Core Muscle Endurance, Upper Extremity Muscle Strength, Grip Strength, and Hand-eye Coordination in Generalized Joint Hypermobility

Study Overview
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Brief Summary
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Every individual with joint hypermobility may not apply to a health institution because they do not have a complaint that will affect their daily life. Although hypermobility is a common clinical entity in the society, this issue has not been fully understood yet. In particular, individuals with GJH are either neglected in physiotherapy and rehabilitation evaluations and practices, or they encounter an incomplete assessment and physiotherapy practices. In this study, in order to better understand the effect of GJH on core muscle endurance, upper extremity strength, grip strength and coordination, we will include the individuals identified GJH among the university students (hypermobility severity ≥4/9 according to Beighton diagnostic criteria) as study group and the healthy peers as control group. We believe the results we will obtain at the end of our study will make a contribution to the literature in terms of revealing the role of core muscle endurance and upper extremity strength, grip strength and coordination in the evaluation and rehabilitation of individuals with GJH. In addition, it will contribute to the inclusion of individuals with GJH who are professional athletes, dancers or musicians in a more comprehensive evaluation program and the creation of physiotherapy and rehabilitation programs. According to the information we have obtained from the literature, it is a fact that hypermobility can increase the susceptibility to musculoskeletal system diseases. For this reason, early solutions to problems can be provided by evaluating hypermobility in patients who apply to health institutions with various musculoskeletal complaints, raising awareness of patients with hypermobility to prevent injuries caused by hypermobility, and strengthening muscles.

Detailed Description
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Many people may have more than one hypermobile joint, and when certain conditions are met, this condition called generalized joint hypermobility (GJH) is not detrimental. In recent years, the spectrum of the disorder has been changed in the classification of joint hypermobility, from asymptomatic GJH to the multisystem involvement and painful condition called hypermobile Ehlers Danlos Syndrome. Beighton criteria are most commonly used in the diagnosis of hypermobility. The Beighton score is an easy scoring method that is scored by performing five maneuvers and includes a total of nine points. If four of these maneuvers are positive, the patient is considered to have hypermobility. Numerous studies associate hypermobility with conditions such as soft tissue injuries, pain, joint instability, decreased soft tissue strength, increased frequency of traumatic injuries, and pain-related inactivity. The study was designed as a cross-sectional descriptive and comparative study. With this study, in order to better understand the effect of GJH on core muscle endurance, upper extremity strength, grip strength, and coordination, we aim to include volunteers with identified GEH among the university students (hypermobility severity ≥4/9 according to Beighton diagnostic criteria). 27 students between the ages of 17-26 who are studying at the Faculty of Health Sciences of Bezmialem Vakif University and scored 4 and above according to the Beighton score, and the 27 students who are in the same age group studying at the same faculty, do not have GJH will be included. In the study, after evaluating flexibility with sit-reach test, core muscle endurance, upper extremity muscle strength, hand grip strength, finger grip strength and hand-eye coordination tests will be applied to all participants. SPSS v.20 program will be used for data analysis. All data will be analyzed with the Kolmogorov-Smirnov test to determine the distribution characteristics. In the study, descriptive statistics (mean±standard deviation, minimum-maximum, number and percentile) will be given for discrete and continuous variables. When the differences between two independent groups are evaluated, t-Test in Independent Groups in case the parametric test prerequisites are met; If not, the Mann Whitney -U Test will be used. Chi-Square Test will be used to determine the relationships between two discrete variables. When the variables meet the parametric test prerequisites, the correlation coefficients and statistical significance will be calculated with the Pearson Test, when they do not, the correlation coefficients and statistical significance for the relations between the variables will be calculated with the Spearman Test. Although there are studies in the literature evaluating muscle strength, grip strength and trunk endurance in individuals with joint hypermobility, no study evaluating hand-eye coordination has been encountered. However, no study has been encountered that evaluated core muscle endurance, upper extremity strength, grip strength, and hand-eye coordination in individuals with GJH. We believe that the results we will obtain at the end of our study will contribute to the literature in terms of revealing the role of core muscle endurance and upper extremity strength, grip and coordination in the evaluation and rehabilitation of individuals with GJH.

Official Title
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Evaluation of Core Muscle Endurance, Upper Extremity Muscle Strength, Grip Strength, and Hand-eye Coordination in Young Adults With Generalized Joint Hypermobility

Conditions
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Muscle Weakness, Hypermobility, Joint, Coordination Lack

Intervention / Treatment
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* Other: Core muscle endurance
* Other: Upper extremity muscle strength
* Other: Grip strength
* Other: Pinch strength
* Other: Alternate hand-wall toss test


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Getting a score of 4 or higher according to the Beighton criteria Being between the ages of 17-26 Exclusion Criteria: Presence of benign joint hypermobility syndrome Presence of any neurological, rheumatic, musculoskeletal, metabolic and connective tissue disease History of fracture in the upper extremity History of pain, deformity or surgery associated with the vertebral column and upper extremity Presence of cognitive, mental and/or serious psychiatric illness Participating in any exercise program or sportive activity in the last six months

Ages Eligible for Study
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Minimum Age: 17 Years
Maximum Age: 26 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Study group<br>27 young adults aged 17-26 who scored 4 or more according to the Beighton scoring | Other: Core muscle endurance<br>* Trunk flexion, trunk extension, side bridge exercises and prone bridge test developed by McGill will be used to evaluate core muscle endurance.<br>Other: Upper extremity muscle strength<br>* Isometric muscle strength assessment of the shoulder, elbow and wrist muscles will be performed with a hand-held dynamometer.<br>Other: Grip strength<br>* Grip strength will be evaluated with a hand dynamometer in the position recommended by the American Association of Hand Therapists.<br>Other: Pinch strength<br>* Pinch strength will be evaluated with a pinchmeter in three positions.<br>Other: Alternate hand-wall toss test<br>* To measure hand-eye coordination, it is performed by changing hands by throwing and catching the ball against the wall.<br>|
| Control group<br>27 young adults aged 17-26 who scored less than 4 points according to the Beighton scoring | Other: Core muscle endurance<br>* Trunk flexion, trunk extension, side bridge exercises and prone bridge test developed by McGill will be used to evaluate core muscle endurance.<br>Other: Upper extremity muscle strength<br>* Isometric muscle strength assessment of the shoulder, elbow and wrist muscles will be performed with a hand-held dynamometer.<br>Other: Grip strength<br>* Grip strength will be evaluated with a hand dynamometer in the position recommended by the American Association of Hand Therapists.<br>Other: Pinch strength<br>* Pinch strength will be evaluated with a pinchmeter in three positions.<br>Other: Alternate hand-wall toss test<br>* To measure hand-eye coordination, it is performed by changing hands by throwing and catching the ball against the wall.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Alternate hand-wall toss test | To measure hand-eye coordination, it is performed by changing hands by throwing and catching the ball against the wall. The action is repeated for a period of 30 seconds. | One day | 
| Core muscle endurance tests | Trunk flexion, trunk extension, side bridge exercises and prone bridge test developed by McGill will be used to evaluate core muscle endurance. | One day | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Upper extremity muscle strength measurement | Isometric muscle strength assessment of the shoulder, elbow and wrist muscles will be performed with a hand-held dynamometer. | One day | 
| Grip strength measurement | Grip strength will be evaluated with a hand grip dynamometer in the position recommended by the American Association of Hand Therapists. | One day | 
| Pinch strength measurement | It will be evaluated with a pinchmeter. Measurements will be made bilaterally in three different positions as lateral, palmar and fingertip grips. | One day |