Clinical Rheumatology

, Volume 31, Issue 4, pp 647–653 | Cite as

Acceptability and practicality of pGALS in screening for rheumatic disease in Malawian children

  • Eve SmithEmail author
  • Elizabeth Molyneux
  • Geert Tom Heikens
  • Helen Foster
Original Article


The pGALS (paediatric Gait, Arms, Legs, Spine) Musculoskeletal (MSK) screen is validated in English-speaking school-aged children and has been shown to be useful in acute paediatric practice in the UK. The aim of this study is to evaluate the practicality and acceptability of pGALS in children in an acute hospital setting in Malawi. School-aged inpatients and children presenting to the Queen Elizabeth Hospital Blantyre, Malawi, participated. Practicality (time taken, degree of completion) and patient/parent assessed acceptability (time take, discomfort) were assessed using a ‘smiley face’ visual analogue scale. Fifty-one children (median age 8 years) were assessed; 23 out of 51 (45%) in the emergency department and the remainder were inpatients. Most presentations were infection or trauma related (n = 35, 69%). Practicality of pGALS was good [median time to complete pGALS—4 min (range 1.8–7.4)] and completed in 48 out of 51 children (94%). Acceptability was high; 98% of parents considered the time taken to be acceptable, 84% of children deemed little/no additional discomfort. Abnormalities using pGALS were found in 21 out of 51 (41%), mostly in the lower limbs. The pGALS MSK screen was practical and acceptable in this acute setting. Abnormal findings were common.


Low resourced country Musculoskeletal examination Paediatric clinical assessment Rheumatology 

List of abbreviations


Accident and emergency


British Society of Rheumatology


Community Orientated Programme for the Control of Rheumatic Diseases


Gait, Arms, Legs and Spine


Human immunodeficiency virus


International League Against Rheumatism




Juvenile Idiopathic Arthritis




Paediatric Gait, Arms, Legs and Spine


Queen Elizabeth Central Hospital


Systemic lupus erythmatosus




Temporomandibular joint


World Health Organization



ES would like to thank Limbani Mapata, Ichabod Chiwamila and Praise Misozi Chirambo for their great help with translation during the study.




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Copyright information

© Clinical Rheumatology 2011

Authors and Affiliations

  • Eve Smith
    • 1
    Email author
  • Elizabeth Molyneux
    • 2
  • Geert Tom Heikens
    • 2
  • Helen Foster
    • 3
  1. 1.Paediatric RheumatologyGreat North Children’s HospitalNewcastle upon TyneUK
  2. 2.Department of Paediatrics and Child Health, College of Medicine, Queen Elizabeth Central HospitalUniversity of MalawiBlantyre 3Malawi
  3. 3.Newcastle Musculoskeletal Research GroupNewcastle upon TyneUK

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