Kinematics and kinetics of people who are hypermobile. A systematic review

There are many studies investigating movement in individuals with hypermobile joints such that it is timely to systematically review the literature. This review concerns studies of lower limb tasks that compared kinematics and kinetics of hypermobile people with healthy controls. Its aims were to determine the quality of research completed so far and to collate what information is available regarding these factors in order to identify gaps in knowledge and provide direction for future research. A systematic search of AMED, CINAHL, Embase and MEDLINE databases alongside hand searching identified six articles fulfilling the selection criteria. Quality was evaluated using a modified Downs & Black [1] 'Quality Index' checklist and data extraction undertaken. All six articles investigated gait. Two rated as low quality and four as moderate quality. One study was omitted from data extraction to avoid a possible duplication of results. Of the remaining studies, three investigated Generalised Joint Hypermobility and two investigated Joint Hypermobility Syndrome. Sixty seven different outcome measures were used across the studies to quantify differences in gait, and these are summarised. For some of the common factors studied, conflicting findings were reported. There is no convincing evidence that hypermobile gait differs from normal in a consistent manner, and in addition, confounding factors such as pain have not been addressed. Data-dredging may have been an issue in the reviewed articles, and future research would benefit by linking outcome measures to clinically relevant factors. There is a lack of research into any task other than gait.