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Table 1 Characteristics of Study Participants, Study Characteristics, and Risk of Bias Assessment of Included Studies

From: Joint hypermobility in athletes is associated with shoulder injuries: a systematic review and meta-analysis

Author, year
Study design Participants, n,
age, (female, %)a
Sport Exposure (tool) Outcome Risk of bias assessment (NOS)b
Azma, 2014
Iran [32]
Prospective cohort (duration 3 months) Iranian army soldiers,
n = 718,
19.6 years, (0)
Military GJH (Beighton score ≥ 4/9) Shoulder dislocation verified by orthopaedist 9/9,
Cameron, 2013
USA [35]
Prospective cohort (duration 4 years) Freshmen entering the U.S. Military Academy, n = 714 (1420 shoulders), 18.8 years, (11.8) Military Self-reported history of shoulder instability (previous shoulder dislocation or subluxation) using study-specific questions. Acute shoulder instability verified by orthopaedic surgeons 8/9,
Caplan, 2007
USA [33]
Cross-sectional Female collegiate gymnasts,
n = 457,
N/A, (100)
Elite gymnastics GJH (Hyperlaxity signs using a study-specific unvalidated questionnaire, ≥ 2/4) Traumatic shoulder injury, self-reported using a study-specific questionnaire. 5/10,
Chahal, 2010
Canada [22]
Case-control Skeletally mature individuals < 30 years performing recreational or competitive sporting activities, n = 149,
23.9 years, (26.2)
Recreational or competitive sports activities GJH (The Hospital Del Mar, ≥ 4/10 males, ≥ 5/10 females) or
Shoulder external rotation exceeding 85°.
Acute, first-time, traumatic anterior shoulder dislocation verified by orthopaedic surgeons 8/9,
Myklebust, 2013
Norway [4]
Cross-sectional Female handball players of the Norwegian elite league, n = 179,
22 years, (100)
Elite handball Anterior shoulder instability (apprehension and relocation tests) Shoulder pain using a modified Fahlström questionnaire. 6/10,
Saremi, 2016
Iran [34]
Cross-sectional Athletes having a history of sports activity for at least six months,
n = 118,
Range 17–37 years, (32.2)
Professional athletes from multiple sports GJH (Beighton score ≥ 4/9) Acute shoulder injury according to documents of local branch of national federation of sports medicine. 6/10,
  1. GJH Generalised Joint Hypermobility, NOS Newcastle - Ottawa Quality Assessment Scale with high scores representing low risk of bias. an = number of participants included in analysis, age reported as mean years unless indicated otherwise
  2. bThe risk of bias assessment is presented in Additional file 5. Thresholds for risk of bias were the following: low, 3 or 4 stars in selection domain AND 1 or 2 stars in comparability domain AND 2 or 3 stars in outcome/exposure domain; moderate, 2 stars in selection domain AND 1 or 2 stars in comparability domain AND 2 or 3 stars in outcome/exposure domain; high, 0 or 1 star in selection domain OR 0 stars in comparability domain OR 0 or 1 star in outcome/exposure domain