Beyond pGALS: the need for a multifaceted musculoskeletal decision-making tool ('pGALSplus') in community-based clinical practice

Vicky Mercer; Nicola Smith; Sharmila Jandial; Michela Guglieri; Simon A Jones; Helen E Foster

doi:10.1093/rap/rkae004

Beyond pGALS: the need for a multifaceted musculoskeletal decision-making tool ('pGALSplus') in community-based clinical practice

Rheumatol Adv Pract. 2024 Jan 23;8(1):rkae004. doi: 10.1093/rap/rkae004. eCollection 2024.

Authors

Vicky Mercer^{1

2

3}, Nicola Smith¹, Sharmila Jandial^{4

5}, Michela Guglieri⁶, Simon A Jones⁷, Helen E Foster⁸

Affiliations

¹ Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
² Children's Physiotherapy, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK.
³ Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK.
⁴ School of Medicine, Newcastle University, Newcastle upon Tyne, UK.
⁵ Paediatric Rheumatology, Great North Children's Hospital, Newcastle upon Tyne, UK.
⁶ John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
⁷ Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester, UK.
⁸ Population Health Institute, Newcastle University, Newcastle upon Tyne, UK.

Abstract

Musculoskeletal (MSK) problems in children are common, and health-care professionals must identify those requiring onward referral. Paediatric gait, arms, legs and spine (pGALS) is an MSK assessment to discern abnormal joints. We aimed to identify MSK assessments to add to pGALS (pGALSplus) to facilitate decision-making in the context of exemplar conditions representing a spectrum of MSK presentations, namely JIA, mucopolysaccharidoses, muscular dystrophy and developmental co-ordination disorder. A literature review identified 35 relevant articles that focused on clinical assessments [including questionnaire(s), physical examination and functional tests] used by health-care professionals in the context of the exemplar conditions. We provide a description of these assessments and the rationale regarding how they, or components of such tools, might be useful within pGALSplus. This process provides a foundation for further work to develop and validate pGALSplus.

Keywords: allied health; assessment; children; decision-making; musculoskeletal; pGALS; rheumatology; triage.

Publication types

Review