Management of childbearing with hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders: A scoping review and expert co-creation of evidence-based clinical guidelines.

OBJECTIVE: To co-create expert guidelines for the management of pregnancy, birth, and postpartum recovery in the context of hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorders (HSD). DESIGN: Scoping Review and Expert Co-creation. SETTING: United Kingdom, United States of America, Canada, France, Sweden, Luxembourg, Germany, Italy, and the Netherlands. SAMPLE: Co-creators (n = 15) included expertise from patients and clinicians from the International Consortium on the Ehlers-Danlos syndromes and Hypermobility Spectrum Disorders, facilitated by the Ehlers-Danlos Society. METHODS: A scoping review using Embase, Medline, the Cochrane Central Register of Controlled Trials and CINHAL was conducted from May 2022 to September 2023. Articles were included if they reported primary research findings in relation to childbearing with hEDS/HSD, including case reports. No language limitations were placed on our search, and our team had the ability to translate and screen articles retrieved in English, French, Spanish, Italian, Russian, Swedish, Norwegian, Dutch, Danish, German, and Portuguese. The Mixed Methods Appraisal Tool was used to assess bias and quality appraise articles selected. The co-creation of guidelines was based on descriptive evidence synthesis along with practical and clinical experience supported by patient and public involvement activities. RESULTS: Primary research studies (n = 14) and case studies (n = 21) including a total of 1,260,317 participants informed the co-creation of guidelines in four overarching categories: 1) Preconceptual: conception and screening, 2) Antenatal: risk assessment, management of miscarriage and termination of pregnancy, gastrointestinal issues and mobility, 3) Intrapartum: risk assessment, birth choices (mode of birth and intended place of birth), mobility in labor and anesthesia, and 4) Postpartum: wound healing, pelvic health, care of the newborn and infant feeding. Guidelines were also included in relation to pain management, mental health, nutrition and the common co-morbidities of postural orthostatic tachycardia syndrome, other forms of dysautonomia, and mast cell diseases. CONCLUSIONS: There is limited high quality evidence available. Individualized strategies are proposed for the management of childbearing people with hEDS/HSD throughout pregnancy, birth, and the postpartum period. A multidisciplinary approach is advised to address frequently seen issues in this population such as tissue fragility, joint hypermobility, and pain, as well as common comorbidities, including dysautonomia and mast cell diseases.

An analysis of peak pelvis rotation speed, gluteus maximus and medius strength in high versus low handicap golfers during the golf swing.

PURPOSE/HYPOTHESIS: The kinematic sequence of the golf swing is an established principle that occurs in a proximal-to-distal pattern with power generation beginning with rotation of the pelvis. Few studies have correlated the influence of peak pelvis rotation to the skill level of the golfer. Furthermore, minimal research exists on the strength of the gluteal musculature and their ability to generate power during the swing. The purpose of this study was to explore the relationship between peak pelvis rotation, gluteus medius and gluteus maximus strength, and a golfer's handicap. SUBJECTS: 56 healthy subjects. MATERIAL/METHODS: Each subject was assessed using a hand-held dynamometry device per standardized protocol to determine gluteus maximus and medius strength. The K-vest was placed on the subject with electromagnetic sensors at the pelvis, upper torso, and gloved lead hand to measure the rotational speed at each segment in degrees/second. After K-vest calibration and 5 practice swings, each subject hit 5 golf balls during which time, the sensors measured pelvic rotation speed. RESULTS: A one-way ANOVA was performed to determine the relationships between peak pelvis rotation, gluteus medius and gluteus maximus strength, and golf handicap. A significant difference was found between the following dependent variables and golf handicap: peak pelvis rotation (p=0.000), gluteus medius strength (p=0.000), and gluteus maximus strength (p=0.000). CONCLUSION: Golfers with a low handicap are more likely to have increased pelvis rotation speed as well as increased gluteus maximus and medius strength when compared to high handicap golfers. CLINICAL RELEVANCE: The relationships between increased peak pelvis rotation and gluteus maximus and medius strength in low handicap golfers may have implications in designing golf training programs. Further research needs to be conducted in order to further explore these relationships.