Thijs van Meulenbroek, Arnoud E. A. Conijn, Ivan P. J. Huijnen, Raoul H. H. Engelbert, Jeanine A. Verbunt
Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, The Netherlands.
DOI: 10.2340/20030711-1000033

Background: To determine whether adolescents with generalized hypermobility spectrum disorder/hypermobile Ehlers-Danlos syndrome (G-HSD/hEDS) show changes in the level of disability, physical functioning, perceived harmfulness and pain intensity after completing multidisciplinary rehabilitation treatment.
Methods: Pre-test post-test design. Fourteen adole-scents with G-HSD/hEDS participated. The multidisciplinary rehabilitation treatment consisted of a combination of physical training and exposure in vivo. Physical training aims to improve aerobic capacity, muscle strength and propriocepsis for compensating hypermobility. Exposure in vivo aims to decrease disability and pain-related fear. Pre- and post-treatment assessments were conducted to assess the level of disability, physical functioning (motor performance, muscle strength and physical activity level), perceived harmfulness and pain intensity.
Results: After completing multidisciplinary rehabilitation treatment, the adolescents showed a significant and clinically relevant improvement (improvement of 67%, p < 0. 01) in functional disability. Furthermore, significant improvements were found in motor performance (p < 0. 01), muscle strength (p < 0. 05), perceived harmfulness (p < 0. 01) and pain intensity (p < 0. 01) after completing multidisciplinary rehabilitation treatment.
Conclusion: Multidisciplinary rehabilitation treatment leads to a significantly and clinically relevant improvement in the level of disability for adole-scents with G-HSD/hEDS. Positive effects were also found in physical functioning, perceived harmfulness and pain intensity. Although the results of this multidisciplinary rehabilitation treatment for adolescents with G-HSD/hEDS are promising, further study is needed to confirm these findings in a randomized design.

In this study, changes in disability, physical function-ing and other pain-related outcomes are evaluated for hypermobile adolescents (age 12–21 years) with chronic musculoskeletal pain after following an outpatient multidisciplinary rehabilitation treatment. This treatment consists of a combination of physical training and cognitive-behavioural therapy (exposure ). Physical training (8 weeks; 2 h 2×/week) aims to improve physical parameters, such as aerobic capacity, muscle strength and propriocepsis. Exposure (6 weeks; 1 h/week) aims to restore a normal pattern of daily functioning by decreasing pain-related fear. After treatment, the adolescents had lower levels of disability, decreased pain-related fear, a reduction in pain intensity and increased levels of physical func-tioning. It is concluded that the results are promising, but the findings are based on a small sample size with-out a randomized controlled group. Therefore, the results should be interpreted with caution.