The Beighton score is a valid measure for generalized hypermobility in children ages 6 to 12 based on this study of 551 Dutch children. More than 35% of children scored above the cutoff of 5/9 on the Beighton scale, indicating increased joint mobility. Children with higher Beighton scores showed increased range of motion in other joints measured as well. There were no significant differences in prevalence of joint pain or pain after exercise between groups with different Beighton scores. The Beighton score effectively measured generalized joint mobility in this population of school-aged children.
Definition of osteoporosis,
Types of osteoporosis,
Primary osteoporosis,
Secondary osteoporosis,
Causes of osteoporosis,
Risk factors of osteoporosis,
Pathophysiology of osteoporosis,
Clinical features of osteoporosis,
Physical examination of osteoporosis,
Bone mass density test,
FRAX
Investigation of osteoporosis,
Physiotherapy management
Definition of osteoporosis,
Types of osteoporosis,
Primary osteoporosis,
Secondary osteoporosis,
Causes of osteoporosis,
Risk factors of osteoporosis,
Pathophysiology of osteoporosis,
Clinical features of osteoporosis,
Physical examination of osteoporosis,
Bone mass density test,
FRAX
Investigation of osteoporosis,
Physiotherapy management
Shoulder is the most mobile and most unstable joint in the body. Most common among shoulder is frozen shoulder which is discussed in detail in this presentation. This presentation includes detailed discussion on managing by exercising.
This presentation was presented in a workshop on 8-8-2021
Thomas Test (or as it called Hugh Owen Thomas well leg raising test) is used to measure the flexibility of the hip flexor muscles. It’s used to test for hip flexion contracture and psoas syndrome, which is more common in runners, dancers, and gymnasts with symptoms of hip “stiffness” and “clicking” feeling when flexing at the waist.
For more, See:
https://www.orthofixar.com/special-test/thomas-test/
PRE PARTICIPATION EXAMINATION I Dr.RAJAT JANGIR JAIPUR
knee injury, ligament injury knee, pcl injury, sports injury, Acl injury in football player surgery, Acl injury in football players, Acl injury in taekwondo, Acl reconstruction in jaipur, Acl reconstruction in taekwondo, Acl reconstruction surgery in football, Acl surgery in jaipur, Acl surgery ke baad physiotherapy, Best acl surgeon in india, Best acl surgeon in jaipur, Best knee surgeon in jaipur, Best ligament doctor in hindi, Meniscus repair surgery in jaipur, Sports injury doctor, acl surgery, acl surgery recovery, acl tear
Ataxia Physiotherapy Presentation - COAP study dayAtaxia UK
This is a presentation given by Anita Watson, Lecturer in Physiotherapy, at the Care of Ataxia Patients (COAP) study day on 18 November 2011 in Manchester. It is an overview of physiotherapy treatment options for people with ataxia.
Shoulder is the most mobile and most unstable joint in the body. Most common among shoulder is frozen shoulder which is discussed in detail in this presentation. This presentation includes detailed discussion on managing by exercising.
This presentation was presented in a workshop on 8-8-2021
Thomas Test (or as it called Hugh Owen Thomas well leg raising test) is used to measure the flexibility of the hip flexor muscles. It’s used to test for hip flexion contracture and psoas syndrome, which is more common in runners, dancers, and gymnasts with symptoms of hip “stiffness” and “clicking” feeling when flexing at the waist.
For more, See:
https://www.orthofixar.com/special-test/thomas-test/
PRE PARTICIPATION EXAMINATION I Dr.RAJAT JANGIR JAIPUR
knee injury, ligament injury knee, pcl injury, sports injury, Acl injury in football player surgery, Acl injury in football players, Acl injury in taekwondo, Acl reconstruction in jaipur, Acl reconstruction in taekwondo, Acl reconstruction surgery in football, Acl surgery in jaipur, Acl surgery ke baad physiotherapy, Best acl surgeon in india, Best acl surgeon in jaipur, Best knee surgeon in jaipur, Best ligament doctor in hindi, Meniscus repair surgery in jaipur, Sports injury doctor, acl surgery, acl surgery recovery, acl tear
Ataxia Physiotherapy Presentation - COAP study dayAtaxia UK
This is a presentation given by Anita Watson, Lecturer in Physiotherapy, at the Care of Ataxia Patients (COAP) study day on 18 November 2011 in Manchester. It is an overview of physiotherapy treatment options for people with ataxia.
Effect of smart phone using duration and gender on dynamic balancedbpublications
Abstract : Smart phones are constantly used for extended periods while looking at the visual display terminals this
may causes musculoskeletal problems. So, the purpose of this study was to investigate effect of smart phone using
duration and gender on dynamic balance.
Keywords: Smartphone, using duration, gender, dynamic balance
OutlineThesis Statement Due to racism, African Americans are molianaalbee2qly
Outline
Thesis Statement: Due to racism, African Americans are more likely to face higher sentencing than the average American.
Argument #1- Mass Incarceration
Argument #2- Effects from Racial Sentencing
Argument #3- Community Damage
Opposing View Point
Body Paragraph #1
Argument#1- Mass Incarceration
Example #1- Overcrowded Jails/ Prisons
Example #2- Physical/ Mental Health Issues
Example #3- History
Body Paragraph #2
Argument #2- Effects of Racial Sentencing
Example #1- Broken Families
Example #2- Suicide / Death
Body Paragraph #3
Argument #3- Community Damage
Example #1- Employment
Example #2- Homelessness
Body Paragraph #4
Opposing View Point- How African Americans are sentenced fairly
Conclusion
Sum up Thesis Statement/ Body
Am J Health Behav.™ 2018;42(3):47-55 47
The obesity epidemic has a dominant glob-al and national presence. Research shows that 35% of American men and 40.4% of
women over the age of 19 years are obese.1 These
statistics demonstrate that a high proportion of the
population in the United States (US) is impacted
directly by the obesity epidemic, which has been
proven to be both economically and physiologi-
cally taxing. Obesity is defined as the excess accu-
mulation of body fat to the point that it can have a
negative impact on health. Numerous factors have
been identified as obesogenic (those contributing
to the development of obesity), including decreased
energy expenditure, increased energy intake, and
decreased levels of physical activity.2 Concerted ef-
forts are being made to understand this epidemic
from all possible viewpoints.
Insufficient and poor sleep have emerged as obe-
sogenic risk factors. Sleep pattern disturbances are
associated with impaired cognitive abilities, poor
memory, confusion, reduced intellectual capacity,
and altered motor function.3 Impaired sleep also
can decrease academic performance,4 and increase
the incidence of vehicular accidents.5 Furthermore,
poor sleep quality and reduced sleep duration may
be associated with weight gain.6 College students
often report chronic reduced sleep quality and
sleep duration.7
The specific causes of poor sleep quality and du-
ration are diverse, but the presence of media de-
vices within the bedroom, such as smart phones
and tablets, is a novel point of discussion in terms
of their effect on sleep quality and duration. The
effect of cell phone presence in the bedroom on
sleep has been described in adolescents and adults
and implicated as a potential obesogenic factor,8,9
Jonathon Whipps, Doctoral Student, Translational Biomedical Sciences, Ohio University, Athens, OH. Mark Byra, Professor, Division of Kinesiology
and Health, University of Wyoming, Laramie, WY. Kenneth G Gerow, Professor, Department of Statistics, University of Wyoming, Laramie, WY.
Emily Hill Guseman, Assistant Professor, Diabetes Institute and Department of Family Medicine, Ohio University Heritage College of Osteopathic
Medicine, Athens, O ...
OutlineThesis Statement Due to racism, African Americans are mo.docxkarlhennesey
Outline
Thesis Statement: Due to racism, African Americans are more likely to face higher sentencing than the average American.
Argument #1- Mass Incarceration
Argument #2- Effects from Racial Sentencing
Argument #3- Community Damage
Opposing View Point
Body Paragraph #1
Argument#1- Mass Incarceration
Example #1- Overcrowded Jails/ Prisons
Example #2- Physical/ Mental Health Issues
Example #3- History
Body Paragraph #2
Argument #2- Effects of Racial Sentencing
Example #1- Broken Families
Example #2- Suicide / Death
Body Paragraph #3
Argument #3- Community Damage
Example #1- Employment
Example #2- Homelessness
Body Paragraph #4
Opposing View Point- How African Americans are sentenced fairly
Conclusion
Sum up Thesis Statement/ Body
Am J Health Behav.™ 2018;42(3):47-55 47
The obesity epidemic has a dominant glob-al and national presence. Research shows that 35% of American men and 40.4% of
women over the age of 19 years are obese.1 These
statistics demonstrate that a high proportion of the
population in the United States (US) is impacted
directly by the obesity epidemic, which has been
proven to be both economically and physiologi-
cally taxing. Obesity is defined as the excess accu-
mulation of body fat to the point that it can have a
negative impact on health. Numerous factors have
been identified as obesogenic (those contributing
to the development of obesity), including decreased
energy expenditure, increased energy intake, and
decreased levels of physical activity.2 Concerted ef-
forts are being made to understand this epidemic
from all possible viewpoints.
Insufficient and poor sleep have emerged as obe-
sogenic risk factors. Sleep pattern disturbances are
associated with impaired cognitive abilities, poor
memory, confusion, reduced intellectual capacity,
and altered motor function.3 Impaired sleep also
can decrease academic performance,4 and increase
the incidence of vehicular accidents.5 Furthermore,
poor sleep quality and reduced sleep duration may
be associated with weight gain.6 College students
often report chronic reduced sleep quality and
sleep duration.7
The specific causes of poor sleep quality and du-
ration are diverse, but the presence of media de-
vices within the bedroom, such as smart phones
and tablets, is a novel point of discussion in terms
of their effect on sleep quality and duration. The
effect of cell phone presence in the bedroom on
sleep has been described in adolescents and adults
and implicated as a potential obesogenic factor,8,9
Jonathon Whipps, Doctoral Student, Translational Biomedical Sciences, Ohio University, Athens, OH. Mark Byra, Professor, Division of Kinesiology
and Health, University of Wyoming, Laramie, WY. Kenneth G Gerow, Professor, Department of Statistics, University of Wyoming, Laramie, WY.
Emily Hill Guseman, Assistant Professor, Diabetes Institute and Department of Family Medicine, Ohio University Heritage College of Osteopathic
Medicine, Athens, O ...
Company Chosen Suncorp Bank Across Australia and globally, th.docxjanthony65
Company Chosen: Suncorp Bank
Across Australia and globally, the nature and practice of Human Resource Management (HRM) is in a constant state of evolution as organisational forms, management standards, labour markets and whole economies shift, adapt and change. In this assignment you are required to select an organisation, and undertake an investigation and evaluation regarding the HRM practices and policies present in that organisation. Your assignment is thus in two parts. The first section (of approximately 900 words) requires you to account for, and discuss, the ways in which your selected organisation:
· Recruits and inducts new staff
· Manages staff performance and engagement
· Identifies and advances high performing staff
· Ensures that staff operate safely
· Advances a diversity agenda across its staff and management base
· Encourages staff to stay at the organisation
· Resolves disputes and/or negotiates pay and benefits
In the second part of the assignment (approximately 1100 words in length) you should offer informed suggestions, supported by peer-reviewed academic literature (i.e. quality journal articles) on how the organisation can better structure its HRM practices and policies to advance employee performance (such as engagement, wellbeing, safety, commitment etc.) and organisational outcomes (e.g. profit and standing). Your suggestions should be critical and based on evidence, and at least 8 peer-reviewed academic articles should be cited in this section.
Home-based exergaming among children with
overweight and obesity: a randomized clinical trial
A. E. Staiano , R. A. Beyl , W. Guan , C. A. Hendrick , D. S. Hsia and
R. L. Newton Jr.
Pennington Biomedical Research Center, Baton
Rouge, Louisiana, USA
Address for correspondence:
AE Staiano, Pennington Biomedical
Research Center, 6400 Perkins Rd,
Baton Rouge, LA 70815, USA.
E-mail: [email protected]
Received 14 February 2018; revised 30 April 2018;
accepted 26 May 2018
Summary
Background: Given children’s low levels of physical activity and high
prevalence of obesity, there is an urgent need to identify innovative physical activity
options.
Objective: This study aims to test the effectiveness of exergaming (video
gaming that involves physical activity) to reduce children’s adiposity and improve
cardiometabolic health.
Methods: This randomized controlled trial assigned 46 children with
overweight/obesity to a 24-week exergaming or control condition. Intervention par-
ticipants were provided a gaming console with exergames, a gameplay curriculum
(1 h per session, three times a week) and video chat sessions with a fitness coach
(telehealth coaching). Control participants were provided the exergames following fi-
nal clinic visit. The primary outcome was body mass index (BMI) z-score. Secondary
outcomes were fat mass by dual energy X-ray absorptiometry and cardiometabolic
health metrics.
Results: Half of the participants were girls, and 57% were African–American.
Int.
Company Chosen Suncorp Bank Across Australia and globally, th.docxtemplestewart19
Company Chosen: Suncorp Bank
Across Australia and globally, the nature and practice of Human Resource Management (HRM) is in a constant state of evolution as organisational forms, management standards, labour markets and whole economies shift, adapt and change. In this assignment you are required to select an organisation, and undertake an investigation and evaluation regarding the HRM practices and policies present in that organisation. Your assignment is thus in two parts. The first section (of approximately 900 words) requires you to account for, and discuss, the ways in which your selected organisation:
· Recruits and inducts new staff
· Manages staff performance and engagement
· Identifies and advances high performing staff
· Ensures that staff operate safely
· Advances a diversity agenda across its staff and management base
· Encourages staff to stay at the organisation
· Resolves disputes and/or negotiates pay and benefits
In the second part of the assignment (approximately 1100 words in length) you should offer informed suggestions, supported by peer-reviewed academic literature (i.e. quality journal articles) on how the organisation can better structure its HRM practices and policies to advance employee performance (such as engagement, wellbeing, safety, commitment etc.) and organisational outcomes (e.g. profit and standing). Your suggestions should be critical and based on evidence, and at least 8 peer-reviewed academic articles should be cited in this section.
Home-based exergaming among children with
overweight and obesity: a randomized clinical trial
A. E. Staiano , R. A. Beyl , W. Guan , C. A. Hendrick , D. S. Hsia and
R. L. Newton Jr.
Pennington Biomedical Research Center, Baton
Rouge, Louisiana, USA
Address for correspondence:
AE Staiano, Pennington Biomedical
Research Center, 6400 Perkins Rd,
Baton Rouge, LA 70815, USA.
E-mail: [email protected]
Received 14 February 2018; revised 30 April 2018;
accepted 26 May 2018
Summary
Background: Given children’s low levels of physical activity and high
prevalence of obesity, there is an urgent need to identify innovative physical activity
options.
Objective: This study aims to test the effectiveness of exergaming (video
gaming that involves physical activity) to reduce children’s adiposity and improve
cardiometabolic health.
Methods: This randomized controlled trial assigned 46 children with
overweight/obesity to a 24-week exergaming or control condition. Intervention par-
ticipants were provided a gaming console with exergames, a gameplay curriculum
(1 h per session, three times a week) and video chat sessions with a fitness coach
(telehealth coaching). Control participants were provided the exergames following fi-
nal clinic visit. The primary outcome was body mass index (BMI) z-score. Secondary
outcomes were fat mass by dual energy X-ray absorptiometry and cardiometabolic
health metrics.
Results: Half of the participants were girls, and 57% were African–American.
Int.
Company Chosen Suncorp Bank Across Australia and globally, th.docxmccormicknadine86
Company Chosen: Suncorp Bank
Across Australia and globally, the nature and practice of Human Resource Management (HRM) is in a constant state of evolution as organisational forms, management standards, labour markets and whole economies shift, adapt and change. In this assignment you are required to select an organisation, and undertake an investigation and evaluation regarding the HRM practices and policies present in that organisation. Your assignment is thus in two parts. The first section (of approximately 900 words) requires you to account for, and discuss, the ways in which your selected organisation:
· Recruits and inducts new staff
· Manages staff performance and engagement
· Identifies and advances high performing staff
· Ensures that staff operate safely
· Advances a diversity agenda across its staff and management base
· Encourages staff to stay at the organisation
· Resolves disputes and/or negotiates pay and benefits
In the second part of the assignment (approximately 1100 words in length) you should offer informed suggestions, supported by peer-reviewed academic literature (i.e. quality journal articles) on how the organisation can better structure its HRM practices and policies to advance employee performance (such as engagement, wellbeing, safety, commitment etc.) and organisational outcomes (e.g. profit and standing). Your suggestions should be critical and based on evidence, and at least 8 peer-reviewed academic articles should be cited in this section.
Home-based exergaming among children with
overweight and obesity: a randomized clinical trial
A. E. Staiano , R. A. Beyl , W. Guan , C. A. Hendrick , D. S. Hsia and
R. L. Newton Jr.
Pennington Biomedical Research Center, Baton
Rouge, Louisiana, USA
Address for correspondence:
AE Staiano, Pennington Biomedical
Research Center, 6400 Perkins Rd,
Baton Rouge, LA 70815, USA.
E-mail: [email protected]
Received 14 February 2018; revised 30 April 2018;
accepted 26 May 2018
Summary
Background: Given children’s low levels of physical activity and high
prevalence of obesity, there is an urgent need to identify innovative physical activity
options.
Objective: This study aims to test the effectiveness of exergaming (video
gaming that involves physical activity) to reduce children’s adiposity and improve
cardiometabolic health.
Methods: This randomized controlled trial assigned 46 children with
overweight/obesity to a 24-week exergaming or control condition. Intervention par-
ticipants were provided a gaming console with exergames, a gameplay curriculum
(1 h per session, three times a week) and video chat sessions with a fitness coach
(telehealth coaching). Control participants were provided the exergames following fi-
nal clinic visit. The primary outcome was body mass index (BMI) z-score. Secondary
outcomes were fat mass by dual energy X-ray absorptiometry and cardiometabolic
health metrics.
Results: Half of the participants were girls, and 57% were African–American.
Int ...
A Comprehensive Mixed-Longitudinal Study of Growth in Boys with Autism Spectr...Cherie Green
The first aim in the current study was to replicate previous findings indicating a phase of early overgrowth of HC, height and weight. The second aim was to investigate if growth dysregulation was also apparent in older children and adolescents with ASD. If a general growth dysregulation was found in boys with ASD from birth - 16 years of age, it was hypothesized that this growth dysregulation may be the result of either 1) connective tissue abnormalities, and/or
2) dysregulation of the HPA axis. A further exploratory aim was to identify biologically distinct subgroups within ASD based on specific growth, behavioural, and biological patterns.
The results from both Study 1 and 2 confirmed that an overall growth dysregulation exists in ASD. Boys with ASD are smaller at birth, but then grow at a faster rate, so that by 4 years of age they are larger than TD boys. They then stay larger throughout childhood and adolescence. Although there were no group differences in the overall rate of growth from 4- to 16-years of age, the pattern of growth was visibly different and requires further investigation.
Although the abnormal growth trajectory is clear, the reasoning behind it is less so. Boys with ASD had longer limbs than TD boys, indicating possible connective tissue abnormalities. The HPA axis may also be involved, as more severe autistic symptoms were correlated with a greater CAR and with being large overall. Further research is required to determine if boys who are large overall also have increased CAR and represent a biologically distinct subgroup within ASD.
Assessing the Relationship between Body Composition and Spinal Curvatures in ...peertechzpublication
Introduction: Although it is thought that abdominal adiposity is one of the risk factor for postural deviation, such as increased lumbar lordosis, the studies in the literature only explored the effects of body mass index on spinal alignment and postural changes. The aim of this study was to investigate the correlation with detailed body composition and spine alignment in healthy young adults.
Body mass-index-quality-of-life-and-migraine-in-studentsAnnex Publishers
Migraine is reported globally with a higher prevalence in students. The present study aims to evaluate the association between nutritional status, quality of life (QL) and characteristics of migraine.
A cross-sectional study. Headache characteristics, level of disability caused by migraine crises (Pediatric Migraine Disability Assessment - PedMIDAS) and QL (Pediatric Quality of Life Inventory- PedsQL) were assessed. Anthropometric variables were also measured.
Data were collected from 98 students with a mean age of 11.2 ± 1.7 years. Migraine had the highest prevalence (54.8%). The average Body Mass Index (BMI) of the total sample was 20.0 ± 3.8 kg/m2, and among students with migraine and students with tension headache, the average BMIs were 20.4 ± 4.0 and 19.5 ± 3.4 kg/m2, respectively (p = 0.264, Student's t-test). Around 47.5% from migraineurs were overweight or obese. Regarding QL, the average total score in students with migraine was 74.4 ± 12.4, with no differences observed among normal weight, overweight or obese students, and no correlation between the scores of the PedsQL and BMI (r = -0.182, p = 0.165, Pearson correlation coefficient) was observed. There was a high percentage of overweight students with migraine. Analyses show no associations between the nutritional status, frequency, severity, disability caused by crises, or QL.
Am J Health Behav.™ 2018;42(3)47-55 47 The obesity epidem.docxdaniahendric
Am J Health Behav.™ 2018;42(3):47-55 47
The obesity epidemic has a dominant glob-al and national presence. Research shows that 35% of American men and 40.4% of
women over the age of 19 years are obese.1 These
statistics demonstrate that a high proportion of the
population in the United States (US) is impacted
directly by the obesity epidemic, which has been
proven to be both economically and physiologi-
cally taxing. Obesity is defined as the excess accu-
mulation of body fat to the point that it can have a
negative impact on health. Numerous factors have
been identified as obesogenic (those contributing
to the development of obesity), including decreased
energy expenditure, increased energy intake, and
decreased levels of physical activity.2 Concerted ef-
forts are being made to understand this epidemic
from all possible viewpoints.
Insufficient and poor sleep have emerged as obe-
sogenic risk factors. Sleep pattern disturbances are
associated with impaired cognitive abilities, poor
memory, confusion, reduced intellectual capacity,
and altered motor function.3 Impaired sleep also
can decrease academic performance,4 and increase
the incidence of vehicular accidents.5 Furthermore,
poor sleep quality and reduced sleep duration may
be associated with weight gain.6 College students
often report chronic reduced sleep quality and
sleep duration.7
The specific causes of poor sleep quality and du-
ration are diverse, but the presence of media de-
vices within the bedroom, such as smart phones
and tablets, is a novel point of discussion in terms
of their effect on sleep quality and duration. The
effect of cell phone presence in the bedroom on
sleep has been described in adolescents and adults
and implicated as a potential obesogenic factor,8,9
Jonathon Whipps, Doctoral Student, Translational Biomedical Sciences, Ohio University, Athens, OH. Mark Byra, Professor, Division of Kinesiology
and Health, University of Wyoming, Laramie, WY. Kenneth G Gerow, Professor, Department of Statistics, University of Wyoming, Laramie, WY.
Emily Hill Guseman, Assistant Professor, Diabetes Institute and Department of Family Medicine, Ohio University Heritage College of Osteopathic
Medicine, Athens, OH.
Correspondence Dr Guseman; [email protected]
Evaluation of Nighttime Media Use and Sleep
Patterns in First-semester College Students
Jonathon Whipps, MS
Mark Byra, PhD
Kenneth G. Gerow, PhD
Emily Hill Guseman, PhD
Objective: We evaluated how nighttime media use is associated with sleep behaviors in first-
semester college students, and variation by weight status. Methods: In September 2016, first-se-
mester college students (N = 114) completed surveys evaluating nighttime media usage (NMU)
and sleep behaviors. Height, weight, and waist circumference were measured, and weight status
was determined by body mass index. Results: Students reported a mean sleep duration of 7.26 ±
0.93 hours. Only 33% (N = 38) reported sleeping at least 8 ...
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
Welcome to Secret Tantric, London’s finest VIP Massage agency. Since we first opened our doors, we have provided the ultimate erotic massage experience to innumerable clients, each one searching for the very best sensual massage in London. We come by this reputation honestly with a dynamic team of the city’s most beautiful masseuses.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
1. Beighton Score: A Valid Measure for Generalized Hypermobility in Children
Bouwien Smits-Engelsman, PhD, Marie¨tte Klerks, MS, and Amanda Kirby, MRCGP, PhD
Objective To evaluate the validity of the Beighton score as a generalized measure of hypermobility and to mea-
sure the prevalence of hypermobility and pain in a random population of school age children.
Study design Prospective study of 551 children attending various Dutch elementary schools participated; 47%
were males (258) and 53% (293) females, age range was 6 to 12 years. Children’s joints and movements were as-
sessed according to the Beighton score by qualified physiotherapists and by use of goniometry measuring 16 pas-
sive ranges of motion of joints on both sides of the body.
Results More than 35% of children scored more than 5/9 on the Beighton score. Children who scored high on the
Beighton score also showed increased range of motion in the other joints measured. Moreover 12.3% of children
had symptoms of joint pain, and 9.1% complained of pain after exercise or sports. Importantly, this percentage was
independent of the Beighton score. There were no significant differences in Beighton score for sex in this popula-
tion.
Conclusion The Beighton score, when goniometry is used, is a valid instrument to measure generalized joint mo-
bility in school-age children 6 to 12 years. No extra items are needed to improve the scale. (J Pediatr 2010;-:---).
J
oint hypermobility, defined as a more-than-normal range of movement (ROM) in a joint, is either localized (increased
ROM of a single joint) or generalized. The prevalence of asymptomatic generalized hypermobility in children has been
variably and widely reported, between 3% and 30%.1-12
Generalized joint hypermobility (GJH) is said to be more prev-
alent among girls than boys with sex ratios of approximately 3:1 to 2:1, females/males.1-8
In children, joint mobility is also in-
versely related with age, with younger children showing higher joint mobility than older children and with sex differences noted
as they get older.1-3,6,12
Symptomatic generalized hypermobility is believed to be less common10-12
and poorly recognized in childhood.12
In 1967,
Kirk et al11
described musculoskeletal complaints in association with general hypermobility in adults, which was called hyper-
mobility syndrome.
Joint hypermobility syndrome (JHS) is diagnosed when, in addition to the hypermobility, individuals report musculoskeletal
symptoms in more than 4 joints, including pain over a period of more than 12 weeks, and when other heritable disorders of
connective tissue and other causes of the symptoms have been excluded.13-15
Individuals with collagen disorders, such as
Ehlers-Danlos syndrome, have also been described with the term JHS with their heritable disorders of connective tissue diag-
nosis.16
Joint hypermobility in children is commonly diagnosed with criteria for an adult population and ROM is judged by eye. To
evaluate hypermobility, clinicians mainly use two scoring systems: the Beighton score (Table I)1
and the Bulbena Criteria.17
The Beighton score, more commonly used in diagnosing hypermobility in childhood,2-9,18
has its cutoff point internationally
debated.2,6,9,18
Originally the Beighton score cutoff points offered no differentiation between adults and children, sex, and eth-
nicity. However, given the noted variations, it would seem that cutoff values that take these into account are required. The lack
of specific criteria for children motivated this study. A standardized protocol is lacking, and a uniform description of the test
items in children is needed for reliable testing of hypermobility. For example, it is not clear whether the Beighton score has to be
performed actively or passively.1,19
Juul et al19
defined a standardized protocol for the Beighton score with passive range of
motion for clinical studies of reproducibility in adults. To standardize the Beighton score for children, we described and tested
a goniometry protocol (Appendix; available at www.jpeds.com).
The Beighton score has never been tested for validity, although it is used clinically as a basis of examination and diagnosis.20,21
Therefore a second aim of the study concerned the validation of the Beighton score as a measure of generalized hypermobility in
children. A third aim was to examine the prevalence of reported pain after exercise or sport, and pes planus in a random pop-
ulation, to consider whether this was associated with the classification of mobil-
ity. A final consideration was to measure the prevalence of hypermobility in
From the Faculty of Kinesiology and Rehabilitation
Sciences, K.U.Leuven, Avans, University for
Professionals, Breda (B.S.), The Netherlands; Private
Practice, Peize (M.K.), The Netherlands, and the
Dyscovery Centre, School of Education, University of
Wales, Newport, Wales, United Kingdom (A.K.)
The authors declare no conflicts of interest.
0022-3476/$ - see front matter. Copyright Ó 2010 Mosby Inc.
All rights reserved. 10.1016/j.jpeds.2010.07.021
GJH Generalized joint hypermobility
JHS Joint hypermobility syndrome
ROM Range of movement
SBP Standardized Beighton score protocol
SJP Standardized joint-mobility protocol
1
2. a random population of elementary school–age children and
to consider whether there were sex or body side differences in
the population.
Method
Standardized Beighton Score Protocol
All the items were described and visualized with photos.
Cutoff points for declaring an item as positive or negative
were included (Appendix). Goniometry was used to
measure the passive bilateral dorsiflexion of the fifth
metacarpophalangeal joint and the passive bilateral
hyperextension of the elbow and knee.
Standardized Joint Mobility Protocol
To obtain a reliable impression of overall joint mobility, an
extended ‘‘standardized joint mobility protocol’’ (SJP) was
developed. This describes test position, positioning of the go-
niometer, anatomic landmarks, and motion to be tested. In
this protocol passive range of motion was used to standardize
the measurement as much as possible and to be less depen-
dent on the child’s notion of a full range of movement. Six-
teen ROMs of 8 different joints were measured bilaterally to
the nearest 1-degree with a standard 2-legged 360-degree type
Collehon extendable goniometer (01135; Lafayette Instru-
ment Company, Lafayette, Indiana). For small joints, a plastic
180-degree goniometer (type HIRes) was used. Included in
this protocol are several extra observations that are clearly de-
scribed, including pes planus and ‘‘heel-to-the-buttock’’
movement.
Training Procedure
To collect reliable data, 6 pediatric physical therapists were
trained. The protocol was explained, and items were taught
under supervision. Then therapists used SBP and SJP to mea-
sure the passive joint mobility and the Beighton score of 6
healthy Dutch children. Intraclass correlation between the
first and second measurements was high (0.99), indicating
excellent reliability. The mean difference (absolute [Measure-
ment 1 À Measurement 2]) between all the joints measured
by the 6 therapists was 8.05 degrees (SD 5.9), with the exor-
otation of the shoulder being the least reliable (mean absolute
difference of 15.8 degrees) and the passive extensions of the
hip and knee being the best reproducible maneuvers (mean
absolute difference of 4.5 degrees). The standard error of
measurement for the ranges of motion for the joints included
in the SBP (knee and elbow extension and dorsiflexion of the
fifth metacarpophalangeal) was 2 degrees.
Test Procedure
All children were measured by the 6 trained pediatric physical
therapists according to the SBP and the full bilateral SJP.
Children wore shorts and shirts and no shoes. Before the as-
sessment, the movement was demonstrated by the tester first,
supported with verbal instructions. Children were instructed
to relax their muscles as much as possible, and the maneuver
was performed without evoking pain. Additionally, the pres-
ence of pes planus (the arch lowers and flattens fully, exces-
sively and easily, with the talus bulging medially22
) and
muscle length of the rectus femoris were assessed (heel to
buttock in prone position) (Appendix). Background
information about the child’s health was also gathered with
a questionnaire.
Participants
A total of 551 children, attending 11 Dutch elementary
schools, participated in the study. Teachers selected every
second child of the register in the respective classes. Approval
was gained from the local ethics committee. Parental consent
was obtained and additional assent from children before par-
ticipation.
Of this sample, 86% were white, and 14% were from first-
generation Dutch families (all the children were born in the
Netherlands). There were 46.8% males (258) and 53.2%
(293) females in the group. Nearly 13% of children were
left handed.
Data Analysis
Totals on the Beighton score were compared by use of inde-
pendent samples t testing for sex differences and side of the
body. Scores on the Beighton score were calculated on the ba-
sis of the SBP. Based on cutoff scores reported in the litera-
ture, children were placed into 3 bands as follows: band 1:
not hypermobile (0-4); band 2: increased mobility (5-6);
band 3: hypermobile (7-9). These Beighton score bands
were used as independent variables to compare the 16 mea-
sured ROM of the joints (means of left and right side were
used) with analysis of variance. Frequency of reported pain
after exercise and sport and pes planus were analyzed with
Table II. Demographic information
Mean Range
Age 8 years, 9 months 6-12 years
Weight 31 kg 17-83 kg
Height 1 m 37cm 1m 5 cm–1 m 73 cm
BMI 16.5* 10-36
*Overall, 14% of the children in this sample were overweight.
Table III. Distribution of Beighton score total
Frequency Percent Cumulative percent
Band 1: 0-4 Normal ROM
0 40 7.3 7.3
1 46 8.3 15.6
2 102 18.5 34.1
3 64 11.6 45.7
4 103 18.7 64.4
Band 2: 5-6 Increased ROM
5 69 12.5 77.0
6 77 14.0 90.9
Band 3: 7-9 Hypermobile
7 33 6.0 96.9
8 16 2.9 99.8
9 1 .2 100.0
Total 551 100.0
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2 Smits-Engelsman, Klerks, and Kirby
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3. the c2
test. Data were analyzed with SPSS version 15.0 (SPSS
Inc., Chicago, Illinois).
Results
In this random sample, 9.1% of the children scored 7 or more
out of a possible 9 points on the Beighton score, and 35.6%
scored 5 or more (Table III). Complaints of pain in joints,
muscles, or ligaments were quite common. Overall, 13.3%,
12.8%, and 4.1% of participants cited this in respective
Beighton score bands 1, 2 and 3. Pain after exercise or
sport was reported for 8.8%, 9.6%, and 10% of the
children, in bands 1, 2, and 3, respectively. These
percentages were not significantly different between
children with less or more mobility and therefore do not
seem to be specific for children with high Beighton scores.
Scale Analysis
The question to be answered in this study was, ‘‘Is the
Beighton score a valid measure for generalized hypermobility
in children?’’ To answer this question, 16 mean ROMs of all
major extremity joints were compared between groups on the
basis of the 3 bands of the Beighton score (Table IV). The
analysis of variance revealed significant differences between
the degrees of motion of all joints examined. Moreover, as
shown in Table V, post-hoc tests also showed that the
ROMs of all joints were significantly different between the
classification groups (flexion knee: P = .02 extension hip:
P = .06, all the other joints P .001).
Sex Differences
With the Beighton score, where 9 points is the maximum
possible score, no significant differences (P = .22) for sex
were found. If analyzed per item, only hands on the floor
(item 5) was different (t (1549) = 4.66, P .001); with girls
being more flexible than boys.
Differences in Right and Left Sides on Testing
Comparing scores on the left and the right sides of the body,
there was a significant difference, with right-sided measures
showing less mobility than those on the left side (t (1550)
= 2.14, P .032). Mean scores for right side were 1.75 and
for the left side, 1.82. If analyzed per item, only the item
‘‘thumb to volar aspect of the forearm’’ (item 2) was signifi-
cantly different (t (1550) = 2.42, P .016), with the left
thumb being more flexible.
Asymmetric mobility was also examined. Children were
defined as asymmetrically mobile if the difference between
the summed left and right part of the Beighton score was
more than 2 points (4 being the maximum score for one
side). In total, 4.9% of the children were classified to have
asymmetric mobility (3.5% showed larger movements on
the left side, 1.8% on the right). Moreover, 19.6% showed
a 1-point advantage in ROM on the left side of the body,
and the respective figure was 15.4% for the joints on the right
side. No sex differences in asymmetry were found.
Table IV. ROM in degrees per joint for the 3 Beighton
score bands (mean and standard deviation)
Joint
Beighton
score Bands
Number
of
participants
ROM
mean
ROM
SD
Lower Extremity
Extension MTP1
0-4 355 69 11
5-6 146 74 9
7-9 50 77 10
Dorsal flexion ankle
0-4 355 24 7
5-6 146 27 6
7-9 50 30 6
Plantar flexion ankle
0-4 355 61 8
5-6 146 67 7
7-9 50 69 6
Flexion knee
0-4 355 155 10
5-6 146 157 4
7-9 50 158 4
Extension knee
0-4 355 4 4
5-6 146 8 4
7-9 50 10 3
Flexion hip
0-4 355 108 8
5-6 146 111 8
7-9 50 114 5
Extension hip
0-4 355 22 7
5-6 146 23 7
7-9 50 24 7
Exorotation hip
0-4 355 49 8
5-6 146 52 10
7-9 50 57 12
Endorotation hip
0-4 355 49 8
5-6 146 53 10
7-9 50 59 11
Upper extremity
Dorsiflexion MCP Digit 5
0-4 355 82 12
5-6 146 91 10
7-9 50 96 9
Extention wrist
0-4 355 93 8
5-6 146 100 8
7-9 50 103 8
Flexion wrist
0-4 355 100 10
5-6 146 109 11
7-9 50 111 9
Flexion elbow
0-4 355 151 6
5-6 146 153 5
7-9 50 154 5
Extension elbow
0-4 355 9 6
5-6 146 13 6
7-9 50 16 5
Flexion shoulder
0-4 355 171 14
5-6 146 178 13
7-9 50 184 12
Exorotation shoulder
0-4 355 88 14
5-6 146 98 13
7-9 50 105 13
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4. Pes Planus
In this typically developing sample, 30% of children were ob-
served to have pes planus as described in the protocol. There
was an increasing prevalence (c2
5.29, df = 1 , P = .021) in pes
planus per mobility band (band 1: 27%, band 2: 32.2%, band
3: 44%).
Heel to Buttock
To explore supplementary value of other hypermobility ma-
neuvers, ‘‘heel to buttock’’ was also tested. In 87% of the chil-
dren, the heels could passively be brought to contact the
buttocks. Twelve percent of children were unable to do so
with two legs and 1% with one leg. Importantly, the frequen-
cies of difficulty with ‘‘heel to buttock’’ were not different for
children in the 3 Beighton score bands.
Discussion
The Beighton score is a valid measure for generalized joint hy-
permobility in children, on the basis of the detailed analysis of
the ranges of motion of all major joints. Although the
Beighton score covers a sample of joints, it was shown that in-
creased mobility is present in other joints not covered. Pain
over a period of time or after exercise does not seem to be valid
extra information in hypermobility related complaints in
children under 13 years. This concurs with the study by El-
Metwally et al who reported that hypermobility (Beighton
6/9) was not predictive of future musculoskeletal pain in pre-
teen and adolescent children.23
However, it may be useful to
explore pain symptoms such as waking in the night.
Pes planus is a frequent symptom in children (33%), not
only in children with hypermobile joints but in all children.
Adib12
found that pes planus was one of the main features
in children with JHS, and this is confirmed for children
with a high Beighton score, but its high frequency is not re-
stricted just to this group. Because the mean ROMs of all
joints measured were significantly increased if children
were classified as hypermobile, it was concluded that the
Table V. Post hoc test (Tukey HSD)
Dependent
Variable
(I) Beighton
Band
(J) Beighton
Band
Mean
Difference
(I-J) P value
Lower extremity
Extension MTP1
0-4 5-6 -5.49* .000
7-9 -7.98* .000
5-6 0-4 5.49* .000
7-9 -2.48 .330
Dorsal flexion ankle
0-4 5-6 -2.93* .000
7-9 -6.48* .000
5-6 0-4 2.93* .000
7-9 -3.54* .003
Plantar flexion ankle
0-4 5-6 -5.77* .000
7-9 -7.71* .000
5-6 0-4 5.77* .000
7-9 -1.94 .296
Flexion knee
0-4 5-6 -1.76 .080
7-9 -2.72 .078
5-6 0-4 1.76 .080
7-9 -.96 .761
Extension knee
0-4 5-6 -3.82* .000
7-9 -5.96* .000
5-6 0-4 3.82* .000
7-9 -2.13* .003
Flexion hip
0-4 5-6 -3.22* .000
7-9 -5.55* .000
5-6 0-4 3.22* .000
7-9 -2.33 .177
Extension hip
0-4 5-6 -1.58* .045
7-9 -2.59* .031
5-6 0-4 1.58* .045
7-9 -1.00 .636
Exorotation hip
0-4 5-6 -3.78* .000
7-9 -8.55* .000
5-6 0-4 3.78* .000
7-9 -4.77* .003
Endorotation hip
0-4 5-6 -3.87* .000
7-9 -9.82* .000
5-6 0-4 3.87* .000
7-9 -5.95* .000
Upper extremity
Dorsiflexion MCP Digit 5
0-4 5-6 -9.45* .000
7-9 -14.10* .000
5-6 0-4 9.45* .000
7-9 -4.65* .029
Extension wrist
0-4 5-6 -6.55* .000
7-9 -10.12* .000
5-6 0-4 6.55* .000
7-9 -3.57* .016
Flexion wrist
0-4 5-6 -8.55* .000
7-9 -10.53* .000
5-6 0-4 8.55* .000
7-9 -1.97 .481
Flexion elbow
0-4 5-6 -1.99* .001
7-9 -3.35* .000
5-6 0-4 1.99* .001
7-9 -1.36 .293
Extension elbow
(continued )
Table V. Continued
Dependent
Variable
(I) Beighton
Band
(J) Beighton
Band
Mean
Difference
(I-J) P value
0-4 5-6 -4.23* .000
7-9 -7.26* .000
5-6 0-4 4.23* .000
7-9 -3.02* .005
Flexion shoulder
0-4 5-6 -6.88* .000
7-9 -13.11* .000
5-6 0-4 6.88* .000
7-9 -6.23* .012
Exorotation shoulder
0-4 5-6 -10.41* .000
7-9 -16.80* .000
5-6 0-4 10.41* .000
7-9 -6.39* .011
*The mean difference is significant at the .05 level.
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4 Smits-Engelsman, Klerks, and Kirby
ARTICLE IN PRESS
5. currently used standardized protocol of the Beighton score is
a valid measure for generalized hypermobility in children.
Therefore we see no advantage in adding more joints or ma-
neuvers to this scale, nor adding joint pain as part of the scale,
because it is not specific to hypermobility in children. Pain
measures a different construct, which may be more time sen-
sitive than joint mobility, and its presence as a complaint in
all children should always be explored.
Our impression that too many children are classified as hy-
permobile by use of a threshold of 5/9 was confirmed. With
the Beighton score 5/9 scoring system led to a prevalence of
35.6%, which is greater than an earlier study in which gener-
alized hypermobile joints were reported in 11.1% of the
Dutch population between the ages of 4 to 12.18
Comparison
between studies is hard to undertake because no standardized
description of the Beighton score existed, and ranges of mo-
tion were estimated, but not measured. Future studies with
this standardized protocol may help determine the best cutoff
scores, and validation of these scores for diagnostic purposes
requires scores to show both high sensitivity and specificity.
Studies are needed that explore different cutoff scores in
groups of children with JHS and typically developing chil-
dren.
On the basis of statistical grounds and in conjunction
with Jansson et al,6
a stricter cutoff score for hypermobility
should be considered. If a score between 7/9 were used to
classify hypermobility, the percentage in our study would
drop to 9%.
When comparing sides of the body, it was found that hy-
permobility was greater on the left side of the body. This also
confirms earlier results.1-3,18
Asymmetry in typically develop-
ing children was rare (5%), and 60% of the children had an
identical Beighton score for the right and left sides. For quick
screening procedures, one could rely on the left-sided
Beighton protocol. In a clinical situation it is recommended
to use the full standardized Beighton protocol.
Sex difference for cutoff points were not found in using the
Standardized Beighton Protocol in Dutch children at the age
6 to 12 years, which corroborates with findings of Rikken et
al,2
El-Garf et al,3
and van der Giessen et al,18
but contrasts
with others.5-7
The Beighton score calculated with the standardized
Beighton protocol is a valid instrument to evaluate general-
ized joint mobility in primary school–aged children. No extra
items are needed to improve the scale. In white children be-
tween 6 and 12 years of age, it is recommended that 7/9 be the
cutoff for the Beighton score. n
We thank the pediatric physiotherapists for measuring all the children
and the children for their participation.
Submitted for publication Jan 28, 2010; last revision received Jun 15, 2010;
accepted Jul 13, 2010.
Reprint requests: Bouwien Smits-Engelsman, Avans+ University for
Professionals, P.O. Box 2087, 4800 CB Breda, The Netherlands. E-mail:
bengelsman@avansplus.nl.
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bility Syndrome. Br J Rheumatol 2000;27:1777-9.
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16. Tofts LJ, Elliott EJ, Munns C, Pacey V, Silence D. The differential diag-
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6. Appendix. Standardized test positions and goniometer positioning of the Beighton score protocol.
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7. Appendix. Continued
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8. Appendix. Continued
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9. Table I. The 9-point Beighton score of hypermobility
Description Bilateral Testing
Scoring
(max. points)
Passive dorsiflexion of the fifth metacarpophalangeal joint to $ 90 degrees Yes 2
Passive hyperextension of the elbow $ 10 degrees Yes 2
Passive hyperextension of the knee $ 10 degrees Yes 2
Passive apposition of the thumb to the flexor side of the forearm, while shoulder
is flexed 90 degrees, elbow is extended, and hand is pronated
Yes 2
Forward flexion of the trunk, with the knees straight, so that the hand palms rest easily on the floor No 1
Total 9
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