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Cited by 110Connective tissue disorders researchMusculoskeletal pain and rehabilitationFibromyalgia and Chronic Fatigue Syndrome Research

Prevalence of generalized joint hypermobility, musculoskeletal injuries, and chronic musculoskeletal pain among American university students

Open access
Reuter, Peter R., Fichthorn, Kaylee R.·2019·PeerJ
DOI 10.7717/peerj.7625PMC PMC6744937
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Abstract

The objective of this study was to investigate the prevalence of generalized joint hypermobility (GJH) in a university-aged population, whether young adults (aged 18–25 years) with GJH are prone to sustain more musculoskeletal injuries, and are more likely to suffer from chronic musculoskeletal pain. The study used an interactive survey to gather data; GJH was assessed using a cut-off Beighton score of ≥5 in accordance with the 2017 International Classification of EDS criteria. The analyzed sample consisted of 482 female and 172 male participants from Florida Gulf Coast University (USA). The prevalence of GJH in a university-aged population can be estimated at 12.5%. Women did not have higher rates of GJH than men. However, female participants showed significantly higher rates of hypermobility of the spine as well as the right knee and elbow joints. The Beighton scores did not differ by ethnicity/race. Female participants had a lower rate of self-reported injuries than male participants, although this difference was not significant. There was no difference in the proportion of all participants classified within different categories (0; 1–4; 5–9) of Beighton scores and whether or not they reported having been injured. Male and female participants reported chronic pain of joints and neck or back at the same rates across the Beighton score categories. Female participants, however, reported higher pain intensity for chronic neck and back pain. This study increases knowledge about a correlation between GJH, musculoskeletal injuries, and chronic pain of joints, neck, and back in a university-aged population.

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Written from the paper’s full text.

TL;DR

This cross-sectional survey of 654 Florida Gulf Coast University undergraduates estimated generalized joint hypermobility (GJH) prevalence at 12.5% for a university-aged US population using a Beighton score ≥5. It found no significant association between Beighton score categories and self-reported musculoskeletal injuries or chronic joint/neck/back pain, though women reported higher neck/back pain intensity.

Key findings

  • Among 654 analyzed students, 14.2% had a Beighton score of 5–9 (GJH), 57.5% had 1–4, and 28.3% had 0; adjusted to the US sex ratio, estimated GJH prevalence was 12.5% for Beighton ≥5 and 18.2% for ≥4.
  • Women did not have significantly higher GJH rates than men (16.2% vs. 8.7%), but they had significantly higher hypermobility of the spine (51.5% vs. 25.1%, p < 0.0001), right knee (21.7% vs. 10.6%, p = 0.0013), and right elbow (18.8% vs. 8.1%, p = 0.0010).
  • Self-reported musculoskeletal injury was reported by 54.7% overall; female participants reported lower rates than male participants (51.2% vs. 64.5%, p = 0.0026), but this was not significant under the Bonferroni threshold. Injury proportions did not differ across Beighton score categories (p = 0.0241).
  • Chronic joint pain was reported by 14.5% and chronic neck/back pain by 20.8%; neither differed across Beighton score categories. Female participants reported higher chronic neck/back pain intensity than male participants (4.6 ± 1.7 vs. 3.7 ± 1.8, p = 0.0066).

Methods

  • Cross-sectional anonymous interactive survey of undergraduate students enrolled in Human Anatomy & Physiology with lab I at Florida Gulf Coast University, January 2016–October 2017; 1,350 surveys were handed out, 686 returned, and 654 analyzed after excluding missing age, age <18, or age ≥26. The analyzed sample included 482 female and 172 male participants (mean age 19.31 ± 1.24 years).
  • GJH was assessed using a Beighton score cut-off of ≥5 per the 2017 International Classification of EDS criteria; joint mobility was assessed in groups of two to four students using goniometers under trained supervision, and self-reported injuries were grouped using ICD-10-CM codes.
  • Analyses used two-tail Fisher’s exact tests, Pearson Chi-square tests, odds ratios, Wilcoxon rank sums, and Kruskal–Wallis tests, with a Bonferroni-corrected significance threshold of p < 0.0015.

Limitations

  • The paper states three main limitations: participant selection from one prerequisite course narrows the age range and excludes other majors; reliance on recall of past injuries introduces recall bias; and reliance on self-reported chronic pain may misclassify duration despite a provided three-month definition.
  • The paper also notes that the Beighton score omits other joints, so pauciarticular GJH may produce false positives or negatives, and historical variability in cut-off scores limits comparability.
  • Evident from the text: the sample was 73.7% female and drawn from a single university, not representative of the FGCU or US population; the cross-sectional design cannot establish causation; and voluntary participation may introduce self-selection bias.

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Integrity signals

Registry

Crossref · 10.7717/peerj.7625

Cites

82 of 82 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 67 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    There was no difference in the proportion of all participants classified within different categories (0; 1-4; 5-9) of Beighton scores and whether or not they reported having been injured.

    “There was no difference in the proportion of all participants classified within different categories (0; 1–4; 5–9) of Beighton scores and whether or not they reported having been injured.”
    • Also stated in: § Beighton score and self-reported musculoskeletal injuries · plain
      “There was no difference in the proportion of respondents classified within different categories of Beighton scores (categories: 0; 1–4; 5–9) and whether or not they reported having been injured (Pearson Chi-square test, DF = 2, Chi-square = 7.453, p = 0.0241).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Self-reported musculoskeletal injuries and chronic pain are accurate enough to estimate prevalence and associations.
  • Findingown data

    Women did not have higher rates of GJH than men.

    “Women did not have higher rates of GJH than men.”
    • Also stated in: § Beighton scores · plain
      “Women did not have significantly higher rates of GJH (16.2%) than men (8.7%) (Pearson Chi-square test, DF = 1, Chi-square = 5.786, p = 0.0162).”
    Quote in the paperNot a substantial claim
  • Findingown data

    The prevalence of generalized joint hypermobility (GJH) in a university-aged population can be estimated at 12.5%.

    “The prevalence of GJH in a university-aged population can be estimated at 12.5%.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The convenience sample of students enrolled in Human Anatomy & Physiology lab classes at Florida Gulf Coast University is representative of the university-aged population in the USA, so prevalence estimates can be generalized.
  • Findingown data

    Female participants reported higher pain intensity for chronic neck and back pain.

    “Female participants, however, reported higher pain intensity for chronic neck and back pain.”
    • Also stated in: § Beighton score and chronic musculoskeletal pain · plain
      “However, they did differ in their reported chronic neck and back pain intensity (Wilcoxon rank sums test, DF = 1, Chi-square = 7.3980, p = 0.0066) with male participants reporting lower (3.7 ± 1.8) pain intensity than female participants (4.6 ± 1.7).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Self-reported musculoskeletal injuries and chronic pain are accurate enough to estimate prevalence and associations.
  • Findingown data

    Male and female participants reported chronic pain of joints and neck or back at the same rates across the Beighton score categories.

    “Male and female participants reported chronic pain of joints and neck or back at the same rates across the Beighton score categories.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Self-reported musculoskeletal injuries and chronic pain are accurate enough to estimate prevalence and associations.
  • May combine two claims. 30
  • Classified as probably not a substantial claim. 36

  • May combine two claims.

    Findingown data

    Female participants had a lower rate of self-reported injuries than male participants, although this difference was not significant.

    “Female participants had a lower rate of self-reported injuries than male participants, although this difference was not significant.”
    • Also stated in: § Beighton score and self-reported musculoskeletal injuries · plain
      “Female participants reported lower rates of self-reported injuries (51.2%, n = 247 out of 482) than male respondents (64.5%, n = 111 out of 172; Pearson’s Chi-square test, DF = 1, Chi-square = 9.037, p = 0.0026; odds ratio: 1.73), although this difference was not significant.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Self-reported musculoskeletal injuries and chronic pain are accurate enough to estimate prevalence and associations.

  • May combine two claims.

    Findingown data

    Female participants showed significantly higher rates of hypermobility of the spine as well as the right knee and elbow joints.

    “However, female participants showed significantly higher rates of hypermobility of the spine as well as the right knee and elbow joints.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Out of 654 participants, 28.3% had a Beighton score of 0, 57.5% had LJH (1-4), and 14.2% had GJH (5-9).

    “Out of 654 participants, 28.3% had a Beighton score of 0 (no joint laxity), 57.5% had LJH (Beighton score of 1–4), and 14.2% of participants had a Beighton score of 5–9 (GJH).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The convenience sample of students enrolled in Human Anatomy & Physiology lab classes at Florida Gulf Coast University is representative of the university-aged population in the USA, so prevalence estimates can be generalized.

  • May combine two claims.

    Findingown data

    Female participants had greater rates of hypermobility of the knees, left elbow, little fingers, and thumbs than male participants, but differences were not statistically significant for those joints.

    “Though female participants had greater rates of hypermobility of the knees, left elbow, little fingers, and thumbs than rates for male participants, the differences between the genders were not statistically significant for those joints (Table 4).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Joint hypermobility assessments performed by students in groups under supervision are accurate and valid.

  • May combine two claims.

    Findingown data

    Young adults with GJH are not reporting higher rates of chronic pain in joints, neck, or back regardless of gender, nor do they suffer from more severe pain.

    “Young adults with GJH are not reporting higher rates of chronic pain in joints, the neck or the back regardless of their gender nor do they suffer from more severe pain.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    The study population composition (73.7% female, 26.3% male) does not reflect the demographics of the FGCU student body or the United States population.

    “The composition of our study population, with 73.7% female and 26.3% male participants, does not reflect the demographics of the FGCU student body (53% female students and 47% male students) or the United States population (50.8% females, 49.2% males) (Florida Gulf Coast University, 2018; United States Census Bureau, 2018).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Florida Gulf Coast University, 2018

      Not checked in the free run.

    • cites United States Census Bureau, 2018

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Study participants who reported having been injured reported a total of 611 different injuries.

    “Study participants who reported having been injured (n = 354 participants) reported a total of 611 different injuries.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Self-reported musculoskeletal injuries and chronic pain are accurate enough to estimate prevalence and associations.

  • May combine two claims.

    Findingown data

    GJH prevalence in male participants was 8.7% for ≥5 and 12.2% for ≥4.

    “GJH prevalence determined for male (8.7% for ≥5; 12.2% for ≥4)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Most injured individuals (n=206) had been injured only once, though many (n=152) had been injured two or more times.

    “Most of these individuals (n = 206 participants) had been injured only once, though many (n = 152 participants) had been injured two or more times (Fig. 2).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Self-reported musculoskeletal injuries and chronic pain are accurate enough to estimate prevalence and associations.

  • May combine two claims.

    Findingown data

    The only other injury codes with an overall prevalence of ≥4% were S43 (6.9%), S63 (5.2%), S62 (4.7%), and S86 (4%).

    “The only other injury codes with an overall prevalence of ≥4% in our study population were S43 with 6.9%, S63 with 5.2%, S62 with 4.7%, and S86 with 4%.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Self-reported musculoskeletal injuries and chronic pain are accurate enough to estimate prevalence and associations.

  • May combine two claims.

    Findingown data

    The average neck and back pain intensity did not differ across students with a Beighton score of 0, 1-4, and 5-9, and there was no effect after adjusting for gender.

    “The average neck and back pain intensity did not differ across students with a Beighton score of 0, 1–4, and 5–9 (Kruskal–Wallis rank sums test, DF = 2, Chi-square = 0.2453, p = 0.8846, and there was no effect once adjusting on gender (standard least squares test, DF = 2, F-ratio = 0.3350, p = 0.7160, gender as a random effect).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    GJH prevalence in female participants was 16.2% for ≥5 and 23.9% for ≥4.

    “female participants (16.2% for ≥5; 23.9% for ≥4)”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based).

    Findingown data

    When examining women and men separately, the proportion of respondents reporting injuries did not differ by their Beighton score category.

    “Likewise, when examining women and men separately, the proportion of respondents reporting injuries also did not differ by their Beighton score category (Females: Pearson Chi-square test, DF = 2, Chi-square = 3.445, p = 0.1787; Males: Pearson Chi-square test, DF = 2, Chi-square = 10.936, p = 0.0042; Fig. 3).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Self-reported musculoskeletal injuries and chronic pain are accurate enough to estimate prevalence and associations.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    A total of 24 survey entries did not contain enough information to assign one of the 18 ICD-10-CM codes.

    “A total of 24 survey entries did not contain enough information to assign one of the 18 ICD-10-CM codes listed in Table 2.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Study participants with a Beighton score of 1-4 had the highest prevalence for all three major injury groups overall and for both genders.

    “Study participants with a Beighton score of 1–4 had the highest prevalence for all three major injury groups overall and for both genders.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Pain in the lower back/lumbar area was reported by 79 respondents, pain in the neck by 33, and pain in the upper back/thoracic area by 15.

    “Pain in the lower back/lumbar area was reported by 79 respondents, pain in the neck by 33 respondents, and pain in the upper back/thoracic area by 15 respondents.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Self-reported musculoskeletal injuries and chronic pain are accurate enough to estimate prevalence and associations.

  • May combine two claims.

    Findingown data

    The overall prevalence of GJH in the sample was 14.2% for Beighton ≥5 and 20.8% for ≥4.

    “the overall prevalence of GJH of 14.2% for a cut-off score of ≥5 and of 20.8% for a cut-off score of ≥4 in our sample”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The scoring system currently used in most epidemiologic studies of GJH was described by Beighton, Solomon & Soskolne (1973).

    “The scoring system currently used in most epidemiologic studies of GJH was described by Beighton, Solomon & Soskolne (1973).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Beighton, Solomon & Soskolne (1973) source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    There has long been a lack of a universally acknowledged definition or terminology for joint laxity or hypermobility.

    “Although joint laxity or hypermobility is a well-known condition, there has long been a lack of a universally acknowledged definition or terminology (Remvig et al., 2014).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Remvig et al., 2014 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    While some studies show GJH is associated with more musculoskeletal injuries, other studies show a similar or reduced injury risk for athletes with GJH.

    “While it has been shown in some studies that GJH is associated with more musculoskeletal injuries, there are, however, studies that show a similar or reduced injury risk for athletes with GJH (Scheper et al., 2013; Decoster et al., 1999; Nicholas, 1970; Stewart & Burden, 2004; Krivickas & Feinberg, 1996).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Scheper et al., 2013 source

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    • cites Decoster et al., 1999

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    • cites Nicholas, 1970 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The Beighton test has moderate to high inter-tester repeatability and demonstrated validity and reliability in a number of studies.

    “The test has a moderate to high inter-tester repeatability (Junge et al., 2013) and demonstrated validity and reliability in a number of studies (Morris et al., 2017; Bulbena et al., 1992; Smits-Engelsman, Klerks & Kirby, 2011; Juul-Kristensen et al., 2007).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Junge et al., 2013 source

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    • cites Morris et al., 2017 source

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    • cites Bulbena et al., 1992

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Russek & Errico (2016) reported an overall prevalence of 26.2% for GJH in a healthy university student population using a cut-off Beighton score of ≥5 and a prevalence of 19.5% for BJHS using the Brighton criteria.

    “Russek & Errico (2016) reported an overall prevalence of 26.2% for GJH in a healthy university student population using a cut-off Beighton score of ≥5 and a prevalence of 19.5% for BJHS using the Brighton criteria.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Russek & Errico (2016) source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Compared to individuals without joint hypermobility, adult individuals with GJH are reported to have a higher rate of osteoarthritis of hip, knee, and hand joints.

    “Compared to individuals without joint hypermobility, adult individuals with GJH are reported to have a higher rate of osteoarthritis of hip, knee, and hand joints (Konopinski, Jones & Johnson, 2012).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Konopinski, Jones & Johnson, 2012

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Symptomatic as well as asymptomatic joint hypermobility is due to inherited alterations of proteins that lead to laxity of connective tissue, although there is no consensus on the underlying pathophysiology.

    “Symptomatic as well as asymptomatic joint hypermobility is due to inherited alterations of proteins that lead to a laxity of connective tissue, although there is no consensus on the underlying pathophysiology (Scheper et al., 2014; Remvig et al., 2011; Remvig, Jensen & Ward, 2007).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Scheper et al., 2014 source

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    • cites Remvig et al., 2011 source

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    • cites Remvig, Jensen & Ward, 2007

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In the past, a Beighton score of ≥4 was often used to indicate GJH in adults, although studies used cut-off scores of ≥3, ≥5 or ≥6.

    “In the past, a Beighton score of ≥4 was often used to indicate GJH in adults, although there were studies that used cut-off scores of ≥3, ≥5 or ≥6 (Morris et al., 2017; Beighton, Solomon & Soskolne, 1973; Bulbena et al., 1992; Russek, 1999).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Morris et al., 2017 source

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    • cites Beighton, Solomon & Soskolne, 1973 source

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    • cites Bulbena et al., 1992

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Studies using a cut-off Beighton score of ≥4 report prevalence rates of approximately 35% for populations of children and adolescents (3-18 years).

    “Studies that used a cut-off Beighton score of ≥4 report prevalence rates of approximately 35% for populations consisting of children and adolescents (3–18 years of age) (Smits-Engelsman, Klerks & Kirby, 2011; Arroyo, Brewer & Giannini, 1988; Juul-Kristensen et al., 2009; Qvindesland & Jonsson, 1999).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Smits-Engelsman, Klerks & Kirby, 2011 source

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    • cites Arroyo, Brewer & Giannini, 1988

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    • cites Juul-Kristensen et al., 2009 source

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  • May combine two claims.

    Premisecitation

    While some longitudinal studies seem to support an association between GJH and MSP, they have not provided evidence for GJH being a causative factor for MSP.

    “While some longitudinal studies seem to support an association between GJH and MSP, they have not provided evidence for GJH being a causative factor for MSP (El-Metwally et al., 2004; Tobias et al., 2013; Sohrbeck-Nohr et al., 2014).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites El-Metwally et al., 2004 source

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    • cites Tobias et al., 2013 source

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    • cites Sohrbeck-Nohr et al., 2014 source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The prevalence of GJH in the adult population has been reported to range from 10% to 30%.

    “The prevalence of GJH in the adult population has been reported to range from 10% to 30% (Scheper et al., 2014; Collinge & Simmonds, 2009).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Scheper et al., 2014 source

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    • cites Collinge & Simmonds, 2009

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Generalized hypermobility was reported to be higher among Africans than people of European descent and higher among Asians than Africans.

    “Generalized hypermobility was also reported to be higher among Africans than people of European descent and to be higher among Asians than Africans (Russek, 1999; Wordsworth et al., 1987; Hakim, Malfait & Paepe, 2010; Grahame, 1990).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Russek, 1999 source

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    • cites Wordsworth et al., 1987 source

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    • cites Hakim, Malfait & Paepe, 2010 source

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  • May combine two claims.

    Premisecitation

    The divergence of reported GJH prevalence results is mainly due to various methods of evaluation, different cut-off Beighton scores, different populations studied, and joint laxity being highest during early childhood and decreasing during adolescence and adult life.

    “The divergence of these results is mainly due to the various methods of evaluation (Beighton score, Brighton criteria) and different cut-off Beighton scores used (see above), the different populations studied as well as the fact that joint laxity is highest during early childhood and continues to decrease during adolescence and adult life (Middleditch, 2003).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Middleditch, 2003 source

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  • Classified as probably not a substantial claim.

    Premisecitation

    In 2017, the International Consortium on the Ehlers-Danlos syndromes proposed cut-off Beighton scores for diagnosis of GJH: ≥6 for pre-pubertal children and adolescents, ≥5 for pubertal men and women up to age 50, and ≥4 for those >50 years.

    “In 2017, the International Consortium on the Ehlers-Danlos syndromes (EDSs) proposed to use the following cut-off Beighton scores for the diagnosis of GJH: ≥6 for pre-pubertal children and adolescents, ≥5 for pubertal men and women up to the age of 50, and ≥4 for those >50 years of age (Malfait et al., 2017).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Malfait et al., 2017 source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The higher prevalence of GJH in females does not apply to all joints used as part of the Beighton score.

    “However, this does not apply to all joints used as part of the Beighton score (Cameron et al., 2010; Didia, Dapper & Boboye, 2002).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Cameron et al., 2010 source

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    • cites Didia, Dapper & Boboye, 2002

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Baeza-Velasco et al. (2011) found a prevalence of 39.5% of BJHS among French university students using the Brighton criteria.

    “Baeza-Velasco et al. (2011) found a prevalence of 39.5% of BJHS among French university students using the Brighton criteria.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Baeza-Velasco et al., 2011 source

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  • May combine two claims.

    Premisecitation

    A systematic review of GJH and MSP in children did not show an association in Caucasian populations and only a potential association in African and Asian populations.

    “Yet, a systematic review of GJH and MSP in children did not show an association in Caucasian populations and only a potential association in African and Asian populations (McCluskey et al., 2012).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites McCluskey et al., 2012 source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Heritable disorders of connective tissue are caused by mutations in genes that code for proteins of the connective tissue matrix, such as collagens, fibrillins, elastins, and proteoglycans.

    “Heritable disorders of connective tissue (HDCTs) are caused by mutations in genes that code for proteins of the connective tissue matrix, such as collagens, fibrillins, elastins, and proteoglycans (Baeza-Velasco et al., 2011; Collinge & Simmonds, 2009; Grahame, 2000a; Malfait et al., 2006).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Baeza-Velasco et al., 2011 source

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    • cites Collinge & Simmonds, 2009

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    • cites Grahame, 2000a

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    Premisecitation

    The main complaint of individuals with symptomatic GJH is chronic musculoskeletal pain that may affect daily activities, leading to decreased quality of life.

    “The main complaint of individuals with symptomatic GJH is chronic musculoskeletal pain (MSP) that may affect their daily activities, leading to a decreased quality of life (Kumar & Lenert, 2017; Morris et al., 2017; Leone et al., 2009; Hakim, Malfait & Paepe, 2010; Scheper et al., 2013; Chustecka, 2004; Grahame, 2000b; Simonsen et al., 2012; Nikolajsen et al., 2013).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Kumar & Lenert, 2017 source

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    • cites Morris et al., 2017 source

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    • cites Leone et al., 2009 source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Jessee, Owen & Sagar (1980) reported no statistically significant differences for arthritis/arthralgia and joint complaints between participants with and without hypermobile joints.

    “They also reported that there were no statistically significant differences for arthritis/arthralgia and joint complaints between participants with and without hypermobile joints.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Jessee, Owen & Sagar (1980)

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The prevalence of GJH in child and adult populations has been reported to range from 2% to almost 65%.

    “The prevalence of GJH in child and adult populations has been reported to range from 2% to almost 65% (Scheper et al., 2014; Remvig et al., 2011; Rikken-Bultman, Wellink & Van Dongen, 1997; Simmonds & Keer, 2007; Lamari, Chueire & Cordeiro, 2005; Leone et al., 2009).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Scheper et al., 2014 source

      Not checked in the free run.

    • cites Remvig et al., 2011 source

      Not checked in the free run.

    • cites Rikken-Bultman, Wellink & Van Dongen, 1997 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A study of freshman students at the United States Military Academy at West Point found a prevalence of 1.5% for GJH using a cut-off score of ≥4.

    “A study involving students of the freshman class of the United States Military Academy at West Point, NY found a prevalence of 1.5% for GJH using a cut-off score of ≥4 (Cameron et al., 2010).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Cameron et al., 2010 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Many individuals with GJH remain asymptomatic throughout their lives.

    “Many individuals with GJH remain asymptomatic throughout their lives (Kirk, Ansell & Bywaters, 1967).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Kirk, Ansell & Bywaters, 1967

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Jessee, Owen & Sagar (1980) published a study showing a prevalence of hypermobility of 4.9% among 637 blood donors.

    “Jessee, Owen & Sagar (1980) published a study in 1980 showing a prevalence of hypermobility of 4.9% among 637 blood donors.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Jessee, Owen & Sagar (1980)

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisenone given

    Since the Beighton criteria were introduced more than 45 years ago, only a few studies have been published that looked at the overall prevalence of GJH among child or adult populations in North America.

    “Since the Beighton criteria were introduced more than 45 years ago, only a few studies have been published that looked at the overall prevalence of GJH among child or adult populations in North America.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Joint assessments were performed by students in groups of two to four using goniometers under supervision by trained members of the research team.

    “They assessed each other’s joints as a group assessment (two to four students working together) using goniometers under supervision by trained members of the research team.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Joint hypermobility assessments performed by students in groups under supervision are accurate and valid.

  • May combine two claims.

    Premisecitation

    GJH is more often pauciarticular than polyarticular, and not all joints used in the Beighton criterion are equally affected.

    “Despite the condition being termed “GJH,” it is more often pauciarticular than polyarticular, and not all joints used as part of the Beighton criterion are equally affected (Russek & Errico, 2016; Al-Rawi, Al-Aszawi & Al-Chalabi, 1985; Cameron et al., 2010; Quresh, Maalik & Ahmad, 2010).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Russek & Errico, 2016 source

      Not checked in the free run.

    • cites Al-Rawi, Al-Aszawi & Al-Chalabi, 1985 source

      Not checked in the free run.

    • cites Cameron et al., 2010 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The research protocol and its amendment were approved by an ethical review board at Florida Gulf Coast University prior to data collection.

    “The research protocol and its amendment were approved by an ethical review board (Institutional Review Board; IRB) at Florida Gulf Coast University prior to data collection (FGCU; IRB 2014-64, November 17, 2014; IRB 2014-64 amendment, November 9, 2015).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Estimated prevalence of GJH in a university-aged US population is 12.5% using Beighton ≥5 and 18.2% using ≥4.

    “our study allows us to estimate a prevalence of GJH in a university-aged US population as 12.5% using a Beighton score of ≥5 and as 18.2% using a Beighton score of ≥4 (United States Census Bureau, 2018).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites United States Census Bureau, 2018

      Not checked in the free run.

    • Rests on an assumption: The sample's GJH prevalence, adjusted only for gender ratio, is representative of the university-aged US population.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The analyzed pool consisted of 654 respondents, including 482 female (73.7%) and 172 male (26.3%) participants.

    “Thus the analyzed pool of respondents consisted of 654 respondents, including 482 female (73.7% of respondent pool) and 172 male (26.3% of respondent pool) participants (Table 3).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The mean age of participants (19.31 ± 1.24 years) is close to the upper range of adolescence, so results can only be considered applicable to young adults.

    “The mean age of participants (19.31 ± 1.24 years) is close to the upper range of adolescence and our result can only be considered to be applicable to young adults.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    There is no indication that participants with different Beighton scores recalled past injuries to varying degrees.

    “However, there is no indication that participants with different Beighton scores may have recalled past injuries to varying degrees.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Of 686 students who participated, 32 were excluded because they failed to provide age, were younger than 18, or were 26 or older.

    “Of the 686 students who participated in the survey, 32 respondents were excluded from the analyzed data set because they failed to provide an age, were younger than 18 years of age or were 26 years or older.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    All researchers involved in data collection were trained in ethical data collection through the Collaborative Institutional Training Initiative.

    “All researchers involved in data collection were trained in ethical data collection through the Collaborative Institutional Training Initiative.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Participants may have responded positively to chronic pain without having suffered from pain for three months or more.

    “even though our survey contains a definition of chronic pain as pain lasting three months or more, participants may have responded positively without having suffered from pain for such an extended period of time.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    There is no indication that participants with different Beighton scores were more or less prone to misjudge the length of time they had been suffering from pain.

    “Again, however, there is no indication that participants with different Beighton scores may be more or less prone to misjudge the length of time they have been suffering from pain.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    A Bonferroni correction was applied and p < 0.0015 was used as the threshold for significance.

    “Given the number of statistical analyses performed, we have applied a Bonferroni correction and use a p < 0.0015 as the threshold for significance.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    Participant selection (undergraduate prerequisite course for health professions) narrows the age range and excludes students from other areas of study.

    “asking students in an undergraduate university course that is a prerequisite requirement for health professions majors to participate in a study narrows down the age range of participants and excludes students from other areas of study.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Limiting the number of joints assessed could increase the likelihood of false positive or false negative results.

    “With GJH most often being pauciarticular, it is conceivable that limiting the number of joints assessed could increase the likelihood of false positive or false negative results.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Beighton scoring system has been criticized for not including more joints in other parts of the body.

    “the scoring system currently in use to determine the Beighton score has been criticized for not including more joints in other parts of the body (Remvig et al., 2014).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Remvig et al., 2014 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The mean age of respondents was 19.31 ± 1.24 years (range 18-25; median 19).

    “The mean age of respondents was 19.31 ± 1.24 years (mean ± standard deviation; range: 18–25 years; median age = 19 years).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Information on musculoskeletal injuries was grouped using ICD-10-CM codes.

    “Information provided on musculoskeletal injuries was used to group the injuries using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM; Table 2) (Centers for Disease Control and Prevention, 2018).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Centers for Disease Control and Prevention, 2018

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Written consent was obtained from participants.

    “The cover page of the survey consisted of an IRB approved consent form; in other words, written consent was obtained.”
    Quote in the paperNot a substantial claim
60 of 60

  • The paper relies on this without support.

    The convenience sample of students enrolled in Human Anatomy & Physiology lab classes at Florida Gulf Coast University is representative of the university-aged population in the USA, so prevalence estimates can be generalized.

    “This study used data gathered from a convenience sample of 686 male and female students at an American university to determine the prevalence of GJH, injuries to the musculoskeletal system, and of chronic MSP in this population.”

  • The paper relies on this without support.

    Self-reported musculoskeletal injuries and chronic pain are accurate enough to estimate prevalence and associations.

    “The third group asked questions about athletic involvement, and the fourth group about the history of joint, ligament/tendon, and muscle injuries of the participants as well as past or current hernias and herniated discs in their back or spine. The last group of questions focused on the medical history of the participants, including chronic MSP, as well as their family medical history in regard to”

  • The paper relies on this without support.

    Joint hypermobility assessments performed by students in groups under supervision are accurate and valid.

    “They assessed each other’s joints as a group assessment (two to four students working together) using goniometers under supervision by trained members of the research team.”

  • The paper relies on this without support.

    The sample's GJH prevalence, adjusted only for gender ratio, is representative of the university-aged US population.

    “Based on the GJH prevalence determined for male (8.7% for ≥5; 12.2% for ≥4) and female participants (16.2% for ≥5; 23.9% for ≥4) and a female-to-male ratio of 51:49 in the US population, our study allows us to estimate a prevalence of GJH in a university-aged US population as 12.5% using a Beighton score of ≥5 and as 18.2% using a Beighton score of ≥4 (United States Census Bureau, 2018).”
4 of 4

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?

  • Studies of college students (typical ages between 18 and 24) report a GJH prevalence between 11%-12.5% and other studies between 12.5%-26%.

    “Studies of “college students” (typical ages between 18 and 24) report a GJH prevalence between 11%-12.5%[16,17] and other between 12.5%-26%.[2,18,19]”

    From Hypermobility spectrum disorders: A review (2023) · cites this paper as [17]

Self-check

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

Each contradiction between two passages listed here was confirmed by an independent check.

  • Joint-pain intensity sex counts do not match the table total

    Minor

    The results assign chronic joint-pain intensity data to 24 men and 99 women, or 123 people. Table 8 reports only 92 respondents for chronic joint-pain intensity.

  • Three injury-code percentages do not total their reported share

    Minor

    Table 6 lists S76, S93, and S83 at 24.9%, 19.3%, and 17.1%, totaling 61.3% rather than the stated 63.2%. The stated count of 371 out of 587 does support 63.2%, indicating a discrepancy in the table percentages.

    Reported 63.2 · recomputed 61.3

  • Neck/back pain-intensity category counts do not add to the table total

    Minor

    Table 8 lists 28, 70, and 20 respondents across the three Beighton categories, totaling 118 rather than the All-row count of 123.

    Reported 123 · recomputed 118

  • Odds ratios run opposite to their stated direction

    Minor

    The methods define the odds ratios as females to males, but Table 4 gives ratios below 1 even where the female hypermobility rate is higher. For the spine, 51.5% in females versus 25.1% in males cannot yield a female-to-male odds ratio of 0.317.

  • Neck/back pain-intensity sample size differs within Table 8

    Minor

    Table 8's title states n = 113 for chronic neck or back pain, but its All row states n = 123.

  • Two different female spine-hypermobility percentages

    Minor

    The results text gives 52.5% for women with a positive trunk flexion test, whereas Table 4 gives 51.5%.

6 of 6

Cites

Flagged first, then by citations

1 of the 83 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. Gumà, 2001, Una estimación de la laxitud en la consulta externa, Revista Española de Reumatología, 28, 298
  2. Rappleye, 2015, Gender ratio of nurses across 50 states, Becker’s Hospital Review

Cited by

Sorted by citations

Related

Authors
Reuter, P. R., & Fichthorn, K. R.
Affiliations
Florida Gulf Coast University (US)
Corresponding author
Reuter, Peter R.
ORCID
Reuter, Peter R.
Venue
PeerJ
Publisher
PeerJ
Published
2019-09-11
Volume
7
Pages
e7625
ISSN
2167-8359 (ISSN-L)
DOI
10.7717/peerj.7625
PMC
PMC6744937
OpenAlex
W2972464221
Semantic Scholar
b16c3695d810740fb45982f76d276c96e48c3651
Cited by
110
References
83
Citations by year
2026: 11 · 2025: 9 · 2024: 10 · 2023: 11 · 2022: 13 · 2021: 40 · 2020: 14 · 2019: 2
FWCI
10.40
Type
journal article
Language
en
Open access
Licence
Locations
  • PeerJ (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • 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
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
Keywords
generalized joint hypermobility, musculoskeletal injuries, chronic musculoskeletal pain, Beighton score, young adults, university students, sex differences, neck and back pain, Ehlers-Danlos syndrome

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.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

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.

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