Clinical trial NCT06202924: Muscle Strength and Balance in Individuals With Joint Hypermobility
Official title: The Effect of Attention Focus on Muscle Strength and Balance in Individuals With Joint Hypermobility
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Joint Hypermobility
Balance
Muscle Strength
Lead sponsor: Gazi University
Sponsor class: OTHER
First posted: 2024-01-12
Enrollment: 32
Sex: ALL
Minimum age (years): 18
Maximum age (years): 35
Standard ages: ADULT
Observational model: COHORT
Time perspective: CROSS_SECTIONAL
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Individuals between the ages of 18-35 who score 5 or more out of 9 according to the Beighton scoring will be included in the research. Among these individuals, those with any pathology related to the musculoskeletal system or a history of surgery within the last 6 months will be excluded from the study.

The study will be initiated with individuals who volunteer for the study as a result of the inclusion and exclusion criteria. Individuals will be evaluated for static balance, dynamic balance and lower extremity muscle strength without the use of any instructions/focus. Then, individuals' static balance, dynamic balance and lower extremity muscle strength will be evaluated according to internal and external focus techniques, respectively.

Brief summary: Joint hypermobility is a clinical condition characterized by joints having a range of motion beyond their normal limits. Joint hypermobility (JH) makes the joints more vulnerable to trauma in individuals with increased joint range of motion, changes in neuromuscular reflexes and decreased joint position sense. Individuals with JH have difficulty in stabilization and end of extension range of motion compared to healthy individuals. Accordingly, findings such as balance problems and an increased risk of falling occur in these patients. Recent evidence suggests that children and adults with JH may be identified with seemingly unrelated, common clinical problems such as chronic fatigue, anxiety, and a range of gastrointestinal functional disorders.

The use of internal and external focus in learning motor skills is important in terms of performance and activity. In the external focus of attention (EF), attention is directed to movement and an environmental stimulus. In the internal focus (IF), attention is directed directly to body movements. In revealing positive effects in external focus; Methods such as metaphor, analogy, imaginary objects, mental analogies can be used. Adopting an external focus of attention (focusing on the effects of movements on the object or environment), as opposed to an internal focus of attention (focusing on body movements), has been found to significantly improve performance on a variety of tasks. For example, to improve balance performance, while a patient performs a single-leg balance task on a Bosu ball, the therapist may instruct the patient using an internal focus of attention such as "minimize movement of the feet." However, instructions can also be given externally by changing just one word, such as "minimize Bosu's movement." Additionally, a metaphor (e.g., "stand still as if stuck to Velcro"), analogy ("imagine being on top of a mountain, stay on the mountain!"), an object attached to the body ("keep the tape stuck to the chest still"), or the target of the movement An imaginary object (e.g., straight line) of which a mental image is obtained has been used within external focus instructions.

Detailed description: Joint hypermobility is a clinical condition characterized by joints having a range of motion beyond their normal limits. Joint hypermobility (JH) makes the joints more vulnerable to trauma in individuals with increased joint range of motion, changes in neuromuscular reflexes and decreased joint position sense. Individuals with (external focus) EF have difficulty in stabilization and end of extension range of motion compared to healthy individuals. Accordingly, findings such as balance problems and an increased risk of falling occur in these patients. Recent evidence suggests that children and adults with JH may be identified with seemingly unrelated, common clinical problems such as chronic fatigue, anxiety, and a range of gastrointestinal functional disorders.

The benefit of an external focus of attention compared to an internal focus of attention to enhance motor skill learning and performance has been consistently demonstrated by a large body of evidence across different populations, tasks, and skill levels . These developments included tasks such as balance, running, agility performance, direction changing performance, force production, horizontal and vertical jumping performance. In general, an external focus of attention has been shown to produce more accurate performance, improved reaction time, and more efficient movement (e.g., reduced muscle activity). According to the constrained action hypothesis, an IF encourages broader involvement of cognitive processes due to greater reliance on conscious control strategies. These strategies interfere with the normal automatic control processes of the motor system. An EF, on the other hand, encourages these automatic control processes, thus further enhancing motor learning. With the use of external focus of attention in neuromuscular training; It has been stated that in addition to improving motor performance and biomechanical changes, the connection between the sensory areas of the brain and the thalamus has increased. It has been found to possibly reduce "noise" in the central nervous system that interferes with fine movement control and affects the outcome of movement; dopamine availability may increase, which may strengthen memory by increasing synaptogenesis processes; It has been stated in publications that newly learned motor skills can be preserved and resistance to stress and fatigue can be achieved. Considering all these situations, investigators think that young individuals with joint hypermobility may have problems with muscle strength and balance skills, which are among the physical fitness parameters. It is important to optimally evaluate physical fitness parameters in order to prevent injuries and ensure the effectiveness of the modalities used in treatment. This study was planned to investigate whether external focus of attention is effective in revealing balance skills and muscle strength at an optimal level compared to internal focus of attention in individuals with joint hypermobility.

Eligibility criteria: Inclusion Criteria:

* Scored 5 out of 9 or more according to Beighton scoring
* Individuals between the ages of 18-35 will be included in the research.

Exclusion Criteria:

* These individuals do not have any pathology related to the musculoskeletal system
* Those with a history of surgery within the last 6 months will be excluded from the study.

Primary outcomes:
measure: Static balance assessment:
timeFrame: 1-3 months
measure: Dynamic balance assessment:Y balance test
timeFrame: 1-3 months
measure: Isokinetic strength evaluation
timeFrame: 1-3 months
Secondary outcomes:
Other outcomes:
Locations:
city: Ankara
country: Turkey
facility: Rabia ZORLULAR
Study officials:
affiliation: Study Principal Investigator
name: Ali ZORLULAR
role: PRINCIPAL_INVESTIGATOR
References:
citation: Smits-Engelsman B, Klerks M, Kirby A. Beighton score: a valid measure for generalized hypermobility in children. J Pediatr. 2011 Jan;158(1):119-23, 123.e1-4. doi: 10.1016/j.jpeds.2010.07.021. Epub 2010 Sep 17.
citation: Engelbert RH, Bank RA, Sakkers RJ, Helders PJ, Beemer FA, Uiterwaal CS. Pediatric generalized joint hypermobility with and without musculoskeletal complaints: a localized or systemic disorder? Pediatrics. 2003 Mar;111(3):e248-54. doi: 10.1542/peds.111.3.e248.
citation: Lohse KR. The influence of attention on learning and performance: pre-movement time and accuracy in an isometric force production task. Hum Mov Sci. 2012 Feb;31(1):12-25. doi: 10.1016/j.humov.2011.06.001. Epub 2011 Jul 20.
citation: Zachry T, Wulf G, Mercer J, Bezodis N. Increased movement accuracy and reduced EMG activity as the result of adopting an external focus of attention. Brain Res Bull. 2005 Oct 30;67(4):304-9. doi: 10.1016/j.brainresbull.2005.06.035.