Self-Reported Joint Hypermobility: Evaluation of the Five-Part Questionnaire in Adults in China

 This study aimed to evaluate the effectiveness of the Chinese-translated version of the 5PQ in assessing people who are asymptomatic hypermobile, with a particular focus on its validity and reliability, compared against the Beighton Score.

The translation of the English 5PQ into Chinese was developed by professional translators, followed by a back-translation process to ensure equivalence. A total of 625 Mandarin-speaking participants residing in Chengdu, China, were recruited using convenience sampling. Eventually, 324 participants completed the Chinese version of the 5PQ twice, with an interval of 7 days, to test reliability. Another group of 615 participants completed the 5PQ once and then underwent a Beighton Score assessment during the same visit. A cut-off score of 2/5 was used for the 5PQ and 5/9 for the Beighton Score. Statistical comparisons were made between the results of the 5PQ and the Beighton Score to determine the 5PQ’s accuracy, sensitivity, and specificity.

The Chinese 5PQ showed an overall accuracy of 72.2% when compared with the Beighton Score. Sensitivity was 54.5%, while specificity was 65.8%. The area under the ROC curve was 0.722, reflecting moderate diagnostic performance. The 5PQ demonstrated substantial agreement, with a Cohen's kappa value of 0.703, and moderate reliability based on the intra-class correlation coefficient （ICC） of 0.707.

The Chinese version of the Five-Point Questionnaire （5PQ） is a valid and reliable tool for identifying generalised joint hypermobility in non-clinical Mandarin-speaking adults. While the tool's sensitivity is moderate, its reliability is substantial, making it useful for large-scale screenings where time and resources are limited.

This is the first study to investigate the validity and reliability of 5PQ in China. The Chinese 5PQ could be effectively implemented in both clinical and research settings, particularly where physical examination is impractical. A reliable tool to assess the prevalence of JH condition in Chinese population is essential due to the ethnicity impact on JH. Although refinement may be necessary to improve its sensitivity, the 5PQ offers a practical and efficient alternative for large-scale JH identification, supporting earlier diagnosis and potential interventions for hypermobility spectrum disorders in China.