OBJECTIVE: Joint hypermobility, common in childhood, can be associated with severe pain and significant morbidity. Physiotherapy, the mainstay of treatment, lacks a robust evidence base. This study is aimed at determining the best physiotherapy intervention in managing childhood hypermobility. METHODS: A prospective randomized comparative trial (RCT) compared a 6-week generalized programme, improving muscular strength and fitness, with a targeted programme aimed at correcting motion control of symptomatic joints. Patients were assessed on symptom scores (pain/global-impact), function, muscle strength and fitness. RESULTS:Fifty-seven children, aged 7-16 years with symptomatic hypermobility, were randomly assign to receive a targeted (T; n = 30) or generalized (G; n = 27) programme. Statistically significant improvements were demonstrated in both the children's and parental pain scores across both the randomized groups between baseline and follow-up assessments (P < 0.05). However, the difference in improvement between the groups was not statistically significant. Child's assessment of change in pain score: mean difference (95% CI) T - G, 3.97 (-15.59, 20.85) at the end of treatment and 9.41 at 3-month follow-up (-17.42, 36.24). At the end of treatment, parental assessment of change in pain score, T - G was: -0.27 (-15.05, 14.50) and at 3-month follow-up it was: -9.48 (-26.40, 7.43). Change in parental global assessment was statistically significant, in favour of targeted physiotherapy at final assessment: -21.29 (-40.03, -2.55). CONCLUSION: This is the first physiotherapy RCT for treating hypermobility. It demonstrated significant and sustained reduction in pain when both groups were combined, but did not detect any difference between the groups. This study provides normative and methodological data for future studies of hypermobility. TRIAL REGISTRATION: Current Controlled Trials, www.controlled-trials.com, ISRCTN58523390.
RCT Entities:
OBJECTIVE: Joint hypermobility, common in childhood, can be associated with severe pain and significant morbidity. Physiotherapy, the mainstay of treatment, lacks a robust evidence base. This study is aimed at determining the best physiotherapy intervention in managing childhood hypermobility. METHODS: A prospective randomized comparative trial (RCT) compared a 6-week generalized programme, improving muscular strength and fitness, with a targeted programme aimed at correcting motion control of symptomatic joints. Patients were assessed on symptom scores (pain/global-impact), function, muscle strength and fitness. RESULTS: Fifty-seven children, aged 7-16 years with symptomatic hypermobility, were randomly assign to receive a targeted (T; n = 30) or generalized (G; n = 27) programme. Statistically significant improvements were demonstrated in both the children's and parental pain scores across both the randomized groups between baseline and follow-up assessments (P < 0.05). However, the difference in improvement between the groups was not statistically significant. Child's assessment of change in pain score: mean difference (95% CI) T - G, 3.97 (-15.59, 20.85) at the end of treatment and 9.41 at 3-month follow-up (-17.42, 36.24). At the end of treatment, parental assessment of change in pain score, T - G was: -0.27 (-15.05, 14.50) and at 3-month follow-up it was: -9.48 (-26.40, 7.43). Change in parental global assessment was statistically significant, in favour of targeted physiotherapy at final assessment: -21.29 (-40.03, -2.55). CONCLUSION: This is the first physiotherapy RCT for treating hypermobility. It demonstrated significant and sustained reduction in pain when both groups were combined, but did not detect any difference between the groups. This study provides normative and methodological data for future studies of hypermobility. TRIAL REGISTRATION: Current Controlled Trials, www.controlled-trials.com, ISRCTN58523390.
Authors: Divya S Booshanam; Binu Cherian; Charles Premkumar A R Joseph; John Mathew; Raji Thomas Journal: Rheumatol Int Date: 2010-05-20 Impact factor: 2.631
Authors: Francis Fatoye; Shea Palmer; Fiona Macmillan; Philip Rowe; Marietta van der Linden Journal: Rheumatol Int Date: 2011-01-26 Impact factor: 2.631
Authors: Peter Bale; Vicky Easton; Holly Bacon; Emma Jerman; Laura Watts; Garry Barton; Allan Clark; Kate Armon; Alex J MacGregor Journal: Pediatr Rheumatol Online J Date: 2019-01-08 Impact factor: 3.054
Authors: Verity Pacey; Louise Tofts; Roger D Adams; Craig F Munns; Leslie L Nicholson Journal: Pediatr Rheumatol Online J Date: 2013-08-14 Impact factor: 3.054
Authors: M C Scheper; R H H Engelbert; E A A Rameckers; J Verbunt; L Remvig; B Juul-Kristensen Journal: Biomed Res Int Date: 2013-07-22 Impact factor: 3.411