Development and initial validation of the Bristol Impact of Hypermobility questionnaire.
OBJECTIVES
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.


DESIGN
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).


SETTING
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.


PARTICIPANTS
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.


INTERVENTIONS
None.


MAIN OUTCOME MEASURES
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.
['Palmer|S|S|', 'Cramp|F|F|', 'Lewis|R|R|', 'Gould|G|G|', 'Clark|E M|EM|']
D000328:Adult D000368:Aged D005260:Female D006801:Humans D007407:Interviews as Topic D007593:Joint Instability D008297:Male D008875:Middle Aged D026741:Physical Therapy Modalities D011594:Psychometrics D011788:Quality of Life D015203:Reproducibility of Results D012720:Severity of Illness Index D011795:Surveys and Questionnaires D006113:United Kingdom D055815:Young Adult
Hypermobility Questionnaires Joint Focus groups Interview Familial Joint laxity Validity of results