Development and validation of self-reported line drawings of the modified Beighton score for the assessment of generalised joint hypermobility

Abstract

BackgroundThe impracticalities and comparative expense of carrying out a clinical assessment is an obstacle in many large epidemiological studies. The purpose of this study was to develop and validate a series of electronic self-reported line drawing instruments based on the modified Beighton scoring system for the assessment of self-reported generalised joint hypermobility.MethodsFive sets of line drawings were created to depict the 9-point Beighton score criteria. Each instrument consisted of an explanatory question whereby participants were asked to select the line drawing which best represented their joints. Fifty participants completed the self-report online instrument on two occasions, before attending a clinical assessment. A blinded expert clinical observer then assessed participants’ on two occasions, using a standardised goniometry measurement protocol. Validity of the instrument was assessed by participant-observer agreement and reliability by participant repeatability and observer repeatability using unweighted Cohen’s kappa (k). Validity and reliability were assessed for each item in the self-reported instrument separately, and for the sum of the total scores. An aggregate score for generalised joint hypermobility was determined based on a Beighton score of 4 or more out of 9.ResultsObserver-repeatability between the two clinical assessments demonstrated perfect agreement (k 1.00; 95% CI 1.00, 1.00). Self-reported participant-repeatability was lower but it was still excellent (k 0.91; 95% CI 0.74, 1.00). The participant-observer agreement was excellent (k 0.96; 95% CI 0.87, 1.00). Validity was excellent for the self-report instrument, with a good sensitivity of 0.87 (95% CI 0.81, 0.91) and excellent specificity of 0.99 (95% CI 0.98, 1.00).ConclusionsThe self-reported instrument provides a valid and reliable assessment of the presence of generalised joint hypermobility and may have practical use in epidemiological studies.Electronic supplementary materialThe online version of this article (10.1186/s12874-017-0464-8) contains supplementary material, which is available to authorized users.

Factors associated with pain and osteoarthritis at the hip and knee in Great Britain’s Olympians: a cross-sectional study

“…The visual classification of the index to ring finger ratio consisted of classifying each hand according to whether the index finger was visually longer than (type 1), equal to (type 2) or shorter than (type 3) the ring finger. Joint flexibility was determined by self-examination using line drawings of nine genetically determined sites from the 9-point Beighton score 13. A cut-off threshold of equal to or greater than 4 out of 9 on the modified Beighton 9-point scoring system was used to denote generalised joint hypermobility, as recommended by the British Society of Rheumatology 14.…”

Interrater and Intrarater Reliability of the Beighton Score: A Systematic Review

“… ‡ References 1 , 3 , 5 , 8 , 11 , 15 , 18 , 20 – 23 , 27 , 29 , 31 , 34 , 35 , 37 , 46 , 49 , 57 , 58 , 62 , 63 , 65 . …”

Congenital absence of lingual frenum in a non-syndromic patient: a case report

“…Diagnosing EDS early in life is a major necessity to reduce any future impact on affected patients and implementation of an appropriate therapy tailored to each case. The diagnosis of EDS is mainly a clinical one using scoring of involved organs according to Beighton Hypermobility Score (Table 1) [25, 26]. However, patients often may show no significant findings other than vascular involvement (aneurysm or spontaneous arterial dissection) which is a major criterion [27].…”

“…The threshold for joint laxity in a young adult ranges from 4 to 6. Any score above 6 indicates hypermobility, but is not necessarily true [25, 26]JointFindingPointsLeft little (fifth) fingerPassive dorsiflexion beyond 90°1Passive dorsiflexion ≤ 90°0Right little (fifth) fingerPassive dorsiflexion beyond 90°1Passive dorsiflexion ≤ 90°0Left thumbPassive dorsiflexion to the flexor aspect of the forearm1Cannot passively dorsiflex thumb to flexor aspect of the forearm0Right thumbPassive dorsiflexion to the flexor aspect of the forearm1Cannot passively dorsiflex thumb to flexor aspect of the forearm0Left elbowHyperextends beyond 10°1Extends ≤ 10°0Right elbowHyperextends beyond 10°1Extends ≤ 10°0Left kneeHyperextends beyond 10°1Extends ≤ 10°0Right kneeHyperextends beyond 10°1Extends ≤ 10°0Forward flexion of trunk with knees fully extendedPalms and hands can rest flat on the floor1Palms and hands cannot rest flat on the floor0…”