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Are Diagnostic Criteria for General Joint Hypermobility and Benign Joint Hypermobility Syndrome Based on Reproducible and Valid Tests?
A Review of the Literature
LARS REMVIG, DORTE V. JENSEN, and ROBERT C. WARD ABSTRACT. Objective. In this review we focus on current knowledge of the reliability of tests and diagnostic criteria for generalized joint hypermobility (GJH) and benign joint hypermobility syndrome (BJHS). Methods. Currently, The British Society of Rheumatology recommends the Beighton scoring system. With this approach, GJH is judged present when 4 or more of 9 tests are positive. Curiously, only one inter/intrarater reproducibility study is available and it uses a cutoff level of 6, rather than the Beighton-recommended 4 positive tests. Results. Using a 6 cut level, intra- and interobserver kappa scores were 0.75 and 0.78, respectively. Beighton scoring recommendations have been correlated with a global joint mobility index as well as with 2 other scoring systems, the Carter and Wilkinson, and the Rotès-Quérol. All illustrate high concurrent validity with one another. For the recently proposed Brighton criteria diagnosing BJHS no reproducibility studies exist. In the latter, the recommendations reflect high nosographic sensitivity and specificity while predictive values for positive test scores are poor. Conclusion. In general, the reproducibility of the various tests seems to be good, especially when performed by experienced rheumatologists. (First Release Jan 15 2007; J Rheumatol 2007;34:798–803) Key Indexing Terms:
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LAXITY From the Clinic of Orthopaedic Medicine and Rehabilitation, Rigshospitalet, Copenhagen University, Copenhagen; Department of Rheumatology, Frederiksborg County Hospital, Hoersholm, Denmark; and College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA. L. Remvig, MD, DMSc, Chief Physician in Rheumatology, Clinic of Orthopaedic Medicine and Rehabilitation, Rigshospitalet, Copenhagen University; D.V. Jensen, MD, Staff Specialist, Department of Rheumatology, Frederiksborg County Hospital; R.C. Ward, DO, Professor Emeritus, College of Osteopathic Medicine, Michigan State University. Address reprint requests to Dr. L. Remvig, Clinic of Orthopaedic Medicine and Rehabilitation, Rigshospitalet, Department 4124, University Hospital of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark. E-mail: lars.remvig@rh.hosp.dk Accepted for publication November 17, 2006.
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