1 00:00:00,040 --> 00:00:03,160 Hey, I'm Hyper Mobile and if you're listening to this, I'm 2 00:00:03,200 --> 00:00:19,610 guessing you might be too. Hi, my name is Alex and I'm your 3 00:00:19,610 --> 00:00:23,090 hyper mobile host and today we are talking all about the bait 4 00:00:23,090 --> 00:00:25,290 and scale. Now for those of you who don't 5 00:00:25,290 --> 00:00:27,330 know what the bait and scale is, trust me, you're going to want 6 00:00:27,330 --> 00:00:30,090 to stick around for this one. There's a love story, there's 7 00:00:30,090 --> 00:00:34,610 travel to distant lands, there's controversy and most excitingly 8 00:00:34,650 --> 00:00:38,050 there's room for improvement. There's something here that we 9 00:00:38,050 --> 00:00:41,410 can certainly look at I think at least and make better, which is 10 00:00:41,410 --> 00:00:44,330 really, really exciting when you're dealing with hyper mobile 11 00:00:44,330 --> 00:00:47,090 connective tissue and sometimes injuries and conditions where if 12 00:00:47,290 --> 00:00:49,770 people can feel often. Quite stuck, so this is exciting 13 00:00:49,770 --> 00:00:52,850 for me in my clinical work as an osteopath based in the UK. 14 00:00:53,090 --> 00:00:56,090 Now the bait and Scale. First we got to talk about what 15 00:00:56,090 --> 00:00:57,650 it is right. Before we go any further, the 16 00:00:57,650 --> 00:01:01,290 bait and Scale is an assessment tool for looking at something 17 00:01:01,290 --> 00:01:03,730 called generalized joint hyper mobility. 18 00:01:03,810 --> 00:01:07,250 Now it's important to note that generalized joint hyper mobility 19 00:01:07,250 --> 00:01:11,530 is not a diagnosis, it's not a diagnosis like for example 20 00:01:11,530 --> 00:01:14,570 Hyperbody Spectrum Disorder or hyper mobile Ehlers Den Loss 21 00:01:14,570 --> 00:01:17,090 Syndrome. Generalized joint hyper mobility 22 00:01:17,090 --> 00:01:21,010 is simply a. And in fact approximately 10% of 23 00:01:21,010 --> 00:01:24,530 the population will demonstrate generalized joint hypermobility. 24 00:01:24,850 --> 00:01:28,010 So it's something which can truly be benign, it can be 25 00:01:28,010 --> 00:01:29,850 harmless. You you see hypermobile people, 26 00:01:29,850 --> 00:01:32,970 they do exist where they're not having issues and they're not in 27 00:01:32,970 --> 00:01:35,650 pain because they don't have a connective tissue disorder. 28 00:01:35,730 --> 00:01:40,410 However, generalized joint hypermobility is a hallmark sign 29 00:01:40,490 --> 00:01:43,170 of conditions like for example hypermobile others animals 30 00:01:43,170 --> 00:01:46,850 syndrome and hyperbility spectrum disorder and whereas 31 00:01:46,850 --> 00:01:49,770 10% of the population. Can demonstrate generalized 32 00:01:49,770 --> 00:01:53,370 joint hyper mobility only approximately one in 500 people 33 00:01:53,450 --> 00:01:57,330 will have the diagnosis of hyper mobility syndrome or hyperbility 34 00:01:57,330 --> 00:02:00,450 spectrum disorder. As always, if you're looking for 35 00:02:00,450 --> 00:02:03,050 my research or sorry the research that I'm citing, it's 36 00:02:03,050 --> 00:02:05,690 certainly not my research, but the research by the wonderful 37 00:02:05,690 --> 00:02:07,570 researchers out there that I am referring to. 38 00:02:07,770 --> 00:02:09,970 You can find it in the show notes. 39 00:02:10,250 --> 00:02:14,490 Now we have this tool which helps us look in theory at 40 00:02:14,490 --> 00:02:16,970 patients and their hyper and their hyper mobility or lack 41 00:02:16,970 --> 00:02:21,130 thereof and. And this tool has become so 42 00:02:21,130 --> 00:02:23,650 ingrained in the assessment of hyper mobile joints that it's 43 00:02:23,650 --> 00:02:28,770 actually even part of the 2017 HEDS diagnostic criteria, in 44 00:02:28,770 --> 00:02:31,210 fact, in that tripartite criteria. 45 00:02:31,210 --> 00:02:34,490 So there's three parts to it. The bait and scale really makes 46 00:02:34,490 --> 00:02:37,290 up the majority of about 1/3 of it. 47 00:02:37,490 --> 00:02:40,970 The part A, there's part A/B and C and the bait and scale really 48 00:02:40,970 --> 00:02:43,610 makes up almost 1/3 of that diagnostic criteria. 49 00:02:43,930 --> 00:02:46,690 So it's something which we all have to deal with whether you 50 00:02:46,690 --> 00:02:49,810 like it or not, but before we. Get into seven of the biggest 51 00:02:49,810 --> 00:02:52,090 problems with with the baton scale, which I can't wait to 52 00:02:52,090 --> 00:02:56,330 talk about and two solutions which may be on the horizon 53 00:02:56,330 --> 00:02:59,330 perhaps if if we keep making progress in this field and keep 54 00:02:59,330 --> 00:03:02,050 improving what we're doing as clinicians, we're going to start 55 00:03:02,050 --> 00:03:04,370 at the very beginning. Because I think to really 56 00:03:04,370 --> 00:03:06,890 understand something you do need to go back to the beginning and 57 00:03:06,890 --> 00:03:11,850 we're going back to 1964. So in 1964 we had something 58 00:03:11,850 --> 00:03:15,530 called the Carter and Wilkinson scale and this was a scale that 59 00:03:15,530 --> 00:03:18,250 was made to assess congenital hip issue. 60 00:03:18,330 --> 00:03:20,330 Using children. So we were actually looking at 61 00:03:20,370 --> 00:03:25,010 the range of motion in joints and infants and this scale was a 62 00:03:25,010 --> 00:03:27,050 paired scale. So in order to get the point on 63 00:03:27,050 --> 00:03:31,090 this scale you had to have both hips for example demonstrated to 64 00:03:31,090 --> 00:03:32,970 be hyper mobile or whatever it was. 65 00:03:33,210 --> 00:03:36,890 I'm not an expert in that scale, OK, but the joints were paired. 66 00:03:36,890 --> 00:03:39,130 You couldn't just have the right side be hyper mobile, you had to 67 00:03:39,130 --> 00:03:41,890 have the left side too. Now at that time there was a 68 00:03:41,890 --> 00:03:45,010 gentleman named Peter Baton and he was actually working. 69 00:03:45,010 --> 00:03:46,770 I believe it was St. Thomas's hospital around that 70 00:03:46,770 --> 00:03:48,250 time and he would later go on to. 71 00:03:48,330 --> 00:03:51,810 Become a geneticist and contribute a huge amount of 72 00:03:51,810 --> 00:03:55,330 research to this hyper mobility field. 73 00:03:55,650 --> 00:03:58,250 He published over 430 medical articles. 74 00:03:58,250 --> 00:04:01,930 Now not to be undone, he had a he had a wife. 75 00:04:02,330 --> 00:04:03,970 They have actually both passed away. 76 00:04:03,970 --> 00:04:06,810 He passed away I believe it was a few weeks ago actually, and 77 00:04:06,810 --> 00:04:08,410 she passed away quite a few years ago now. 78 00:04:08,570 --> 00:04:12,530 But he had a wife named who went on to become named Greta Baton 79 00:04:12,610 --> 00:04:17,050 and she was working as a social worker and a midwife and a nurse 80 00:04:17,290 --> 00:04:20,209 and somehow their paths. Crossed and through their shared 81 00:04:20,209 --> 00:04:23,650 love of the assessment of joint hyper mobility, they went on to 82 00:04:23,650 --> 00:04:26,890 do a lot of amazing things together in this field and the 83 00:04:26,890 --> 00:04:29,850 Baden scale was actually developed as part of their 84 00:04:29,850 --> 00:04:33,690 research looking at semi nomadic tribes people in the Kalahari 85 00:04:33,690 --> 00:04:36,410 Desert. So Greta and Peter needed a 86 00:04:36,410 --> 00:04:39,410 scale that would allow them to assess hyper mobility in this 87 00:04:39,410 --> 00:04:42,690 population of people who probably didn't speak very good, 88 00:04:42,810 --> 00:04:47,010 if any English who didn't really know them they were researchers 89 00:04:47,010 --> 00:04:49,530 going into. Man, that was quite far away. 90 00:04:49,890 --> 00:04:53,330 Trying to collect data on the hyper mobility in that 91 00:04:53,330 --> 00:04:55,210 population. And again I use the word 92 00:04:55,210 --> 00:04:59,290 population because unlike in a clinical setting which is 1 to 93 00:04:59,290 --> 00:05:02,010 one, you have the healthcare provider and the patient. 94 00:05:02,170 --> 00:05:05,690 These were researchers looking at what they probably really 95 00:05:05,690 --> 00:05:08,530 wanted to be a very large sample size because better data will 96 00:05:08,530 --> 00:05:10,730 usually come from a larger sample size. 97 00:05:10,970 --> 00:05:14,930 So they needed a tool and it was actually Greta who came up with 98 00:05:14,970 --> 00:05:18,130 the idea of modifying and building upon the Carter and 99 00:05:18,130 --> 00:05:19,930 Will. Kinson scale and her major 100 00:05:19,930 --> 00:05:22,570 contribution was unpairing the joints. 101 00:05:22,570 --> 00:05:25,530 So instead of for example having to have the right thumb and the 102 00:05:25,530 --> 00:05:28,410 left thumb be hyper mobile, she said, you know what, we're all a 103 00:05:28,410 --> 00:05:30,810 little bit different side to side and I think people should 104 00:05:30,810 --> 00:05:33,290 get the point even if they're only hyper mobile on the right 105 00:05:33,290 --> 00:05:37,010 hand side for example. So that was the the big step in 106 00:05:37,010 --> 00:05:39,930 terms of progress there. She also changed the card on 107 00:05:39,930 --> 00:05:42,410 Wilkinson scale so you didn't have to have every single finger 108 00:05:42,410 --> 00:05:44,410 be hyper mobile. It just became the pinky that we 109 00:05:44,410 --> 00:05:46,650 were looking at, the pinky and the thumb and so on and there 110 00:05:46,650 --> 00:05:48,250 are a few modifications there, but that's. 111 00:05:48,330 --> 00:05:51,810 How we got to the bait and scale, which we know and some 112 00:05:51,810 --> 00:05:54,530 people love, some people hate, but regardless that's how where 113 00:05:54,530 --> 00:05:59,130 we got to where we are today. Now the bait and scale is is 114 00:05:59,130 --> 00:06:01,810 problematic in nature. If you've seen any of my 115 00:06:01,810 --> 00:06:04,810 contacts online, you know I have some issues with it because so 116 00:06:04,810 --> 00:06:08,170 often I see patients who end up coming to me in my clinical work 117 00:06:08,170 --> 00:06:10,490 as an osteopath who specializes in working with hyper mobile 118 00:06:10,490 --> 00:06:12,810 patients in the UK. And they're telling me, I was 119 00:06:12,810 --> 00:06:15,930 told I failed the bait and scale and that was my whole assessment 120 00:06:15,930 --> 00:06:18,250 and I don't know what to do and firstly the bait and scale. 121 00:06:18,330 --> 00:06:21,530 Should not be used as a comprehensive assessment when 122 00:06:21,530 --> 00:06:23,530 you're looking at someone trying to figure out if they're hyper 123 00:06:23,530 --> 00:06:25,730 mobile or not. As much as there are some good 124 00:06:25,730 --> 00:06:28,330 things about the bait and scale and I'll talk about those for a 125 00:06:28,330 --> 00:06:31,010 minute. There are many, many issues with 126 00:06:31,010 --> 00:06:32,730 it. So in terms of good things about 127 00:06:32,730 --> 00:06:34,810 this bait and scale, it certainly was an improvement 128 00:06:34,810 --> 00:06:38,090 from the Carter and Wilkinson scale and it worked really well 129 00:06:38,090 --> 00:06:40,810 for Greta and Peter's research purposes. 130 00:06:40,850 --> 00:06:43,210 They were dealing with people where they wanted something 131 00:06:43,210 --> 00:06:45,530 quick, something that was really easy. 132 00:06:45,910 --> 00:06:49,950 Something that didn't involve them having to awkwardly touch 133 00:06:49,950 --> 00:06:52,630 people who they didn't know. Assessing someone's hip hyper 134 00:06:52,710 --> 00:06:56,990 mobility passively requires you to touch their hips, right? 135 00:06:57,030 --> 00:07:00,350 So they developed a scale which worked beautifully for their 136 00:07:00,350 --> 00:07:03,910 research purposes. And this scale, again, it was 137 00:07:03,910 --> 00:07:06,350 not made for a 1 to 1 clinical setting. 138 00:07:06,350 --> 00:07:10,430 It was developed for researchers looking at large populations. 139 00:07:10,430 --> 00:07:13,070 They just wanted to get that data so they could then go do 140 00:07:13,070 --> 00:07:15,590 their research and look into the hyper mobility of that 141 00:07:15,590 --> 00:07:19,160 population. This bait and scale was adopted 142 00:07:19,160 --> 00:07:21,920 by the medical community. Some someone must have seen, I 143 00:07:21,920 --> 00:07:24,440 don't know who, but they saw the bait and scale and it started to 144 00:07:24,440 --> 00:07:26,960 be used medically. And that was how it really 145 00:07:26,960 --> 00:07:30,760 became part of the Medical Assessment of Generalized Joint 146 00:07:30,760 --> 00:07:32,960 Hyper Mobility. It was adopted. 147 00:07:33,160 --> 00:07:36,400 However, what's really, really weird is it hasn't been changed 148 00:07:36,400 --> 00:07:38,880 since then, and because I'm I'm just so excited to start 149 00:07:38,880 --> 00:07:40,680 speaking about the problems with the bait and scale, we're just 150 00:07:40,680 --> 00:07:43,720 going to get into it now. OK, so here are these 7 151 00:07:43,840 --> 00:07:46,480 problems, seven of the biggest problems of the bait and scale. 152 00:07:46,680 --> 00:07:50,840 My original list was much longer, but it is a deeply 153 00:07:50,840 --> 00:07:54,280 flawed scale. So firstly, the bait and scale 154 00:07:54,280 --> 00:07:57,600 was initially developed to study large populations as an 155 00:07:57,680 --> 00:08:00,480 epidemiological research tool, and I've already said this 156 00:08:00,480 --> 00:08:03,520 during this podcast. But a tool that is made to look 157 00:08:03,520 --> 00:08:06,920 at a large population is not going to necessarily be really 158 00:08:06,920 --> 00:08:10,600 good at looking at a smaller population or a sample size even 159 00:08:10,600 --> 00:08:12,560 of 1 like we see in a clinical setting. 160 00:08:12,760 --> 00:08:15,520 We need different tools for different things and the bait 161 00:08:15,520 --> 00:08:17,800 and scale all. Though it worked, really, or it 162 00:08:17,800 --> 00:08:20,840 seems to work quite well on larger population sizes, it 163 00:08:20,840 --> 00:08:23,720 seems to have some issues when we're looking at the all of the 164 00:08:23,760 --> 00:08:26,880 quirks and anomalies and unique presentations that we see when 165 00:08:26,880 --> 00:08:28,720 we're looking just at one patient. 166 00:08:28,990 --> 00:08:33,590 Additionally, no rationale was provided for which joints were 167 00:08:33,909 --> 00:08:35,990 chosen from a medical perspective. 168 00:08:35,990 --> 00:08:39,150 So the joints were selected, and the joints that were selected 169 00:08:39,150 --> 00:08:42,950 were the two thumbs, the two elbows, the two pinkies, the two 170 00:08:42,950 --> 00:08:46,430 knees and touching the floor. And Greta and Peter, as far as 171 00:08:46,430 --> 00:08:50,350 I'm aware, never provided a clear justification of why they 172 00:08:50,350 --> 00:08:53,270 chose those joints. We can certainly speculate, and 173 00:08:53,270 --> 00:08:56,110 I do speculate that they chose those joints because they were 174 00:08:56,230 --> 00:08:58,790 easily accessible when dealing with a. 175 00:08:58,990 --> 00:09:01,510 Population which they, you know, they were strangers to. 176 00:09:01,510 --> 00:09:04,630 They were, they were researchers coming there to gather that data 177 00:09:05,070 --> 00:09:07,510 and they chose something that was quick and easy. 178 00:09:07,630 --> 00:09:11,070 However, in healthcare settings, it is essential that we don't 179 00:09:11,070 --> 00:09:14,150 prioritize something being quick and easy over what's actually 180 00:09:14,150 --> 00:09:16,230 best for the patient in terms of assessment. 181 00:09:16,350 --> 00:09:19,030 So the baiting scale, although I think perhaps it became so 182 00:09:19,030 --> 00:09:22,030 popular because it's so quick and it's so easy, it doesn't 183 00:09:22,030 --> 00:09:24,670 necessarily mean that it became popular because it was the best 184 00:09:24,670 --> 00:09:27,910 way of assessing hyper mobility in joints additionally. 185 00:09:28,340 --> 00:09:31,860 There are no explicit instructions on how to do the 186 00:09:31,860 --> 00:09:34,980 bait and scale. There's not even any clear 187 00:09:34,980 --> 00:09:37,860 instruction whether it's to be done actively or passively. 188 00:09:38,780 --> 00:09:41,460 The bait and scale is done differently by different people. 189 00:09:41,460 --> 00:09:43,540 I've observed different healthcare providers in 190 00:09:43,540 --> 00:09:46,140 different clinical settings and everyone will do it a little bit 191 00:09:46,140 --> 00:09:48,260 differently. And this creates problems, 192 00:09:48,260 --> 00:09:51,700 obviously. In terms of replicability, my 7 193 00:09:51,700 --> 00:09:54,580 out of nine bait and scale might not be the same as some other 194 00:09:54,580 --> 00:09:57,500 healthcare providers. 7 out of nine bait and scale and this 195 00:09:57,500 --> 00:10:00,580 introduces. An element of subjectivity into 196 00:10:00,620 --> 00:10:04,020 the medical assessment of patients and again, we need to 197 00:10:04,020 --> 00:10:07,740 remember that part of Healthcare is there are a lot of subjective 198 00:10:07,740 --> 00:10:09,900 things that affect healthcare and that affect clinical 199 00:10:09,900 --> 00:10:12,100 decision making. But whenever possible and 200 00:10:12,100 --> 00:10:15,900 reasonable, we do want to try and reduce how that influences 201 00:10:15,900 --> 00:10:18,060 patient care. The next point is that there's 202 00:10:18,060 --> 00:10:20,460 no real age or ethnicity adjustment. 203 00:10:20,460 --> 00:10:23,740 So we know that different people with different ethnic 204 00:10:23,740 --> 00:10:26,180 backgrounds or different ages are going to have different 205 00:10:26,180 --> 00:10:28,100 joint mobility. It's well. 206 00:10:28,340 --> 00:10:31,740 Documented that mobility can vary depending on the population 207 00:10:31,740 --> 00:10:35,180 that we're looking at and that for example the mobility of 208 00:10:35,180 --> 00:10:37,620 joints in children is going to be different than the mobility 209 00:10:37,620 --> 00:10:41,140 of the joints that we see in a quote UN quote normal 60 year 210 00:10:41,140 --> 00:10:43,940 old. Now recently in the 2017 HGDS 211 00:10:43,940 --> 00:10:47,140 diagnostic criteria they did actually for what I believe is 212 00:10:47,140 --> 00:10:51,980 the first time put in age guidelines for what constitutes 213 00:10:51,980 --> 00:10:55,100 a positive or what do you what do you call a successful 214 00:10:55,100 --> 00:10:58,260 maintenance score but that's the first time that's happened. 215 00:10:58,420 --> 00:11:01,540 And it's it shouldn't. It's surprising that it takes us 216 00:11:01,540 --> 00:11:04,940 so long to see very sensible things like that start to make 217 00:11:04,940 --> 00:11:08,340 their appearances. And although good science is 218 00:11:08,340 --> 00:11:12,140 slow science, it's surprising that it does take that long to 219 00:11:12,140 --> 00:11:14,780 see what I consider to be relatively straightforward and 220 00:11:14,780 --> 00:11:20,040 basic changes start to become. Official In terms of how things 221 00:11:20,040 --> 00:11:24,280 are meant to be done, continuing with problems, there is no 222 00:11:24,280 --> 00:11:28,320 explicitly agreed upon and validated Positive score for a 223 00:11:28,320 --> 00:11:31,600 score of four out of nine is typically considered to be 224 00:11:31,600 --> 00:11:33,760 indicative of generalized joint hyper mobility. 225 00:11:34,040 --> 00:11:38,920 But there nobody has come out. No research consortium or group 226 00:11:39,000 --> 00:11:41,960 of individuals, no no particular authority. 227 00:11:41,960 --> 00:11:44,040 You know, Greta and Peter didn't offer this either. 228 00:11:44,040 --> 00:11:46,720 No one said this is what this is what needs to be counted as 229 00:11:46,720 --> 00:11:48,560 positive for generalized joint. Vulnerability. 230 00:11:48,600 --> 00:11:51,360 There are some people who will count to 3, some people who will 231 00:11:51,360 --> 00:11:54,000 count to 5. Four is for the most part what 232 00:11:54,000 --> 00:11:55,960 you see in terms of clinical practice. 233 00:11:55,960 --> 00:12:01,200 But again there is no official this a score of this or greater 234 00:12:01,280 --> 00:12:03,720 is hyper mobile. It really doesn't seem to be the 235 00:12:03,720 --> 00:12:06,640 case. And again this can lead to a lot 236 00:12:06,640 --> 00:12:10,680 of confusion in patients and variability in terms of how this 237 00:12:10,680 --> 00:12:13,080 scale is scored by healthcare providers. 238 00:12:13,160 --> 00:12:17,920 It's also important to note that six out of the nine points. 239 00:12:18,000 --> 00:12:22,160 So remember, every single joint is a point, and touching the 240 00:12:22,160 --> 00:12:24,640 floor is the weird point that gives gets us to #9. 241 00:12:24,640 --> 00:12:28,720 But anyways, out of the nine points available, six of those 242 00:12:28,720 --> 00:12:31,440 points are found in the upper extremities, which is the 243 00:12:31,440 --> 00:12:34,480 technical term for your arms. Six of the points are in the 244 00:12:34,480 --> 00:12:37,560 upper extremities. I cannot tell you how often I 245 00:12:37,560 --> 00:12:41,080 see patients who have, for example, hypermobile hips. 246 00:12:41,350 --> 00:12:43,190 Which are not counted or acknowledged by the bait and 247 00:12:43,390 --> 00:12:46,310 hypermobile ankles, Which again, are not counted or acknowledged 248 00:12:46,310 --> 00:12:49,670 by the bait and scale. Hypermobile toes, again, they 249 00:12:49,670 --> 00:12:52,310 don't matter. Hypermobile jaws, hypermobile 250 00:12:52,310 --> 00:12:54,710 spines, all. None of those joints matter. 251 00:12:54,710 --> 00:12:57,870 None of those joints are taken into account in the bait and 252 00:12:57,870 --> 00:13:00,150 scale. And this is deeply problematic 253 00:13:00,150 --> 00:13:02,990 because there are some hyperbole, people who don't have 254 00:13:02,990 --> 00:13:05,790 that much upper extremity hypermobility, but who do have 255 00:13:05,790 --> 00:13:08,750 more of the hyperability in their lower extremities or their 256 00:13:08,750 --> 00:13:12,030 spine, and they are a completely neglected patient group. 257 00:13:12,030 --> 00:13:15,550 And that's these are the people who most often I end up seeing 258 00:13:15,550 --> 00:13:18,510 in clinic, who have tried to do everything right, but they're 259 00:13:18,510 --> 00:13:20,830 hitting walls. And it's simply because their 260 00:13:20,830 --> 00:13:24,830 body was not part of the thought process and the development and 261 00:13:24,830 --> 00:13:26,950 adoption of the scale by the wider medical community. 262 00:13:26,950 --> 00:13:28,750 And it's not their fault. They're just getting stuck. 263 00:13:28,950 --> 00:13:32,790 Because they're hitting a wall. And my final problem with the 264 00:13:32,790 --> 00:13:36,630 bait and scale is that there is no such thing as 1/2 point. 265 00:13:36,910 --> 00:13:39,990 It is a binary scale. It is a yes or no scale. 266 00:13:40,230 --> 00:13:44,150 So for example, I will see patients whose thumbs can almost 267 00:13:44,150 --> 00:13:46,310 touch their forearms, but because they don't touch, they 268 00:13:46,310 --> 00:13:50,310 don't get the point. There's no room for discretion. 269 00:13:50,310 --> 00:13:55,350 There's no room for for anything other than a binary yes, no 270 00:13:55,350 --> 00:13:58,750 outcome in this scale. And that does, certainly. 271 00:13:58,830 --> 00:14:01,270 Problems for patients, especially for patients who may 272 00:14:01,270 --> 00:14:03,870 have been more hypermobile in, for example, a joint like their 273 00:14:03,870 --> 00:14:06,630 thumb when they were younger but who have now aged. 274 00:14:06,630 --> 00:14:10,030 And as a part of the natural aging consequence, natural aging 275 00:14:10,030 --> 00:14:13,590 consequence, they are no longer hypermobile in that joint. 276 00:14:13,830 --> 00:14:16,750 So we have people again who are perhaps being told that they 277 00:14:16,750 --> 00:14:19,590 fail the bait and scale when actually they don't. 278 00:14:19,590 --> 00:14:22,470 And in this type of situation what we're seeing is someone 279 00:14:22,470 --> 00:14:25,110 who. Really is hyper mobile. 280 00:14:25,110 --> 00:14:28,470 Who would have had those points maybe a decade ago but who now 281 00:14:28,470 --> 00:14:31,950 as due to the natural consequences of aging has lost 282 00:14:31,950 --> 00:14:34,830 that mobility in those joints and is going to be missed if 283 00:14:34,830 --> 00:14:37,590 they are only assessed using the bait and scale. 284 00:14:37,750 --> 00:14:40,310 Now before I talk about alternatives to the bait and 285 00:14:40,310 --> 00:14:43,950 scale and what I think we can do better as a field and I say this 286 00:14:43,950 --> 00:14:45,270 is a healthcare provider myself, right? 287 00:14:45,270 --> 00:14:48,110 And I want to believe that we can do better and we must do 288 00:14:48,110 --> 00:14:50,270 better. I want to give you a tip now 289 00:14:50,270 --> 00:14:52,710 there's a brilliant research paper which I'm going to link in 290 00:14:52,710 --> 00:14:54,510 the show notes. If you're someone who's having 291 00:14:54,510 --> 00:14:56,830 issues with the bait and scale you feel like you're hyper 292 00:14:56,830 --> 00:14:59,230 mobile, you're a medical provider or healthcare provider. 293 00:14:59,230 --> 00:15:01,110 They're they're saying you're not and you're really really 294 00:15:01,110 --> 00:15:04,670 confused by all of this. You must go read that research 295 00:15:04,670 --> 00:15:07,630 paper. It's from the 2021 Rheumatology 296 00:15:07,630 --> 00:15:10,350 International Journal and it's called the Bait and Score as a 297 00:15:10,350 --> 00:15:13,510 measure of generalized joint Hyper mobility and it's by Malik 298 00:15:13,590 --> 00:15:17,030 Reinhold and Pierce and it is the best discussion of the bait 299 00:15:17,030 --> 00:15:20,750 and scale that I've seen ever possibly And what's really 300 00:15:20,750 --> 00:15:23,310 interesting is after their analysis of the bait and. 301 00:15:23,390 --> 00:15:26,310 Scale and looking at a lot of studies which have used it and 302 00:15:26,470 --> 00:15:29,590 how it works or doesn't work, They go on to say this in the 303 00:15:29,590 --> 00:15:31,870 conclusion. The evidence presented here 304 00:15:31,870 --> 00:15:34,670 brings into question the validity of the Baden scale as a 305 00:15:34,670 --> 00:15:38,150 direct and indirect indicator of generalized joint hyper mobility 306 00:15:38,510 --> 00:15:42,150 and disputes its continued use as a diagnostic tool. 307 00:15:42,460 --> 00:15:44,340 Now, if you're someone who doesn't do a lot of scientific 308 00:15:44,340 --> 00:15:47,940 writing, you might not be aware of how strongly worded that is 309 00:15:47,940 --> 00:15:50,660 for a scientific paper. So scientific writing is always 310 00:15:50,660 --> 00:15:53,860 measured, it's always precise. That's how it has to be. 311 00:15:54,140 --> 00:15:58,500 And to see 3 researchers in a major journal writing from that, 312 00:15:58,500 --> 00:16:01,220 from a from a position of such strength where they feel 313 00:16:01,220 --> 00:16:04,460 confident enough to say that means that there there are 314 00:16:04,460 --> 00:16:06,780 issues with the scale. At least that's how I interpret 315 00:16:06,780 --> 00:16:09,070 this. These researchers went on to say 316 00:16:09,110 --> 00:16:12,390 that the current use of a negative bait and scale score to 317 00:16:12,390 --> 00:16:14,830 exclude the presence of generalized joint hyper mobility 318 00:16:14,830 --> 00:16:17,950 is a practice that must be discontinued and again very, 319 00:16:17,950 --> 00:16:20,110 very strong rooting there. What they're trying to 320 00:16:20,110 --> 00:16:22,830 communicate is that a bait and score that's found to be 321 00:16:22,830 --> 00:16:25,630 positive, so typically that's going to be a great four or 322 00:16:25,630 --> 00:16:28,870 greater out of nine, that that score does accurately identify 323 00:16:28,870 --> 00:16:30,950 people who have generalized joint hyper mobility. 324 00:16:31,190 --> 00:16:34,870 However, there are some people who really should qualify as 325 00:16:34,870 --> 00:16:37,430 having generalized joint hyper mobility who are scoring. 326 00:16:37,510 --> 00:16:40,630 In less than four out of nine on the bait and scale, and those 327 00:16:40,630 --> 00:16:43,230 people are being missed. So in patients who are scoring 328 00:16:43,230 --> 00:16:47,270 less than four out of nine, the bait and scale is potentially 329 00:16:47,270 --> 00:16:49,790 creating harm. These researchers go on to say 330 00:16:49,990 --> 00:16:53,270 that ultimately this is not only diagnostically inaccurate, but 331 00:16:53,270 --> 00:16:56,750 could also deny a patient their fundamental right to a correct 332 00:16:56,750 --> 00:17:00,150 diagnosis and hence access to appropriate support. 333 00:17:00,510 --> 00:17:03,470 Instead, the bait and scale should be used as intended, IE 334 00:17:03,470 --> 00:17:06,270 as an initial screening method after which other notable 335 00:17:06,270 --> 00:17:08,270 joints, for example the shoulder, hips, ankles and 336 00:17:08,270 --> 00:17:09,869 remaining digits could be examined. 337 00:17:09,910 --> 00:17:12,069 So what these researchers are saying is look the bait and 338 00:17:12,069 --> 00:17:14,390 scale. It's not bad for a kind of quick 339 00:17:14,390 --> 00:17:17,109 and dirty initial assessment, but it by number means is 340 00:17:17,109 --> 00:17:19,030 perfect. And this is the attitude that we 341 00:17:19,030 --> 00:17:20,869 really need to adopt in this field. 342 00:17:21,030 --> 00:17:23,349 Field is OK, we can talk about a bait and scale. 343 00:17:23,349 --> 00:17:26,470 You know, we can give patients a bait and score, but is it good 344 00:17:26,470 --> 00:17:28,490 enough? And I really think it's not. 345 00:17:28,610 --> 00:17:32,570 Now, there are alternative scales, but unfortunately 346 00:17:32,650 --> 00:17:35,450 they're not used very often and there's not much information on 347 00:17:35,450 --> 00:17:37,170 them. Three that you might want to try 348 00:17:37,170 --> 00:17:41,330 and look up are the Hospital Del Mar criteria, the Rotez Carol 349 00:17:41,370 --> 00:17:43,770 criteria, and I'm sorry if I mispronounced that I've tried my 350 00:17:43,770 --> 00:17:47,570 best, and the lower limb assessment score. 351 00:17:47,730 --> 00:17:51,010 The problem with these different scoring systems and why they're 352 00:17:51,010 --> 00:17:54,250 not used as often is precisely that because they're not used as 353 00:17:54,250 --> 00:17:57,010 often, they haven't been used in published research as much. 354 00:17:57,290 --> 00:18:00,570 And we don't really know. Not enough about them to know if 355 00:18:00,570 --> 00:18:03,330 they work well or not. However, from my position as 356 00:18:03,330 --> 00:18:07,050 someone who has looked a little bit into them, they seem to be 357 00:18:07,170 --> 00:18:09,810 better in some ways. For example, the Hospital Del 358 00:18:09,810 --> 00:18:12,930 Mar criteria does look at people's hips, which I think is 359 00:18:12,930 --> 00:18:16,770 really important. It includes a more comprehensive 360 00:18:16,810 --> 00:18:18,810 assessment which which is really what we need. 361 00:18:19,140 --> 00:18:22,820 Another reason why I think that these alternative scales are not 362 00:18:22,820 --> 00:18:25,540 used very often is simply because they're time consuming 363 00:18:25,540 --> 00:18:29,300 and I hate doing this, but we always have to think of the 364 00:18:29,380 --> 00:18:32,420 business side of healthcare and whether that would be time 365 00:18:32,420 --> 00:18:35,180 constraints in a public healthcare setting or in a 366 00:18:35,180 --> 00:18:37,780 private healthcare setting. Because remember, clinicians 367 00:18:37,780 --> 00:18:39,980 want to get you in and out because it's they're trying to 368 00:18:39,980 --> 00:18:41,660 see as many patients as possible, right? 369 00:18:41,660 --> 00:18:43,660 And again, that's that's just how it works, OK. 370 00:18:43,860 --> 00:18:47,140 We always have to think of the system of the healthcare system 371 00:18:47,380 --> 00:18:49,820 in which we are existing. Patients. 372 00:18:50,100 --> 00:18:53,300 But if you have something that's really quick, do you want to do 373 00:18:53,300 --> 00:18:57,180 something that takes longer? Potentially not as a community. 374 00:18:57,180 --> 00:19:00,140 It seems like there's always so much discussion about genetics 375 00:19:00,140 --> 00:19:01,940 research and looking for gene therapies. 376 00:19:01,940 --> 00:19:04,620 And while that's all wonderful and I think it's great that 377 00:19:04,620 --> 00:19:07,180 we're looking into those types of treatment options, I really 378 00:19:07,180 --> 00:19:10,140 think that improving the bait and scale would be such a 379 00:19:10,140 --> 00:19:13,060 wonderful place to start and I think it would do so much good 380 00:19:13,060 --> 00:19:16,060 for so many people. The bait and scale has existed 381 00:19:16,060 --> 00:19:19,700 for 50 years. It was first made in 19. 73 382 00:19:19,700 --> 00:19:22,900 We're in 2023 now and I believe it's time for a change. 383 00:19:23,020 --> 00:19:26,620 My hope is that we will start to see more and more healthcare 384 00:19:26,620 --> 00:19:29,660 providers doing a holistic assessment of patients and 385 00:19:29,660 --> 00:19:32,140 looking at all their joints and looking at the ranges of motion 386 00:19:32,140 --> 00:19:36,100 and using that to inform their understanding of that patients 387 00:19:36,180 --> 00:19:38,660 generalized joint hyper mobility or lack thereof. 388 00:19:38,740 --> 00:19:41,660 But I hope that you leave today's episode knowing a bit 389 00:19:41,660 --> 00:19:44,780 more about the bait and scale, why it's something that's used 390 00:19:44,780 --> 00:19:48,660 so widely today and why it is far from perfect now if you 391 00:19:48,660 --> 00:19:50,020 found today's. Episode helpful. 392 00:19:50,020 --> 00:19:52,580 Please do be sure to check out some of my other content. 393 00:19:52,580 --> 00:19:55,860 You can find me on TikTok and Instagram and YouTube. 394 00:19:55,860 --> 00:19:59,980 And of course, if you want to delve a bit deeper into some of 395 00:19:59,980 --> 00:20:02,660 the issues that I talk about, you might want to consider 396 00:20:02,660 --> 00:20:05,100 joining the Hyperbole. The HQ Private Membership. 397 00:20:05,140 --> 00:20:07,820 The Hyperbole HQ Private Membership is a private 398 00:20:07,820 --> 00:20:10,780 membership community that I run and it's really for the 399 00:20:10,780 --> 00:20:14,060 scientifically minded, hyper mobile person who wants to share 400 00:20:14,380 --> 00:20:18,020 thoughts and strategies and ideas about what it means to 401 00:20:18,020 --> 00:20:19,540 live in a hyper mobile. Body. 402 00:20:19,620 --> 00:20:23,820 We host lives two times a week and we talk about everything 403 00:20:23,900 --> 00:20:27,780 from fashion to dental issues to you name it. 404 00:20:28,100 --> 00:20:30,940 Obviously it's not medical advice, it cannot be medical 405 00:20:30,940 --> 00:20:34,820 advice, but it can be so helpful sometimes to hear what other 406 00:20:34,820 --> 00:20:37,500 people have tried or what's worked for them or what hasn't. 407 00:20:37,540 --> 00:20:40,100 And you know some of the Physiology behind hypermobility 408 00:20:40,100 --> 00:20:44,100 and how living in a hypermobile body can make sense sometimes 409 00:20:44,100 --> 00:20:46,140 when you think about some of the science behind it. 410 00:20:46,220 --> 00:20:49,060 Anyways, if you want to join, be sure to check that out the link. 411 00:20:49,180 --> 00:20:52,020 Will be in the show notes for that too, and I look forward to 412 00:20:52,020 --> 00:20:53,940 having you join me for next episode. 413 00:20:53,940 --> 00:20:57,060 Be sure to leave a review, like, share, subscribe, and I'll see 414 00:20:57,060 --> 00:20:57,820 you next time.