Abstract
Joint hypermobility shows considerable variability across populations, yet validated screening tools for Mandarin-speaking cohorts are lacking. The Five-Part Questionnaire (5PQ) is widely used internationally, but its properties have not been evaluated in Chinese populations. This study assessed the validity and reliability of the Chinese version of the 5PQ (5PQ-CN) in a cohort of young Chinese university students. Participants completed the 5PQ-CN and underwent clinician-administered Beighton Score (BS) assessment, using the internationally recommended cut off of ≥ 5 to identify generalised joint hypermobility (GJH). Diagnostic validity was examined using sensitivity, specificity, predictive values, accuracy, and the area under the receiver operating characteristic curve (AUC). Test-retest reliability was evaluated using Cohen’s kappa (κ) and intraclass correlation coefficients (ICC). A total of 1,910 participants were recruited; 615 were included in the validity analysis and 325 in the reliability subgroup. The 5PQ-CN showed 78.6% sensitivity, 65.8% specificity, 72.2% accuracy, and an AUC of 0.722. Test-retest reliability demonstrated substantial agreement (κ = 0.703) and moderate consistency for the total score (ICC = 0.707). The 5PQ-CN is a valid and reliable self-report instrument for screening GJH in young Chinese adults within a university setting. Its high feasibility and sensitivity make it a useful complement to clinician-based assessments, particularly in large-scale or resource-limited epidemiological settings.
Similar content being viewed by others
Data availability
The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.
Abbreviations
- AUC:
-
Area under the curve
- HSD:
-
Hypermobility spectrum disorders
- hEDS:
-
Hypermobile Ehlers-Danlos syndrome
- BMI:
-
Body mass index
- BS:
-
Beighton score
- CI:
-
Confidence interval
- χ2:
-
Chi-square
- 5PQ:
-
Five-Part Questionnaire
- 5PQ-CN:
-
Chinese version of the Five-Part Questionnaire
- GJH:
-
Generalised joint hypermobility
- ICC:
-
Intraclass correlation coefficient
- κ:
-
Cohen’s kappa
- NPV:
-
Negative predictive value
- OR:
-
Odds ratios
- p :
-
P value
- PPV:
-
Positive predictive value
- ROC:
-
Receiver operating characteristic
- COSMIN:
-
Consensus-based Standards for the selection of health Measurement Instruments
References
Hakim, A. & Grahame, R. Joint hypermobility. Best Pract. Res. Clin. Rheumatol. 17 (6), 989–1004 (2003).
Klemp, P., Williams, S. M. & Stansfield, S. A. Articular mobility in Maori and European New Zealanders. Rheumatol. (Oxford). 41 (5), 554–557 (2002).
Birrell, F. N., Adebajo, A. O., Hazleman, B. L. & Silman, A. J. High prevalence of joint laxity in West Africans. Br. J. Rheumatol. 33 (1), 56–59 (1994).
Remvig, L., Jensen, D. V. & Ward, R. C. Epidemiology of general joint hypermobility and basis for the proposed criteria for benign joint hypermobility syndrome: review of the literature. J. Rheumatol. 34 (4), 804–809 (2007).
Larsson, L. G., Baum, J. & Mudholkar, G. S. Hypermobility: features and differential incidence between the sexes. Arthritis Rheum. 30 (12), 1426–1430 (1987).
Bird, H. A. Joint hypermobility in children. Rheumatol. (Oxford). 44 (6), 703–704 (2005).
Verhoeven, J. J., Tuinman, M. & Van Dongen, P. W. Joint hypermobility in African non-pregnant nulliparous women. Eur. J. Obstet. Gynecol. Reprod. Biol. 82 (1), 69–72 (1999).
Al-Rawi, Z. S., Al-Aszawi, A. J. & Al-Chalabi, T. Joint mobility among university students in Iraq. Br. J. Rheumatol. 24 (4), 326–331 (1985).
Larsson, L. G., Baum, J., Mudholkar, G. S. & Kollia, G. D. Benefits and disadvantages of joint hypermobility among musicians. N Engl. J. Med. 329 (15), 1079–1082 (1993).
Armstrong, R. Joint hypermobility, dynamic balance and postural control in dancers: Implications for clinical practice. Physiotherapy 114, e145 (2022).
Skwiot, M., Sliwinski, G., Milanese, S. & Sliwinski, Z. Hypermobility of joints in dancers. PLoS One. 14 (2), e0212188 (2019).
Castori, M. et al. A framework for the classification of joint hypermobility and related conditions. Am. J. Med. Genet. C Semin Med. Genet. 175 (1), 148–157 (2017).
Malfait, F. et al. The 2017 international classification of the Ehlers-Danlos syndromes. Am. J. Med. Genet. C Semin Med. Genet. 175 (1), 8–26 (2017).
Heighes, L. A., Abelleyra Lastoria, D. A., Beni, R., Iftikhar, A. & Hing, C. B. The relationship between joint hypermobility and patellar instability: A systematic review. J. Orthop. 56, 40–49 (2024).
Kumar, B. & Lenert, P. Joint Hypermobility Syndrome: Recognizing a Commonly Overlooked Cause of Chronic Pain. Am. J. Med. 130 (6), 640–647 (2017).
To, M., Strutton, P. H. & Alexander, C. M. Central fatigue is greater than peripheral fatigue in people with joint hypermobility syndrome. J. Electromyogr. Kinesiol. 48, 197–204 (2019).
Roma, M., Marden, C. L., De Wandele, I., Francomano, C. A. & Rowe, P. C. Postural tachycardia syndrome and other forms of orthostatic intolerance in Ehlers-Danlos syndrome. Auton. Neurosci. 215, 89–96 (2018).
Lam, C. et al. Gastrointestinal symptoms and nutritional issues in patients with hypermobility disorders: assessment, diagnosis and management. Frontline Gastroenterol. 14 (1), 68–77 (2023).
Eccles, J., Tung, J., Harrison, N., Mathias, C. & Critchley, H. Joint hypermobility syndrome and anxiety disorder: Structural brain correlates. Eur. Psychiat. 41, S233–S4 (2017).
Hakim, A. J. & Sahota, A. Joint hypermobility and skin elasticity: the hereditary disorders of connective tissue. Clin. Dermatol. 24 (6), 521–533 (2006).
Boileau, A., Brierre, T., Castel-Lacanal, E., Soulie, M. & Game, X. Lower urinary tract involvement in Ehlers-Danlos and Joint Hypermobility syndromes: Review of the literature. Fr. J. Urol. 34 (13), 102698 (2024).
Wang, Y., Strutton, P. H. & Alexander, C. M. Falls and balance impairment; what and how has this been measured in adults with joint hypermobility? A scoping review. BMC Musculoskelet. Disord. 26 (1), 88 (2025).
Schubart, J. R., Schaefer, E. W., Knight, D. R. T., Mills, S. E. & Francomano, C. A. Estimates of the excess cost burden of Ehlers-Danlos syndromes: a United States MarketScan(R) claims database analysis. Front. Public. Health. 12, 1365712 (2024).
Malek, S., Reinhold, E. J. & Pearce, G. S. The Beighton Score as a measure of generalised joint hypermobility. Rheumatol. Int. 41 (10), 1707–1716 (2021).
Beighton, P. et al. International Nosology of Heritable Disorders of Connective Tissue, Berlin, 1986. Am. J. Med. Genet. 29 (3), 581–594 (1988).
Hakim, A. J. & Grahame, R. A simple questionnaire to detect hypermobility: an adjunct to the assessment of patients with diffuse musculoskeletal pain. Int. J. Clin. Pract. 57 (3), 163–166 (2003).
Schlager, A. et al. Validity of the self-reported five-part questionnaire as an assessment of generalized joint hypermobility in early pregnancy. BMC Musculoskelet. Disord. 21 (1), 514 (2020).
Glans, M., Humble, M. B., Elwin, M. & Bejerot, S. Self-rated joint hypermobility: the five-part questionnaire evaluated in a Swedish non-clinical adult population. BMC Musculoskelet. Disord. 21 (1), 174 (2020).
Moraes, D. A., Baptista, C. A., Crippa, J. A. & Louzada-Junior, P. Translation into Brazilian Portuguese and validation of the five-part questionnaire for identifying hypermobility. Rev. Bras. Reumatol. 51 (1), 53–69 (2011).
Zhong, G. et al. Prevalence and dynamic characteristics of generalized joint hypermobility in college students. Gait Posture. 84, 254–259 (2021).
Liu, M. et al. Study on the balance and gait characteristics of subjects with generalized joint hypermobility residing in high-altitude using wearable devices: a cross-sectional study. BMC Musculoskelet. Disord. 25 (1), 837 (2024).
Singh, H. et al. Beighton scores and cut-offs across the lifespan: cross-sectional study of an Australian population. Rheumatol. (Oxford). 56 (11), 1857–1864 (2017).
Boyle, K. L., Witt, P. & Riegger-Krugh, C. Intrarater and Interrater Reliability of the Beighton and Horan Joint Mobility Index. J. Athl Train. 38 (4), 281–285 (2003).
Physio-pedia. Hypermobility Syndrome 2025 [Available from: https://www.physio-pedia.com/Hypermobility_Syndrome#cite_note-p1-1
Corbacioglu, S. K. & Aksel, G. Receiver operating characteristic curve analysis in diagnostic accuracy studies: A guide to interpreting the area under the curve value. Turk. J. Emerg. Med. 23 (4), 195–198 (2023).
Cohen, J. Citation-Classic - a Coefficient of Agreement for Nominal Scales. Cc/Soc Behav. Sci. 3, 18 (1986).
Koo, T. K. & Li, M. Y. A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. J. Chiropr. Med. 15 (2), 155–163 (2016).
Scheper, M. C. et al. Generalized joint hypermobility in professional dancers: a sign of talent or vulnerability? Rheumatol. (Oxford). 52 (4), 651–658 (2013).
Bulbena, A. et al. Clinical assessment of hypermobility of joints: assembling criteria. J. Rheumatol. 19 (1), 115–122 (1992).
Mokkink, L. B. et al. The COSMIN checklist for evaluating the methodological quality of studies on measurement properties: A clarification of its content. BMC Med. Res. Methodol. 10, 22 (2010).
Acknowledgements
The authors thank all participants for their involvement in the study. We also gratefully acknowledge the staff of the Rehabilitation and Nursing Department at Chengdu Art and Science College and Chengdu Sport University for their support with participant recruitment and data collection.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Author information
Authors and Affiliations
Contributions
Yu Wang and Yiduo Wang conceived and designed the study and drafted the manuscript. Xin Li, Yiduo Wang and Yu Wang collected the data. Yu Wang and Yiduo Wang performed the analyses. All authors critically reviewed the manuscript, approved the final version, and agree to be accountable for all aspects of the work.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Ethics approval and consent to participate
This study was approved by the Research Ethics Committee of Chengdu Sport University (Approval No. [2021] 46). Written informed consent was obtained from all participants prior to data collection. This study was conducted in accordance with the Helsinki Declaration.
Consent for publication
Not applicable.
Clinical trial number
Not applicable.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Wang, Y., Li, X. & Wang, Y. Diagnostic validation of the Chinese version of the five-part questionnaire for screening joint hypermobility in young adults. Sci Rep (2026). https://doi.org/10.1038/s41598-026-45970-8
Received:
Accepted:
Published:
DOI: https://doi.org/10.1038/s41598-026-45970-8
