The effectiveness of conservative interventions for the management of syndromic hypermobility: a systematic literature review

Abstract

Introduction 'Syndromic hypermobility' encompasses heritable connective tissue disorders such as hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders which are characterised by excessive joint range of motion and pain. Conservative interventions such as exercise are the cornerstone of management, yet their effectiveness is unclear. Aim To systematically appraise the effectiveness of conservative management for people with syndromic hypermobility. Method A systematic online database search was conducted (AMED, BND, CINAHL Plus, MEDLINE, PEDro, PsychINFO and SportDiscus). Potential articles were assessed for eligibility by two researchers against the following criteria: adults and children with a hEDS/HSD diagnosis (or equivalent diagnosis using specific criteria); non-pharmacological or non-surgical interventions; outcomes related to pain, physical function, psychological well-being or quality of life. Controlled trials and cohort studies were included. Critical Appraisal Skills Programme checklists were used to assess methodological quality. Results Eleven studies were included, comprising eight controlled trials and three cohort studies. All studies investigated interventions that had exercise as the primary component. Three small controlled studies demonstrated superior effects of conservative management relative to a control group. However, those studies only focused on a single area of the body, only recruited women, and had no long-term follow-up. All studies reported improvements in a wide range of outcomes over time. Conclusion Controlled trial evidence for the superiority of conservative management over comparators is weak. There is some evidence that people improve over time. Robust randomised controlled trial research of the long-term effectiveness of 'wholebody' (rather than individual joints or body areas) conservative management is required.

Multidisciplinary Approach to Treating Chronic Pain in Patients with Ehlers–Danlos Syndrome: Critically Appraised Topic

“…This was chosen to provide a background on which strategies are considered most effective in management of Ehlers–Danlos syndrome. 14 The next selection was a clinical trial by Celletti et al involving pain management in patients with hEDS and chronic back pain with neurocognitive exercises. This was one of the only clinical trials conducted regarding pain management and Ehlers–Danlos syndrome, and which was published subsequent to the Palmer et al systematic review.…”

“…The wide differences in complementary approaches, exercise regimens, and the various length of the studies included in the systematic review prevented meta-analysis. 14 …”

“…Therefore, the randomized controlled trials included in the systematic review only offered weak evidence that conservative interventions as defined as exercise therapy as the main component were more effective than no treatment. 14 …”

“… 15 These findings are similar to the findings of Palmer et al that found statistically significant decreases in pain from pre-treatment to post-treatment groups after conservative interventions of syndromic hypermobility. The lack of control group makes it difficult, however, to determine if the reduction in pain in the trial by Celleti et al was due to neurocognitive therapy, or instead due to the effect of time, as suggested by the systematic review by Palmer et al 14 , 15 …”

Physiotherapy protocol for patient with symptoms of joint hypermobility – case study

“…These exercises can involve resistance bands; however, the level of resistance must be tailored so that a patient does not experience pain. It is worth involving general body development exercises and not focus solely on joints where pain ailments occur [2,5,6,7,8]. It is also worth reminding patients to be mindful of daily functions: avoiding static overload, such as sitting in one position for a prolonged time; controlling body weight to avoid overloading joints and spine; and avoiding excessive muscle strain -overloaded muscles do not act as a protective barrier to the joints, which additionally stresses the ligamentous-capsular apparatus.…”