Joint hypermobility and its relationship to musculoskeletal pain in schoolchildren: a cross-sectional study

Valentina Leone ^1*, Gianluca Tornese ¹, Marlenka Zerial ¹, Chiara Locatelli ¹, Roberta Ciambra ¹, Marco Bensa ¹ and Mauro Pocecco ¹

¹ Paediatric Department, Maurizio Bufalini Hospital, Cesena, Italy

^* To whom correspondence should be addressed. E-mail: valentinaleone{at}doctors.org.uk.

Accepted 13 April 2009

Abstract

Objectives: To determine if joint hypermobility is associated with musculoskeletal pain in a population of Italian schoolchildren.

Methods: Design Cross-sectional, school based study, using a pre-tested questionnaire administered to schoolchildren to enquire about musculoskeletal pain and Beighton criteria, with score of 5 as a cutoff, to test for hypermobility.

Setting: Eight primary schools in the town of Cesena, Italy.

Participants: 1,230 Italian schoolchildren aged 7 to 15 representing an opportunistic sample of 10% of the schoolchildren in Cesena.

Main outcome measures: a) The strength of association between hypermobiliy and musculoskeletal pain.

b) The impact of hypermobility on daily activities, using a subjective "disability score" and a "physical activity score"

Analysis Sample size calculation for evaluating if hypermobility was associated with musculoskeletal pain was performed prior starting the study. Children experiencing pain at least once a week were used as cases, children experiencing pain seldom or never served as controls.

Results: A total of 1,046 consenting Italian schoolchildren (mean age 10.8 years), were included. The prevalence of musculoskeletal pain reported by schoolchildren was 18%. 22% of children with musculoskeletal pain versus 23% of controls had hypermobility (OR 1.057, 95% CI 0.7-1.4). Functional limitations measured by a "disability score" correlated in a weak negative way with Beighton score (p=0.03). The "physical activity score" correlated in a weak positive way with Beighton score (p=0.012).

Conclusions: We found no association between hypermobility and musculoskeletal pain.

Hypermobile children did not experience functional limitations in daily activities. They were slightly more active than non hypermobile ones.