Falls and balance impairment; what and how has this been measured in adults with joint hypermobility? A scoping review

Abstract Background People with joint hypermobility have excessive joint flexibility, which is more common in young women. The people with symptomatic hypermobility report poor balance and even falls. This scoping review aims to identify and map the available evidence related to balance and falling...

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Main Authors: Yiduo Wang, Paul H. Strutton, Caroline M. Alexander
Format: Article
Language:English
Published: BMC 2025-01-01
Series:BMC Musculoskeletal Disorders
Subjects:
Online Access:https://doi.org/10.1186/s12891-025-08318-3
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author Yiduo Wang
Paul H. Strutton
Caroline M. Alexander
author_facet Yiduo Wang
Paul H. Strutton
Caroline M. Alexander
author_sort Yiduo Wang
collection DOAJ
description Abstract Background People with joint hypermobility have excessive joint flexibility, which is more common in young women. The people with symptomatic hypermobility report poor balance and even falls. This scoping review aims to identify and map the available evidence related to balance and falling in adults with joint hypermobility to support research planning and ideas for treatment direction. Methods A framework for the search was constructed using the Joanna Briggs Institute (JBI) approach. Electronic searches of primary evidence were performed using the following databases: Medline, Web of Science, CINAHL, Scopus and EMBASE. Papers written in English and published between 1946 and November 2023 were included. Titles, abstracts, and full papers were independently screened by two reviewers. Data extracted related to the population, the concept under investigation, the method of measurement, the level of evidence and the result. Results Nineteen of 1,950 screened articles were included. In terms of the population, details related to ethnicity of the research participants was missing. The hypermobility classification criteria varied; it was not always clear if people who were hypermobile had symptoms. Concepts related to fear of falling, balance and adaptive strategies prompted by different postural tasks with and without vision were explored. Centre of pressure, muscle activity, kinematics and psychological factors were measured using force plates, electromyography (EMG), motion capture, patient and clinician reported outcome measures, focus groups and interviews. Most papers were low on the hierarchy of evidence (i.e. equal or lower than a case control study). The participants with joint hypermobility had increased sway, different muscle activity, and different kinematics compared to people without hypermobility. When surveyed, they commonly fell and had a fear of falling. Conclusions It is unclear whether the participants represent the population of people with hypermobility. Different classification systems were used making it difficult to generalise the results. Although the methods used suggest a low level of evidence, it seems clear that people who are hypermobile have poor balance. The underlying mechanisms driving poor balance have not been explored in depth.
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spelling doaj-art-99fb0982f0964b958a7a408a2e01d35e2025-02-02T12:05:27ZengBMCBMC Musculoskeletal Disorders1471-24742025-01-0126112610.1186/s12891-025-08318-3Falls and balance impairment; what and how has this been measured in adults with joint hypermobility? A scoping reviewYiduo Wang0Paul H. Strutton1Caroline M. Alexander2The Nick Davey Laboratory, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Sir Michael Uren Hub, Imperial College London, White City CampusThe Nick Davey Laboratory, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Sir Michael Uren Hub, Imperial College London, White City CampusThe Nick Davey Laboratory, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Sir Michael Uren Hub, Imperial College London, White City CampusAbstract Background People with joint hypermobility have excessive joint flexibility, which is more common in young women. The people with symptomatic hypermobility report poor balance and even falls. This scoping review aims to identify and map the available evidence related to balance and falling in adults with joint hypermobility to support research planning and ideas for treatment direction. Methods A framework for the search was constructed using the Joanna Briggs Institute (JBI) approach. Electronic searches of primary evidence were performed using the following databases: Medline, Web of Science, CINAHL, Scopus and EMBASE. Papers written in English and published between 1946 and November 2023 were included. Titles, abstracts, and full papers were independently screened by two reviewers. Data extracted related to the population, the concept under investigation, the method of measurement, the level of evidence and the result. Results Nineteen of 1,950 screened articles were included. In terms of the population, details related to ethnicity of the research participants was missing. The hypermobility classification criteria varied; it was not always clear if people who were hypermobile had symptoms. Concepts related to fear of falling, balance and adaptive strategies prompted by different postural tasks with and without vision were explored. Centre of pressure, muscle activity, kinematics and psychological factors were measured using force plates, electromyography (EMG), motion capture, patient and clinician reported outcome measures, focus groups and interviews. Most papers were low on the hierarchy of evidence (i.e. equal or lower than a case control study). The participants with joint hypermobility had increased sway, different muscle activity, and different kinematics compared to people without hypermobility. When surveyed, they commonly fell and had a fear of falling. Conclusions It is unclear whether the participants represent the population of people with hypermobility. Different classification systems were used making it difficult to generalise the results. Although the methods used suggest a low level of evidence, it seems clear that people who are hypermobile have poor balance. The underlying mechanisms driving poor balance have not been explored in depth.https://doi.org/10.1186/s12891-025-08318-3FallsJoint HypermobilityBalance
spellingShingle Yiduo Wang
Paul H. Strutton
Caroline M. Alexander
Falls and balance impairment; what and how has this been measured in adults with joint hypermobility? A scoping review
BMC Musculoskeletal Disorders
Falls
Joint Hypermobility
Balance
title Falls and balance impairment; what and how has this been measured in adults with joint hypermobility? A scoping review
title_full Falls and balance impairment; what and how has this been measured in adults with joint hypermobility? A scoping review
title_fullStr Falls and balance impairment; what and how has this been measured in adults with joint hypermobility? A scoping review
title_full_unstemmed Falls and balance impairment; what and how has this been measured in adults with joint hypermobility? A scoping review
title_short Falls and balance impairment; what and how has this been measured in adults with joint hypermobility? A scoping review
title_sort falls and balance impairment what and how has this been measured in adults with joint hypermobility a scoping review
topic Falls
Joint Hypermobility
Balance
url https://doi.org/10.1186/s12891-025-08318-3
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