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

Background: 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 range of motion as it involves multiple joints and stretching of muscular structures.
Objectives: To determine the value of the item HOF to the Beighton score in children age 6-11 years.
Methods: Exploratory research was conducted on children in grades one to four 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 of ≥5/8 on the Beighton score excluding the item HOF.
Results: 460 children (median age 8.58 years [IQR 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 additional value of the item HOF of the Beighton score in children.