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Hanene LF, Amdouni N, Emna R, Hela S, Kaouther BA, Dorra BN, Dhia K, Kaouther M, Wafa H. Reliability of the tunisian pediatric gait, arms, legs, and spine: toward a valid screening tool for tunisian children with musculoskeletal conditions. Pediatr Rheumatol Online J 2023; 21:133. [PMID: 37919792 PMCID: PMC10621183 DOI: 10.1186/s12969-023-00905-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/04/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Pediatric musculoskeletal disorders account for 10% of first-line consultations in Tunisia. Referral delay and deficiencies in musculoskeletal screening raise a challenge to the early diagnosis and management of rheumatic conditions in children. The pGALS (Pediatric Gait Arms Legs Spine) was developed and translated into many languages to overcome these deficiencies. Our study aimed to adapt and validate pGALS to the Tunisian dialect for school-age children. METHODS Using the Delphi method, we carried out a cross-cultural adaptation of the pGALS to the Tunisian dialect. This consensual version was validated in a cross-sectional study, in two pediatric centers. RESULTS Ninety-two patients were enrolled, 43 females (46.7%) and 49 males (53.3%), mean age was 9.4 ± 2.6 years. The mean test duration was 3.4 ± 2.3 min, and the acceptability and comprehension of the test were good. Six patients had a musculoskeletal complaint, 19 had positive pGALS, and 14 were diagnosed with musculoskeletal disease. The internal consistency score (Cronbach's α) was 0.852. The sensitivity of the test was 92.8%, the specificity was 92.3%, the positive likelihood ratio was 2.16, and the negative likelihood ratio was 0.01. CONCLUSION The pGALS test adapted to the Tunisian dialect is a relevant, quick, and valid tool for screening musculoskeletal abnormalities in school-age children.
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Affiliation(s)
- Lassoued Ferjani Hanene
- Rheumatology department, Kassab orthopedics institute, Ksar Saïd, Tunisia.
- Faculty of Medicine of Tunis, University Tunis el Manar, Ksar Saïd, Tunisia.
- Research Unit UR17SP04, Ksar Said, Tunis, 2010, Tunisia.
| | - Narjess Amdouni
- Pediatric out clinics, Tbourba Hospital, Ksar Said, Tunis, Tunisia
| | - Rabhi Emna
- Rheumatology department, Kassab orthopedics institute, Ksar Saïd, Tunisia
| | - Sahli Hela
- Faculty of Medicine of Tunis, University Tunis el Manar, Ksar Saïd, Tunisia
- Rheumatology department, Rabta Hospital, Tunis, Tunisia
| | - Ben Abdelgheni Kaouther
- Faculty of Medicine of Tunis, University Tunis el Manar, Ksar Saïd, Tunisia
- Rheumatology department, Mongi Slim Hospital, Tunis, Tunisia
| | - Ben Nessib Dorra
- Rheumatology department, Kassab orthopedics institute, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Ksar Saïd, Tunisia
- Research Unit UR17SP04, Ksar Said, Tunis, 2010, Tunisia
| | - Kaffel Dhia
- Rheumatology department, Kassab orthopedics institute, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Ksar Saïd, Tunisia
- Research Unit UR17SP04, Ksar Said, Tunis, 2010, Tunisia
| | - Maatallah Kaouther
- Rheumatology department, Kassab orthopedics institute, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Ksar Saïd, Tunisia
- Research Unit UR17SP04, Ksar Said, Tunis, 2010, Tunisia
| | - Hamdi Wafa
- Rheumatology department, Kassab orthopedics institute, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Ksar Saïd, Tunisia
- Research Unit UR17SP04, Ksar Said, Tunis, 2010, Tunisia
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Giray E, Kenis-Coskun O, Karadag-Saygi E, Ozyemisci-Taskiran O. Interrater Reliability, Acceptability, and Practicality of Real-Time Video Pediatric Gait, Arms, Legs, and Spine for Musculoskeletal Assessment of Children During Telemedicine Visits. J Clin Rheumatol 2022; 28:235-239. [PMID: 35319535 DOI: 10.1097/rhu.0000000000001840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVE With the COVID-19 (coronavirus disease 2019) pandemic, telemedicine applications gained momentum, and clinicians tried to develop various musculoskeletal examination methods to be used in telemedicine visits. The aim of this study is to investigate the interrater reliability, acceptability, and practicality of the real-time video Pediatric Gait, Arms, Legs, and Spine (v-pGALS) assessment used in the evaluation during the telemedicine visit. METHODS The study was designed as cross-sectional. Twenty school-aged children who presented to outpatient clinics with musculoskeletal complaints were included. For interrater reliability, the children were evaluated by face-to-face examination with v-pGALS, and then the child was reevaluated by another physiatrist with real-time evaluation (online video call) with the help of a parent. For acceptability, the time taken and the discomfort caused were evaluated by patients/parents with the smiley face visual analog scale, whereas to assess practicality, the ratio of completeness to duration of examination completion was recorded. RESULTS κ coefficient of the agreement was found to be 0.88 between the results of the face-to-face examination and online video examination, suggesting very good agreement between the 2 raters. Acceptability of v-pGALS by parents and patients was high; 60% of children and 80% of parents found the duration of examination acceptable, and 70% of the patients and 95% of parents reported no discomfort caused by examination. The duration of face-to-face examination was 5.75 ± 1.29 minutes, whereas the duration of online examination was 15.81 ± 4.9 minutes. CONCLUSIONS Video pGALS is a reliable, acceptable, and practical examination system that can be used for musculoskeletal assessment of children in telemedicine visits.
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Affiliation(s)
- Esra Giray
- From the Department of Physical Medicine and Rehabilitation, University of Health Sciences, Fatih Sultan Mehmet Research and Training Hospital
| | - Ozge Kenis-Coskun
- Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine
| | - Evrim Karadag-Saygi
- Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine
| | - Ozden Ozyemisci-Taskiran
- Department of Physical Medicine and Rehabilitation, Koç University School of Medicine, Istanbul, Turkey
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Palermi S, Annarumma G, Spinelli A, Massa B, Serio A, Vecchiato M, Demeco A, Brugin E, Sirico F, Giada F, Biffi A. Acceptability and Practicality of a Quick Musculoskeletal Examination into Sports Medicine Pre-Participation Evaluation. Pediatr Rep 2022; 14:207-216. [PMID: 35645365 PMCID: PMC9149839 DOI: 10.3390/pediatric14020028] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 04/26/2022] [Accepted: 04/30/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Child musculoskeletal (MSK) diseases are common and, even if often benign, sometimes can lead to significant impairment in the future health of children. Italian pre-participation evaluation (PPE), performed by a sports medicine physician, allows for the screening of a wide range of children every year. Therefore, this study aims to evaluate the feasibility and the acceptability of pGALS (pediatric Gait, Arms, Legs and Spine) screening, a simple pediatric MSK screening examination, when performed as part of a routine PPE. METHODS Consecutive school-aged children attending a sports medicine screening program were assessed with the addition of pGALS to the routine clinical examination. Practicability (time taken) and patient acceptability (discomfort caused) were recorded. RESULTS 654 children (326 male, mean age 8.9 years) were evaluated through pGALS. The average time taken was 4.26 min (range 1.9-7.3 min). Acceptability of pGALS was deemed high: time taken was "adequate" (97% of parents) and caused little or no discomfort (94% of children). Abnormal MSK findings were common. CONCLUSIONS pGALS is a practical and acceptable tool to perform in sports medicine PPE, even if performed by a non-expert in MSK medicine. Although common, abnormal MSK findings need to be interpreted in the global clinical context and assessment.
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Affiliation(s)
- Stefano Palermi
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy; (S.P.); (G.A.); (A.S.); (B.M.); (A.S.); (F.S.)
| | - Giada Annarumma
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy; (S.P.); (G.A.); (A.S.); (B.M.); (A.S.); (F.S.)
| | - Alessandro Spinelli
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy; (S.P.); (G.A.); (A.S.); (B.M.); (A.S.); (F.S.)
| | - Bruno Massa
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy; (S.P.); (G.A.); (A.S.); (B.M.); (A.S.); (F.S.)
| | - Alessandro Serio
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy; (S.P.); (G.A.); (A.S.); (B.M.); (A.S.); (F.S.)
| | - Marco Vecchiato
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, 35100 Padova, Italy;
| | - Andrea Demeco
- Unit of Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy;
| | - Erica Brugin
- Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale Hospital, 30033 Noale, Italy; (E.B.); (F.G.)
| | - Felice Sirico
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy; (S.P.); (G.A.); (A.S.); (B.M.); (A.S.); (F.S.)
| | - Franco Giada
- Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale Hospital, 30033 Noale, Italy; (E.B.); (F.G.)
| | - Alessandro Biffi
- Med-Ex, Medicine & Exercise, Medical Partner Scuderia Ferrari, 00118 Rome, Italy
- Correspondence:
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Smith N, Foster HE, Jandial S. A mixed methods evaluation of the Paediatric Musculoskeletal Matters (PMM) online portfolio. Pediatr Rheumatol Online J 2021; 19:85. [PMID: 34108019 PMCID: PMC8188761 DOI: 10.1186/s12969-021-00567-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 05/18/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The PMM Portfolio is comprised of the Paediatric Musculoskeletal Matters (PMM) website, the paediatric Gait, Arms, Legs and Spine (pGALS) app and e-learning modules (ELM). The target audiences are non-specialists in paediatric musculoskeletal medicine. Our study aimed to evaluate impact on learning and clinical practice. METHODS Mixed methods (analytics, online survey, interviews) were used with PMM and ELM registered users and purposive sampling of users using international contacts within paediatrics and paediatric rheumatology. Data was analysed using descriptive statistics and qualitative techniques. A Paired T-Test compared self-rated confidence before and after use of the PMM Portfolio. RESULTS There has been wide reach for all the e-resources; PMM website (662,827 hits, 262,476 users, 214 countries, data 31st July 2020); pGALS app (12,670 downloads, 70 countries, data 31st July 2020); ELM (150 users, 30 countries, data 30th May 2019). There were 164 responses (students, trainees and health care professionals) to the survey from 25 countries. Most responders deemed the PMM Portfolio useful / very useful for their learning with significantly increased self-rated confidence in their clinical examination and reasoning skills following access to the PMM website, p = < 0.01, pGALS app, p = < 0.01 and ELM, p = < 0.01. The most popular PMM website pages related to clinical assessment techniques (especially pGALS). There was high uptake of the pGALS app and pGALS ELM especially from trainees and allied health professionals. Many clinicians reported the PMM Portfolio to be useful when used to teach others. User feedback reported that easy navigation, open access, clinical images and cases were the most valued features. User feedback highlighted need to increase awareness of the e-resources through training programmes. CONCLUSIONS The PMM Portfolio was developed to aid learning for clinicians who are not specialists in paediatric MSK medicine. Our evaluation demonstrates wide international reach and positive feedback on learning. The PMM Portfolio is a highly useful e-resource for paediatric rheumatologists in their teaching of others to raise awareness, facilitate early diagnosis and referral of children with suspected disease. The wide user engagement informed future PMM Portfolio development and the mixed method of evaluation is transferable to other e-resources.
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Affiliation(s)
- Nicola Smith
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - Helen E. Foster
- grid.1006.70000 0001 0462 7212Population and Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK ,grid.459561.a0000 0004 4904 7256Paediatric Rheumatology, Great North Children’s Hospital, Newcastle Upon Tyne, UK
| | - Sharmila Jandial
- grid.1006.70000 0001 0462 7212Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK ,grid.459561.a0000 0004 4904 7256Paediatric Rheumatology, Great North Children’s Hospital, Newcastle Upon Tyne, UK
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Rustad AM, Nolan BE, Ollech A, Boctor MJ, Paller AS. Incorporating joint pain screening into the pediatric dermatologic examination. Pediatr Dermatol 2021; 38:92-97. [PMID: 33275304 DOI: 10.1111/pde.14454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Joint manifestations are a feature of many pediatric skin disorders, among them psoriasis, autoimmune and autoinflammatory diseases, hypermobility disorders, and as an adverse effect of certain medications. Identifying joint disease early is important for intervention and prevention of chronic damage. However, pediatric musculoskeletal complaints are common and determining whether symptoms warrant a rheumatology referral for arthritis can be challenging. METHODS Pediatric dermatologists were surveyed for their comfort in screening for joint disease. Through literature review and interviews with three pediatric rheumatologists, key joints involved in disorders with skin manifestations and arthritis were identified and the essential evaluations were determined. RESULTS Of 100 surveyed practicing board-certified pediatric dermatologists, 79% did not feel confident in their ability to perform a joint-focused physical examination, a key step in screening for joint disease. A rapid joint examination technique (R-JET) was developed, along with an accompanying three-question survey and body diagram for patient self-report of symptoms. A video demonstration of the R-JET was created as a teaching tool. CONCLUSIONS Teaching and incorporation of a rapid screening examination for arthritis by pediatric dermatologists has the potential to identify pediatric arthritis earlier, facilitate referral, and reduce the risk of progressive joint disease. These instruments can easily be incorporated into a pediatric dermatology office visit.
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Affiliation(s)
- Andrea M Rustad
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brian E Nolan
- Departments of Pediatrics/Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ayelet Ollech
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Departments of Pediatrics/Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael J Boctor
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Departments of Pediatrics/Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Shenoi S, Hayward K, Curran ML, Kessler E, Mehta JJ, Riebschleger MP, Foster HE. Telemedicine in pediatric rheumatology: this is the time for the community to embrace a new way of clinical practice. Pediatr Rheumatol Online J 2020; 18:85. [PMID: 33129319 PMCID: PMC7602754 DOI: 10.1186/s12969-020-00476-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/06/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The use of telemedicine in pediatric rheumatology has been historically low. The current COVID 19 global pandemic has forced a paradigm shift with many centers rapidly adopting virtual visits to conduct care resulting in rapid expansion of use of telemedicine amongst practices. BODY: This commentary discusses practical tips for physicians including guidance around administrative and governance issues, preparation for telemedicine, involving the multidisciplinary care team, and teaching considerations. We also outline a standard proforma and smart phrases for the electronic health record. A proposed variation of the validated pediatric gait arms legs spine examination (pGALS) called the video pGALS (VpGALS) as a means of conducting virtual pediatric rheumatology physical examination is presented. CONCLUSION This commentary provides a starting framework for telemedicine use in pediatric rheumatology and further work on validation and acceptability is needed.
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Affiliation(s)
- Susan Shenoi
- Department of Pediatrics, Division of Rheumatology, Seattle Children's Hospital and Research Center, University of WA, MA.7.110 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Kristen Hayward
- Department of Pediatrics, Division of Rheumatology, Seattle Children’s Hospital and Research Center, University of WA, MA.7.110 4800 Sand Point Way NE, Seattle, WA 98105 USA
| | - Megan L. Curran
- grid.430503.10000 0001 0703 675XDepartment of Pediatrics, Section of Rheumatology, University of Colorado, 13123 E. 16th Ave, B311, Aurora, CO 80045 USA
| | - Elizabeth Kessler
- grid.413656.30000 0004 0450 6121Department of Pediatrics, Section of Rheumatology, Helen DeVos Children’s Hospital, Grand Rapids, MI. 35 Michigan St NE, Grand Rapids, MI 49503 USA
| | - Jay J. Mehta
- grid.239552.a0000 0001 0680 8770Division of Rheumatology, Children’s Hospital of Philadelphia, 3501 Civic Center Blvd, Philadelphia CTRB 10109, Philadelphia, PA 19104 USA
| | - Meredith P. Riebschleger
- grid.214458.e0000000086837370Department of Pediatrics, Division of Rheumatology, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI 48109 USA
| | - Helen E. Foster
- grid.1006.70000 0001 0462 7212Professor Pediatric Rheumatology, Population Health Sciences Institute, Newcastle University, The Medical School, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
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A global perspective on the challenges and opportunities in learning about rheumatic and musculoskeletal diseases in undergraduate medical education. Clin Rheumatol 2019; 39:627-642. [DOI: 10.1007/s10067-019-04544-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 04/01/2019] [Indexed: 10/26/2022]
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Foster HE, Vojinovic J, Constantin T, Martini A, Dolezalova P, Uziel Y, Smith E, Lamot L, Wouters C, Avcin T, Wulffraat N. Educational initiatives and training for paediatric rheumatology in Europe. Pediatr Rheumatol Online J 2018; 16:77. [PMID: 30526605 PMCID: PMC6286498 DOI: 10.1186/s12969-018-0289-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/30/2018] [Indexed: 01/08/2023] Open
Abstract
The Paediatric Rheumatology European Society (PReS) has over many years, developed a portfolio of educational activities to address increasing educational needs of workforce and support young clinicians to acquire skills to develop new knowledge and deliver clinical care in the future. These educational activities aim to facilitate growth of paediatric rheumatology and ultimately improve the clinical care for children and families. This article describes the current portfolio of PReS educational activities and their relevance to the international paediatric rheumatology community.
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Affiliation(s)
- Helen E. Foster
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Paediatric Rheumatology, Great North Children’s Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jelena Vojinovic
- Faculty of Medicine, Department Pediatric Rheumatology, University of Nis, Nis, Serbia
| | - Tamas Constantin
- 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | | | - Pavla Dolezalova
- Paediatric Rheumatology and Autoinflammatory Diseases Centre, Department of Paediatrics and Adolescent Medicine, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Yosef Uziel
- Department of Pediatrics, Meir medical center, Tel Aviv University Sackler School of Medicine, Kfar-Saba, Israel
| | - E.M.D Smith
- Department of Women’s & Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Lovro Lamot
- Department of Pediatrics, University of Zagreb School of Medicine, Zagreb, Croatia
- Division of Clinical Immunology and Rheumatology, Department of Pediatrics, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Carine Wouters
- University of Leuven, Department of Microbiology and Immunology, Laboratory Immunobiology, Leuven, Belgium
- University Hospitals Leuven, Pediatric Rheumatology, Leuven, Belgium
| | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children’s Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Nico Wulffraat
- Department of Paediatrics, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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Relationship between obesity and musculoskeletal system findings among children and adolescents. Turk J Phys Med Rehabil 2017; 63:207-214. [PMID: 31453456 DOI: 10.5606/tftrd.2017.422] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 10/03/2016] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to demonstrate the relationship between obesity and musculoskeletal system examination findings and functionality among 5-16 years old population-based sample. Patients and methods This is a cross-sectional field study. Sample of this study was selected from 4,246 participants of a study, which assessed the prevalence of obesity among school children aged between 6-15 in Pendik, Istanbul, in 2013-2014 school year. Physical examination included inspection, gait, balance, muscle strength and range of motion (ROM) assessment. Turkish version of Pediatric Outcomes Data Collection Instrument (PODCI) was used. Physical examination findings and PODCI scores of "normal weight" and "overweight/obese" groups were compared. Correlation between body mass index (BMI), ROM and PODCI subscale scores were also evaluated. Results A total of 318 children were included in the study. 39.3% (n=125) were normal weight, 61.7% (n=193) were overweight/obese. Pes planus was the most common musculoskeletal problem with a rate of 23.9%. We found that pes planus was more common (p=0.000), standing time on one leg was shorter (p=0.002), time to complete timed up and go test (TUG) was longer (p=0.004) and "happiness" subscale scores of PODCI were lower (p=0.000) in overweight/obese children compared to their normal weight peers. Range of motion values were decreased, especially on the lower limbs, in overweight/obese children (p<0.05) compared to normal weight children. Body mass index values showed a negative correlation with ROM and PODCI "happiness" subscale scores (p<0.05). Conclusion Musculoskeletal problems are more common in overweight/obese children than in their normal weight peers. Increase in BMI correlates with decrease in balance, emotional functionality and ROM values. It may be possible to protect overweight/obese children from serious musculoskeletal disorders by interventions that reduce BMI.
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Baker KF, Jandial S, Thompson B, Walker D, Taylor K, Foster HE. Use of structured musculoskeletal examination routines in undergraduate medical education and postgraduate clinical practice - a UK survey. BMC MEDICAL EDUCATION 2016; 16:277. [PMID: 27765034 PMCID: PMC5073898 DOI: 10.1186/s12909-016-0799-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 10/11/2016] [Indexed: 05/07/2023]
Abstract
BACKGROUND Structured examination routines have been developed as educational resources for musculoskeletal clinical skills teaching, including Gait-Arms-Legs-Spine (GALS), Regional Examination of the Musculoskeletal System (REMS) and paediatric GALS (pGALS). In this study, we aimed to assess the awareness and use of these examination routines in undergraduate medical teaching in UK medical schools and UK postgraduate clinical practice. METHODS Electronic questionnaires were distributed to adult and paediatric musculoskeletal teaching leads at UK medical schools and current UK doctors in training. RESULTS Responses were received from 67 tutors representing teaching at 22/33 [67 %] of all UK medical schools, and 70 trainee doctors across a range of postgraduate training specialities. There was widespread adoption, at responding medical schools, of the adult examination routines within musculoskeletal teaching (GALS: 14/16 [88 %]; REMS: 12/16 [75 %]) and assessment (GALS: 13/16 [81 %]; REMS: 12/16 [75 %]). More trainees were aware of GALS (64/70 [91 %]) than REMS (14/67 [21 %]). Of the 39 trainees who used GALS in their clinical practice, 35/39 [90 %] reported that it had improved their confidence in musculoskeletal examination. Of the 17/22 responding medical schools that included paediatric musculoskeletal examination within their curricula, 15/17 [88 %] used the pGALS approach and this was included within student assessment at 4 medical schools. CONCLUSIONS We demonstrate the widespread adoption of these examination routines in undergraduate education and significant uptake in postgraduate clinical practice. Further study is required to understand their impact upon clinical performance.
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Affiliation(s)
- Kenneth F Baker
- Musculoskeletal Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, NE2 4HH, Newcastle upon Tyne, UK.
| | - Sharmila Jandial
- Musculoskeletal Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, NE2 4HH, Newcastle upon Tyne, UK
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ben Thompson
- Musculoskeletal Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, NE2 4HH, Newcastle upon Tyne, UK
| | - David Walker
- Musculoskeletal Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, NE2 4HH, Newcastle upon Tyne, UK
| | - Ken Taylor
- Policy, Ethics and Life Sciences Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Helen E Foster
- Musculoskeletal Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, NE2 4HH, Newcastle upon Tyne, UK
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Abstract
It is not uncommon in pediatric clinical practice to encounter children with musculoskeletal symptoms. A number of disparate conditions can present with joint complaints in children. In this article, the author describes the clinical approach to a child presenting with joint complaints. A detailed clinical history, including the family history, along with a complete physical examination can provide vital clues to the underlying condition in most cases. A structured screening examination of the musculoskeletal system that has been recently developed (i.e., pGALS) is also discussed. It is also pointed out that the pattern of joint involvement gives us one of the most important clues to the etiology of arthritis. The pediatrician has to be aware of the conditions that can have arthritis as one of the manifestations so as to investigate and treat the child accordingly.
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Smith N, Rapley T, Jandial S, English C, Davies B, Wyllie R, Foster HE. Paediatric musculoskeletal matters (pmm)--collaborative development of an online evidence based interactive learning tool and information resource for education in paediatric musculoskeletal medicine. Pediatr Rheumatol Online J 2016; 14:1. [PMID: 26728031 PMCID: PMC4700751 DOI: 10.1186/s12969-015-0062-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 12/21/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We describe the collaborative development of an evidence based, free online resource namely 'paediatric musculoskeletal matters' (pmm). This resource was developed with the aim of reaching a wide range of health professionals to increase awareness, knowledge and skills within paediatric musculoskeletal medicine, thereby facilitating early diagnosis and referral to specialist care. METHODS Engagement with stakeholder groups (primary care, paediatrics, musculoskeletal specialties and medical students) informed the essential 'core' learning outcomes to derive content of pmm. Representatives from stakeholder groups, social science and web development experts transformed the learning outcomes into a suitable framework. Target audience representatives reviewed the framework and their opinion was gathered using an online survey (n = 74) and focus groups (n = 2). Experts in paediatric musculoskeletal medicine peer reviewed the content and design. RESULTS User preferences informed design with mobile, tablet and web compatible versions to facilitate access, various media and formats to engage users and the content presented in module format (i.e. Clinical assessment, Investigations and management, Limping child, Joint pain by site, Swollen joint(s) and Resources). CONCLUSIONS We propose that our collaborative and evidence-based approach has ensured that pmm is user-friendly, with readily accessible, suitable content, and will help to improve access to paediatric musculoskeletal medicine education. The content is evidence-based with the design and functionality of pmm to facilitate optimal and 'real life' access to information. pmm is targeted at medical students and the primary care environment although messages are transferable to all health care professionals involved in the care of children and young people.
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Affiliation(s)
- Nicola Smith
- Paediatric Rheumatology, Musculoskeletal Research Group, Institute Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK.
| | - Tim Rapley
- Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK.
| | - Sharmila Jandial
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK.
| | - Christine English
- Department of Public Health and Wellbeing, Northumbria University, Newcastle Upon Tyne, UK.
| | - Barbara Davies
- Department of Public Health and Wellbeing, Northumbria University, Newcastle Upon Tyne, UK.
| | - Ruth Wyllie
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK.
| | - Helen E Foster
- Paediatric Rheumatology, Musculoskeletal Research Group, Institute Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK.
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK.
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Jandial S, Stewart J, Foster HE. What do they need to know: achieving consensus on paediatric musculoskeletal content for medical students. BMC MEDICAL EDUCATION 2015; 15:171. [PMID: 26449878 PMCID: PMC4599324 DOI: 10.1186/s12909-015-0449-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 09/22/2015] [Indexed: 06/02/2023]
Abstract
BACKGROUND Children present commonly with musculoskeletal (MSK) problems, due to a spectrum of causes including potentially life threatening disease, to doctors in varied health care settings. However, doctors involved in the care of children report a lack of confidence in their paediatric musculoskeletal (pMSK) clinical skills and many have little exposure to pMSK teaching. There is no current guidance on the pMSK clinical skills and knowledge required for medical students. The objective of this study was to achieve consensus amongst experts on the learning outcomes for a pMSK curriculum for medical students. METHODS This was a two-phase study. In Phase one, pMSK educational topics and categories were identified from UK medical students and experts (recruited from pMSK medicine, child health, education and primary care) utilising focus groups and interviews. These themes and concepts informed the structure of learning outcomes that were presented to a Delphi panel in Phase two, with the aim of achieving consensus on the final content of the curriculum. RESULTS In Phase 1 participants identified pMSK skills, knowledge and attitudes relevant for medical students. This content was translated into learning outcomes. In Phase 2, the proposed outcomes were submitted to scrutiny by a two-iteration Delphi process with experts in the field. The agreed learning outcomes (n = 45) were either generic to child health or specific to pMSK medicine, and related to history taking and examination, knowledge about normal development, key clinical presentation and conditions, approaches to investigation and referral pathways. DISCUSSION This study has identified evidence and consensu based content for a pMSK curriculum for medical students, derived from key stakeholders and to be integrated into medical student pMSK teaching. CONCLUSION It is envisaged that implementation of this content will equip graduating doctors with relevant and important skills and knowledge to assess children with MSK presentations, and facilitate early diagnosis and referral to specialist care.
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Affiliation(s)
- Sharmila Jandial
- Department of Paediatric Rheumatology, Great North Children's Hospital, Newcastle, UK.
| | - Jane Stewart
- School of Medical Education, Newcastle University, Newcastle, UK.
| | - Helen E Foster
- Institute of Cellular Medicine, Newcastle University, Newcastle, UK.
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de Inocencio J, Carro MÁ, Flores M, Carpio C, Mesa S, Marín M. Epidemiology of musculoskeletal pain in a pediatric emergency department. Rheumatol Int 2015; 36:83-9. [PMID: 26259985 DOI: 10.1007/s00296-015-3335-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 07/30/2015] [Indexed: 12/28/2022]
Abstract
The objectives of this study were (1) to determine the percentage of emergency department (ED) visits due to musculoskeletal pain (MSP) by children 3-14 years of age during a period of 1 year; (2) to determine the most frequent presenting complaints; and (3) to characterize their etiology. A cross-sectional study was performed on children aged 3-14(11/12) years attended at the ED of a tertiary hospital due to MSP. The demographic and clinical characteristics of the patients were reviewed 5 days each month for 12 consecutive months. Study days were selected by computer-generated simple random sampling. Out of 4,531 visits to the ED, 826 were due to MSP (18.2 %; 95 % CI 17.1-19.4 %). When compared with children with no skeletal complaints, children with MSP had a similar sex distribution but were older (mean ± SD 7 ± 3.5 years vs 9.9 ± 3.1 years; p < 0.0001). The most common complaints were pain at the wrist (19 %), ankle (19 %) and finger (15 %). The most common etiology was trauma (88.4 %), including contusions (38 %), fractures (21 %) and sprains (18 %). Children with hip (6.7 ± 3 years; p < 0.0001) and elbow (7.8 ± 3.5 years; p < 0.0001) complaints were younger than children with pain in other locations, whereas children with wrist pain (10.5 ± 2.6 years; p < 0.002) and joint sprains (10.7 ± 2.7 years; p < 0.0001) were older. Fractures were more frequent in boys (64 vs 36 %, p = 0.008; OR 1.6; CI 1.1-2.2). Visits to the ED due to MSP increased with age. Pain at three locations represented 50 % of the presenting complaints. Trauma was the principal etiology, but fractures only represented one-fifth of the total.
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Affiliation(s)
- Jaime de Inocencio
- Pediatric Rheumatology Unit, Hospital Universitario 12 de Octubre and Universidad Complutense de Madrid, Avda/Córdoba s/n, 28041, Madrid, Spain.
| | - Miguel Ángel Carro
- Emergency Department, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Marta Flores
- Emergency Department, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carmen Carpio
- Emergency Department, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Sofía Mesa
- Emergency Department, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Milagros Marín
- Emergency Department, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
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Abstract
Joint pains are a common reason for children to present to primary care. The differential diagnosis is large including some diseases that do not primarily affect the musculoskeletal system. Although the cause for many patients will be benign and self-resolving, in rare cases the diagnosis is associated with long-term morbidity and mortality if not detected early and appropriately treated. These include primary and secondary malignancies, septic arthritis, osteomyelitis, inflammatory arthritis, slipped upper femoral epiphysis (SUFE) and non-accidental injury. We highlight the importance of a thorough history and directed yet comprehensive examination. A diagnostic algorithm is provided to direct primary care physicians' clinical assessment and investigation with the evidence base where available. In many cases, tests are not required, but if there is suspicion of malignancy, infection or inflammatory conditions, laboratory tests including full blood count, blood film, erythrocyte sedimentation rate, C-reactive protein and lactate dehydrogenase help to support or exclude the diagnosis. Autoimmune tests, such as antinuclear antibodies and rheumatoid factor, have no diagnostic role in juvenile idiopathic arthritis; therefore, we advise against any form of 'rheumatological/autoimmune disease screen' in primary care. Imaging does have a place in the diagnosis of joint pains in children, with plain radiographs being most appropriate for suspected fractures and SUFE, whilst ultrasound is better for the detection of inflammatory or infective effusions. The appropriate referral of children to paediatric rheumatologists, oncologists, orthopaedic surgeons and the emergency department are discussed.
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Affiliation(s)
- E S Sen
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK; School of Clinical Sciences, University of Bristol, Bristol, UK
| | - S L N Clarke
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK; School of Clinical Sciences, University of Bristol, Bristol, UK
| | - A V Ramanan
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK.
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Chan MO, Sen ES, Hardy E, Hensman P, Wraith E, Jones S, Rapley T, Foster HE. Assessment of musculoskeletal abnormalities in children with mucopolysaccharidoses using pGALS. Pediatr Rheumatol Online J 2014; 12:32. [PMID: 25110468 PMCID: PMC4126068 DOI: 10.1186/1546-0096-12-32] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 07/27/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children with mucopolysaccharidoses (MPS) often have musculoskeletal (MSK) abnormalities. Paediatric Gait, Arms, Legs, and Spine (pGALS), is a simple MSK assessment validated in school-age children to detect abnormal joints. We aimed to identify MSK abnormalities in children with MPS performing pGALS. METHODS Videos of children with a spectrum of MPS performing pGALS were analysed. A piloted proforma to record abnormalities for each pGALS manoeuvre observed in the videos (scored as normal/abnormal/not assessable) was used by three observers blinded to MPS subtype. Videos were scored independently and rescored for intra- and inter-observer consistency. Data were pooled and analysed. RESULTS Eighteen videos of children [12 boys, 6 girls, median age 11 years (4-19)] with MPS (13 type I [5 Hurler, 8 attenuated type I]; 4 type II; 1 mannosidosis) were assessed. The most common abnormalities detected using pGALS were restrictions of the shoulder, elbow, wrist, jaw (>75% cases), and fingers (2/3 cases). Mean intra-observer Κ 0.74 (range 0.65-0.88) and inter-observer Κ 0.62 (range 0.51-0.77). Hip manoeuvres were not clearly demonstrated in the videos. CONCLUSIONS In this observational study, pGALS identifies MSK abnormalities in children with MPS. Restricted joint movement (especially upper limb) was a consistent finding. Future work includes pGALS assessment of the hip and testing pGALS in further children with attenuated MPS type I. The use of pGALS and awareness of patterns of joint involvement may be a useful adjunct to facilitate earlier recognition of these rare conditions and ultimately access to specialist care.
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Affiliation(s)
- Mercedes O Chan
- Paediatric Rheumatology, Institute of Cellular Medicine, The Medical School, Framlington Place, Newcastle University, Newcastle upon Tyne NE2 4HH, UK,Division of Paediatric Rheumatology, Department of Paediatrics, BC Children's Hospital and the University of British Columbia, K4-119 Ambulatory Care Building, 4480 Oak Street, Vancouver BC V6H 3V4, Canada
| | - Ethan S Sen
- Paediatric Rheumatology, Great North Children’s Hospital, Royal Victoria Infirmary, Newcastle upon Tyne NHS Hospitals Foundation Trust, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK
| | - Elizabeth Hardy
- Paediatric Rheumatology, Great North Children’s Hospital, Royal Victoria Infirmary, Newcastle upon Tyne NHS Hospitals Foundation Trust, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK
| | - Pauline Hensman
- Willink Biochemicals Genetics Unit, Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK
| | - Edmond Wraith
- Willink Biochemicals Genetics Unit, Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK
| | - Simon Jones
- Willink Biochemicals Genetics Unit, Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK
| | - Tim Rapley
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK
| | - Helen E Foster
- Paediatric Rheumatology, Institute of Cellular Medicine, The Medical School, Framlington Place, Newcastle University, Newcastle upon Tyne NE2 4HH, UK,Paediatric Rheumatology, Great North Children’s Hospital, Royal Victoria Infirmary, Newcastle upon Tyne NHS Hospitals Foundation Trust, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK
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Foster HE, Jandial S. pGALS - paediatric Gait Arms Legs and Spine: a simple examination of the musculoskeletal system. Pediatr Rheumatol Online J 2013; 11:44. [PMID: 24219838 PMCID: PMC4176130 DOI: 10.1186/1546-0096-11-44] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 10/25/2013] [Indexed: 11/10/2022] Open
Abstract
We describe pGALS (paediatric Gait, Arms, Legs and Spine) - a simple quick musculoskeletal assessment to distinguish abnormal from normal joints in children and young people. The use of pGALS is aimed at the non-specialist in paediatric musculoskeletal medicine as a basic clinical skill to be used in conjunction with essential knowledge about red flags, normal development and awareness of patterns of musculoskeletal pathologies. pGALS has been validated in school-aged children and also in the context of acute general paediatrics to detect abnormal joints. We propose that pGALS is an important part of basic clinical skills to be acquired by all doctors who may be involved in the care of children. The learning of pGALS along with basic knowledge is a useful way to increase awareness of joint disease, facilitate early recognition of joint problems and prompt referral to specialist teams to optimise clinical outcomes. We have compiled this article as a resource that can be used by the paediatric rheumatology community to facilitate teaching.
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Affiliation(s)
- Helen E Foster
- Musculoskeletal Research Group, Newcastle University, Newcastle upon Tyne and Great North Children's Hospital, Newcastle upon Tyne, UK.
| | - Sharmila Jandial
- Musculoskeletal Research Group, Newcastle University, Newcastle upon Tyne and Great North Children’s Hospital, Newcastle upon Tyne, UK
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