Multidisciplinary intervention for treatment of benign joint hypermobility syndrome in childhood

INTERVENTION: Those consenting to take part will be invited for a screening assessment undertaken by the trial physiotherapist to identify their eligibility for inclusion. Written consent will be sought from eligible children and their parents. Those consenting to take part will be randomised to receive either multidisciplinary care or standard care. Minimisation will be used to ensure balance among age and gender strata. The multidisciplinary intervention will comprise an appointment with a physiotherapist for assessment and basic advice; a programme of 6 physiotherapy sessions to improve core stability and work on strengthening exercises; gait analysis and provision of foot orthoses as necessary; an OT assessment at hospital clinic and at home with provision of appliances as necessary; an OT school visit to discuss diagnosis with teachers and provide appliances as necessary. Those with problems in their hands will also receive an OT directed exercise programme. The groups will be reviewed at 3 and 12 months to assess which treatment approach was of greatest benefit in helping their pain and improving their physical functioning and quality of life. Data will also be collected on function, social activities and schooling. Data will also be collected that will allow a health economic evaluation. CONDITION: Benign joint hypermobility syndrome ; Musculoskeletal Diseases PRIMARY OUTCOME: Level of pain and physical functioning, assessed by the Childhood Health Assessment Questionnaire (CHAQ) at baseline, 3 months and 12 months SECONDARY OUTCOME: Measured at baseline, 3 months and 12 months:; 1. Health‐related quality of life, assessed using the CHU 9D (9 dimensional Child Health Utility); 2. Number of primary care and hospital attendances and school attendance, measured using the BJH resource use questionnaire; 3. Grip strength, assessed using a hand‐held dynamometer; 4. Pain, assessed using the VAS/Faces Pain Score; 5. Function and gross and fine motor skills, assessed using the Movement Assessment Battery for Children; 6. Participation in sport, measured using a questionnaire INCLUSION CRITERIA: 1. Children aged between 5‐16 years old 2. Satisfy the Brighton criteria for classification of BJS 3. Reporting musculoskeletal pain in one or more areas of the body for a duration of greater than three months 4. Written informed consent