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

Research output: Contribution to journalArticle

Original languageEnglish
Pages (from-to)64-69
Number of pages6
JournalMusculoskeletal Science and Practice
Early online date24 Aug 2017
DateAccepted/In press - 21 Aug 2017
DateE-pub ahead of print - 24 Aug 2017
DatePublished (current) - 1 Dec 2017


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.

    Research areas

  • Benign hypermobility syndrome, Ehlers-danlos syndrome, Hypermobility type, Test-retest reliability, Questionnaire

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    Rights statement: This is the author accepted manuscript (AAM). The final published version (version of record) is available online via Elsevier at Please refer to any applicable terms of use of the publisher.

    Accepted author manuscript, 537 KB, PDF document


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