1
|
Garreth Brittain M, Flanagan S, Foreman L, Teran-Wodzinski P. Physical therapy interventions in generalized hypermobility spectrum disorder and hypermobile Ehlers-Danlos syndrome: a scoping review. Disabil Rehabil 2024; 46:1936-1953. [PMID: 37231592 DOI: 10.1080/09638288.2023.2216028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 05/13/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE Physical therapy (PT) plays a central role in treating individuals with Generalized Hypermobility Spectrum Disorder (G-HSD) and Hypermobile Ehlers-Danlos Syndrome (hEDS). However, there is limited research describing these individuals' PT management. This review aims to systematically map the evidence on PT interventions to treat this patient population. METHODS A systematic literature search of PubMed, CINAHL, and Embase from January 2000 to April 2023 was performed. After the screening process, studies were appraised and classified based on the type of PT interventions used. Five reviewers independently assessed the articles. RESULTS The search produced 757 articles. Twenty-eight met the inclusion criteria. The studies included 630 participants, mostly female, with a mean age of 26.2 (ranging from 2 to 69). The PT interventions used were therapeutic exercise, patient instruction, motor function training, adaptive equipment, manual therapy, and functional training. CONCLUSIONS The evidence indicates that therapeutic exercise and motor function training are efficacious methods to treat individuals with G-HSD and hEDS. There is also weak evidence for using adaptive equipment, patient instruction, manual therapy, and functional training. Recent studies emphasize multidisciplinary care and understanding of the psychological impact of G-HSD/hEDS. Additional research is needed to determine the effectiveness and dosage of PT interventions.
Collapse
Affiliation(s)
- Mackenzie Garreth Brittain
- School of Physical Therapy and Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Sarah Flanagan
- School of Physical Therapy and Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Lindsey Foreman
- School of Physical Therapy and Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Patricia Teran-Wodzinski
- School of Physical Therapy and Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Wesley A, Coussens M, Chan C, Pacey V, Bray P, Nicholson LL. Conservative management of hand impairment in children and adolescents with heritable disorders of connective tissue: A scoping review. Phys Occup Ther Pediatr 2023; 44:19-41. [PMID: 37125678 DOI: 10.1080/01942638.2023.2199846] [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: 08/19/2022] [Accepted: 04/02/2023] [Indexed: 05/02/2023]
Abstract
AIMS To synthesize and critically appraise available interventions in the conservative management of hand impairment for children and adolescents with heritable disorders of connective tissue (HDCT). METHODS A search of peer-reviewed literature and online platforms were included with data regarding hand impairment and function, conservative management and outcome measures extracted and appraised. Levels of evidence were applied to published literature. RESULTS Ten peer-reviewed papers, eleven webpages and YouTube videos met the inclusion criteria. Reported interventions included: strengthening, orthoses, assistive equipment, education and pacing. Evidence of intervention effectiveness and evidence-based guidance on dosage were absent, with no consistency of outcome measures monitoring intervention effectiveness. Online platforms posted by health professionals predominantly provided advice for families without clinical detail of interventions. CONCLUSIONS There is a consistent suite of interventions identified in both peer-reviewed literature and online platforms used by clinicians and families to manage hand impairment for children and adolescents with HDCT. Clear dosage parameters and outcome measures are needed in future intervention studies to determine the effectiveness of interventions and guide clinicians in how best to treat hand impairment. Increasing accountability and quality of online resources posted by health professionals for families is warranted to ensure dosage details and precautions are provided.
Collapse
Affiliation(s)
- Alison Wesley
- Occupational Therapy Department, The Children's Hospital at Westmead, Sydney, Australia
- Department of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Marie Coussens
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Cliffton Chan
- Department of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Verity Pacey
- Department of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Paula Bray
- Department of Medicine and Health, The University of Sydney, Sydney, Australia
- The Sydney Children's Hospitals Network, Sydney, Australia
| | - Leslie L Nicholson
- Department of Medicine and Health, The University of Sydney, Sydney, Australia
| |
Collapse
|
4
|
Baeza-Velasco C. Neurodevelopmental atypisms in the context of joint hypermobility, hypermobility spectrum disorders, and Ehlers-Danlos syndromes. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2021; 187:491-499. [PMID: 34741402 DOI: 10.1002/ajmg.c.31946] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/28/2021] [Accepted: 10/16/2021] [Indexed: 12/13/2022]
Abstract
Joint hypermobility (JHM), defined as an increased range of joint motion, is a frequent somatic trait in the general population but also the hallmark of many of the hereditary disorders of connective tissue. Ehlers-Danlos syndromes (EDS) belong to this group of diseases and are characterized by tissue fragility, skin abnormalities, and JHM. Between JHM and EDS, there are the so-called hypermobility spectrum disorders (HSD), which is an umbrella term referring to people with symptomatic JHM who do not fulfill criteria for a syndromic connective tissue disorder such as EDS. Among the variety of clinical correlates of JHM/HSD/EDS, neurodevelopmental atypisms are common although often not screened for and identified in the clinical setting. This article reviews the pertinent literature concerning neurodevelopmental conditions for which there is some evidence of an association with JHM/HSD/EDS. These include hyperactivity and attention deficit, learning, communication, and motor problems including tic disorders such as Tourette syndrome and autism spectrum disorders. Underlying mechanism hypotheses for such interconnections are also reviewed. The coexistence of connective tissue-altered conditions and neurodevelopmental atypisms increases disability in patients from an early age. Thus, increased awareness among clinicians and researchers is necessary to promote assessment, diagnosis, and develop management strategies to meet the specific needs of those affected.
Collapse
Affiliation(s)
- Carolina Baeza-Velasco
- Université de Paris, Laboratoire de Psychopathologie et Processus de Santé, Boulogne Billancourt, France.,Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France.,IGT, University of Montpellier, CNRS, INSERM, Montpellier, France
| |
Collapse
|
5
|
Jensen AM, Andersen JQ, Quisth L, Ramstrand N. Finger orthoses for management of joint hypermobility disorders: Relative effects on hand function and cognitive load. Prosthet Orthot Int 2021; 45:36-45. [PMID: 33834743 PMCID: PMC7978036 DOI: 10.1177/0309364620956866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 08/06/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Joint hypermobility refers to joints that move beyond their normal limits. Individuals with hypermobility of the fingers experience difficulties in activities of daily living. Finger orthoses are available for managing hypermobility of the fingers, but their effectiveness has received little attention in scholarly literature. OBJECTIVES To determine if use of custom fit finger orthoses leads to improvements in time needed to perform standardised hand function tests, and attentional demand required to perform these tests, in individuals with joint hypermobility syndrome, Hypermobile Ehlers-Danlos syndrome or Classical Ehlers-Danlos syndrome. STUDY DESIGN Repeated-measures study. METHODS Fourteen participants performed three different hand function tests (target box and block test, writing and picking up coins), with and without their finger orthoses. Time to complete each test was recorded as a measure of functional performance. Brain activity was recorded in the pre-frontal cortices as a measure of attentional demand. RESULTS Functional performance significantly improved for all but one test (picking up coins with non-dominant hand) when participants wore finger orthoses (p < 0.05). Activity in the pre-frontal cortex was lower when using the orthosis to perform the coin test (dominant hand; p < 0.05). No differences were observed in other tests (p > 0.05). CONCLUSIONS Results suggested that finger orthoses improved hand function and provided limited evidence to suggest that they may also affect attentional demand. While the limited sample does not provide conclusive evidence supporting the use of finger orthosis in this clinical population, results warrant further investigation in large scale longitudinal studies or randomised controlled trials.
Collapse
Affiliation(s)
| | | | | | - Nerrolyn Ramstrand
- CHILD Research Group, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| |
Collapse
|
6
|
Feldman ECH, Hivick DP, Slepian PM, Tran ST, Chopra P, Greenley RN. Pain Symptomatology and Management in Pediatric Ehlers-Danlos Syndrome: A Review. CHILDREN-BASEL 2020; 7:children7090146. [PMID: 32967103 PMCID: PMC7552757 DOI: 10.3390/children7090146] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 12/12/2022]
Abstract
Ehlers-Danlos syndromes (EDS) are a group of connective tissue disorders that manifest with hyperextensibility of joints and skin, and general tissue fragility. While not a major criterion for clinical diagnosis, pain is a frequently endorsed symptom across subtypes of EDS. As such, the present review aims to summarize research to date on pain characteristics and management, and the relationship between such pain symptomatology and quality of life in pediatric EDS. Characteristics of pain, including theorized etiology, relative intensity and extent of pain are described, as well as descriptions of frequently endorsed pain sites (musculoskeletal, and non-musculoskeletal). Interventions related to the management of musculoskeletal (e.g., pharmaceutical intervention, physical therapy) and non-musculoskeletal pain (e.g., pharmaceutical and psychological interventions) are discussed, highlighting the need for additional research related to pediatric pain management in the context of hypermobility syndromes. In addition, the relationship between pain in pediatric EDS and quality of life is described. Finally, limitations of literature to date are described and recommendations for future lines of research are outlined.
Collapse
Affiliation(s)
- Estée C. H. Feldman
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA;
- Correspondence:
| | - Daniel P. Hivick
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA;
| | - P. Maxwell Slepian
- Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada;
| | - Susan T. Tran
- Department of Psychology, DePaul University, Chicago, IL 60614, USA;
| | - Pradeep Chopra
- Alpert Medical School, Brown University, Providence, RI 02903, USA;
| | - Rachel Neff Greenley
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA;
| |
Collapse
|
7
|
Exercise in Children with Disabilities. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2019. [DOI: 10.1007/s40141-019-0213-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
8
|
Bale P, Easton V, Bacon H, Jerman E, Watts L, Barton G, Clark A, Armon K, MacGregor AJ. The effectiveness of a multidisciplinary intervention strategy for the treatment of symptomatic joint hypermobility in childhood: a randomised, single Centre parallel group trial (The Bendy Study). Pediatr Rheumatol Online J 2019; 17:2. [PMID: 30621718 PMCID: PMC6325876 DOI: 10.1186/s12969-018-0298-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/10/2018] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Joint hypermobility is common in childhood and can be associated with musculoskeletal pain and dysfunction. Current management is delivered by a multidisciplinary team, but evidence of effectiveness is limited. This clinical trial aimed to determine whether a structured multidisciplinary, multisite intervention resulted in improved clinical outcomes compared with standard care. METHOD A prospective randomised, single centre parallel group trial comparing an 8-week individualised multidisciplinary intervention programme (bespoke physiotherapy and occupational therapy in the clinical, home and school environment) with current standard management (advice, information and therapy referral if deemed necessary). The primary endpoint of the study was between group difference in child reported pain from baseline to 12 months as assessed using the Wong Baker faces pain scale. Secondary endpoints were parent reported pain (100 mm visual analogue scale), parent reported function (child health assessment questionnaire), child reported quality of life (child health utility 9-dimensional assessment), coordination (movement assessment battery for children version 2) and grip strength (handheld dynamometer). RESULTS 119 children aged 5 to 16 years, with symptomatic hypermobility were randomised to receive an individualised multidisciplinary intervention (I) (n = 59) or standard management (S) (n = 60). Of these, 105 completed follow up at 12 months. No additional significant benefit could be shown from the intervention compared to standard management. However, there was a statistically significant improvement in child and parent reported pain, coordination and grip strength in both groups. The response was independent of the degree of hypermobility. CONCLUSION This is the first randomised controlled trial to compare a structured multidisciplinary, multisite intervention with standard care in symptomatic childhood hypermobility. For the majority, the provision of education and positive interventions aimed at promoting healthy exercise and self-management was associated with significant benefit without the need for more complex interventions. TRIAL REGISTRATION The trial was registered prospectively with the national database at the Clinical Research Network (UKCRN Portfolio 9366). The trial was registered retrospectively with ISRCTN ( ISRCTN86573140 ).
Collapse
Affiliation(s)
- Peter Bale
- Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, UK.
| | - Vicky Easton
- grid.240367.4Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, UK
| | - Holly Bacon
- grid.240367.4Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, UK
| | - Emma Jerman
- grid.439334.aNorfolk Community Health and Care NHS Trust, Norwich, UK
| | - Laura Watts
- grid.240367.4Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, UK ,0000 0001 1092 7967grid.8273.eNorwich Medical School, University of East Anglia, Norwich, UK
| | - Garry Barton
- 0000 0001 1092 7967grid.8273.eNorwich Medical School, University of East Anglia, Norwich, UK
| | - Allan Clark
- 0000 0001 1092 7967grid.8273.eNorwich Medical School, University of East Anglia, Norwich, UK
| | - Kate Armon
- grid.240367.4Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, UK
| | - Alex J. MacGregor
- grid.240367.4Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, UK ,0000 0001 1092 7967grid.8273.eNorwich Medical School, University of East Anglia, Norwich, UK
| |
Collapse
|
9
|
Rosenblum S, Gafni-Lachter L. Handwriting Proficiency Screening Questionnaire for Children (HPSQ–C): Development, Reliability, and Validity. Am J Occup Ther 2015; 69:6903220030. [DOI: 10.5014/ajot.2015.014761] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. To adapt the Handwriting Proficiency Screening Questionnaire (HPSQ), previously designated for adults, into a children’s self-report version (the HPSQ for Children, or HPSQ–C) and to examine its reliability and validity.
METHOD. Participants included 230 children ages 7–14 yr from regular schools in Israel. The questionnaire’s content validity, internal consistency, and concurrent and construct validity were assessed.
RESULTS. The tool demonstrated good internal consistency (α = .77). We found a significant moderate correlation between final HPSQ–C scores and the HPSQ, r = .51, p < .001, establishing the HPSQ–C’s concurrent validity. Construct validity was also confirmed. Results demonstrated that the HPSQ–C significantly distinguished between children with and without handwriting deficiencies on the basis of measures of handwriting product (Hebrew Handwriting Evaluation) and handwriting process (Computerized Penmanship Evaluation Tool).
CONCLUSION. The HPSQ–C is suitable for identification of handwriting deficiency among school-aged children and is appropriate for varied academic and clinical uses.
Collapse
Affiliation(s)
- Sara Rosenblum
- Sara Rosenblum, PhD, is Associate Professor and Head, Laboratory of Complex Human Activity and Participation (CHAP), Department of Occupational Therapy, University of Haifa, Mount Carmel, Haifa, Israel;
| | - Liat Gafni-Lachter
- Liat Gafni-Lachter, MSc, is Assistant Professor, Department of Occupational Therapy, College of Health and Human Services, Saginaw Valley State University, University Center, MI
| |
Collapse
|
10
|
Smith TO, Bacon H, Jerman E, Easton V, Armon K, Poland F, Macgregor AJ. Physiotherapy and occupational therapy interventions for people with benign joint hypermobility syndrome: a systematic review of clinical trials. Disabil Rehabil 2013; 36:797-803. [DOI: 10.3109/09638288.2013.819388] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|