A randomised comparative trial of generalised versus targeted physiotherapy in the management of childhood hypermobility
The Hypermobility Trial
This study aimed to compare a generalised exercise programme with a targeted programme within a randomised trial and assess the impact of these interventions on symptom scores.
Liverpool Childrens Local Research Ethics Committee approved on the 26th April 2004 (ref: 04/Q1502/7)
Randomised comparative trial
Primary study design
Secondary study design
Randomised controlled trial
Patient information sheet
Not available in web format, please use the contact details below to request a patient information sheet
Each child received six, sequential, weekly appointments for individual half-an-hour physiotherapy treatments, in which the allocated intervention was administered. Patients were randomised to a General Exercise Program or Targeted Exercise Program.
Primary outcome measure
Improvement in the child's pain assessment score. Younger children used a faces scale ranging from 1 to 5 while older children (age greater than 11 years) used a Visual Analogue Scale (VAS). Participants were asked to indicate on the linear 100 mm scale their pain level in the past week. Change in pain-VAS was used to assess the impact of therapy on symptoms. Measured at baseline (pre-treatment), midpoint (following 6-week intervention) and follow up (3 months after midpoint).
Secondary outcome measures
1. Parent's assessment of their child's pain: parental-VAS
2. Parent's global evaluation of the impact of their child's hypermobility in the previous week: global-VAS
3. Functional impairment measured using the Childhood Health Assessment Questionnaire (CHAQ)
4. Six-minute shuttle test (measured at baseline and midpoint only)
Measured at baseline (pre-treatment), midpoint (following 6 week intervention) and follow up (3 months after midpoint).
Overall trial start date
Overall trial end date
Reason abandoned (if study stopped)
Participant inclusion criteria
1. Children aged 7 to 16 years, either sex
2. Treated at the Department of Rheumatology, Royal Liverpool Children's NHS Trust, Liverpool, UK between June 2004 and May 2007
3. Identified as having symptomatic hypermobility*
4. Symptomatic patients had arthralgia for three preceding months or more
*Children were hypermobile if they met Revised Criteria for benign joint hypermobility syndrome (BJHS). In brief, they had to fulfil either two major criteria, one major and two minor criteria, four minor criteria, or two minor criteria and a first degree relative with hypermobility.
Major criteria were:
1. Beighton score of greater than 4
2. Arthralgia in greater than 4 joints
Minor criteria included:
1. Beighton score less than 4
2. Arthralgia in less than 4 joints
3. Mechanical back pain for greater than 3 months
4. Hypermobility in first degree relative
Beighton score assesses hypermobility of the following: placing hands flat on floor without bending knees, hyperextension of knees and elbows greater than 100, little finger metacarpalphalangeal hyperextension to greater than 900, bending thumb to forearm.
Target number of participants
Participant exclusion criteria
Patients were excluded if they refused consent.
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
Department of Rheumatology
Royal Liverpool Children's NHS Trust (UK)
c/o Ms Dot Lambert
Research and Development Manager
Research and Development Department
Royal Liverpool Children's NHS Trust (UK) - Research and Development Department
Funding Body Type
Funding Body Subtype
Results and Publications
Publication and dissemination plan
Not provided at time of registration
Intention to publish date
Participant level data
Not provided at time of registration
Basic results (scientific)
2009 results in http://www.ncbi.nlm.nih.gov/pubmed/19948753
Kemp S, Roberts I, Gamble C, Wilkinson S, Davidson JE, Baildam EM, Cleary AG, McCann LJ, Beresford MW, A randomized comparative trial of generalized vs targeted physiotherapy in the management of childhood hypermobility., Rheumatology (Oxford), 2010, 49, 2, 315-325, doi: 10.1093/rheumatology/kep362.