Efficacy of Orthotic Intervention for Patients with Hypermobile Ehlers-Danlos Syndrome

Clinical Question

Background

Joint hypermobility disorders, including hEDS, classical EDS (cEDS), joint hypermobility syndrome (JHS), generalized hypermobility (GH), hypermobility spectrum disorders (HSD), and symptomatic flexible flatfoot, can present with excessive joint motion, pain, fatigue, and functional limitations.^1-5 Reviewed orthoses included positional finger orthoses, a shoulder orthosis, customized arch-support insoles, and dynamic elastomeric fabric orthoses (DEFOs). These devices improve joint positioning or stability while preserving functional movement. Therapeutic exercises and motor-function training for people with GH and hEDS were also supported, indicating that orthotic intervention can be considered as one component of multidisciplinary rehabilitation rather than as a replacement for exercise or functional training. The purpose of this CAT is to evaluate whether orthotic intervention improves pain, joint stability, cognitive effort, and functional performance in people with hypermobility-related conditions.

Search Strategy

Synthesis of Results

Across the reviewed studies, orthotic interventions generally provided support, improved alignment or stability, or limited excessive motion while allowing functional activity.^3-5 Jensen et al. found that positional finger orthoses significantly reduced the time required for functional hand tests, although the expected reduction in prefrontal cortical activity was observed only during the dominant-hand coin task.³ Kotler et al. reported improved bed mobility and transfers, less pain, and fewer dislocations in a patient receiving multidisciplinary rehabilitation that included a shoulder orthosis.⁴ Hsieh et al. found significant improvements in pain/comfort, physical health, stair-ascent time, physical and upper-extremity function, and transfers after 12 weeks of customized arch-support insoles in children with symptomatic flexible flatfoot.² Snowdon and Dadla identified immediate relief, improved proprioception, and enhanced joint stability as recurring themes in expert experiences with DEFOs.⁵ Brittain et al. concluded that therapeutic exercise and motor-function training are effective approaches for GH and hEDS, with weaker evidence for adaptive equipment, patient instruction, manual therapy, and functional training.¹

The evidence is limited by small or heterogeneous samples, lack of control groups in some studies, short or absent long-term follow-up, variable treatment compliance, and reliance on expert or retrospective evidence in some articles. These limitations make it difficult to determine which orthotic designs, wear schedules, or patient characteristics produce the greatest benefit. The findings support controlling painful or excessive motion while maintaining function, but they do not establish orthoses as a stand-alone treatment.