Schlager Angela, Ahlqvist Kerstin, Pingel Ronnie, Nilsson-Wikmar Lena, Olsson Christina B, Kristiansson Per
Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, Box 564, 752 37, Uppsala, Sweden.
Department of Statistics, Uppsala University, Uppsala, Sweden.
BMC Musculoskelet Disord. 2020 Aug 3;21(1):514. doi: 10.1186/s12891-020-03524-7.
The assessment of generalized joint hypermobility is difficult due to differences in classification methods and in the performance of joint mobility assessment. The primary aim was to evaluate the validity of the self-reported five-part questionnaire, 5PQ, for identifying generalized joint hypermobility using the Beighton score as reference test. The secondary aim was to describe how joint angles measured in degrees included in the Beighton score varied in different cut-off levels in the self-reported 5PQ and the Beighton score.
A cross-sectional validity study with a total of 301 women in early pregnancy, mean age of 31 years, were included in the study. The participants answered the self-reported 5PQ before the joint angles were measured. To standardize the joint mobility measurement, a structural protocol was used. The sensitivity, specificity, receiver operating characteristic curve, area under curve, positive- and negative predictive value, positive likelihood ratio and Spearman's rank correlation between the self-reported 5PQ ≥ 2 and the Beighton score ≥ 5 were used as main outcome measures in the validity analyses. Joint angles, measured in degrees, were calculated with means in relation to different cut-off levels.
There was moderate correlation between the self-reported 5PQ and the Beighton score. The highest combined sensitivity, 84.1%, as well as specificity, 61.9%, was on 5PQ cut-off level ≥ 2, with a 38% false-positive rate, a moderate area under curve, a low positive predictive value and likelihood ratio, and a high negative predictive value. The odds of a self-reported 5PQ, cut-off level ≥ 2, among women with generalized joint hypermobility, Beighton ≥5, was low indicating a low post-test probability. The mean for all joint angles measured in degrees increased with increased cut-off levels, both in the Beighton score and in the self-reported 5PQ. However, there was a significant variation for each cut-off level.
There is uncertainty in identifying generalized joint hypermobility in young women using the self-reported 5PQ with a cut-off level of ≥2 when the Beighton score ≥ 5 is used as the reference test. The strength of the self-reported 5PQ is to rule-out women without generalized joint hypermobility.
由于分类方法和关节活动度评估表现的差异，全身性关节过度活动的评估具有难度。主要目的是使用布莱顿评分作为参考测试，评估自我报告的五部分问卷（5PQ）用于识别全身性关节过度活动的有效性。次要目的是描述在自我报告的5PQ和布莱顿评分中，布莱顿评分所包含的以度数衡量的关节角度在不同截断水平上是如何变化的。
一项横断面效度研究纳入了总共301名早孕女性，平均年龄31岁。参与者在测量关节角度之前回答了自我报告的5PQ。为使关节活动度测量标准化，采用了结构化方案。在效度分析中，以自我报告的5PQ≥2和布莱顿评分≥5之间的敏感性、特异性、受试者工作特征曲线、曲线下面积、阳性和阴性预测值、阳性似然比以及斯皮尔曼等级相关性作为主要结局指标。以度数衡量的关节角度通过与不同截断水平相关的均值进行计算。
自我报告的5PQ与布莱顿评分之间存在中等相关性。在5PQ截断水平≥2时，组合敏感性最高，为84.1%，特异性为61.9%，假阳性率为38%，曲线下面积中等，阳性预测值和似然比低，阴性预测值高。在全身性关节过度活动（布莱顿评分≥5）的女性中，自我报告的5PQ截断水平≥2的概率较低，表明检验后概率较低。无论是在布莱顿评分还是在自我报告的5PQ中，所有以度数衡量的关节角度均值都随着截断水平的增加而增加。然而，每个截断水平都存在显著差异。
当以布莱顿评分≥5作为参考测试时，使用截断水平≥2的自我报告5PQ来识别年轻女性的全身性关节过度活动存在不确定性。自我报告的5PQ的优势在于排除没有全身性关节过度活动的女性。
