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

S. Palmer, S. Manns, F. Cramp, R. Lewis, E. M. Clark

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)
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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.

Original languageEnglish
Pages (from-to)64-69
Number of pages6
JournalMusculoskeletal Science and Practice
Early online date24 Aug 2017
Publication statusPublished - Dec 2017
Externally publishedYes

Bibliographical note

NOTICE: this is the author’s version of a work that was accepted for publication in Musculoskeletal Science and Practice. 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 Musculoskeletal Science and Practice, 32, (2017)
DOI: 10.1016/j.msksp.2017.08.007

© 2017, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/


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

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation


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