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

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Abstract

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.

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Abbreviations

A&E:

Accident and emergency

BSR:

British Society of Rheumatology

COPCORD:

Community Orientated Programme for the Control of Rheumatic Diseases

GALS:

Gait, Arms, Legs and Spine

HIV:

Human immunodeficiency virus

ILAR:

International League Against Rheumatism

IV:

Intravenous

JIA:

Juvenile Idiopathic Arthritis

MSK:

Musculoskeletal

pGALS:

Paediatric Gait, Arms, Legs and Spine

QECH:

Queen Elizabeth Central Hospital

SLE:

Systemic lupus erythmatosus

TB:

Tuberculosis

TMJ:

Temporomandibular joint

WHO:

World Health Organization

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Acknowledgements

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

Disclosures

None.

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Authors and Affiliations

  1. Paediatric Rheumatology, Great North Children’s Hospital, Richardson Road, Newcastle upon Tyne, NE1 4LP, England, UK

    Eve Smith

  2. Department of Paediatrics and Child Health, College of Medicine, Queen Elizabeth Central Hospital, University of Malawi, Blantyre 3, Malawi

    Elizabeth Molyneux & Geert Tom Heikens

  3. Newcastle Musculoskeletal Research Group, Institute Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, NE2 4HH, England, UK

    Helen Foster

Authors
  1. Eve Smith
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  2. Elizabeth Molyneux
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  3. Geert Tom Heikens
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  4. Helen Foster
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Correspondence to Eve Smith.

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Smith, E., Molyneux, E., Heikens, G.T. et al. Acceptability and practicality of pGALS in screening for rheumatic disease in Malawian children. Clin Rheumatol 31, 647–653 (2012). https://doi.org/10.1007/s10067-011-1901-4

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  • DOI: https://doi.org/10.1007/s10067-011-1901-4

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