Phenotype-based prediction of functional improvements following structured exercise intervention in children with hypermobility spectrum disorder
DOI:
https://doi.org/10.17267/2238-2704rpf.2026.e6668Keywords:
Joint Hypermobility, Child, Proprioception, Motor ActivityAbstract
BACKGROUND: Exercise therapy is widely prescribed for children with hypermobility spectrum disorder (HSD), yet intervention studies consistently report substantial inter-individual variability in functional outcomes. Mean-based efficacy analyses dominate the literature and obscure mechanistic differences in sensorimotor control that may constrain rehabilitation responsiveness. OBJECTIVE: To determine whether baseline sensorimotor control and movement variability predict functional responsiveness to structured exercise in children with HSD. METHODS: In this prospective, single-group interventional study, 48 children aged 9–12 years with HSD completed an 18-week structured exercise program emphasizing proprioceptive training, neuromuscular control, and functional task practice. Functional performance was assessed using the Pediatric Outcomes Data Collection Instrument (PODCI) Sports & Physical Function domain. Baseline joint position sense error, gait step-time variability, and inter-joint coordination variability were examined as predictors of functional improvement using multivariable regression, responder classification, and phenotype-stratified analyses. RESULTS: Functional performance improved significantly following intervention (mean Δ PODCI = 10.2 ± 5.4 points; p < 0.001). Baseline joint position sense error, gait step-time variability, and inter-joint coordination variability independently predicted functional gains and together explained a substantial proportion of inter-individual variance (adjusted R² = 0.43; model p < 0.001). Higher baseline proprioceptive error and greater movement variability were associated with attenuated improvement (p < 0.05). Phenotype stratification demonstrated a graded response pattern. CONCLUSION: Exercise responsiveness in pediatric HSD is constrained by baseline sensorimotor control and movement variability rather than uniform exercise exposure, supporting phenotype-informed rehabilitation strategies.
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Copyright (c) 2026 Kshama Susheel Shetty, Hariharasudhan Ravichandran, Kumaragurubaran Ravikumar, Madhusudhan Shivanna, Sutamali Subramanian, Balamurugan Janakiraman
This work is licensed under a Creative Commons Attribution 4.0 International License.
This work is licensed under a Creative Commons Attribution 4.0 International License.
