Joint Hypermobility Syndrome (JHS) and Ehlers Danlos Syndrome-Hypermobility Type
(EDS-HM) referred to collectively as Hypermobility Syndromes (HMS), are heritable
disorders of connective tissue comprising symptomatic joint hypermobility predisposing to
arthralgia, soft-tissue injury and joint instability which if not managed effectively result in
ongoing cycles of disability. How HMS affects paediatric patients and how physiotherapists
approach the condition in this population is unclear. The aim of this thesis was to address
gaps in knowledge and practice and advance strategies in assessment and management of
symptoms. Study 1 involved an original online survey of paediatric physiotherapists,
gauging understanding of HMS in children, and investigating current trends in clinical
practice regarding diagnosis, treatment and management, in a UK context. Findings
highlighted the prevalence of musculoskeletal pain and injury in children, the unsuitability of
current diagnostic tools for assessing children, the lack of a standardised approach to
diagnosis in addition to preferences for exercise interventions. This needs analysis informed
Study 2 which involved the design and implementation of a novel Physical Assessment
Battery for Paediatric Hypermobility merging 4 existing tests: the Nine-Point Beighton
Score, Revised Brighton Criteria, Paediatric Balance Scale and Paediatric Pain
Questionnaire, to capture a more complete profile of symptoms in the functional and clinical
assessment of children. Children with diagnoses of HMS were assigned to a clinical group
(n=29), and age and gender matched children recruited as a control group (n=25) were
tested. Distinct differences were revealed between groups in terms of functional balance,
pain intensity and location and trends in physical activity, exercise and sport, in addition to
significant correlations observed between hypermobility and both balance and pain intensity
scores. Findings from Study 1 and Study 2 twinned with supplementary qualitative data,
collectively confirm the need to validate a paediatric specific assessment tool, and design
blended treatment and management strategies for children experiencing symptoms to
increase quality of life and reduce disability
