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Rheumatology Advance Access published online on November 15, 2007
Rheumatology, doi:10.1093/rheumatology/kem290
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© The Author 2007. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Inter-examiner reproducibility of tests and criteria for generalized joint hypermobility and benign joint hypermobility syndrome

B. Juul-Kristensen1, H. Røgind2, D. V. Jensen3 and L. Remvig1

1Department of Medical Orthopaedics and Rehabilitation, Rigshospitalet, University Hospital, Copenhagen, 2Department of Rheumatology, Frederiksberg Hospital, 3Department of Rheumatology, Hospital of Nordsjælland, Hørsholm, Denmark

Correspondence to: B. Juul-Kristensen, Department of Medical Orthopaedics and Rehabilitation, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, Dk-2100 Copenhagen Ø, Denmark. E-mail: birgit.juul.kristensen{at}rh.regionh.dk; bjkprivat{at}mail.dk


  Abstract

Objective. To test the reproducibility of tests and criteria for generalized joint hypermobility (GJH) and benign joint hypermobility syndrome (BJHS).

Methods. A standardized protocol for clinical reproducibility studies was followed using a three-phase study (with a training, an overall agreement and a test phase). An overall agreement of at least 0.80 was required to proceed to the test phase. Phases 1, 2 and 3 used 14 patients (with varying degrees of hypermobility), 20 patients (50% cases) and 40 patients (50% cases), respectively. The inclusion criterion for cases was hypermobility (patients with Ehlers-Danlos Syndrome or BJHS) and for controls, non-hypermobility (patients with shoulder and/or back pain); patients were selected from patients’ files (phases 1 and 2) or included consecutively from our outpatient clinic (phase 3).

Results. The overall agreement in phase 2 was 0.95 for GJH and 0.90 for BJHS. Reproducibility for diagnosing GJH and BJHS in phase 3 showed kappa values of 0.74 and 0.84, respectively. Kappa in the Beighton tests for diagnosing GJH (currently or historically) was generally above 0.80, except for the fifth fingers and elbows (≥0.60). In the Brighton tests for diagnosing BJHS, kappa was above 0.73, except for the skin signs (0.63). Lowest kappa was found in the Rotès-Quérol tests, where it was ≥0.57, except for the right shoulder (0.31).

Conclusion. We found a good-to-excellent reproducibility of tests and criteria for GJH and BJHS. Future research on the validity of the tests and criteria for joint hypermobility is urgently needed.

KEY WORDS: Hypermobility, Beighton tests, Brighton criteria, Rotès-Quérol tests, Standardized protocol

Submitted 15 April 2007; revised version accepted 19 September 2007.
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