Combining psychological, physical strategies effective for Ehlers-Danlos, hypermobility
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Key takeaways:
- Psychological interventions can significantly reduce pain-related fear and the physical impacts of pain in hypermobility spectrum disorders.
- The interventions are most effective when combined into a multidisciplinary program.
Multidisciplinary strategies combining physical and psychological strategies were the most effective for patients with hypermobility spectrum disorders or Ehlers-Danlos syndrome, according to a systematic review.
“Physiotherapy is frequently recommended for these patients, primarily to address their musculoskeletal complaints and joint pain,” Natalie L. Clark, MBPsS, MSc, of the South Tees Hospitals NHS Foundation Trust, in the United Kingdom, and colleagues wrote in Rheumatology International. “The success of physiotherapy, however, is variable. Presently, there appears to be limited evidence on how to effectively manage patients beyond the obvious physical manifestations of [hypermobility spectrum disorders (HSD) and Ehlers-Danlos syndrome (EDS)].”
To examine whether psychological interventions could help improve the lived experience of patients with HSD or Ehlers-Danlos syndrome (EDS), Clark and colleagues conducted a systematic review. They included a total of six studies that assessed psychological interventions and narratively synthesized their findings. These six studied represented a total of 628 patients, although only 343 were included in the current analysis due to attrition.
According to the researchers, one of the studies involved a 5-week program for adults with EDS that delivered “positive psychology topics,” such as “spot the positives,” “mindful observation” and “best possible self.” The other five studies examined psychological interventions as part of multidisciplinary programs, such as:
- a 6-week program for adults with joint hypermobility syndrome “informed by a cognitive behavioral approach;”
- an EDS program involving 10 workshops about living with the disease; and
- an 8-week, all-ages EDS program adhering to “a rehabilitative plan, ‘felt sense’ approach and language informed by narrative medicine.”
Overall, interventions that targeted both physical and psychological effects of pain and physical disability were shown to be most effective, regardless of patient age, according to the researchers. The interventions significantly cut down on pain-related fear and catastrophizing, as well as the physical impacts of pain on functioning and disability.
A combined approach was also effective at controlling pain interference and pain-related fear. The isolated, positive psychology intervention, on the other hand, “could only improve the physical disability as a result of pain in the short term, and was seemingly better at improving the affective factors in the long term,” Clark and colleagues wrote.
“Our findings confirm the previous suggestions to develop and use psychologically informed physiotherapy approaches, especially for pain,” Clark and colleagues wrote. “However, for this to be effective, there needs to be an increase in psychological intervention training and knowledge for physiotherapists, including cognitive behavioral therapy, effective communication, and behavior change techniques.”
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