The Spider; A Multisystemic Symptom Impact Tool for People with Hypermobility-Related Disorders. Initial Validation in Adolescents 2025 Ewer et al

Objectives
The multisystemic comorbid symptoms/conditions of hypermobility spectrum disorders (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS) often significantly affect daily life. Many of these symptoms are under-recognized during diagnosis and treatment; therefore, a comprehensive questionnaire was developed to evaluate their presence and impact. The Spider’s 8 domains assess neuromusculoskeletal, pain, fatigue, cardiac dysautonomia, urogenital, gastrointestinal, anxiety, and depression symptoms. This study aims to evaluate the construct validity of the Spider in adolescents.

Study design
This cross-sectional study recruited international participants through 3 patient charities and a hypermobility unit. Adolescents aged 13-18 years, with and without HSD/hEDS, were included. Validated and frequently used comparator questionnaires were used to establish convergent validity. Participants answered each Spider domain and the respective comparator via 4 online surveys. Convergent validity was assessed by comparing Spider domain and comparator scores through correlational analysis. Known-group validity was assessed by comparing Spider domain scores of hypermobile and control groups using Mann-Whitney U analysis.

Results
In total, 1154 adolescents participated, 1036 with HSD/hEDS and 118 controls. Six domains (pain, fatigue, depression, cardiac dysautonomia, gastrointestinal, and neuromusculoskeletal) demonstrated strong correlations (r = −0.7 to 0.8) with the respective comparator. The urogenital and anxiety domains showed moderate correlations (r = 0.6). All correlations reached statistical significance (P < .001). Known-group validity was demonstrated in 7 domains (P < .001). The urogenital domain did not show a significant difference between the groups (P = .094).

Conclusions
The Spider domains demonstrate acceptable convergent validity. The Spider questionnaire can accurately, rapidly, and concisely measure the effect of common multisystemic comorbid symptoms/conditions associated with HSD/hEDS to help direct care in adolescents.

Open access

 

I you open a clinic for people with neuromusculoskeletal, pain, fatigue, cardiac dysautonomia, urogenital, gastrointestinal, anxiety, and depression symptoms you are likely to attract people with neuromusculoskeletal, pain, fatigue, cardiac dysautonomia, urogenital, gastrointestinal, anxiety, and depression symptoms.

I doubt Spider will go down very well as a name.