Reproducibility of Hypermobility Assessment Scales for Children When Performed Using Telehealth versus In-Person Modes

Abstract

Aims

Evaluate reproducibility of hypermobility assessments using in-person versus telehealth modes.

Methods

Hypermobility of 20 children (7–12 years) was evaluated using the Beighton Score, Upper Limb Hypermobility Assessment Tool (ULHAT), and Lower Limb Assessment Score (LLAS) via in-person and telehealth modes. Agreement between the two modes was examined using percentage of exact agreement (%EA and %EA ± 2), Limits of Agreement (LoA) and Smallest detectable change (SDC). Reliability was calculated using intra-class correlation coefficients (ICCs).

Results

Agreement between modes for total Scores was best for the Beighton (%EA = fair, %EA ± 2 = good), then the ULHAT (%EA = poor, %EA ± 2 = excellent), and LLAS (%EA = poor, %EA ± 2 = fair). Total scores for all scales showed wide LoA, large SDC (25-31%), and fair to good reliability (ICC = 0.54–0.61). Exact agreement for Generalized Joint Hypermobility classification was excellent for the Beighton (≥7/9 threshold) and fair for the ULHAT and LLAS (≥7/12 threshold). Percentage of individual test items with good/excellent agreement was highest for the Beighton (78%, 7/9 items), then the ULHAT (58%, 14/24) and LLAS (42%, 10/24).

Conclusion

Total Scores of hypermobility scales showed low exact agreement between in-person and telehealth, but fair–excellent agreement within two points. Classification using the Beighton ≥7/9 threshold was excellent. Research is recommended to increase accuracy of online assessments.

Keywords:

• Beighton Score
• children
• hypermobility
• Lower Limb Assessment Score
• Telehealth
• Upper Limb Hypermobility Assessment Tool

Acknowledgements

We would like to thank the children and their parents for generously donating their time to participate, Professor Trevor Russel for advice and assistance with utilizing the eHAB videoconferencing system and the Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Australia who supported this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Elizabeth A. Hornsby

Elizabeth A. Hornsby, BPhty, is a physiotherapist who has worked clinically with infants, children and their families for over 30 years. She is a PhD candidate at The University of Queensland.

Kylie Tucker

Kylie Tucker is a research and teaching academic at The University of Queensland, where she is head of the Laboratory for Motor Control and Pain Research. Associate Professor Tucker’s research focuses on understanding the principles that underpin muscle coordination in health and disease, during childhood, adolescence, and adulthood.

Leanne M. Johnston

Leanne M. Johnston is a research and teaching academic at The University of Queensland, where she is Chair of the Children’s Motor Control Research Collaborative (CMCRC). Associate Professor Johnston’s research focuses on improving the quality and effectiveness of assessments and treatments for children with disorders of motor control.