Tools

Five-part questionnaire for hypermobility (5PQ)

Five yes/no questions that pick up hypermobility, including hypermobility you used to have

The five-part questionnaire was published by Alan Hakim and Rodney Grahame in 2003 as a quick way to identify generalised joint hypermobility without a physical examination. It asks five yes/no questions, and two or more "yes" answers is a positive screen. In the original study of 212 hypermobile women attending London clinics and 57 healthy volunteers it had a sensitivity of 84% and a specificity of 89%; a second clinic group gave 84% and 80%.

Its particular value is the phrase "or could you ever". The Beighton score measures joint range today, and joints stiffen with age, injury, and surgery. Someone who was markedly hypermobile at 20 can fail the Beighton cut-off at 45. The 5PQ captures that history, which is why the 2017 hEDS criteria use it: if your Beighton score is exactly one point below the Beighton cut-off for your group, a positive 5PQ makes up the difference for Criterion 1.

It takes under a minute. If you screen positive, the next steps are the Beighton score for today's joint range and, if hEDS is a question, the 2017 hEDS criteria checker, which uses both.

This is not a diagnostic tool. A positive screen suggests generalised joint hypermobility is likely; it does not diagnose hypermobile EDS, a hypermobility spectrum disorder, or anything else. The original studies were in women attending hypermobility clinics, and later studies outside clinics found lower specificity (75% in Swedish adults, 62% in pregnant women), so false positives are common. It has not been validated in children. Discuss your result with your doctor. Based on: Hakim AJ, Grahame R. A simple questionnaire to detect hypermobility: an adjunct to the assessment of patients with diffuse musculoskeletal pain. Int J Clin Pract. 2003;57(3):163–166.

Answer each question yes or no. "Could you ever" means at any point in your life, not just now.

1. Can you now (or could you ever) place your hands flat on the floor without bending your knees?

2. Can you now (or could you ever) bend your thumb to touch your forearm?

3. As a child, did you amuse your friends by contorting your body into strange shapes, or could you do the splits?

4. As a child or teenager, did your shoulder or kneecap dislocate on more than one occasion?

5. Do you consider yourself “double-jointed”?

Understanding your 5PQ score

What the score measures

The five-part questionnaire (5PQ) is a five-question yes/no screen for generalised joint hypermobility, published by Hakim and Grahame in 2003. Two or more "yes" answers is a positive screen. Two questions ask what you can do now or could ever do, and two ask about childhood, so it can pick up hypermobility that has faded with age or injury.

The score is the number of "yes" answers, with five questions chosen from a longer set (Hakim and Grahame 2003).

Score bands

There are two bands: 0 or 1 "yes" is a negative screen, and 2 to 5 is positive. A higher count has no separate meaning.

In the original study, two or more "yes" answers picked up 84% of hypermobile women attending London clinics (sensitivity) and correctly gave a negative result to 89% of healthy volunteers (specificity); a second clinic group gave 84% and 80%. Outside clinics it gives more false positives: specificity was 75% in Swedish adults and 62% in pregnant women, while sensitivity stayed at 84% or more.

How often two or more "yes" answers agreed with a hypermobility assessment
GroupSensitivitySpecificitySource
Hypermobile women at London clinics (212) and healthy volunteers (57)84%89%Hakim and Grahame 2003
Second clinic group: 170 patients and 50 controls84%80%Hakim and Grahame 2003
Swedish adults outside clinics (284)91%75%Glans et al. 2020
Swedish women in early pregnancy (301)84%62%Schlager et al. 2020

So a negative screen is fairly reassuring, while a positive one is a prompt for a check, not a finding.

Under the 2017 criteria for hypermobile Ehlers-Danlos syndrome, the 5PQ only counts when your Beighton score is exactly one point below the Beighton cut-off for your group (6 or more for pre-pubertal children and adolescents, 5 or more from puberty to age 50, 4 or more over 50). In that case two or more "yes" answers allow generalised joint hypermobility to be recorded. It does not replace the Beighton score when the score is further below.

What a change in score means

No minimal important change exists. Most questions are about your history, so answers should rarely change, and a different result usually means a question was read differently. Swedish students who answered twice gave highly repeatable totals (Glans et al. 2020).

What it does not measure

No. It is a screening questionnaire. A positive result means generalised joint hypermobility is likely enough to be worth checking with the Beighton score and a clinical examination. On its own it says nothing about hypermobile EDS or a hypermobility spectrum disorder, which need further criteria and the exclusion of other conditions.

It does not measure pain, how much hypermobility affects you, or your current joint range. The questionnaire has not been validated in children (Malfait et al. 2017). For today's range, use the Beighton score.

Taking this to your GP or consultant

Bring the count, the date, which questions you answered "yes" and your Beighton score if you have one. Describe the 5PQ as a published five-question screen for hypermobility, including past hypermobility. It can support a request for a hypermobility examination; it cannot diagnose anything. The hEDS criteria checklist applies both scores together. See also preparing for a GP appointment.

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