23/2023] [Accepted: 03/03/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Clinical-functional assessment of patients affected by Osteogenesis Imperfecta and Ehlers-Danlos Syndromes is essential for clinical management. However, there is no clear information on disease-specific tools of assessment for clinical practice, thus limiting quantification and management of the diseases-related impairments. OBJECTIVE The present scoping review was aimed at investigating the most common clinical-functional features and assessment tools in individuals with Osteogenesis Imperfecta and Ehlers-Danlos Syndromes, and to provide an updated International Classification of Functioning (ICF) model related to functional impairments for each disease. METHODS The literature revision was conducted on PubMed, Scopus and Embase databases. Articles reporting an ICF model of clinical-functional features and assessment tools for Osteogenesis Imperfecta and Ehlers-Danlos Syndromes individuals were included. RESULTS A total of 27 articles were included, 7 reporting an ICF model, and 20 reporting clinical-functional assessment tools. It was reported that patients with Osteogenesis Imperfecta and Ehlers-Danlos Syndromes show impairments in both Body Function and Structure, and Activities and Participation domains of the ICF. A heterogeneous number of assessment tools was found for both diseases regarding proprioception, pain, endurance to exercise, fatigue, balance and motor coordination, and mobility. CONCLUSION Patients with Osteogenesis Imperfecta and Ehlers-Danlos Syndromes show several impairments and limitations in Body Function and Structure, and Activities and Participation domains of the ICF. Thus, an appropriate and ongoing assessment of the disease-related impairments is necessary to improve clinical practice. Several functional tests and clinical scales can be used to assess the patients despite the heterogeneity of assessment tools found in previous literature.
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Affiliation(s)
- Luciana Labanca
- Physical Medicine and Rehabilitation Unit, IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
| | - Evelise Brizola
- Department of Rare Skeletal Disorders, IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Deianira Luciani
- Physical Medicine and Rehabilitation Unit, Single Regional Health Company - Large Area 4, Porto San Giorgio, Italy
| | - Giulia Luppi
- Physical Medicine and Rehabilitation Unit, IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Sangiorgi
- Department of Rare Skeletal Disorders, IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maria Grazia Benedetti
- Physical Medicine and Rehabilitation Unit, IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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13
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Baeza-Velasco C, Rodriguez N, Parra L, Gutiérrez-Rosado T. Adjustment to disease and quality of life in people with vascular Ehlers-Danlos and Loeys-Dietz syndromes: A mixed-method study. Front Psychol 2023; 14:1019863. [PMID: 36925590 PMCID: PMC10011476 DOI: 10.3389/fpsyg.2023.1019863] [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: 08/15/2022] [Accepted: 01/30/2023] [Indexed: 03/08/2023] Open
Abstract
Background Vascular Ehlers-Danlos (vEDS) and Loeys-Dietz syndromes (LDS) are hereditary disorders of connective tissue having severe vascular complications (HDCTv) which lead to an increased risk of premature death. Little is known about the impact of the disease in patient's daily life. Method Sixteen HDCTv patients (vEDS = 9 and LDS = 7), 16 age and sex-matched hypermobile Ehlers-Danlos syndrome patients (hEDS) and 18 healthy subjects (HS), responded to self-questionnaires assessing psychosocial adjustment, quality of life (QoL), anxiety, depression, pain, fatigue and sleep problems. Patients with HDCTv were also interviewed in order to explore qualitatively their experience with the disease. Results Compared with HS, patients with HDCTv scored significantly higher on anxiety, depression, fatigue, sleep problems, and lower on QoL. Most HDCTv patients (93.8%) have optimal psychosocial adjustment. In addition, HDCTv patients scored higher on QoL and psychosocial adjustment, but lower in pain, fatigue, sleep problems, and depressive symptoms than hEDS patients. Four main themes were identified in qualitative analyses: living with HDCTv, knowledge/ignorance of the disease, health behaviors/self-care and coping strategies. Conclusion Our results suggest that despite the negative impact of HDCTv on the patients' daily lives, overall, they present an optimal disease adjustment which points to appropriate coping strategies. More research in psychosocial aspects of people with these rare diseases are needed to confirm these results and better understand their needs.
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Affiliation(s)
- Carolina Baeza-Velasco
- Laboratoire de Psychopathologie et Processus de Santé (LPPS UR4057), Université Paris Cité, Boulogne-Billancourt, Paris, France.,Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France.,Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
| | | | - Laura Parra
- Laboratoire de Psychopathologie et Processus de Santé (LPPS UR4057), Université Paris Cité, Boulogne-Billancourt, Paris, France
| | - Teresa Gutiérrez-Rosado
- Department of Clinical and Health Psychology, University Autonomous of Barcelona, Barcelona, Spain
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14
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Jones JT, Black WR, Moser CN, Rush ET, Malloy Walton L. Gender dysphoria in adolescents with Ehlers-Danlos syndrome. SAGE Open Med 2022; 10:20503121221146074. [PMID: 36600979 PMCID: PMC9806399 DOI: 10.1177/20503121221146074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/30/2022] [Indexed: 12/27/2022] Open
Abstract
Objectives Ehlers-Danlos Syndrome represents a family of heritable connective tissue disorders that include joint hypermobility, tissue fragility, and skin hyperextensibility. Ehlers-Danlos Syndrome presents with clinical sequela across multiple body systems that require multidisciplinary care. Little is known about adolescents with Ehlers-Danlos Syndrome who are transgender and gender diverse. To date, there have been no reports of transgender and gender diverse youth in pediatric patients with Ehlers-Danlos Syndrome. The objective of this study was to characterize transgender and gender diverse adolescents with Ehlers-Danlos Syndrome seen in a pediatric multidisciplinary specialty clinic. Methods A retrospective chart review was performed and it was found that 28 patients were seen in the Ehlers-Danlos Syndrome multidisciplinary clinic were reported being transgender and gender diverse. Chart review included analysis of all documents in the electronic medical record, including demographic data, gender identity, chosen pronouns, specialty care previously received for Ehlers-Danlos Syndrome, symptoms and conditions related to it, and medications. Results Of the 166 total adolescents seen in the pediatric multidisciplinary Ehlers-Danlos Syndrome clinic during the study period, 17% reported gender dysphoria. The average age at Ehlers-Danlos Syndrome diagnosis was 13.5 years (range 8-17 years). Most (61%) reported their gender identity as transgender, followed by nonbinary (14%). Most had preferred male (he/him) pronouns (47%), followed by nonbinary (they/them) pronouns (39%). The vast majority reported fatigue (75%), musculoskeletal issues (96%), psychiatric issues (86%), cardiac issues (71%), gastrointestinal issues (68%), and neurologic issues (79%). Conclusions Here we report the first cohort of transgender and gender diverse adolescents in the Ehlers-Danlos syndrome population and show an association between the two. This report increases awareness for providers who care for patients with Ehlers-Danlos Syndrome. As care for those with Ehlers-Danlos Syndrome is often complex and multidisciplinary, providers should adopt practices of gender-affirming medical care that contribute to improved care and outcomes.
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Affiliation(s)
- Jordan T. Jones
- Children’s Mercy Kansas City, Kansas
City, MO, USA,University of Missouri-Kansas City
School of Medicine, Kansas City, MO, USA,University of Kansas School of
Medicine, Kansas City, KS, USA,Jordan T. Jones, Department of Pediatrics,
Division of Rheumatology, Children’s Mercy Kansas City, 2401 Gillham Rd, Kansas
City, MO 64108, USA.
| | - William R. Black
- University of Kansas School of
Medicine, Kansas City, KS, USA,Center for Children’s Healthy
Lifestyles and Nutrition, Kansas City, MO, USA
| | - Christine N. Moser
- Children’s Mercy Kansas City, Kansas
City, MO, USA,University of Missouri-Kansas City
School of Medicine, Kansas City, MO, USA
| | - Eric T. Rush
- Children’s Mercy Kansas City, Kansas
City, MO, USA,University of Missouri-Kansas City
School of Medicine, Kansas City, MO, USA,University of Kansas School of
Medicine, Kansas City, KS, USA
| | - Lindsey Malloy Walton
- Children’s Mercy Kansas City, Kansas
City, MO, USA,University of Missouri-Kansas City
School of Medicine, Kansas City, MO, USA,University of Kansas School of
Medicine, Kansas City, KS, USA
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15
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A Comprehensive Review: Chronic Pain Sequelae in the Presence of Ehlers-Danlos Syndrome. Curr Pain Headache Rep 2022; 26:871-876. [PMID: 36434419 DOI: 10.1007/s11916-022-01093-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Patients diagnosed with Ehlers-Danlos syndromes (EDS), and especially those with the hypermobility subtype, often experience a diverse range of acute and chronic pain conditions throughout their lifetime. These can present in a variety of different phenotypes and comorbidities, making it difficult to develop structured treatment protocols. This review seeks to summarize the current literature to address old and novel treatments for EDS. RECENT FINDINGS Historically, medications and surgery have been used to treat patients with EDS but with low efficacy. Newer therapies that have shown promising effects for both decreasing pain and increasing quality of life include physical/occupational therapy, transcutaneous electrical nerve stimulation units, trigger point injections, low-dose naltrexone, and laser therapy. In addition, addressing the psychosocial aspects of pain with EDS through methods like cognitive behavioral therapy and patient education has shown to be vital in minimizing pain. Most research also emphasizes that pain management should not only focus on pain reduction, but on helping reduce symptoms of hypermobility, central sensitization, and fatigue to make an impactful difference. Research on pain in EDS is still limited with good clinical practice guidelines often limited by poor sample size and lack of clinical studies. Treatment options should be structured based on the specific type of pain pathology and presenting symptoms of each patient and their comorbidities. Future research should attempt to prioritize larger sample sizes, clear definitions of EDS subtypes, randomized trials for treatment efficacy, and more studies dedicated to non-musculoskeletal forms of pain.
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16
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Jones JT, Black WR, Cogan W, Callen E. Resource utilization and multidisciplinary care needs for patients with Ehlers-Danlos syndrome. Mol Genet Genomic Med 2022; 10:e2057. [PMID: 36151850 PMCID: PMC9651604 DOI: 10.1002/mgg3.2057] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/23/2022] [Accepted: 09/05/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Ehlers-Danlos syndrome (EDS) represents a family of heritable connective tissue disorders with overlapping phenotypic features, frequently including joint hypermobility, tissue fragility, and skin hyperextensibility. Comorbid symptoms are common for patients with EDS and include multiple body systems marked by neurologic, cardiovascular, gastrointestinal, musculoskeletal issues, chronic pain, headaches, and anxiety and depression. The many comorbidities lead to high disease burden, which requires greater healthcare utilization. METHODS This survey of families examines healthcare utilization, of adults and minors, through evaluation of subspecialty care appointments across many healthcare systems in one region. RESULTS There were 155 adults and 83 minors with a diagnosis of EDS with a total of 693 unique visits across 27 different specialties at over 20 different hospitals or clinics in the surveyed area. Cardiology, neurology, and gastroenterology were the most utilized subspecialties for adults, while rheumatology, cardiology, and neurology were most utilized by minors. Many respondents (67%) reported their medical care needs are not being met, and 87% reported interest in a multidisciplinary clinic for EDS with the most interest in pain management, physical and occupational therapy, and rheumatology. CONCLUSION Understanding healthcare utilization and needs of those with EDS can provide the foundation for improved care for those with EDS through a coordinated multidisciplinary care model.
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Affiliation(s)
- Jordan T. Jones
- Department of PediatricsChildren's Mercy Kansas CityKansas CityMissouriUSA
- Department of PediatricsUniversity of Missouri‐Kansas City School of MedicineKansas CityMissouriUSA
- Department of PediatricsUniversity of Kansas School of MedicineKansas CityKansasUSA
| | - William R. Black
- Department of PediatricsUniversity of Kansas School of MedicineKansas CityKansasUSA
- Center for Children's Healthy Lifestyles and NutritionChildren's Mercy Kansas CityKansas CityMissouriUSA
| | - Wendy Cogan
- EDSKC Collaboration Inc, A Non‐Profit Patient Advocacy OrganizationKansas CityMissouriUSA
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17
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Ahimaz P, Kramer T, Swaroop P, Mitchell M, Hernan R, Anyane-Yeboa K, Pereira EM. Assessment of the beliefs, needs, and expectations for genetic counseling of patients with hypermobile Ehlers-Danlos syndrome. Am J Med Genet A 2022; 188:3172-3183. [PMID: 36209348 DOI: 10.1002/ajmg.a.62945] [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: 03/26/2022] [Revised: 05/16/2022] [Accepted: 06/19/2022] [Indexed: 01/31/2023]
Abstract
Ehlers-Danlos syndrome, hypermobility type (hEDS) is a heritable connective tissue disorder that currently does not have a known molecular etiology. Previous studies have explored the complex symptomology, clinical diagnosis, and psychological aspects of hEDS. Genetics providers currently aid in the diagnosis and management guidance of patients with hEDS, but there is limited data describing the needs and expectations of individuals with hEDS from a clinical genetics appointment. Our study sought to explore these items through the use of an online survey to assess participants' beliefs, needs and expectations (BNE) for genetic counseling as well as questions about demographics, hEDS symptoms, and current medical care. A total of 460 respondents with hEDS completed the survey. Most participants felt joint pain/weakness (n = 392; 88%) was one of the most disruptive symptoms of hEDS and 63% (n = 289) reported having psychiatric conditions. BNE scores were highest in two domains: expectations to have psychosocial concerns addressed during a genetic counseling appointment (mean score = 4.4/5; SD = 0.56) and desire for positive feelings after a genetic counseling session (mean score = 4.3/5; SD = 0.59). Participants who previously had genetic counseling felt less unsure about their diagnosis (p = 0.02) and had lower need for information about hEDS (p < 0.001). Majority of participants did not feel that their doctors were knowledgeable about hEDS (n = 269; 58%) and strongly supported a multidisciplinary approach to their care (n = 445; 97%). This research provides a framework for genetics providers and other healthcare professionals to assess the needs and expectations of patients with hEDS and consider re-structuring their appointment formats to service this population.
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Affiliation(s)
- Priyanka Ahimaz
- Department of Pediatrics, Division of Molecular Genetics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Tamar Kramer
- Department of Pediatrics, Division of Clinical Genetics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Pooja Swaroop
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - McKenzie Mitchell
- Medical Genetics Clinic, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Rebecca Hernan
- Department of Pediatrics, Division of Molecular Genetics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Kwame Anyane-Yeboa
- Department of Pediatrics, Division of Clinical Genetics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Elaine M Pereira
- Department of Pediatrics, Division of Clinical Genetics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
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18
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Baeza-Velasco C, Hamonet C, Montalescot L, Courtet P. Suicidal Behaviors in Women With the Hypermobile Ehlers-Danlos Syndrome. Arch Suicide Res 2022; 26:1314-1326. [PMID: 33596399 DOI: 10.1080/13811118.2021.1885538] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Hypermobile Ehlers-Danlos syndrome (hEDS) is the most frequent heritable disorder of the connective tissue. This is characterized by a generalized fragility of tissues leading to chronic pain, disability and high levels of psychological distress. Suicidal behaviors in those affected are not uncommon but they have not been well studied. We aimed to explore aspects of suicidality and related factors in a group of patients with hEDS. METHOD Thirty-five women with hEDS were included in this cross-sectional study. They were assessed with the Mini-International Neuropsychiatric Interview for Axis 1 DSM-IV mental disorders and suicidality. They also responded to self-questionnaires assessing health (pain, BMI, and diagnosis delay) and psychosocial variables (social support, physical functioning, coping strategies, personality disturbances, and resilience). RESULTS Eleven patients (31.4%) had attempted suicide in the past. Fifteen patients (42.9%) had some degree of suicide risk at the time of evaluation, mainly mild risk (60%). Compared with patients without a history of suicide attempt, those who had attempted suicide were younger, scored higher on personality disturbances, especially on depressive, avoidant, antisocial, and borderline trait subscores, and had an increased prevalence of lifetime major depression, mania/hypomanic episodes, and anxiety disorders (p < .05). Binary logistic regression showed that personality disturbances and anxiety disorders increase the probability of belonging to the attempters group. CONCLUSIONS Consistent with previous reports, these data highlight the high frequency of suicidal behaviors in hEDS patients as well as the importance to explore psychopathology in those affected in order to identify vulnerable individuals and provide specific support.HIGHLIGHTSAttempted suicide in patients with hEDS is not uncommon.Age and the presence of psychopathology are associated with suicide attempt in hEDS patients.Personality disturbances and lifetime anxiety disorders predicted suicide attempted in this sample.
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19
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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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20
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Anderson LK, Lane KR. The diagnostic journey in adults with hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders. J Am Assoc Nurse Pract 2021; 34:639-648. [PMID: 34739411 DOI: 10.1097/jxx.0000000000000672] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/29/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Researchers have identified lengthy diagnosis delays in patients with hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders (hEDS/HSD), but the reason for these delays is unclear. OBJECTIVE This review seeks to synthesize the existing qualitative research about hEDS/HSD to understand the reasons for diagnosis delay. DATA SOURCES We searched PubMed, Scopus, CINAHL, Google Scholar, and Dissertations and Theses databases for all qualitative studies about hEDS/HSD that mentioned the diagnosis process. A total of 283 studies were retrieved, from which we identified 13 studies to include in this synthesis. CONCLUSIONS The reviewers identified and organized diagnosis delay themes under four overarching categories: disease, patient, provider, and system. Disease factors included the nature of the symptoms and lack of a confirmatory test. Patient factors included psychological and emotional responses, seeing multiple providers, and receiving multiple diagnoses. Provider factors related to limited knowledge and attitudes. System factors included silo-based health care systems and bureaucratic barriers. IMPLICATIONS FOR PRACTICE Diagnosis delays result from complex, overlapping, and interacting factors. Nurse practitioners have a critical role in improving care and reducing diagnosis delays in patients with hEDS/HSD. Further research is needed to understand the causes and consequences of diagnosis delays in hEDS/HSD.
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Affiliation(s)
- Linda K Anderson
- Sinclair School of Nursing, University of Missouri-Columbia, Columbia, Missouri
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Kalisch L, Boniwell I, Osin E, Baeza-Velasco C. Feeling Good Despite EDS: The Effects of a 5-Week Online Positive Psychology Programme for Ehlers-Danlos-Syndromes Patients. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2021; 52:79-87. [PMID: 34667333 PMCID: PMC8517566 DOI: 10.1007/s10879-021-09521-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 01/07/2023]
Abstract
Ehlers–Danlos-Syndromes (EDS) is a group of hereditary, chronic and potentially disabling conditions. Few studies have tested the effects of psychological interventions to increase well-being in this population. We hypothesized that Positive Psychology Interventions (PPI), first applied to healthy and mentally ill subjects, can also be useful for people with somatic conditions and conducted a study to evaluate the efficacy of a 5-week online PPI designed to improve well-being in EDS patients. A sample of 132 EDS patients were allocated to three groups: assigned PPI, self-selected PPI, and waitlist control-group (WLC). Measures of positive and negative affect, pain disability, fatigue, and life satisfaction were administered before program start, 6 weeks later, and 1 month later. Satisfaction with the program was also evaluated. The results revealed that participants in the self-selected PPI-group, but not in the assigned PPI group, reported significantly lower levels of fatigue and higher levels of positive affect and life satisfaction compared to WLC after 6 weeks. There were no effects on negative affect and pain disability measures. Finally, 77% of the participants were satisfied or very satisfied with the program. These findings confirm and extend previous research by showing the efficacy of PPI for people with chronic illness under the condition that individuals can choose the program content. From a healthcare perspective, online PPIs could complement treatments aimed at symptom reduction and increase well-being in patients with EDS.
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Affiliation(s)
| | - Ilona Boniwell
- Positran, Epone, France
- Faculty of Science and Engineering Cambridge, Anglia Ruskin University (UK), Cambridge, UK
| | - Evgeny Osin
- International Laboratory of Positive Psychology of Personality and Motivation, National Research University Higher School of Economics, Moscow, Russia
- Laboratory LINP2, University of Paris Nanterre, Nanterre, France
| | - Carolina Baeza-Velasco
- LPPS, Université de Paris, 92100 Boulogne Billancourt, France
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France
- IGT, University of Montpellier, CNRS, INSERM, Montpellier, France
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Shirk DV, Williams SD. Psychiatric Manifestations of Ehlers-Danlos Syndrome in Adolescents: A Case Report and Literature Review. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2021. [DOI: 10.2174/2666082216999201126165311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Ehlers-Danlos Syndromes (EDS) comprise a group of heterogeneous hereditary
connective tissue disorders [1, 2]. Psychiatric disorders such as depression, anxiety, panic
disorder, agoraphobia, schizophrenia, neurodevelopmental disorders, personality disorder, eating
disorders, substance misuse and interpersonal issues have been reported in the literature to be associated
with EDS [1-3].
Objectives:
The case of a 15-year old male who was hospitalized after a suicide attempt by gunshot,
who was discovered to have symptoms suggestive of EDS, is presented in this paper along with the
results of a literature search of psychiatric manifestations of EDS in children and adolescents.
Methods:
Literature review was conducted on the UpToDate website on March 11, 2020 to review
symptoms of Ehlers-Danlos Syndrome for the purpose of preliminary diagnosis of this patient. Additional
literature search was conducted on PubMed on 4/2/20 at 12:10 P.M. and on 4/9/20 at 10:51
P.M. and on the search engine Google on 4/2/20 at 12:25 P.M. On May 11, 2020 at 2 P.M., another
web search was conducted with a review of 6 different websites pertaining to Ehlers-Danlos
Syndrome.
Results:
A systematic review of psychiatric manifestations of Ehlers-Danlos Syndromes revealed a
strong incidence of psychiatric symptoms.
Conclusion:
Our patient’s psychiatric symptoms of depression, suicidal ideations, anxiety and social
and educational struggles may have been at least partially due to chronic pain- abdominal,
headache and musculoskeletal, and social ostracization associated with Ehlers-Danlos Syndrome.
Education regarding this illness helped our patient’s recovery as he came to understand why he was
so “odd” and the cause of his multisystemic chronic pain.
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Affiliation(s)
- Daisy Vyas Shirk
- Department of Psychiatry, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Sarah D. Williams
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, United States
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Oelerich O, Kleinheinz J, Reissmann DR, Köppe J, Hanisch M. Correlation between Oral Health-Related Quality of Life and Objectively Measured Oral Health in People with Ehlers-Danlos Syndromes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218243. [PMID: 33171578 PMCID: PMC7664661 DOI: 10.3390/ijerph17218243] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/26/2020] [Accepted: 11/06/2020] [Indexed: 11/18/2022]
Abstract
It is a well-known fact that people with Ehlers–Danlos syndromes (EDS) report a worse oral health-related quality of life (OHRQoL) than the general population. The aim of this study was to examine whether there is a correlation between the subjective OHRQoL and the objectively measured oral health in people with EDS. To determine the subjective OHRQoL, the German version of the 14-item Oral Health Impact Profile (OHIP-14) questionnaire was used. Furthermore, all participants in the study were clinically examined, and the measured parameters were recorded using the Physical Oral Health Index (PhOX). Altogether, records of 46 participants were collected. The median (interquartile range (IQR)) of the OHIP-14 was 17 (23) points and the median of the PhOX was 73 (16) points. However, a statistically significant correlation could not be demonstrated (r = −0.240, p = 0.108). In the observed cohort, for participants who reported having pain often or very often, the OHIP score (median = 24, IQR = 18, p < 0.01) was higher than the score of the group given by participants who never or intermittently experienced pain (median = 8, IQR = 18). In conclusion, patients with EDS showed a reduced OHRQoL, although it was not possible to observe an association between the subjective OHRQoL and the objective oral health. However, participants who often or very often suffer from pain in their tooth, mouth, and jaw areas showed a reduced OHRQoL.
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Affiliation(s)
- Ole Oelerich
- Department of Cranio-Maxillofacial Surgery, Research Unit Rare Diseases with Orofacial Manifestations (RDOM), University Hospital Münster, D-48149 Münster, Germany; (O.O.); (J.K.)
| | - Johannes Kleinheinz
- Department of Cranio-Maxillofacial Surgery, Research Unit Rare Diseases with Orofacial Manifestations (RDOM), University Hospital Münster, D-48149 Münster, Germany; (O.O.); (J.K.)
| | - Daniel R. Reissmann
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20251 Hamburg, Germany;
| | - Jeanette Köppe
- Institute of Biostatistics and Clinical Research, University of Münster, D-48149 Münster, Germany;
| | - Marcel Hanisch
- Department of Cranio-Maxillofacial Surgery, Research Unit Rare Diseases with Orofacial Manifestations (RDOM), University Hospital Münster, D-48149 Münster, Germany; (O.O.); (J.K.)
- Correspondence:
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