Can Patients Self-report Hypermobility? Study Examines Validity, Reliability of 5PQ

A study published in BMC Musculoskeletal Disorders measured the validity and reliability of the self-assessment five-part questionnaire on hypermobility (5PQ), a tool to self-report generalized joint hypermobility. The researchers concluded that the questionnaire yielded acceptable outcomes.

“The conventional way to identify generalised joint hypermobility is by a physical examination according to the Beighton Score. However, a physical examination is time-consuming in clinical practise and may be unfeasible in population-based studies. The self-assessment five-part questionnaire on hypermobility (5PQ) offers a more practicable way to identify GJH,” the study authors stated.

The researchers recruited 297 patients to participate in the study from a university campus (n = 168), a community health center (n = 112) and the marketing department at the national public TV broadcaster (n = 17). Thirty-one additional university students were also included for reliability tests. Eligible patients were aged between 18 and 65 years. Patients were excluded if they had a physical condition that would interfere with their Beighton Score assessment, which was used as a reference standard for generalized joint hypermobility, or if any data were missing from the Swedish 5PQ.

The 5PQ, compared to the updated reference test criteria, achieved a sensitivity of 91% (95% confidence interval [CI], 72% to 92%), specificity of 75% (95% CI, 69% to 80%), and area under the curve of 0.87 (95% CI, 0.79 to 0.95). When comparing the Swedish 5PQ to the reference test’s traditional recommendations, sensitivity was 72% (95% CI, 57% to 84%), specificity was 78% (95% CI, 72% to 83%), and area under the curve was 0.77 (95% CI, 0.68 to 0.85).

“All aspects of the 5PQ showed substantial to almost perfect agreement,” the researchers noted, reporting an intra-class correlation coefficient for the total-score comparison of 0.92 (95% CI, 0.85 to 0.96).

“The Swedish translation of the 5PQ demonstrated properties similar to what was reported in other linguistic versions and can be considered a valid and reliable instrument to screen for or identify GJH. Moreover, the recommended cut-off score of ≥2 for GJH on the 5PQ, was replicated in our study,” the study authors concluded. They recommended, “A revised version of the 5PQ could include illustrations to facilitate its interpretability. Furthermore, a more detailed wording on item 2 and 4 may improve the test performance.”