Physical therapy interventions in generalized hypermobility spectrum disorder and hypermobile Ehlers-Danlos syndrome: a scoping review

Abstract

Purpose

Physical therapy (PT) plays a central role in treating individuals with Generalized Hypermobility Spectrum Disorder (G-HSD) and Hypermobile Ehlers-Danlos Syndrome (hEDS). However, there is limited research describing these individuals’ PT management. This review aims to systematically map the evidence on PT interventions to treat this patient population.

Methods

A systematic literature search of PubMed, CINAHL, and Embase from January 2000 to April 2023 was performed. After the screening process, studies were appraised and classified based on the type of PT interventions used. Five reviewers independently assessed the articles.

Results

The search produced 757 articles. Twenty-eight met the inclusion criteria. The studies included 630 participants, mostly female, with a mean age of 26.2 (ranging from 2 to 69). The PT interventions used were therapeutic exercise, patient instruction, motor function training, adaptive equipment, manual therapy, and functional training.

Conclusions

The evidence indicates that therapeutic exercise and motor function training are efficacious methods to treat individuals with G-HSD and hEDS. There is also weak evidence for using adaptive equipment, patient instruction, manual therapy, and functional training. Recent studies emphasize multidisciplinary care and understanding of the psychological impact of G-HSD/hEDS. Additional research is needed to determine the effectiveness and dosage of PT interventions.

IMPLICATIONS FOR REHABILITATION

• The lack of guidelines and consensus on physical therapy (PT) interventions to treat and restore function in people with Generalized Hypermobility Spectrum Disorder (G-HSD) and hypermobile Ehlers-Danlos Syndrome (hEDS) challenges clinicians.

• This review supports therapeutic exercise and motor function training to improve function, well-being, and quality of life in people with G-HSD and hEDS.

• There is weak evidence for using adaptive equipment, patient instruction, manual therapy, and functional training.

• We have gathered existing evidence, appraised the quality, and drawn conclusions on this population’s most supported PT interventions.

Keywords:

• Physical therapy
• physiotherapy
• hypermobile Ehlers-Danlos syndrome
• joint hypermobility syndrome
• interventions
• hypermobile spectrum disorder

Acknowledgments

We thank Makenzie Judy, DPT, and Lauren Perrotta, DPT, for their assistance with the first draft of the manuscript.

Author contributions

Concepts/research design: P. Teran-Wodzinski, M. Garreth Brittain, S. Flanagan, L. Foreman.

Data collection: M. Garreth Brittain, M. Judy, L. Perrotta, S. Flanagan, L. Foreman, P. Teran-Wodzinski.

Data analysis: M. Garreth Brittain, M. Judy, L. Perrotta, S. Flanagan, L. Foreman, P. Teran-Wodzinski.

Project management: M. Garreth Brittain, P. Teran-Wodzinski.

Disclosure statement

The authors reported no conflicts of interest. A portion of this study was presented at the 2022 University of South Florida Research Day Conference on February 16, 2022, in Tampa, Florida.

Additional information

Funding

This study did not receive any specific grant from public, commercial, or not-for-profit funding agencies.