Bockhorn Lauren N, Vera Angelina M, Dong David, Delgado Domenica A, Varner Kevin E, Harris Joshua D
Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA.
Orthop J Sports Med. 2021 Jan 20;9(1):2325967120968099. doi: 10.1177/2325967120968099. eCollection 2021 Jan.
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.
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.
Systematic review; Level of evidence, 3.
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.
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.
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.
贝顿评分常用于评估关节活动过度谱系障碍患者的关节活动过度程度。由于对这一具有挑战性的患者群体进行正确诊断和治疗需要有效的、可靠的和有反应性的临床评估，如贝顿评分，因此研究必须正确评估其有效性和实用性。
简要介绍一项系统评价，以确定贝顿评分的评分者间和评分者内信度，以及所有分析研究在临床应用中的方法学质量。
系统评价；证据等级，3级。
对MEDLINE、Embase、CINAHL和SPORTDiscus数据库进行系统评价。纳入测量有或无关节活动过度的人群中贝顿评分的评分者间或评分者内信度的研究。排除非英文、动物、尸体、5级证据以及使用贝顿评分自我评估版本的研究。提取数据以比较评分方法、人群特征以及评分者间和评分者内信度的测量。使用COSMIN（基于共识的健康测量工具选择标准）2017清单评估偏倚风险。
分析了24项研究（1333例患者；平均年龄±标准差为28.19±l7.34岁[范围4 - 71岁]；女性640例，男性594例，性别不明273例）。在这24项研究中，18项报告评分者为医疗保健专业人员或医疗保健专业学生。对于评分者间信度，8项研究中的5项（62.5%）组内相关系数和19项研究中的12项（63.2%）kappa值为中度至几乎完美。在所有使用组内相关系数的研究中，评分者内信度报告为优秀，在7项使用kappa值的文章中，有3项报告几乎完美的值。根据COSMIN标准，我们确定在信度领域，1项研究符合“非常好”标准，7项符合“充分”标准，15项符合“可疑”标准，1项符合“不充分”标准。
贝顿评分是一种高度可靠的临床工具，当由背景和经验水平各异的评分者使用时，其评分者间和评分者内信度为中度至优秀。虽然各研究中偏倚风险的个别组成部分差异很大，但大多数项目为充分至非常好。
