What Is the 5PQ for hEDS and How Is It Scored in Practice?

The 5-part hypermobility questionnaire (often called the 5PQ or Hakim-Grahame questionnaire) is a short screening tool used by doctors to assess a person’s history of joint hypermobility ^[1]. It consists of five simple questions about past and present flexibility and joint issues. A score of 2 or more “yes” answers is considered a positive result, which suggests that the person has a history of historical generalized joint hypermobility (meaning they had widespread joint flexibility in the past, even if their joints have since stiffened) ^[2][3].

While it is a key tool in evaluating hypermobile Ehlers-Danlos Syndrome (hEDS), a positive result on this questionnaire does not diagnose hEDS on its own, nor does a negative result completely rule it out ^[4][5]. Because hEDS currently has no single confirmatory genetic test, doctors rely on clinical evaluations like this questionnaire to help build a complete picture of your health.

The Five Questions

The questionnaire asks patients to answer “yes” or “no” to the following five questions ^[1]. (Note: Do not push a joint farther than is comfortable or try to recreate painful movements just to test yourself. You can report a past ability without demonstrating it 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”?

How It Is Scored and Used in hEDS

The 5PQ is scored by counting the number of “yes” answers. A total of 2 or more positive answers is considered a positive screening result for historical generalized joint hypermobility ^[2].

This questionnaire plays a very specific role in the 2017 diagnostic criteria for hEDS ^[4]. Doctors primarily use a physical exam called the Beighton score to evaluate current joint flexibility. The Beighton score is a 9-point system that tests specific joints (fingers, thumbs, elbows, knees, and the ability to put your palms on the floor) against age- and sex-specific cutoffs ^[4].

Because joints often stiffen with age, pain, or injury, a patient’s current flexibility might not reflect their lifetime hypermobility. If a patient’s current Beighton score is exactly one point below their required cutoff, two or more positive answers on the 5PQ can be used to support a finding of generalized joint hypermobility ^[4]. The 5PQ is not added to your Beighton score; rather, it is a supplementary (adjunct) tool.

A full hEDS diagnosis requires meeting three main criteria:

1. Generalized joint hypermobility (using the Beighton score and 5PQ).
2. At least two of the following three features: systemic (whole-body) manifestations like unusual skin features or structural issues, a qualifying first-degree family history, and/or specific musculoskeletal complications ^[6].
3. Exclusion of alternative diagnoses and other connective tissue disorders ^[7].

If you do not meet the full criteria for hEDS, your doctor may diagnose you with Hypermobility Spectrum Disorder (HSD), which can cause similar symptoms and requires similar management.

Limitations and Clinical Considerations

Because the 5PQ relies partly on a person’s memory of their childhood and teenage years, it is subject to recall limitations ^[3][2]. Some people may not accurately remember what they could do as a child, or may have normalized their joint issues.

Studies show that a negative result may make historical generalized joint hypermobility less likely, but the 5PQ can sometimes produce a false-positive (indicating a history of hypermobility when there wasn’t one) ^[2]. A systematic review found that the questionnaire’s reliability (consistency of results) and validity (accuracy) can vary depending on the population being tested ^[8]. Therefore, doctors cannot rely on the questionnaire alone. The 5PQ must always be combined with a hands-on physical exam and a detailed clinical history to get an accurate picture of a patient’s joint health ^[2][8].