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Development and initial validation of the Bristol impact of hypermobility questionnaire

Palmer, Shea; Cramp, Fiona (Alice); Lewis, Rachel; Gould, Ginny; Clark, Emma


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Shea Palmer
Occasional Associate Lecturer - CHSS - HSW

Fiona Cramp
Professor in Long Term Conditions

Rachel Lewis

Ginny Gould

Emma Clark


Aim of Investigation: Joint Hypermobility Syndrome (JHS) is a heritable disorder associated with excessive joint range of motion and pain in the absence of inflammatory joint disease. Symptomatic joint hypermobility has been reported to affect approximately 5% of women and 0.6% of men. Although it is a relatively common cause of musculoskeletal pain it is generally understood to
be under-recognised and poorly managed in clinical practice. This project had a number of related aims: 1. To identify the impact of JHS on adults with the condition; 2. To develop a questionnaire to assess its impact; 3. To establish the concurrent validity of the new questionnaire against the Short Form (36) Health Survey (SF-36).
Methods: Adults fulfilling the Brighton diagnostic criteria for JHS were invited to take part in focus groups and semi-structured telephone interviews to explore the impact of the condition. Focus groups and telephone interviews were recorded, transcribed verbatim and anonymised. Open coding of the transcripts was used to identify individual questionnaire items and coding was discussed in detail and verified by two researchers. Thematic analysis of the data did not progress beyond this first level of coding as the aim was limited to identification of individual items. The specific wording of individual questions and response options for the draft questionnaire were discussed in detail and agreed by a working group comprising patient research partners and members of the research team. The draft questionnaire and SF-36 were distributed by mail to 1,502 adult members of the Hypermobility Syndromes Association. Completed questionnaires informed a systematic and iterative process of question removal on the basis of low median reported severity (0.7). The total score of the finalised questionnaire was then correlated against responses for the SF-36.
Results: Two focus groups (n=12) and telephone interviews (n=3) were conducted during the initial qualitative phase of the project. Participants comprised 2 men and 13 women aged 18-45 years. The resultant draft questionnaire contained 94 scored items addressing issues such as pain, fatigue, physical function, anxiety, planning and management, and strength and weakness. A total of n=624 valid questionnaires were returned from members of the Hypermobility Syndromes Association (median age 39 years, 95% female). 39 questions were removed on the basis of low median reported severity and/or high correlations with other questions. The final Bristol Impact of Hypermobility (BIoH) questionnaire contains 55 scored items and gives a maximum score of 360. Correlation is strong with the SF-36 Physical Component Score (r=0.722*) but moderate with the Mental Component Score (r=0.446*) (*both p


Palmer, S., Cramp, F. (., Lewis, R., Gould, G., & Clark, E. (2014, October). Development and initial validation of the Bristol impact of hypermobility questionnaire. Poster presented at 15th World Congress on Pain, Buenos Aires, Argentina

Presentation Conference Type Poster
Conference Name 15th World Congress on Pain
Conference Location Buenos Aires, Argentina
Start Date Oct 6, 2014
End Date Oct 11, 2014
Publication Date Oct 6, 2014
Publicly Available Date Jun 6, 2019
Peer Reviewed Peer Reviewed
Keywords joint hypermobility
Public URL
Publisher URL
Additional Information Title of Conference or Conference Proceedings : 15th World Congress on Pain