Development and initial validation of the Bristol Impact of Hypermobility questionnaire

S. Palmer, F. Cramp, R. Lewis, G. Gould, E. M. Clark

Research output: Contribution to journalArticlepeer-review

22 Citations (Scopus)
21 Downloads (Pure)


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.

Original languageEnglish
Pages (from-to)186-192
Number of pages7
JournalPhysiotherapy (United Kingdom)
Issue number2
Early online date4 May 2016
Publication statusPublished - 1 Jun 2017
Externally publishedYes

Bibliographical note

NOTICE: this is the author’s version of a work that was accepted for publication in Physiotherapy. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Physiotherapy, 103:2 (2017) DOI: 10.1016/

© 2016, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International


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

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation


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