{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:27:59Z","timestamp":1792787279754,"version":"4.5.0"},"reference-count":42,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T00:00:00Z","timestamp":1708387200000},"content-version":"unspecified","delay-in-days":19,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100014013","name":"UK Research and Innovation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014013","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"name":"MQ","award":["17\/19"],"award-info":[{"award-number":["17\/19"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2023,12,7]]},"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study sought to explore whether generalised joint hypermobility (GJH, a common marker of variant connective tissue) was a risk factor for self-reported non-recovery from COVID-19 infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Prospective observational study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>\n                      COVID Symptom Study Biobank (\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/cssbiobank.com\/\">https:\/\/cssbiobank.com\/<\/jats:ext-link>\n                      ) UK\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Participants were surveyed in August 2022. 3064 (81.4%) reported at least one infection with COVID-19. These individuals self-reported on recovery and completed a self-report questionnaire to detect GJH (Hakim and Grahame 5-part questionnaire, 5PQ).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was the presence of self-reported non-recovery from COVID-19 infection at the time of the survey. Additional outcomes included scores on 5PQ and self-reported fatigue level (Chalder Fatigue Scale).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The presence of GJH was not specifically associated with reported COVID-19 infection risk per se. However, it was significantly associated with non-recovery from COVID-19 (OR 1.43 (95% CI 1.20 to 1.70)). This association remained after sequential models adjusting for age, sex, ethnic group, education level and index of multiple deprivation (OR 1.33 (95% CI 1.10 to 1.61)) and further adjustment for vaccination status and number of vaccinations (OR 1.33 (95% CI 1.10 to 1.60)). Additionally, including in a model adjusting for all covariates, hypermobility significantly predicted higher fatigue levels (B=0.95, SE=0.25, t=3.77, SE, p=0.002). Fatigue levels mediated the link between GJH and non-recovery from COVID-19 (estimate of indirect effect=0.18, 95% bootstrapped CI 0.08 to 0.29).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Individuals with GJH were approximately 30% more likely not to have recovered fully from COVID-19 infection at the time of the questionnaire, and this predicted the fatigue level. This observation is clinically important through its potential impact for understanding and identifying sub-phenotypes of long COVID for screening and personalised targeted interventions. More generally, greater awareness of GJH and its extra-articular associations is needed for effective patient stratification and implementation of personalised medicine.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2023-000478","type":"journal-article","created":{"date-parts":[[2024,3,19]],"date-time":"2024-03-19T20:19:27Z","timestamp":1710879567000},"page":"e000478","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":19,"title":["Is joint hypermobility linked to self-reported non-recovery from COVID-19? Case\u2013control evidence from the British COVID Symptom Study Biobank"],"prefix":"10.1136","volume":"2","author":[{"given":"Jessica A","family":"Eccles","sequence":"first","affiliation":[{"name":"Department of Clinical Neuroscience, Brighton and Sussex Medical School, Brighton, UK"},{"name":"Neurodevelopmental Service, Sussex Partnership NHS Foundation Trust, Worthing, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorina","family":"Cadar","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Brighton and Sussex Medical School, Brighton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5896-916X","authenticated-orcid":false,"given":"Lisa","family":"Quadt","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Brighton and Sussex Medical School, Brighton, UK"},{"name":"Neurodevelopmental Service, Sussex Partnership NHS Foundation Trust, Worthing, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan J","family":"Hakim","sequence":"additional","affiliation":[{"name":"Division of Medicine, School of Medicine, Penn State University, University Park, Pennsylvania, USA"},{"name":"Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Gall","sequence":"additional","affiliation":[{"name":"Department of Neurocardiology, King\u2019s College Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Covid Symptom Survey Biobank Consortium","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicky","family":"Bowyer","sequence":"additional","affiliation":[{"name":"Department of Twin Research and Genetic Epidemiology, King's College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"Cheetham","sequence":"additional","affiliation":[{"name":"Department of Twin Research and Genetic Epidemiology, King's College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire J","family":"Steves","sequence":"additional","affiliation":[{"name":"Department of Twin Research and Genetic Epidemiology, King's College London, London, UK"},{"name":"Department of Ageing and Health, Guys and St Thomas\u2019s NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugo D","family":"Critchley","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Brighton and Sussex Medical School, Brighton, UK"},{"name":"Neurodevelopmental Service, Sussex Partnership NHS Foundation Trust, Worthing, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin A","family":"Davies","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,3,19]]},"reference":[{"key":"2025083109513106000_2.1.e000478.1","doi-asserted-by":"publisher","DOI":"10.1038\/s41579-022-00846-2"},{"key":"2025083109513106000_2.1.e000478.2","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1016\/S2213-2600(22)00135-7","article-title":"Long COVID: aiming for a consensus","volume":"10","author":"Munblit","year":"2022","journal-title":"Lancet Respir Med"},{"key":"2025083109513106000_2.1.e000478.3","unstructured":"Office for National Statistics (ONS) . 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