Pediatric musculoskeletal assessment using two screening tools: the early arthritis diagnostic questionnaire (EAD) and the pGALS (pediatric gait, legs, arms and spine)

Abstract

INTRODUCTION: There are limitations in the teaching and training of the musculoskeletal exam for the general practitioner, but two screening tools have become available in recent years. OBJECTIVES: Evaluate feasibility and concordance of two musculoskeletal screening tools, the 12-item questionnaire for early arthritis detection of (DPA-12) and the musculoskeletal examination pGALS (pediatric, gait, arms, legs and spine), in the same patient, during the routine practice. METHODS: Participants between 5 and 18 years of age were examined by a trained resident, performing pGALS maneuvers and applying DPA-12 for parents. The diagnoses, descriptive analysis and scores were analyzed, categorizing the pGALS maneuvers as normal or abnormal and DPA-12 scores greater or lower than six. The internal consistency was calculated by Cronbach alpha coefficient and the correlation between categorical measures by kappa statistics. RESULTS: Sixtyseven participants were included, 40 (59.7%) were boys. Forty (59.7%) had at least one abnormal pGALS manoeuver. The diagnoses were classified as musculoskeletal (juvenile idiopathic arthritis and connective tissue diseases, flat feet, hypermobility syndrome, mechanical limb pain) and nonmusculoskeletal (cellulitis and constipation). There were 65 valid questionnaires, 21 (32.3%) scored greater or ecqual to 6, indicating higher probability of musculoskeletal diagnoses. The internal consistency scoreswere 0.79 and 0.87, respectively. The comparison of normal and abnormal variables results, resulted in low agreement by the Cohen kappa coefficient (0.31). CONCLUSION: The application of both tools in the same patients performed well, showing simplicity and feasibility, for identifying functional or structural abnormalities, regardless of the diagnosis. In practice, both tools may be useful and complementary for screening.