Assessment of systemic joint laxity in the clinical context: Relevance and replicability of the Beighton score in chronic fatigue, 2021,Bernhoff et al

[Andy]

Abstract

BACKGROUND:
Persistent symptoms in patients with systemic joint laxity (SJL) are often equivalent with complications. Screening for SJL is an important part of the assessment of musculoskeletal phenotype. The common measuring tool, the Beighton score (BS), still has unclear evidence.

OBJECTIVE:
To assess the Beighton score in a clinical context for (1) ability to classify SJL as absent or present (criterion validity), and (2) interrater reliability (physician-physiotherapist), for a dichotomous cut-off (yes/no), as well as for interpretation in categories (no, some, clear SJL).

METHODS:
This real-world observational study included 149 consecutive patients seeking secondary care for investigation of possible myalgic encephalomyelitis/chronic fatigue syndrome. Assessment was done during a routine examination. Data were evaluated with Cohen’s kappa and Spearman’s rho.

RESULTS:
BS criterion validity showed poor agreement with the assessment of SJL: percentage agreement was 74 % and kappa 0.39 (3-cut level), 73 % and kappa 0.39/0.45 (4-/5-cut level). The best interrater reliability was moderate (rho 0.66) for interpretation in categories.

Open access, https://content.iospress.com/articles/journal-of-back-and-musculoskeletal-rehabilitation/bmr210081

 

[Jonathan Edwards]

The message seems to be that 'experts' don't agree much on what they think hyper mobility consists of.
This should be no surprise to anyone.

 

[Milo]

Excerpts from the paper:

ME/CFS is similar to conditions such as fibromyalgia and whiplash-associated disorder (WAD) [9, 10], in that it is a ‘central sensitivity syndrome’

Here we go again.

We found that a BS alone had effectively no ‘diagnostic ability’, with a minimal – weak kappa coefficient for comparison with the gold standard

Good to know. Save reference for future use.

Limitations in the present study were, firstly, the number of missing data. Only complete pairs of data were put in the analysis, and incomplete cases (no second screening) were excluded. Therefore, the analysis group cannot be trusted to reflect the circumstances for the entire population. However, the analysis group was still rather large, allowing for satisfactory power in identifying a significant outcome, and still seemed to have a balanced distribution (percentage) of soft tissue phenotype between categories. Many in the missing data group had a low score, and there were also many persons with a low score in the analysis (Fig. 2C). Moreover, a greater proportion of individuals with clear systemic joint laxity were in the analysis group from which the results were built. This may have made the analysis group relatively easier to assess, as noted above, and could, in that way, have enhanced the strength of this study’s evidence regarding criterion validity. However, the consequences of the missing data are complex and difficult to evaluate fully. Another limitation is that the results have bearing mainly for women as men were sparsely represented.

Bolding mine.