Compression garments in hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders: a retrospective cohort study.

backgroundHypermobility spectrum disorders (HSD) and hypermobile Ehlers–Danlos syndrome (hEDS) are associated with chronic pain, proprioceptive impairments, and poor quality of life (QoL). Compression garments (CGs) are occasionally prescribed to modulate sensory feedback and reduce symptoms. Although several small studies have explored CG use in hEDS, the scientific evidence is limited for hEDS and almost inexistant for HSD - despite similar clinical burdens.

objectiveTo assess the clinical effectiveness of custom-made CGs with regard to pain, analgesic consumption, fatigue, and QoL in adults with HSD or hEDS.

methodsWe conducted a retrospective cohort study at a single tertiary hospital. By inspecting the center’s medical records from January 2013 to March 2025, we identified 28 adults having been prescribed CGs for symptomatic HSD or hEDS. Twenty of the 28 met the inclusion criteria. Data on demographics, the diagnostic classification, clinical history, Beighton score, five-part questionnaire score, the characteristics of the CG (type, target site, and mean time worn per day), “on-off” effects, tolerance, and adherence to physiotherapy were extracted. The primary outcome was a composite of responses to treatment at follow-up (mean ± standard deviation (SD) duration: 4.4 ± 1.0 months), defined as one or more of a subjective reduction in pain, a reduction in analgesic use (excluding acetaminophen), an improvement in QoL, and a reduction in fatigue.

resultsOf the 20 patients (females: 85%; mean age 39.2 ± 13.0 years; mean body mass index (BMI) 24.4 ± 7 kg/m²), 13 (65%) had hEDS and seven (35%) had HSD. The median [interquartile range] duration of chronic pain was 84 [36–144] months. At follow-up, 16 (80%) of the patients reported a response to treatment: 16 (80%) reported a reduction in pain, seven out of 13 patients with available data (53.8%) reported a reduction in analgesic use, eight (40%) reported an improvement in QoL, and three (15%) reported a reduction in fatigue. There were no significant differences in any of the outcomes when comparing the HSD and hEDS groups. A univariate analysis showed trends towards a beneficial effect for female sex (p = 0.08), a history of sprains (p = 0.08), the presence of an “on-off” effect (p = 0.094), and impaired proprioception (p = 0.11). Compared with nonresponders, responders wore CGs for significantly longer (p = 0.0013; r² = 0.45) and had a higher BMI (17.5 ± 1.0 vs. 26.1 ± 6.1 kg/m², respectively; p = 0.005). Clinical effectiveness was not correlated with the Beighton score.

conclusionsCGs may constitute a well-tolerated, nonpharmacological intervention associated with clinically relevant reductions in pain and analgesic use in patients with HSD or hEDS. The similar degrees of effectiveness observed in HSD and hEDS suggest that the reimbursement of CGs by health system payers should be broadened.