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Test-retest reliability and smallest detectable change of the Bristol Impact of Hypermobility (BIoH) questionnaire

Palmer, Shea; Manns, Sarah; Cramp, Fiona A; Lewis, Rachel; Clark, E. M.


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Shea Palmer
Occasional Associate Lecturer - HAS - HSW

Sarah Manns

Fiona Cramp
Professor in Long Term Conditions

Rachel Lewis

E. M. Clark


© 2017 Elsevier Ltd Objective The Bristol Impact of Hypermobility (BIoH) questionnaire is a patient-reported outcome measure developed in conjunction with adults with Joint Hypermobility Syndrome (JHS). It has demonstrated strong concurrent validity with the Short Form-36 (SF-36) physical component score but other psychometric properties have yet to be established. This study aimed to determine its test-retest reliability and smallest detectable change (SDC). Design A test-retest reliability study. Setting Participants were recruited from the Hypermobility Syndromes Association, a patient organisation in the United Kingdom. Patients Recruitment packs were sent to 1080 adults who had given permission to be contacted about research. Main outcome measures BIoH and SF-36 questionnaires were administered at baseline and repeated two weeks later. An 11-point global rating of change scale (−5 to +5) was also administered at two weeks. Test-retest analysis and calculation of the SDC was conducted on 'stable’ patients (defined as global rating of change −1 to +1). Results 462 responses were received. 233 patients reported a 'stable’ condition and were included in analysis (95% women; mean (SD) age 44.5 (13.9) years; BIoH score 223.6 (54.0)). The BIoH questionnaire demonstrated excellent test-retest reliability (ICC 0.923, 95% CI 0.900–0.940). The SDC was 42 points (equivalent to 19% of the mean baseline score). The SF-36 physical and mental component scores demonstrated poorer test-retest reliability and larger SDCs (as a proportion of the mean baseline scores). Conclusion The results provide further evidence of the potential of the BIoH questionnaire to underpin research and clinical practice for people with JHS.


Palmer, S., Manns, S., Cramp, F. A., Lewis, R., & Clark, E. M. (2017). Test-retest reliability and smallest detectable change of the Bristol Impact of Hypermobility (BIoH) questionnaire. Musculoskeletal Science and Practice, 32, 64-69.

Journal Article Type Article
Acceptance Date Aug 21, 2017
Online Publication Date Aug 24, 2017
Publication Date Dec 1, 2017
Journal Musculoskeletal Science and Practice
Print ISSN 2468-8630
Electronic ISSN 2468-7812
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 32
Pages 64-69
Keywords benign hypermobility syndrome, Ehlers-Danlos Syndrome,
hypermobility type, test-retest reliability, questionnaire
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