PREreview del A Systematised Review of the Beighton Score Compared with Other Commonly Used Measurement Tools for Assessment and Identification of Generalised Joint Hypermobility (GJH)

Short Summary of Main Findings In this systematised review (preprint v2, Nov 2022; later published in Journal of Clinical Rheumatology Research 2023), author Malini Alexander compared the Beighton Score (BS) — the most widely used 9-point tool for identifying generalised joint hypermobility (GJH) — with other instruments (e.g., Hospital Del Mar/Bulbena, Contompasis, Rotès-Quérol, Upper/Lower Limb Hypermobility Assessment Tools). Across 73 included papers, the BS demonstrated acceptable reliability (intra-rater ICC 0.74–0.99; inter-rater ICC 0.72–0.98). However, its validity could not be reliably determined due to widespread incorporation bias (the BS itself was often used as the reference standard to define GJH). Data on alternative tools were scarce and heterogeneous, preventing firm conclusions on superiority; some showed lower or variable reliability (e.g., Contompasis ICC 0.58–0.82). The review highlighted major methodological flaws, lack of standardisation, and the need for better tools or combined assessments.

How This Work Has Moved the Field Forward It is one of the most comprehensive critiques of the Beighton Score’s clinimetric properties, explicitly identifying incorporation bias as a previously under-recognised issue that undermines validity claims. By systematically cataloguing limitations of the BS and alternative scoring systems, it challenges the BS’s status as a de facto gold standard and calls for urgent standardisation, improved study designs, and development of more robust GJH assessment methods — directly relevant to hypermobility spectrum disorders, Ehlers-Danlos syndrome, and musculoskeletal conditions including shoulder instability or pain.

Major Issues

• Single-reviewer process with potential selection and extraction bias; no meta-analysis possible due to high heterogeneity.

• Validity of the BS remains undetermined; the review essentially concludes that current evidence is too flawed for strong recommendations.

• Still primarily available as a preprint on medRxiv (though later published in a journal); English-only studies limit scope.

• No direct patient outcomes or responsiveness data evaluated.

Minor Issues

• Title is long and uses “Systematised Review” (a less common term than “Systematic Review”).

• Limited discussion of clinical implications for specific populations (e.g., athletes, paediatrics, or shoulder patients).

• Grey literature and lower-quality studies included, which broadens scope but reduces rigour in some analyses.

Competing interests

The author declares that they have no competing interests.

Use of Artificial Intelligence (AI)

The author declares that they did not use generative AI to come up with new ideas for their review.