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AB0800 Children with generalized joint hypermobility and musculoskeletal complaints: state of the art on diagnostics, clinical characteristics and treatment.
  1. R. Engelbert1,2,
  2. M. Scheper1,2,
  3. E. Rameckers3,
  4. J. Verbunt3,
  5. L. Remvig4,
  6. B. Juul-Kristensen5
  1. 1Rehabilitation, University hospital amsterdam (AMC)
  2. 2Education for Physical therapy, University of applied sciences, Amsterdam
  3. 3Rehabilitation Medicine, Maastricht University Hospital, Maastricht, Netherlands
  4. 4Rheumatology, Rigshospitalet, Copenhagen
  5. 5Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, Odense, Denmark

Abstract

Background For children the prevalence of generalized joint hypermobility (GJH) varies from 7-36%, primarily depending on the tests and criteria used for diagnosing GJH. Children experience a great variety of impairments as a result of increased laxity of connective tissues. This not only affects physical fitness, motor development, and proprioception, but also include problems with organsystems (skin, vessel and internal organs) and psychological distress. As a result, children experience functional disability, which often presents difficulties in normal daily life.

Objectives To provide a state of the art on diagnostics, clinical characteristics and treatment of GJH and JHS in children and young adults.

Methods A narrative review was performed regarding diagnostics and clinical characteristics. A systematic review with a critical appraisal and best evidence synthesis was performed regarding interventions. Searches of databases Medline and Central were performed. The search terms used were joint hypermobility in GJH, JHS, as well as collagen diseases with joint hypermobility, child, treatment and rehabilitation.

Results Transition literature was explored by ICF domains body function and structure, activity, participation and environmental factors. Knowledge on function and activity in GJH and JHS showed joint hypermobility (based on the Beighton scale with different cut-off points) associated with joint pain, reduced muscle strength and proprioception while children with GJH did not experience functional limitations in daily activities. Children with GJH did not spend fewer weekly hours of physical activity than healthy reference groups. In children with JHS and exercise-induced pain reduced aerobic fitness was found. Knowledge on participation showed a significantly decreased participation in housework, riding a bicycle, taking part in sport or outdoor games, and a higher frequency for non-sporting games. The initial search on interventions identified 1318 studies, eventually leading to three studies (JHS: n=2, Osteogenesis Imperfecta: n=1) available for critical appraisal. These studies showed significant benefits of enhancing physical fitness in terms of relieving musculoskeletal complaints and reducing disability.

Conclusions Based on the narrative and a systematic reviews, function and activity in GJH and JHS were negatively influenced, especially in JHS. Regarding participation, personal and environmental factors was significantly decreased for participation in housework, taking part in sport or outdoor games, as well as a higher frequency for non-sporting games. Based on the sparsely available knowledge of intervention studies, future longitudinal studies should focus on the effect of physical activity and fitness interventions, as well as muscle strength and stabilization training in general, in particular in relation to the hypermobile joints in particular. In JHS and chronic pain, the effectiveness of a multidisciplinary approach should be investigated.

References R.H.H. Engelbert, M.C. Scheper Joint hypermobility with and without musculoskeletal complaints: a physiotherapeutic approach. Int Musc Med:2011;33(4):146-151

Disclosure of Interest None Declared

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