Proprioception and muscle torque deficits in children with hypermobility syndrome

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

doi:10.1093/rheumatology/ken435

Cited by 108 publications

(107 citation statements)

References 34 publications

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“…This comes in agreement also with Fatoye et al, 2009 [19] who used digital myometer [MIE, Medical Research Ltd, Leeds, UK] to assess Maximum isometric knee extensor and flexor muscle torque and found that children with HMS had weaker knee extensor and flexor muscles than healthy controls.…”

Section: Discussionsupporting

confidence: 88%

Comparison Between Muscular Torque and H/Q Ratio in Normal Children and Children With Generalized Joint Hypermobility

Allam¹,

Elsayyad²,

Abdelgawad³

2017

IJPR

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Purpose: the current study intended to investigate the effect of hypermobility on the hamstring's muscular torque, quadriceps' muscular torque and H/Q ratio.Materials and Methods: thirty normal male children aged from seven to eleven years and thirty age-matched male children with GJH were tested using isokinetic dynamometer. Eccentric-concentric and concentric eccentric moods were used for hamstring and quadriceps respectively at angular velocity of 60°/s.Results: the results exposed that there was significant decrease in both peak muscular torques and H/Q ratio in children with GJH when they were compared with normal children [P < .05]. Conclusion:it can be concluded that joint hypermobility decreases muscular torque and H/Q ratio. This may be due to proprioceptive deficits associated with hypermobility and abnormal muscular activation pattern. Further studies are needed to verify the definite cause of decreased muscular torque and H/Q ratio.

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Section: Discussionsupporting

confidence: 88%

Comparison Between Muscular Torque and H/Q Ratio in Normal Children and Children With Generalized Joint Hypermobility

Allam¹,

Elsayyad²,

Abdelgawad³

2017

IJPR

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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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“…Neural inputs derived from proprioceptive sensors are hypothesized to be crucial for the recruitment of motor units in relation to task requirements. [23] It has been shown that proprioception of the knee is reduced in EDS-HT patients, [24,25] however, the impact of proprioception on the association between muscle strength and activity limitations in EDS-HT is unknown.…”

Section: Introductionmentioning

confidence: 99%

The association between muscle strength and activity limitations in patients with the hypermobility type of Ehlers–Danlos syndrome: the impact of proprioception

Scheper

Rombaut

Vries

et al. 2016

Disability and Rehabilitation

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Purpose: The patients diagnosed with Ehlers-Danlos Syndrome Hypermobility Type (EDS-HT) are characterized by pain, proprioceptive inacuity, muscle weakness, potentially leading to activity limitations. In EDS-HT, a direct relationship between muscle strength, proprioception and activity limitations has never been studied. The objective of the study was to establish the association between muscle strength and activity limitations and the impact of proprioception on this association in EDS-HT patients. Methods: Twenty-four EDS-HT patients were compared with 24 controls. Activity limitations were quantified by Health Assessment Questionnaire (HAQ), Six-Minute Walk test (6MWT) and 30-s chair-rise test (30CRT). Muscle strength was quantified by handheld dynamometry. Proprioception was quantified by movement detection paradigm. In analyses, the association between muscle strength and activity limitations was controlled for proprioception and confounders. Results: Muscle strength was associated with 30CRT (r ¼ 0.67, p ¼ <0.001), 6MWT (r ¼ 0.58, p ¼ <0.001) and HAQ (r ¼ 0.63, p¼ <0.001). Proprioception was associated with 30CRT (r ¼ 0.55, p < 0.001), 6MWT (r ¼ 0.40, p ¼ <0.05) and HAQ (r ¼ 0.46, p < 0.05). Muscle strength was found to be associated with activity limitations, however, proprioceptive inacuity confounded this association. Conclusions: Muscle strength is associated with activity limitations in EDS-HT patients. Joint proprioception is of influence on this association and should be considered in the development of new treatment strategies for patients with EDS-HT. ä IMPLICATIONS FOR REHABILITATIONReducing activity limitations by enhancing muscle strength is frequently applied in the treatment of EDS-HT patients. Although evidence regarding treatment efficacy is scarce, the current paper confirms the rationality that muscle strength is an important factor in the occurrence of activity limitations in EDS-HT patients. Although muscle strength is the most dominant factor that is associated with activity limitations, this association is confounded by proprioception. In contrast to common belief proprioception was not directly associated with activity limitations but confounded this association. Controlling muscle strength on the bases of proprioceptive input may be more important for reducing activity limitations than just enhancing sheer muscle strength. ARTICLE HISTORY

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Proprioception and muscle torque deficits in children with hypermobility syndrome

Cited by 108 publications

References 34 publications

Comparison Between Muscular Torque and H/Q Ratio in Normal Children and Children With Generalized Joint Hypermobility

Comparison Between Muscular Torque and H/Q Ratio in Normal Children and Children With Generalized Joint Hypermobility

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

The association between muscle strength and activity limitations in patients with the hypermobility type of Ehlers–Danlos syndrome: the impact of proprioception

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