Gait kinematics and passive knee joint range of motion in children with hypermobility syndrome

Fatoye, Francis; Palmer, Shea; Linden, Marietta van der; Rowe, Peter; Macmillan, Fiona

doi:10.1016/j.gaitpost.2010.12.022

Cited by 54 publications

(48 citation statements)

References 27 publications

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“…This means that even though the current GJH children had bilateral hypermobile knee joint this did not seem to influence the knee joint angle during normal walking. This is in contrast to the only comparable study, which showed a lower peak knee flexion angle in the first half of the stance phase, and an increased knee extension in mid stance during walking in 8–15 year-old children with BJHS compared with controls [32]. A possible explanation for this could be the different study populations, since the children with BJHS presented multiple joint pains, as opposed to the current pain free children with GJH.…”

Section: Discussioncontrasting

confidence: 76%

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Gait pattern in 9-11-year-old children with generalized joint hypermobility compared with controls; a cross-sectional study

Nikolajsen

Larsen

Simonsen

et al. 2013

BMC Musculoskelet Disord

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BackgroundTo study differences in gait patterns in 10-year-old children with Generalized Joint Hypermobility (GJH) and with no GJH (NGJH).MethodsA total of 37 children participated (19 GJH, 18 NGJH, mean age 10.2 (SD 0.5) years). Inclusion criteria for GJH were a Beighton score of ≥5, with at least one hypermobile knee joint; for NGJH a Beighton score of ≤4, and no hypermobile knees and for both groups no knee pain during the previous week. All children were recorded by five video cameras, while they walked across three force platforms. Net joint moments were calculated in 3D by inverse dynamics and peak values provided input to statistical analyses.ResultsIn the frontal plane, children with GJH had a significantly lower peak knee abductor moment and peak hip abductor moment. In the sagittal plane, the peak knee flexor moment and the peak hip extensor moment were significantly lower in the GJH group although the absolute difference was small.ConclusionsThe walking pattern was the same for children with GJH and for healthy children, as there were no differences in kinematics, but it was, however, performed with different kinetics. Children with GJH walked with lower ankle, knee and hip joint moments compared to children with NGJH. However, the clinical importance of these differences during normal gait is unknown. To obtain this knowledge, children with GJH must be followed longitudinally.Trial registrationThe study was approved by the Committee on Biomedical Research Ethics for Copenhagen and Frederiksberg, Denmark (jnr. KF01-2006-178).

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Section: Discussioncontrasting

confidence: 76%

“…One study found a significantly altered gait pattern in children with BJHS compared with controls, i.e. increased knee extension in mid-stance [32]. Among children with BJHS, the most frequent symptom is pain, which is known to influence the gait pattern [33].…”

Section: Introductionmentioning

confidence: 99%

Gait pattern in 9-11-year-old children with generalized joint hypermobility compared with controls; a cross-sectional study

Nikolajsen

Larsen

Simonsen

et al. 2013

BMC Musculoskelet Disord

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“…The presence of GJH, which could be the result of abnormal connective tissue laxity, may result in higher demands on active joint stabilization mechanisms [41,42]. In combination with proprioceptive inaccuracy, during highly coordinative tasks like walking, demanding adaptive strategies like co-contraction or prolonged activation of certain muscle groups are required to stabilize joints during these activities [43].…”

Section: Discussionmentioning

confidence: 99%

The functional consequences of Generalized Joint Hypermobility: a cross-sectional study

Scheper

Vries²,

Juul-Kristensen

et al. 2014

BMC Musculoskelet Disord

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BackgroundGeneralized Joint Hypermobility (GJH) has been found to be associated with musculoskeletal complaints and disability. For others GJH is seen as a prerequisite in order to excel in certain sports like dance. However, it remains unclear what the role is of GJH in human performance. Therefore, the purpose of the study was to establish the association between GJH and functional status and to explore the contribution of physical fitness and musculoskeletal complaints to this association.MethodsA total of 72 female participants (mean age (SD; range): 19.6 (2.2; 17-24)) were recruited among students from the Amsterdam School of Health Professions (ASHP) (n = 36) and the Amsterdam School of Arts (ASA), Academy for dance and theater (n = 36) in Amsterdam, The Netherlands. From each participant the following data was collected: Functional status performance (self-reported Physical activity level) and capacity (walking distance and jumping capacity: side hop (SH) and square hop (SQH)), presence of GJH (Beighton score ≥4), muscle strength, musculoskeletal complaints (pain and fatigue) and demographic characteristics (age and BMI).ResultsGJH was negatively associated with all capacity measures of functional status. Subjects with GJH had a reduced walking distance (B(SE):-75.5(10.5), p = <.0001) and jumping capacity (SH: B(SE):-10.10(5.0), p = .048, and SQH: B(SE):-11.2(5.1), p = .024) in comparison to subjects without GJH, when controlling for confounding: age, BMI and musculoskeletal complaints. In participants with GJH, functional status was not associated with performance measures.ConclusionGJH was independently associated with lower walking and jumping capacity, potentially due to the compromised structural integrity of connective tissue. However, pain, fatigue and muscle strength were also important contributors to functional status.

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“…When compared with healthy control subjects, JHS has been shown to have a significant impact on a wide range of outcomes, such as exercise endurance, gait, pain, proprioception, strength, function and quality of life in both children [20][21][22][23] and adults. [24][25][26][27] A recent systematic review and meta-analysis has also confirmed the impact of JHS on a range of psychological variables such as fear, agoraphobia, anxiety, depression and panic disorders.…”

Section: Fundingmentioning

confidence: 99%

The feasibility of a randomised controlled trial of physiotherapy for adults with joint hypermobility syndrome

Palmer

Cramp

Clark

et al. 2016

Health Technol Assess

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BackgroundJoint hypermobility syndrome (JHS) is a heritable disorder associated with laxity and pain in multiple joints. Physiotherapy is the mainstay of treatment, but there is little research investigating its clinical effectiveness.ObjectivesTo develop a comprehensive physiotherapy intervention for adults with JHS; to pilot the intervention; and to conduct a pilot randomised controlled trial (RCT) to determine the feasibility of conducting a future definitive RCT.DesignPatients’ and health professionals’ perspectives on physiotherapy for JHS were explored in focus groups (stage 1). A working group of patient research partners, clinicians and researchers used this information to develop the physiotherapy intervention. This was piloted and refined on the basis of patients’ and physiotherapists’ feedback (stage 2). A parallel two-arm pilot RCT compared ‘advice’ with ‘advice and physiotherapy’ (stage 3). Random allocation was via an automated randomisation service, devised specifically for the study. Owing to the nature of the interventions, it was not possible to blind clinicians or patients to treatment allocation.SettingStage 1 – focus groups were conducted in four UK locations. Stages 2 and 3 – piloting of the intervention and the pilot RCT were conducted in two UK secondary care NHS trusts.ParticipantsStage 1 – patient focus group participants (n = 25, three men) were aged > 18 years, had a JHS diagnosis and had received physiotherapy within the preceding 12 months. The health professional focus group participants (n = 16, three men; 14 physiotherapists, two podiatrists) had experience of managing JHS. Stage 2 – patient participants (n = 8) were aged > 18 years, had a JHS diagnosis and no other musculoskeletal conditions causing pain. Stage 3 – patient participants for the pilot RCT (n = 29) were as for stage 2 but the lower age limit was 16 years.InterventionFor the pilot RCT (stage 3) the advice intervention was a one-off session, supplemented by advice booklets. All participants could ask questions specific to their circumstances and receive tailored advice. Participants were randomly allocated to ‘advice’ (no further advice or physiotherapy) or ‘advice and physiotherapy’ (an additional six 30-minute sessions over 4 months). The physiotherapy intervention was supported by a patient handbook and was delivered on a one-to-one patient–therapist basis. It aimed to increase patients’ physical activity through developing knowledge, understanding and skills to better manage their condition.Main outcome measuresData from patient and health professional focus groups formed the main outcome from stage 1. Patient and physiotherapist interview data also formed a major component of stages 2 and 3. The primary outcome in stage 3 related to the feasibility of a future definitive RCT [number of referrals, recruitment and retention rates, and an estimate of the value of information (VOI) of a future RCT]. Secondary outcomes included clinical measures (physical function, pain, global status, self-reported joint count, quality of life, exercise self-efficacy and adverse events) and resource use (to estimate cost-effectiveness). Outcomes were recorded at baseline, 4 months and 7 months.ResultsStage 1 – JHS is complex and unpredictable. Physiotherapists should take a long-term holistic approach rather than treating acutely painful joints in isolation. Stage 2 – a user-informed physiotherapy intervention was developed and evaluated positively. Stage 3 – recruitment to the pilot RCT was challenging, primarily because of a perceived lack of equipoise between advice and physiotherapy. The qualitative evaluation provided very clear guidance to inform a future RCT, including enhancement of the advice intervention. Some patients reported that the advice intervention was useful and the physiotherapy intervention was again evaluated very positively. The rate of return of questionnaires was low in the advice group but reasonable in the physiotherapy group. The physiotherapy intervention showed evidence of promise in terms of primary and secondary clinical outcomes. The advice arm experienced more adverse events. The VOI analysis indicated the potential for high value from a future RCT. Such a trial should form the basis of future research efforts.ConclusionA future definitive RCT of physiotherapy for JHS seems feasible, although the advice intervention should be made more robust to address perceived equipoise and subsequent attrition.Trial registrationCurrent Controlled Trials ISRCTN29874209.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 47. See the NIHR Journals Library website for further project information.

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Gait kinematics and passive knee joint range of motion in children with hypermobility syndrome

Cited by 54 publications

References 27 publications

Gait pattern in 9-11-year-old children with generalized joint hypermobility compared with controls; a cross-sectional study

Gait pattern in 9-11-year-old children with generalized joint hypermobility compared with controls; a cross-sectional study

The functional consequences of Generalized Joint Hypermobility: a cross-sectional study

The feasibility of a randomised controlled trial of physiotherapy for adults with joint hypermobility syndrome

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