Relationship between Kinesthesia and Motor Performance in Young Adults with Generalized Joint Hypermobility: A Systematic Review

ABSTRACT

This study was conducted to investigate the relationship between kinesthesia and motor performance in young adults with generalized joint hypermobility (GJH). A systematic review was conducted in accordance with the PRISMA guidelines. PubMed, Embase, Cochrane Library, Web of Science, PsycINFO, CINAHL, Scopus, and Google Scholar were scoured to select relevant papers. Ten papers were selected for the review. The study found no significant impact of GJH on the kinesthetic domains. Several studies suggested varying impacts of GJH on motor performance, with some indicating potential benefits and others indicating possible detriments. Interestingly, the impact of GJH on motor performance was found to be influenced by other factors such as fitness, body mass index, and the use of specific assessment tools. The results suggest that GJH does not significantly impact motor performance in young adults. However, the relationship between GJH and motor performance appears to be complex and may be influenced by several other factors.

INTRODUCTION

A characteristic of generalized joint hypermobility (GJH) is a greater range of movement in joints beyond what is considered normal for a given age, sex, and ethnicity.[1] In spite of its relative frequency, little is known about how GJH affects a person’s ability to move and perceive colors. Kinesthesia, or the awareness of one’s own position and movement in space, is another essential element of motor function that includes balance, coordination, and the capacity to perform precise motions.[2]

It is commonly hypothesized that individuals with GJH may experience altered kinesthetic perception because of the higher laxity and instability of their joints, which could impact their motor function.[3] “Motor performance” covers a broad spectrum of tasks, from simple ones such as standing or walking to more complex ones involving exact balance and coordination. Understanding if increased joint range of motion in the context of GJH enhances or impairs motor function in these individuals is critical.[4,5]

There is a lack of comprehensive reviews that consolidate these findings and explain how they connect to one another within the context of GJH, despite some research looking at the impact of GJH on kinesthesia and motor function independently. A deeper understanding of this link can only be achieved by conducting additional studies in this area to fill in the gaps in the literature. Thus, to gain important insights into the functional implications of GJH and to guide clinical practice and intervention strategies specific to this population, the current study explores and summarizes the body of knowledge regarding the relationship between kinesthesia and motor performance in young adults with GJH through a systematic review of the literature.

MATERIALS AND METHODS

Review design and protocol

The PRISMA protocol[6] was utilized for the review and in the conduction of the database search protocol. The schematics of the article inclusion framework have been delineated through Figure 1.

Figure 1.

PRISMA protocol representation of the article selection process for the review

The Population, Exposure, Comparator, Outcome protocol for this systematic review was defined as follows:

• The population of interest encompassed individuals under the age of 24 years as defined by the WHO.[7]

• The exposure under investigation was GJH.

• The comparators (although not necessarily mandatory) in this review were the children without GJH within the same studies.

• The outcomes measured in the reviewed studies included impacts on various aspects of motor performance and kinesthesia.

Database search protocol

The search strategy for the systematic review was meticulously designed to ensure an exhaustive search across eight different databases: PubMed, Embase, Cochrane Library, Web of Science, PsycINFO, CINAHL, Scopus, and Google Scholar. The Boolean operators “AND” and “OR” were used to combine search terms.

Selection criteria

Table 1 lists the selection criteria that was devised for the review.

Table 1.

Inclusion and exclusion criterion specified for this review

Criteria	Inclusion	Exclusion
Population	Children and young adults aged <24 years of both genders from any geographical location.	Adults, individuals outside the specified age range, studies focusing on animals or in vitro models.
Exposure	Children diagnosed with GJH using recognized clinical criteria such as the Beighton score, Bulbena’s criteria, or other established methods.	Studies where the diagnosis of GJH was unclear, not based on recognized criteria, or not explicitly stated.
Comparator	Studies that included a comparison group of children without GJH.	Studies that did not include a comparator group of children without GJH (not necessarily mandatory)
Outcome	Studies that measured and reported on motor performance or kinesthesia outcomes in children with and without GJH.	Studies that did not measure or report on motor performance or kinesthesia outcomes.

RESULTS

Correlation between GJH and motor performance

Table 2 lists the demographic and technical characteristics of the included studies,[8,9,10,11,12,13,14,15,16,17] where papers were included from 2005 to 2023. Anieto et al.[8] and de Boer et al.[9] explored the relationship between GJH and various aspects of motor performance. Anieto et al.[8] found no direct correlation between GJH and fitness or motor performance, implying that other factors might be responsible for the observed changes. de Boer et al.[9] also found no significant association between GJH and total motor performance but noted a positive relationship between manual dexterity and motor performance in girls with higher Beighton scores.

Table 2.

Demographic and technical characteristics of the included papers

Study ID	Year	Protocol	Region	Sample size (n)	Gender ratio	Age range (in years)
Anieto et al.[8]	2023	Cross-sectional	Nigeria	91	44 males	6–11
de Boer et al.[9]	2015	Prospective case-cohort	Holland	249	111 males	5.51 (mean)
Engelbert et al.[10]	2005	Retrospective case-cohort	Holland	72	42 males	1.3–11.6
Fatoye et al.[11]	2011	Cross-sectional	UK	66	28 males	8–15
Hanewinkel et al.[12]	2009	Cross-sectional	Holland	41	22 males	5–12
Juul et al.[13]	2009	Cross-sectional	Denmark	349	189 males	8
Moore et al.[14]	2019	Cross-sectional	Ireland	73	48 males	6–12
Nikolajsen et al.[15]	2013	Cross-sectional	Denmark	37	19 males	9–11
Wright et al.[16]	2020	Cross-sectional	Australia	60	30 males	6–12
Yardımcı and Mutlu[17]	2023	Prospective	Turkey	112	55 males	2–3.5

Impact of GJH on developmental milestones

Engelbert et al.[10] and Yardımcı and Mutlu[17] investigated the effect of GJH on developmental milestones. Engelbert et al.[10] found no significant correlation between the number of hypermobile joints and delayed motor development, suggesting that hypermobility does not necessarily lead to developmental issues. Similarly, Yardımcı and Mutlu[17] found no significant differences in cognitive, language, proprioception assessment, and motor domains between toddlers with and without GJH.

GJH and specific aspects of motor performance

Fatoye et al.[11] and Nikolajsen et al.[15] focused on specific aspects of motor performance. Fatoye et al.[11] found that children with GJH showed higher levels of passive range of motion but no significant difference in gait speed. Nikolajsen et al.[15] observed differences in walking kinetics in children with GJH, indicating a different biomechanical strategy, even if the walking pattern appeared similar to that of healthy children.

Influence of GJH on physical activity and endurance

Hanewinkel et al.,[12] Juul et al.,[13] and Moore et al.[14] examined the impact of GJH on physical activity levels and endurance. Hanewinkel et al.[12] found no significant association between GJH and the 6MWT, suggesting that GJH might not impact aerobic capacity or endurance. Both Juul et al.[13] and Moore et al.[14] found no significant difference in physical activity levels between children with and without GJH.

GJH and risk of motor coordination issues

Wright et al.[16] looked at the risk of lower motor coordination (LMC) in children with GJH. They found that developing children typically scored significantly higher on the RTSBc than those at risk of LMC and those in the LMC group.

DISCUSSION

Anieto et al.[8] and Juul et al.[13] found both benefits and detriments of GJH on motor performance. This dichotomy was evident in other studies, with GJH altering movement biomechanics[11,16] without necessarily affecting overall mobility or motor performance.[9,11,15,16,17] Our review, like Romeo et al.’s,[18] identified overlap in symptoms and motor difficulties in children with developmental coordination disorder and joint hypermobility. Sobhani et al.[19] reported a cumulative GJH prevalence of 34.1%, with variations based on gender and age. Blajwajs et al.[20] assessed GJH broadly, noting variations in prevalence across ethnic groups, age, gender, and measurement parameters. Recent studies have acknowledged GJH’s systemic implications beyond joint health.[20] While some findings diverged from adult correlations, particularly in autonomic and gastrointestinal systems, others, such as central sensitization, gynecological implications, and urinary dysfunctions, were consistent with adult observations.[18,19,20]

CONCLUSION

A complicated interaction between hypermobility and motor function was shown by the inquiry into the effects of GJH on children’s motor performance and kinesthesia. While some research found no such link, others identified a strong correlation between GJH and measures of motor function and fitness. Moreover, no reliable association between GJH and overall motor performance was found in any of the investigations. A better degree of motor performance was occasionally linked to manual dexterity in girls with GJH; however, this impact seemed to decrease with increasing body mass index.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.