The effectiveness of therapeutic exercise for joint hypermobility syndrome: a systematic review.
BACKGROUND
Joint hypermobility syndrome (JHS) is a heritable connective tissue disorder characterised by excessive range of movement at multiple joints accompanied by pain. Exercise is the mainstay of management yet its effectiveness is unclear.


OBJECTIVE
To establish the effectiveness of therapeutic exercise for JHS.


METHODS
Systematic literature review.


METHODS
A search of nine online databases, supplemented by a hand search and snowballing.
People diagnosed with JHS (rather than asymptomatic generalised joint laxity); therapeutic exercise (of any type) used as an intervention; primary data reported; English language; published research.


METHODS
Methodological quality was appraised by each reviewer using Critical Appraisal Skills Programme checklists. Articles were then discussed collectively and disagreements resolved through debate.


RESULTS
2001 titles were identified. Four articles met the inclusion criteria, comprising one controlled trial, one comparative trial and two cohort studies. All studies found clinical improvements over time. However there was no convincing evidence that exercise was better than control or that joint-specific and generalised exercise differed in effectiveness.


CONCLUSIONS
The studies used heterogeneous outcome measures, preventing pooling of results. Only one study was a true controlled trial which failed to report between-group statistical analyses post-treatment.


CONCLUSIONS
There is some evidence that people with JHS improve with exercise but there is no convincing evidence for specific types of exercise or that exercise is better than control. Further high quality research is required to establish the effectiveness of exercise for JHS.
Department of Allied Health Professions, Faculty of Health & Life Sciences, Glenside Campus, Blackberry Hill, Bristol BS16 1DD, UK. Electronic address: Shea.Palmer@uwe.ac.uk.
Shea
S
Palmer
Department of Allied Health Professions, Faculty of Health & Life Sciences, Glenside Campus, Blackberry Hill, Bristol BS16 1DD, UK.
Samuel
S
Bailey
Royal Devon & Exeter NHS Foundation Trust, Barrack Road, Exeter, Devon EX2 5DW, UK.
Louise
L
Barker
Department of Allied Health Professions, Faculty of Health & Life Sciences, Glenside Campus, Blackberry Hill, Bristol BS16 1DD, UK.
Lauren
L
Barney
Plymouth Hospitals NHS Trust, Derriford Road, Crownhill, Plymouth, Devon PL6 8DH, UK.
Ami
A
Elliott
D004535:Ehlers-Danlos Syndrome / Q000503:physiopathology / Q000534:rehabilitation*; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D007593:Joint Instability / Q000151:congenital
Benign hypermobility syndrome; Exercise; Exercise therapy; Joint hypermobility; Systematic review