52. The management of hypermobility syndromes in children: A group approach

Abstract

38% of all therapy referrals from Rheumatology Consultants over a period of 6 months at Birmingham Children's Hospital were found to be for hypermobility syndromes. This patient group had previously been seen for 1:1 treatment sessions by Physiotherapy and/or Occupational Therapy. This has significant implications for caseload management and departmental economy. There is evidence to show that a multi-disciplinary therapy approach, alongside the promotion of self-management results in successful outcomes for these patients. There is also evidence for the effectiveness of group rehabilitation within the therapy setting. This intervention aimed to develop a multi-disciplinary led group for patients with a diagnosis of hypermobility, to promote evidence based self-management strategies in hypermobility syndrome and to provide a structured, patient centered pathway to improve time and cost effectiveness. From April 2016 onwards all patients with a diagnosis of hypermobility identified as appropriate for the group were screened via a telephone triage service. This assessed diagnosis acceptance and limiting factors to group participation. This was to ensure the patient was appropriate for the group, identify individual difficulties and enable therapists to tailor group sessions to meet the patient's needs and exclude those with significant functional difficulties and potential pain syndromes who would be more appropriate 1:1 treatment. The group was run by an occupational and physiotherapist over three 90 minute sessions and included evidence based content on the following: An introduction to hypermobility, theoretical sessions on fatigue, pacing and sleep hygiene and practical sessions on mindfulness and relaxation, handwriting and physiotherapy circuits. A questionnaire based on functional tasks, pain, fatigue, sleep and mood was completed pre and post group. Patients gave a score of 1-4 to show the frequency of which these were a problem within their daily life from “not ever” to “almost always”. All patients identified individual improvements and reported that they felt more confident to manage their functional difficulties and symptoms after the group. Results also show a significant reduction in average total clinical time spent with each patient after the introduction of the group leading to a more cost effective service. We found this evidence based group to be a cost-effective and patient centred approach to treating and promoting self-management in children aged between 12 and 16 who have been diagnosed with a Hypermobility Syndrome.