title: Inter-examiner reproducibility of tests and criteria for generalized joint hypermobility and benign joint hypermobility syndrome.
abstract: OBJECTIVE
  To test the reproducibility of tests and criteria for generalized joint hypermobility (GJH) and benign joint hypermobility syndrome (BJHS).
  
  
  METHODS
  A standardized protocol for clinical reproducibility studies was followed using a three-phase study (with a training, an overall agreement and a test phase). An overall agreement of at least 0.80 was required to proceed to the test phase. Phases 1, 2 and 3 used 14 patients (with varying degrees of hypermobility), 20 patients (50% cases) and 40 patients (50% cases), respectively. The inclusion criterion for cases was hypermobility (patients with Ehlers-Danlos Syndrome or BJHS) and for controls, non-hypermobility (patients with shoulder and/or back pain); patients were selected from patients' files (phases 1 and 2) or included consecutively from our outpatient clinic (phase 3).
  
  
  RESULTS
  The overall agreement in phase 2 was 0.95 for GJH and 0.90 for BJHS. Reproducibility for diagnosing GJH and BJHS in phase 3 showed kappa values of 0.74 and 0.84, respectively. Kappa in the Beighton tests for diagnosing GJH (currently or historically) was generally above 0.80, except for the fifth fingers and elbows (> or = 0.60). In the Brighton tests for diagnosing BJHS, kappa was above 0.73, except for the skin signs (0.63). Lowest kappa was found in the Rotès-Quérol tests, where it was > or = 0.57, except for the right shoulder (0.31).
  
  
  CONCLUSIONS
  We found a good-to-excellent reproducibility of tests and criteria for GJH and BJHS. Future research on the validity of the tests and criteria for joint hypermobility is urgently needed.
authors.affiliation: Department of Medical Orthopaedics and Rehabilitation, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, Dk-2100 Copenhagen Ø, Denmark. birgit.juul.kristensen@rh.regionh.dk
authors.forename: B
authors.initials: B
authors.lastname: Juul-Kristensen
authors.forename: H
authors.initials: H
authors.lastname: Røgind
authors.forename: D V
authors.initials: DV
authors.lastname: Jensen
authors.forename: L
authors.initials: L
authors.lastname: Remvig
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D053587:Arthrometry, Articular; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000175:diagnosis; D007593:Joint Instability / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011336:Probability; D016059:Range of Motion, Articular / Q000502:physiology*; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric