So I am sat on the train pulling out of Victoria after again sprinting for a train and making it by the skin of my teeth!! I had the pleasure of being invited along by Jane Simmonds to a lecture given by Leslie Nicholson of Sydney University who had very kindly agreed to talk about her research despite only landing in England this morning!! Below is some of the key points that I took from the evening;
- Joint hypermobility is NOT normal! Leslie made a great point about we should consider the levels of mobility seen when screening for generalised joint hypermobility should be one or two standard deviations above the mean. I think that this is something for us all to consider when we get a patient who we are screening.
- A number of factors correlated with fatigue are modifiable– so lets do something about them!! Within Leslie’s work looking at fatigue in patients with symptomatic JHS there was 4 out of 5 strongly correlated factors that could be influenced in order to try and improve the fatigue levels seen in patients. Things like early diagnosis, MDT involvement with a skilled doctor who can act as the base of management and improvement of exercise tolerance are things that as Physiotherapists we should be able to assist in, so lets try and do it!
- There is a number of issues with the Beighton Scale! Through experience it has been noted that patients report instability and symptoms within a number of joints such as the shoulder and ankle which aren’t covered by the Beighton screening test. There is also an issue surrounding the fact that the Beighton Scale only assesses within the sagittal plane and misses out all other accessory movements. This is where tests like the Lower Limb Assessment Scale and Upper Limb Hypermobility Assessment Tool will now hopefully start to come into practice on a more regular basis.
This was a really good evening lecture and one that I really enjoyed especially with my MSc dissertation being on a related topic. It was great to meet Leslie and see her enthusiasm for trying to develop the adoption of evidence based clinical screening tools in identification of Joint Hypermobility. I have included links to a few of her papers below in case people want to read a bit more on the topic.
The Upper Limb Hypermobility Assessment Tool: A novel validated measure of adult joint mobility.- https://www.ncbi.nlm.nih.gov/pubmed/29510315
Features that exacerbate fatigue severity in joint hypermobility syndrome/Ehlers-Danlos syndrome – hypermobility type- https://www.ncbi.nlm.nih.gov/pubmed/28482708