Does the item ‘hands on floor’ add value to the Beighton score in identifying joint hypermobility?

OBJECTIVE Different assessment tools are used to screen for joint hypermobility. One of the most commonly used tools is the Beighton score. However, the inclusion of the item "hands on floor" (HOF) has been questioned, as this maneuver is not a pure measure of the range of motion because it involves multiple joints and stretching of muscular structures. This study therefore aimed to determine the value of the HOF item to the Beighton score in children aged 6-11 years. METHODS Exploratory research involved children in Grades 1-4 attending four different primary schools in South Africa. Children with a severe medical or neurological condition were excluded from the study. Hypermobility was determined as a score ≥5/8 on the Beighton score excluding the HOF item. RESULTS A total of 460 children (median age 8.58 years [interquartile range, 7.33-9.50]) were tested, of which 34.57% were hypermobile. However, only 8.91% of all children scored positive on HOF. Although a significant association was found between HOF and the hypermobility classification (p=0.007), 86.16% of the hypermobile children could not place their hands flat on the floor. Internal consistency improved slightly when HOF was removed from the scale (α changed from 0.698 to 0.703), with a weak corrected item-total correlation (r=0.16). The specificity of the item HOF in identifying hypermobility is high (93.69%); however, the sensitivity is very low (13.84%). CONCLUSION This study does not show an additional value of the item HOF of the Beighton score in children.