Development and initial validation of the Bristol Impact of Hypermobility questionnaire

S. Palmer, A F L Cramp, R. Lewis, V C Gould, Emma M Clark

Research output: Contribution to journalArticle (Academic Journal)peer-review

23 Citations (Scopus)
940 Downloads (Pure)



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.


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).


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.


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.



Main outcome measures

The development of a questionnaire to assess the impact of JHS.


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).


The BIoH questionnaire demonstrated good concurrent validity. Further psychometric properties need to be established.
Original languageEnglish
Pages (from-to)186-192
Number of pages7
Issue number2
Early online date4 May 2016
Publication statusPublished - Jun 2017


  • Hypermobility
  • Joint
  • Joint laxity
  • Familial
  • Questionnaires
  • Interview
  • Focus groups
  • Validity of results


Dive into the research topics of 'Development and initial validation of the Bristol Impact of Hypermobility questionnaire'. Together they form a unique fingerprint.

Cite this