Inter-tester reproducibility and inter-method agreement of two variations of the Beighton test for determining Generalised Joint Hypermobility in primary school children

BMC Pediatrics

Birgit Juul-Kristensen²  Niels Wedderkopp¹  Eva Jespersen³  Tina Junge⁴ 

[1] Institute of Regional Health Services, University of Southern Denmark, Odense, Denmark;Institute of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway;Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark;Department of Physiotherapy, University College Lillebaelt, Odense, Denmark

关键词: Children;    Standardised protocol;    Reproducibility;    Beighton tests;    Hypermobility;   

Others  :  1144030
DOI  :  10.1186/1471-2431-13-214

 received in 2013-04-02, accepted in 2013-12-18,  发布年份 2013

【 摘 要 】

Background

The assessment of Generalised Joint Hypermobility (GJH) is usually based on the Beighton tests, which consist of a series of nine tests. Possible methodological shortcomings can arise, as the tests do not include detailed descriptions of performance, interpretation nor classification of GJH. The purpose of this study was, among children aged 7-8 and 10-12 years, to evaluate: 1) the inter-tester reproducibility of the tests and criteria for classification of GJH for 2 variations of the Beighton test battery (Methods A and B) with a variation in starting positions and benchmarks between methods, and 2) the inter-method agreement for the two batteries.

Methods

A standardised three-phase protocol for clinical reproducibility studies was followed including a training phase, an overall agreement phase and a study phase. The number of participants in the three phases was 10, 70 and 39 respectively. For the inter-method study a total of 103 children participated. Two testers judged each test battery. A score of ≥5 was set as the cut-off level for GJH. Cohen's kappa statistics and McNemar´s test were used to test for agreement and significant differences.

Results

Kappa values for GJH (≥5) were 0.64 (Method A, prevalence 0.42) and 0.59 (Method B, prevalence 0.46), with no difference between testers in Method A (p = 0.45) and B (p = 0.29). Prevalence of GJH in the inter-method study was 31% (A) and 35% (B) with no difference between methods (p = 0.54).

Conclusions

Inter-tester reproducibility of Methods A and B was moderate to substantial, when following a standardised study protocol. Both test batteries can be used in the same children population, as there was no difference in prevalence of GJH at cut point 5, when applying method A and B. However, both methods need to be tested for their predictive validity at higher cut-off levels, e.g. ≥6 and ≥7.

【 授权许可】

   
2013 Junge et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 5.

【 参考文献 】

• [1]Surgeons, A.A.o.O: Joint motion: method of measuring and recording. Edinburgh: Churchill Livingstone; 1965.
• [2]Remvig L, Jensen DV, Ward RC: Epidemiology of general joint hypermobility and basis for the proposed criteria for benign joint hypermobility syndrome: review of the literature. J rheumatol 2007, 34(4):804-809.
• [3]Murray KJ: Hypermobility disorders in children and adolescents. Best practice & research. Clin rheumatol 2006, 20(2):329-351.
• [4]Beighton P, Solomon L, Soskolne CL: Articular mobility in an African population. Ann rheum dis 1973, 32(5):413-418.
• [5]Bulbena A, Duro JC, Porta M, Faus S, Vallescar R, Martin-Santos R: Clinical assessment of hypermobility of joints: assembling criteria. J rheumatol 1992, 19(1):115-122.
• [6]Juul-Kristensen B, Røgind H, Jensen DV, Remvig L: Inter-examiner reproducibility of tests and criteria for generalized joint hypermobility and benign joint hypermobility syndrome. Rheumatology 2007, 46(12):1835-1841.
• [7]Hansen A, Kristensen JH, Bagger J, Remvig L: Interexaminer reliability of selected tests for hypermobility. J Orthop Med 2002, 25(2):48-51.
• [8]Mikkelsson M, Salminen JJ, Kautiainen H: Joint hypermobility is not a contributing factor to musculoskeletal pain in pre-adolescents. J rheumatol 1996, 23(11):1963-1967.
• [9]Patijn J, Remvig L: Reproducibility and Validity Protocol Formats for Diagnostic Procedures in Manual/Musculoskeletal Medicine. 2007. Available from: [http://www.iammm.net/page7/page14/protocolformat.html webcite]
• [10]Grahame R: The need to take a fresh look at criteria for hypermobility. J rheumatol 2007, 34(4):664-665.
• [11]Beighton P, Horan F: Orthopaedic aspects of the Ehlers-Danlos syndrome. J bone joint surg 1969, 51(3):444-453.
• [12]Fleiss J: Reliability of measurement. In The design and analysis of clinical experiments. New York: John Wiley and Sons; 1986:1-32.
• [13]Altman D: Inter-rater agreement. London: Chapman and Hall; 1991:403-409. [Practical statistics for medical research]
• [14]Wedderkopp N: The CHAMPS-study Denmark. 2008. Available from: http://www.sdu.dk/om_sdu/institutter_centre/rich/forskning/forskningsprojekter/svendborg webcite+projektet
• [15]Wedderkopp N, Jespersen E, Franz C, Klakk H, Heidemann M, Christiansen C, Møller NC, Leboeuf Yde C: Study protocol. The Childhood Health, Activity, and Motor Performance School Study Denmark (The CHAMPS-study DK). BMC pediatr 2012, 12:128. BioMed Central Full Text
• [16]Rickham PP: Human Experimentation. Code of Ethics of the World Medical Association. Declaration of Helsinki. Br med j 1964, 2(5402):177.
• [17]Juul-Kristensen B, Kristensen JH, Frausing B, Jensen DV, Røgind H, Remvig L: Motor competence and physical activity in 8-year-old school children with generalized joint hypermobility. Pediatrics 2009, 124(5):1380-1387.
• [18]van der Giessen LJ, Liekens D, Rutgers KJ, Hartman A, Mulder PG, Oranje AP: Validation of beighton score and prevalence of connective tissue signs in 773 Dutch children. J rheumatol 2001, 28(12):2726-2730.
• [19]Landis JT, Koch GG: The Measurement of observer agreement for categorical data. Biometrics 1977, 33(1):159-174.
• [20]Smits Engelsman B, Klerks M, Kirby A: Beighton score: a valid measure for generalized hypermobility in children. J pediatr 2011, 158(1):119-123. 123 e1-4
• [21]Jensen S: Agreement of Beighton score for hypermobility in children. Denmark: Pilot study, CHAMPS-study; 2009.
• [22]Cibere J, Bellamy N, Thorne A, Esdaile JM, McGorm KJ, Chalmers A, Huang S, Peloso P, Shojania K, Singer J, Wong H, Kopec J: Reliability of the knee examination in osteoarthritis: effect of standardization. Arthritis rheum 2004, 50(2):458-468.
• [23]van Trijffel E, van de Pol RJ, Oostendorp RA, Lucas C: Inter-rater reliability for measurement of passive physiological movements in lower extremity joints is generally low: a systematic review. J physiother 2010, 56(4):223-235.
• [24]Keer R, Grahame R: Hypermobility Syndrome in children. London: Butterworth Heinemann; 2003:33-50. [Hypermobility Syndrome]
• [25]Remvig L, Jensen DV, Ward RC: Are diagnostic criteria for general joint hypermobility and benign joint hypermobility syndrome based on reproducible and valid tests? A review of the literature. J rheumatol 2007, 34(4):798-803.
• [26]Sim J, Wright CC: The kappa statistic in reliability studies: use, interpretation, and sample size requirements. Phys Ther 2005, 85(3):257-268.
• [27]Jansson A, Saartok T, Werner S, Renstrom P: General joint laxity in 1845 Swedish school children of different ages: age- and gender-specific distributions. Acta paediatr 2004, 93(9):1202-1206.
• [28]Remvig L, Kummel C, Kristensen JH, Boas G, Juul-Kristensen B: Prevalence of generalized joint hypermobility, arthralgia and motor competence in 10-year-old school children. Int Musculoskelet Med 2011, 33(4):137-145.