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Abstract
Introduction Joint hypermobility is common in childhood and can be associated with musculoskeletal pain and dysfunction. Current management is delivered by a multidisciplinary team but evidence of efficacy is limited. This clinical trial aimed to determine whether a structured multidisciplinary intervention resulted in improved clinical outcomes compared with standard care.
Method A prospective randomised, single centre parallel group trial comparing an 8-week individualised multidisciplinary intervention programme with current standard management (advice and a physiotherapy appointment). Children and young people (CYP) were assessed for pain, function, coordination and strength at baseline, 3 and 12 months.
Results 119 children, aged 5 to 16 years, with symptomatic hypermobility were randomised to receive targeted multidisciplinary intervention (I) (n = 59) or standard management (S) (n = 60). Of these, 105 were followed to 12-months. There was a significant improvement in child and parent reported pain, coordination and strength. However, no added benefit could be shown from the intervention (Table 1). The number of CYP showing significant pain reduction (>=40%) was 27 (50.0%) (I) vs 21 (41.1%) (S). Those pain free at 12 months were 29 (56.9%) (I) vs 20 (45.5%) (S). The response was independent of the degree of hypermobility.
The rate of change in primary and secondary outcomes over 12 month follow-up period, this data includes analysis from multilevel modelling
Conclusions This is the first RCT to compare a structured multidisciplinary intervention with standard care in symptomatic childhood hypermobility. The study demonstrates significant improvement among subjects but no additional benefit from targeted intervention. The findings emphasise the benefit of informed diagnosis and management according to clinical need, but highlight the difficulty in demonstrating subtle benefit from specific interventions without better tools for case definition and outcomes assessment.