Clinical Bottom Line
“How should I apply this information?”
This article provides some evidence that children with hypermobility syndrome (HMS) have problems with hypermobility, pain, activity, participation, and balance. Hence, when examining children with HMS, objective measurement of these areas is warranted. The small number of 20 subjects is a limitation for describing a population. Hence, as the authors say, the results should not be generalized. This means that the differences seen here, between children with the diagnosis and those without it, may not be seen in any individual child with HMS.
This study does not address intervention. Although physical therapists might have something to offer these children, there is no evidence that they will respond in a way that children without this diagnosis might respond. Therefore, relevant objective measures before and after intervention become critical, as does sharing of findings in the form of peer-reviewed publications.
“What should I be mindful about in applying this information?”
The children with HMS were likely aware of their symptoms and those in the control group presumably viewed themselves as able-bodied and therefore the children's responses may just reflect these perceptions, rather than true differences.
The conclusion implies a cause-and-effect relationship between activity level and pain, but this is not supported by the design of the study. What was shown is that children with HMS had more pain and reported less activity than their peers. Unfortunately, the lack of statistical clarity makes the findings of this study difficult to interpret. Covariates were not shown to be significant or insignificant contributors, and neither R nor R2 values for the regression were reported.
Lastly, the children might not have recorded all applicable activity or might be unreliable in what they did record. For example, they might not have considered walking to and from school an “activity” and hence might not have reported it. Perhaps using a standardized scale like the Activities Scale for Kids1 would have provided a more valid and reliable measure.
Lisa Selby-Silverstein, PT, PhD, NCS
Tiffeny Atkins, PT, DPT, PCS
Neumann University, Aston, Pennsylvania
and Kingsway Learning Center, Haddonfield, New Jersey
The authors declare no conflicts of interest.
1. Young NL, Williams JI, Yoshida KK, Wright JG. Measurement properties of the activities scale for kids. J Clin Epidemiol. 2000;53:125–137.