title: Development and initial validation of the Bristol Impact of Hypermobility questionnaire.
abstract: OBJECTIVE
  Stage 1 - to identify the impact of joint hypermobility syndrome (JHS) on adults; Stage 2 - to develop a questionnaire to assess the impact of JHS; and Stage 3 - to undertake item reduction and establish the questionnaire's concurrent validity.
  
  
  METHODS
  A mixed methods study employing qualitative focus groups and interviews (Stage 1); a working group of patients, clinicians and researchers, and 'think aloud' interviews (Stage 2); and quantitative analysis of questionnaire responses (Stage 3).
  
  
  METHODS
  Stages 1 and 2 took place in one secondary care hospital in the UK. Members of a UK-wide patient organisation were recruited in Stage 3.
  
  
  METHODS
  In total, 15, four and 615 participants took part in Stages 1, 2 and 3, respectively. Inclusion criteria were: age ≥18 years; diagnosis of JHS; no other conditions affecting physical function; able to give informed consent; and able to understand and communicate in English.
  
  
  METHODS
  None.
  
  
  METHODS
  The development of a questionnaire to assess the impact of JHS.
  
  
  RESULTS
  Stage 1 identified a wide range of impairments, activity limitations and participation restrictions In Stage 2, a draft questionnaire was developed and refined following 'think aloud' analysis, leaving 94 scored items. In Stage 3, items were removed on the basis of low severity and/or high correlation with other items. The final Bristol Impact of Hypermobility (BIoH) questionnaire had 55 scored items, and correlated well with the physical component score of the Short Form 36 health questionnaire (r=-0.725).
  
  
  CONCLUSIONS
  The BIoH questionnaire demonstrated good concurrent validity. Further psychometric properties need to be established.
authors: Department of Allied Health Professions, University of the West of England, Bristol, UK. Electronic address: Shea.Palmer@uwe.ac.uk.
authors: S
authors: S
authors: Palmer
authors: Department of Allied Health Professions, University of the West of England, Bristol, UK.
authors: F
authors: F
authors: Cramp
authors: Department of Physiotherapy, North Bristol NHS Trust, Bristol, UK.
authors: R
authors: R
authors: Lewis
authors: Musculoskeletal Research Unit, University of Bristol, Bristol, UK.
authors: G
authors: G
authors: Gould
authors: Musculoskeletal Research Unit, University of Bristol, Bristol, UK.
authors: E M
authors: EM
authors: Clark
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007593:Joint Instability / Q000151:congenital* / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities / Q000592:standards*; D011594:Psychometrics; D011788:Quality of Life; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires / Q000592:standards*; D006113:United Kingdom; D055815:Young Adult
keywords: Familial; Focus groups; Hypermobility; Interview; Joint; Joint laxity; Questionnaires; Validity of results