Schlager A1, Ahlqvist K1, Rasmussen-Barr E2, Krefting Bjelland E3, Pingel R1, Olsson CB2, Nilsson-Wikmar L2, Per K1
1Uppsala University, Department of Public Health and Caring Sciences, Uppsala, Sweden, 2Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Stockholm, Sweden, 3Akershus University Hospital, Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway
Background: Generalized joint hypermobility is an often overlooked and too many, unknown conditionalthough it is associated with longstanding musculoskeletal problems, joint pathology and widespread pain. A significant proportion of individuals with generalized joint hypermobility seek help in primary care. There are several assessment methods regarding measurement of generalized joint hypermobilitywhere the Beighton score is the most common used. Other assessment methods are Contompasis score and Hospital del Mar criteria.There is no international consensus regarding measurement for joint mobility assessment which is the base for diagnosis of generalized joint hypermobility. To be able to identify individuals with generalized joint hypermobility and tailor suitable interventions, a specific and reliable clinical assessment method of joint mobility is important.
Purpose: The purpose of this study was to investigate the inter- and intra-rater reliability for measurements of range of motion in joints included in three hypermobility assessment methods using a structured protocol.
Methods: The methodology was planned and developed in accordance with Guidelines for Reporting Reliability and Agreement Studies and Quality Appraisal of Reliability Studies. A standardized joint mobility measurement protocol was developed in order to perform the assessments. A goniometer was used in the test assessments. Each joint was registered to the nearest 1-degree. Healthy adults were consecutively recruited (49 for inter-and29 for intra-rater assessments). Inter- and intra-rater reliability for joint mobility measurements were assessed with a test-retest design of three instruments, the Beighton score, the Contompasis score and the Hospital del Mar criteria.
In the statistical analysis of the inter- and intra-rater reliability intra-class correlations, two-way random effects model (ICC 2.1),Cohen´s Kappa (κ),prevalence-adjusted bias-adjusted Kappa and95% confidence intervalswere calculated forsingle-joint measured in degrees and for the total scores. As a measure of the random error of a single measurement by a single rater, the standard error of measurement was calculated.
Results: Forty-nine adults participated (38 women and 11 men) in the inter-rater-reliability study, and 29 (23 women and 6 men) in the intra-rater reliability study. The inter-and intra-rater reliability for total scores were good-to-excellent and single-joint measurements in degrees were good-to-excellent in all but three joints. The difference between ratings was within 5 degrees except for one joint. Standard error of measurement ranged from 1.0 to 6.2 degrees. Inter-and intra-rater reliability for prevalence of positive hypermobility findings regarding hypermobility cut offs in single joints and for total scores showed moderate-to-almost perfect Cohen´s κ values. Prevalence-adjusted bias-adjusted kappaincreased all kappa values.
Conclusion(s): The standardized joint mobility measurement protocol entailed good to excellent reliability for total scores and for singles joints measured in degrees. The reliability was moderate in some joints indicating difficulties in the performance. Reliability- and validity studies of joint measurements others than those included in the Beighton score are needed, particularly ball-and-socket-joints need to be studied for their importance when assessing generalized joint hypermobility.
Implications: The structured protocol can improve the reliability in joint measurements giving that the assessment of joint mobility is not based by chance.
Keywords: Generalized joint hypermobility, inter-and intra- reliability, joint mobility assessment
Funding acknowledgements: Aleris Research Fund, Primary Care Research Fund in Region Uppsala and Stockholm County Council (PPG and NSV projects).
Purpose: The purpose of this study was to investigate the inter- and intra-rater reliability for measurements of range of motion in joints included in three hypermobility assessment methods using a structured protocol.
Methods: The methodology was planned and developed in accordance with Guidelines for Reporting Reliability and Agreement Studies and Quality Appraisal of Reliability Studies. A standardized joint mobility measurement protocol was developed in order to perform the assessments. A goniometer was used in the test assessments. Each joint was registered to the nearest 1-degree. Healthy adults were consecutively recruited (49 for inter-and29 for intra-rater assessments). Inter- and intra-rater reliability for joint mobility measurements were assessed with a test-retest design of three instruments, the Beighton score, the Contompasis score and the Hospital del Mar criteria.
In the statistical analysis of the inter- and intra-rater reliability intra-class correlations, two-way random effects model (ICC 2.1),Cohen´s Kappa (κ),prevalence-adjusted bias-adjusted Kappa and95% confidence intervalswere calculated forsingle-joint measured in degrees and for the total scores. As a measure of the random error of a single measurement by a single rater, the standard error of measurement was calculated.
Results: Forty-nine adults participated (38 women and 11 men) in the inter-rater-reliability study, and 29 (23 women and 6 men) in the intra-rater reliability study. The inter-and intra-rater reliability for total scores were good-to-excellent and single-joint measurements in degrees were good-to-excellent in all but three joints. The difference between ratings was within 5 degrees except for one joint. Standard error of measurement ranged from 1.0 to 6.2 degrees. Inter-and intra-rater reliability for prevalence of positive hypermobility findings regarding hypermobility cut offs in single joints and for total scores showed moderate-to-almost perfect Cohen´s κ values. Prevalence-adjusted bias-adjusted kappaincreased all kappa values.
Conclusion(s): The standardized joint mobility measurement protocol entailed good to excellent reliability for total scores and for singles joints measured in degrees. The reliability was moderate in some joints indicating difficulties in the performance. Reliability- and validity studies of joint measurements others than those included in the Beighton score are needed, particularly ball-and-socket-joints need to be studied for their importance when assessing generalized joint hypermobility.
Implications: The structured protocol can improve the reliability in joint measurements giving that the assessment of joint mobility is not based by chance.
Keywords: Generalized joint hypermobility, inter-and intra- reliability, joint mobility assessment
Funding acknowledgements: Aleris Research Fund, Primary Care Research Fund in Region Uppsala and Stockholm County Council (PPG and NSV projects).
Topic: Musculoskeletal; Primary health care
Ethics approval required: Yes
Institution: Regional Ethical Review Board in Stockholm
Ethics committee: Regional Ethical Review Board in Stockholm
Ethics number: 2014/655-31/4
All authors, affiliations and abstracts have been published as submitted.
