Physio findings: study shows promise for hypermobility care

Joint hypermobility syndrome (JHS) doesn’t only make people ‘double-jointed’. The condition can cause pain, fatigue, proprioception difficulties, soft-tissue injury and joint instability. 

 

Shea Palmer, professor of musculoskeletal rehabilitation at the University of the West of England, and colleagues set up a study and recruited 29 people aged 16 or more with JHS. 

 

The team aimed to find out if it would be worth conducting a larger full-scale randomised controlled trial. They also looked at cost-effectiveness and a range of clinical measures including physical function and quality of life. 

 

All participants had a session with a physio, in which they could ask questions and receive tailored advice. All were given advice booklets, and the control group had no further treatment. 

 

The physiotherapy group received six more half-hour sessions over the next four months, learning skills to help them manage their condition more effectively. Both groups were followed up at four and seven months.

 

The physiotherapy package ‘was generally very well received by both patients and physiotherapists, and shows evidence of promise in improving the impact of JHS’, the team found. 

 

The control group reported more adverse events than the physiotherapy group. Palmer S et al. The feasibility of a randomised controlled trial of physiotherapy for adults with joint hypermobility syndrome. Health Technology Assessment 2016; 20.   

Physiotherapy, especially exercise, is considered the mainstay of treatment for JHS. However, the authors of this study say there is little robust evidence of its effects in adults. They identified a need to explore the perspectives of patients and health professionals, and used this information to develop a pilot physiotherapy intervention and training package. 

 

The authors investigated the acceptability of a physiotherapy intervention to patients and therapists. They assessed the feasibility of doing a randomised controlled trial (RCT), making an in-depth assessment of issues relating to study design and delivery.

In the study’s focus groups, people thought physiotherapy would be ‘beneficial if used to manage JHS holistically, rather than to treat acute injuries in isolation’. 

 

The study’s findings suggest ‘that the physiotherapy intervention may produce moderate clinical effects on outcome measures that are specific to rheumatological conditions … over and above advice alone.’

 

This pilot research activity is important for researchers who might be considering doing a more detailed RCT on this condition. However, for practitioners treating a patient who has JHS, it’s advisable to exercise some caution when interpreting implications from these initial findings as this is a small scale preliminary study.

 

The authors have produced recommendations on designing and delivering a trial, and concluded that an RCT would be feasible. 

 

Patients and health professionals emphasised the importance of education and raising awareness of JHS to optimise physiotherapy provision. 

 

Breathing problems are the main cause of illness and death from amyotrophic lateral sclerosis (ALS), the commonest form of motor neurone disease. 

 

Physiotherapists use a number of techniques to help. Researchers in the Department of Rehabilitative Medicine and Program in Physical Therapy at Columbia University Medical Center, New York, weighed up the published evidence on the effectiveness of different interventions. 

 

They searched six databases and found seven suitable studies that measured improvements in forced vital capacity and peak cough expiratory flow.

 

‘With the exception of diaphragmatic breathing, pulmonary physical therapy interventions were effective in improving multiple respiratory outcome measures in this population,’ they report. 

 

Inspiratory muscle training (IMT) substantially improved respiratory muscle strength. In addition, patients receiving IMT lived on average one year longer. Lung volume recruitment (LVRT) training strongly enhanced immediate cough efficacy, although manually assisted cough (MAC) only improved peak cough expiratory flow by a small amount. 

 

‘Specific pulmonary physical therapy interventions (IMT, LVRT, and MAC) have effectiveness in improving respiratory outcome measures and increasing survival,’ say the authors. 

 

‘These should be routinely incorporated into the comprehensive management of individuals with ALS,’ they add.

 

The authors call for further research to check these findings. Macpherson CE & Bassile CC. Pulmonary Physical Therapy Techniques to Enhance Survival in Amyotrophic Lateral Sclerosis: A Systematic Review, Journal of Neurologic Physical Therapy 2016; 40:165-175.