CoChat
Sign Up
Cited by 85Connective tissue disorders researchReliability and Agreement in MeasurementMusculoskeletal pain and rehabilitation

Interrater and Intrarater Reliability of the Beighton Score: A Systematic Review

Open access
Bockhorn, Lauren N., Vera, Angelina M., Dong, David, Delgado, Domenica A., Varner, Kevin E., Harris, Joshua D.·2021·Orthopaedic Journal of Sports Medicine
DOI 10.1177/2325967120968099PMC PMC7960900
Open this paper in CoChat — free account

Abstract

Background: The Beighton score is commonly used to assess the degree of hypermobility in patients with hypermobility spectrum disorder. Since proper diagnosis and treatment in this challenging patient population require valid, reliable, and responsive clinical assessments such as the Beighton score, studies must properly evaluate efficacy and effectiveness. Purpose: To succinctly present a systematic review to determine the inter- and intrarater reliability of the Beighton score and the methodological quality of all analyzed studies for use in clinical applications. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review of the MEDLINE, Embase, CINAHL, and SPORTDiscus databases was performed. Studies that measured inter- or intrarater reliability of the Beighton score in humans with and without hypermobility were included. Non-English, animal, cadaveric, level 5 evidence, and studies utilizing the Beighton score self-assessment version were excluded. Data were extracted to compare scoring methods, population characteristics, and measurements of inter- and intrarater reliability. Risk of bias was assessed with the COSMIN (Consensus-Based Standards for the Selection of Health Measurement Instruments) 2017 checklist. Results: Twenty-four studies were analyzed (1333 patients; mean ± SD age, 28.19 ± 17.34 years [range, 4-71 years]; 640 females, 594 males, 273 unknown sex). Of the 24 studies, 18 reported raters were health care professionals or health care professional students. For interrater reliability, 5 of 8 (62.5%) intraclass correlation coefficients and 12 of 19 (63.2%) kappa values were substantial to almost perfect. Intrarater reliability was reported as excellent in all studies utilizing intraclass correlation coefficients, and 3 of the 7 articles using kappa values reported almost perfect values. Utilizing the COSMIN criteria, we determined that 1 study met “very good” criteria, 7 met “adequate,” 15 met “doubtful,” and 1 met “inadequate” for overall risk of bias in the reliability domain. Conclusion: The Beighton score is a highly reliable clinical tool that shows substantial to excellent inter- and intrarater reliability when used by raters of variable backgrounds and experience levels. While individual components of risk of bias among studies demonstrated large discrepancy, most of the items were adequate to very good.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1177/2325967120968099

Cites

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Inter-rater and intra-rater reliability of the Beighton score is substantial to excellent.

    “Inter-rater and intra-rater reliability of the Beighton score has been found to be substantial to excellent [14] and is well-known, quick, and easy to use.”

    From Pediatric joint hypermobility: a diagnostic framework and narrative review (2023) · cites this paper as [14]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

The citation lists haven’t been fetched yet

References 64 · Cited by 85

Research works printed but not linked: 52

  1. [1]Aartun E Degerfalk A Kentsdotter L Hestbaek L. Screening of the spine in adolescents: inter- and intra-rater reliability and measurement error of commonly used clinical tests. BMC Musculoskelet Disord. 2014; 15(1): 37. 24512306 PMC3922274
  2. [2]Adib N Davies K Grahame R Woo P Murray KJ. Joint hypermobility syndrome in childhood: a not so benign multisystem disorder? Rheumatology. 2005; 44(6): 744– 750. 15728418
  3. [3]Aslan UB Çelik E Cavlak U Akdaǧ B. Evaluation of interrater and intrarater reliability of Beighton and Horan Joint Mobility Index. Fiz Rehabil. 2006; 17(3): 113– 119.
  4. [4]Atkinson G Nevill AM. Statistical methods for assessing measurement error (reliability) in variables relevant to sports medicine. Sports Med. 1998; 26(4): 217– 238. 9820922
  5. [5]Baumhauer JF Alosa DM Renström PAFH Trevino S Beynnon B. Test-retest reliability of ankle injury risk factors. Am J Sports Med. 1995; 23(5): 571– 574. 8526272
  6. [6]Beighton P Solomon L Soskolne CL. Articular mobility in an African population. Ann Rheum Dis. 1973; 32(5): 413– 418. 4751776 PMC1006136
  7. [7]Bilsel K Ceylan HH Yıldız F Erden T Toprak A Tuncay I. Acetabular dysplasia may be related to global joint hyperlaxity. Int Orthop. 2016; 40(5): 885– 889. 26419956
  8. [8]Boyle KL Witt P Riegger-Krugh C. Intrarater and interrater reliability of the Beighton and Horan Joint Mobility Index. J Athl Train. 2003; 38(4): 281– 285. 14737208 PMC314385
  9. [10]Buchanan G Torres L Czarkowski B Giangarra CE. Current concepts in the treatment of gross patellofemoral instability. Int J Sports Phys Ther. 2016; 11(6): 867. 27904790 PMC5095940
  10. [11]Bulbena A Duró JC Porta M Faus S Vallescar R Martín-Santos R. Clinical assessment of hypermobility of joints: assembling criteria. J Rheumatol. 1992; 19(1): 115. 1556672
  11. [12]Canham CD Domb BG Giordano BD. Atraumatic hip instability. JBJS Rev. 2016; 4(5): 01874474-201605000-00001. 27490215
  12. [14]Cohen J. Weighted kappa: nominal scale agreement provision for scaled disagreement or partial credit. Psychol Bull. 1968; 70(4): 213– 220. 19673146
  13. [15]Cooper DJ Scammell BE Batt ME Palmer D. Development and validation of self-reported line drawings of the modified Beighton score for the assessment of generalised joint hypermobility. BMC Med Res Methodol. 2018; 18(1): 11. 29343224 PMC5772709
  14. [16]Decoster LC Bernier JN Lindsay RH Vailas JC. Generalized joint hypermobility and its relationship to injury patterns among NCAA lacrosse players. J Athl Train. 1999; 34(2): 99. 16558566 PMC1322897
  15. [17]Denteneer L Stassijns G De Hertogh W Truijen S Van Daele U. Inter- and intrarater reliability of clinical tests associated with functional lumbar segmental instability and motor control impairment in patients with low back pain: a systematic review. Arch Phys Med Rehabil. 2017; 98(1): 151– 164. e6. 27568883
  16. [18]Erdogan FG Tufan A Guven M Goker B Gurler A. Association of hypermobility and ingrown nails. Clin Rheumatol. 2012; 31(9): 1319– 1322. 22661053
  17. [19]Ericson WB Wolman R. Orthopaedic management of the Ehlers-Danlos syndromes. Am J Med Genet Part C Semin Med Genet. 2017; 175(1): 188– 194. 28192621
  18. [20]Erkula G Kiter AE Kilic BA Er E Demirkan F Sponseller PD. The relation of joint laxity and trunk rotation. J Pediatr Orthop B. 2005; 14(1): 38– 41. 15577305
  19. [21]Evans AM Rome K Peet L. The foot posture index, ankle lunge test, Beighton scale and the lower limb assessment score in healthy children: a reliability study. J Foot Ankle Res. 2012; 5(1): 1. 22230105 PMC3283490
  20. [22]Fritz JM Piva SR Childs JD. Accuracy of the clinical examination to predict radiographic instability of the lumbar spine. Eur Spine J. 2005; 14(8): 743– 750. 16047211 PMC3489248
  21. [23]Glasoe WM Allen MK Kepros T Stonewall L Ludewig PM. Dorsal first ray mobility in women athletes with a history of stress fracture of the second or third metatarsal. J Orthop Sports Phys Ther. 2002; 32(11): 560– 565. 12449255
  22. [24]Grahame R. The need to take a fresh look at criteria for hypermobility. J Rheumatol. 2007; 34(4): 664. 17407226
  23. [25]Gulbahar S Şahin E Baydar M, et al. Hypermobility syndrome increases the risk for low bone mass. Clin Rheumatol. 2006; 25(4): 511– 514. 16311714
  24. [26]Hallgren KA. Computing inter-rater reliability for observational data: an overview and tutorial. Tutor Quant Methods Psychol. 2012; 8(1): 23– 34. 22833776 PMC3402032
  25. [27]Hansen A Damsgaard R Kristensen JH Bagger J Remvig L. Interexaminer reliability of selected tests for hypermobility. J Orthop Med. 2002; 24(2): 48– 51.
  26. [29]Hicks GE Fritz JM Delitto A Mishock J. Interrater reliability of clinical examination measures for identification of lumbar segmental instability. Arch Phys Med Rehabil. 2003; 84(12): 1858– 1864. 14669195
  27. [31]Hirsch C Hirsch M John MT Bock JJ. Reliabilität der Beighton-Skala zur Bestimmung der allgemeinen Gelenküberbeweglichkeit durch zahnärztliche Untersucher. J Orofac Orthop. 2007; 68(5): 342– 352. 17882362
  28. [37]Karim A Millet V Massie K Olson S Morganthaler A. Inter-rater reliability of a musculoskeletal screen as administered to female professional contemporary dancers. Work. 2011; 40(3): 281. 22045534
  29. [38]Kim SJ Kumar P Kim SH. Anterior cruciate ligament reconstruction in patients with generalized joint laxity. Clin Orthop Surg. 2010; 2(3): 130– 139. 20808583 PMC2915391
  30. [40]Landis JR Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977; 33(1): 159. 843571
  31. [41]Larson CM Bedi A Dietrich ME, et al. Generalized hypermobility, knee hyperextension, and outcomes after anterior cruciate ligament reconstruction: prospective, case-control study with mean 6 years follow-up. Arthroscopy. 2017; 33(10): 1852– 1858. 28599980
  32. [42]McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb). 2012; 22(3): 276– 282. 23092060 PMC3900052
  33. [43]Moher D Liberati A Tetzlaff J Altman DG; PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement. BMJ. 2009; 339(7716): B2535. 19622551 PMC2714657
  34. [45]Murray KJ. Hypermobility disorders in children and adolescents. Best Pract Res Clin Rheumatol. 2006; 20(2): 329– 351. 16546060
  35. [46]Naal FD Hatzung G Müller A Impellizzeri F Leunig M. Validation of a self-reported Beighton score to assess hypermobility in patients with femoroacetabular impingement. Int Orthop. 2014; 38(11): 2245– 2250. 24993650
  36. [47]Nijs J Van Essche E De Munck M Dequeker J. Ultrasonographic, axial, and peripheral measurements in female patients with benign hypermobility syndrome. Calcif Tissue Int. 2000; 67(1): 37– 40. 10908410
  37. [49]Pitetti K Miller RA Beets MW. Measuring joint hypermobility using the Beighton scale in children with intellectual disability. Pediatr Phys Ther. 2015; 27(2): 143– 150. 25822351
  38. [50]Rankin G Stokes M. Reliability of assessment tools in rehabilitation: an illustration of appropriate statistical analyses. Clin Rehabil. 1998; 12(3): 187– 199. 9688034
  39. [52]Remvig L Jensen DV Ward RC. Epidemiology of general joint hypermobility and basis for the proposed criteria for benign joint hypermobility syndrome: review of the literature. J Rheumatol. 2007; 34(4): 804– 809. 17407233
  40. [53]Ropars M Cretual A Thomazeau H Kaila R Bonan I. Volumetric definition of shoulder range of motion and its correlation with clinical signs of shoulder hyperlaxity: a motion capture study. J Shoulder Elbow Surg. 2015; 24(2): 310– 316. 25193487
  41. [54]Saccomanno MF Fodale M Capasso L Cazzato G Milano G. Reconstruction of the coracoclavicular and acromioclavicular ligaments with semitendinosus tendon graft: a pilot study. Joints. 2014; 2(1): 6– 14. 25606535 PMC4295659
  42. [55]Sacks HA Prabhakar P Wessel LE, et al. Generalized joint laxity in orthopaedic patients: clinical manifestations, radiographic correlates, and management. J Bone Joint Surg Am. 2019; 101(6): 558– 566. 30893238
  43. [56]Sim J Wright CC. The kappa statistic in reliability studies: use, interpretation, and sample size requirements. Phys Ther. 2005; 85(3): 257– 268. 15733050
  44. [57]Smith TO Clark A Neda S, et al. The intra- and inter-observer reliability of the physical examination methods used to assess patients with patellofemoral joint instability. Knee. 2012; 19(4): 404– 410. 21715175
  45. [58]Tarara DT Hegedus EJ Taylor JB. Real-time test-retest and interrater reliability of select physical performance measures in physically active college-aged students. Int J Sports Phys Ther. 2014; 9(7): 874. 25540703 PMC4275192
  46. [60]Uhorchak JM Scoville CR Williams GN Arciero RA St Pierre P Taylor DC. Risk factors associated with noncontact injury of the anterior cruciate ligament: a prospective four-year evaluation of 859 West Point cadets. Am J Sports Med. 2003; 31(6): 831– 842. 14623646
  47. [61]Ukwuani GC Waterman BR Nwachukwu BU, et al. Return to dance and predictors of outcome after hip arthroscopy for femoroacetabular impingement syndrome. Arthroscopy. 2019; 35(4): 1101– 1108. 30857899
  48. [62]Vaishya R Hasija R. Joint hypermobility and anterior cruciate ligament injury. J Orthop Surg (Hong Kong). 2013; 21(2): 182– 184. 24014780
  49. [63]Vallis A Wray A Smith T. Inter- and intra-rater reliabilities of the Beighton score compared to the contompasis score to assess generalised joint hypermobility. Myopain. 2015; 23(1-2): 21– 27.
  50. [64]Weber AE Bedi A Tibor LM Zaltz I Larson CM. The hyperflexible hip: managing hip pain in the dancer and gymnast. Sports Health. 2015; 7(4): 346– 358. 26137181 PMC4481673
  51. [65]van der Giessen LJ Liekens D Rutgers KJ Hartman A Mulder PG Oranje AP. Validation of Beighton score and prevalence of connective tissue signs in 773 Dutch children. J Rheumatol. 2001; 28(12): 2726. 11764224
  52. [66]Wolf JM Cameron KL Owens BD. Impact of joint laxity and hypermobility on the musculoskeletal system. J Am Acad Orthop Surg. 2011; 19(8): 463– 471. 21807914

Authors
Bockhorn, L. N., Vera, A. M., Dong, D., Delgado, D. A., Varner, K. E., & Harris, J. D.
Affiliations
Houston Methodist (US)
Corresponding author
Harris, Joshua D.
ORCID
Venue
Orthopaedic Journal of Sports Medicine
Publisher
SAGE Publications
Published
2021-01-01
Volume
9
Issue
1
Pages
2325967120968099-2325967120968099
ISSN
2325-9671 (ISSN-L)
DOI
10.1177/2325967120968099
PMC
PMC7960900
OpenAlex
W3125328075
Cited by
85
References
64
Citations by year
2026: 20 · 2025: 21 · 2024: 12 · 2023: 21 · 2022: 8 · 2021: 3
FWCI
1.62
Type
journal article
Language
en
Open access
Licence
Locations
  • Orthopaedic Journal of Sports Medicine (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Connective tissue disorders research
  • Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Reliability and Agreement in Measurement
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Keywords
Beighton score, joint hypermobility, hypermobility spectrum disorders, inter-rater reliability, intra-rater reliability, COSMIN, risk of bias

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review