JOURNAL OF CRITICAL REVIEWS

ISSN- 2394-5125 VOL 6, ISSUE 6, 2019 A Research Protocol - Musculoskeletal screening using pGALS in girls and boys aged between 5 and 12 years

DEVYANI PURUSHE1, PRATIK PHANSOPKAR2*

1Final year B.PT, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences (DU) Wardha, Maharashtra. Orchid ID: https://orcid.org/0000-0002-3153-4393 2*/Assistant Professor, Department of Musculoskeletal Sciences, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences (DU) Wardha, Maharashtra. ORCID ID- http://orcid.org/0000-0003-3635-8840 Email: [email protected], 2*[email protected]

Received: 03 Sep 2019 Revised: 11 Oct 2019 Accepted: 23 Nov 2019

ABSTRACT: In school children musculoskeletal disorders are very common. Among children musculoskeletal problem should be treated as soon as possible. pGALs is a screening tool for assessing musculoskeletal problems in the pediatric population. To identify musculoskeletal problem the pGALS (pediatric gait, arms, legs, and spine) is a simple, fast MSK assessment tool validated in children of school age.To find out musculoskeletal disorder in boys and girls using pGALs.This study will be conducted in 3 schools in the School of Scholars, Alphonsa Sr. Sec. School, Sant Chavara School Sawangi Meghe, Wardha. The duration of the study will be six months. In each school, 100 students will be examined. Musculoskeletal examination will be conducted using pGALS.The expected result would be the detection of different musculoskeletal abnormalities in school children that the family does not know about their child's deformities. Data will be analyzed using paired T-test.Conclusion will be published after the result are analyzed. KEY WORDS: pGALs, Musculoskeletal examination, Clinical skill, Normal development, Boys and Girls between the age 5-12, MSK, Musculoskeletal pain.

I. INTRODUCTION Children and youth (CYP) are generally experiencing problems with the musculoskeletal (MSK) and also originally present to physicians doctors specializing in family medicine, emergency surgery, orthopedics that are not trained in pediatric MSK (pMSK) surgery, pediatrics or rheumatology in adolescents are among those. Many triggers of the childhood MSK symptoms are moderate, actualization-limiting and sometimes illness-related; referral to expert services is not often necessary, and encouragement alone can be appropriate in certain situations. Although, MSK indications that cancer, vasculitis and pseudo-accidental injury, pose features of JIA and potentially fatal-threatening features such as malignancy.1 The pGALS (pediatric running style, limbs, feet, and spinal column) seems to be easy, rapid MSK evaluation method validated for children of school age to locate abnormal joints.2 Pediatric musculoskeletal disorders, they are really popular, accounting for approximately 18% of the population the ailments reported to the crisis condition department.3 The GALS(Gait, Arms, Legs and Spine) analysis exam, that presents a reliable approach to adult locomotive system assessment, has been widely taught in the UK over the last decade. Medical schools have demonstrated excellent sensitivity have precision in enhancing clinical efficiency within a pediatric rheumatology environment.4 MSK anomalies typically occur early in the disease and can in some cases be the only sign of a reference.2 MSK presentations for most childhood symptoms are mild, self-limiting and often trauma-induced, specialized care is not always needed and, in many cases, self-confidence may be sufficient.3 To determine the characteristics of a child with MSK, an observer using pGALS requires knowledge of normal development, normal variants, patterns of pathologies at different ages.3 Children experience common musculoskeletal problem.5 In childhood, musculoskeletal symptoms are common. Over 14% of school-year children complain about occasional limb pain and 5% chronic Musculoskeletal System (MSK) painful conditions.6

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ISSN- 2394-5125 VOL 6, ISSUE 6, 2019

Musculoskeletal disorder in school children are often trauma-related and self-limiting; they can sometimes be a symptom of underlying life threatening malignancy and sepsis, such as leukaemia, septic arthritis, or osteomyelitis, etc.5 Musculoskeletal disorders can be linked to a number of diseases that range from flat legs, genu valgum to serious conditions such as infectious arthritis or juvenile idiopathic arthritis that interfere with activities of daily living.6 Some disease, such as idiopathic juvenile arthritis (JIA) can also cause chronic impairement in children.5 All children and parents should be recognized and can be done easily, even by incompetent examiners.5 pGALS (paediatric gait, arms, legs, spine) the instrument is used by healthcare professionals in medical schools in the United Kingdom. A questionnaire designed in the United Kingdom to identify MSK problems with children (median age 11 years; age 4–16 years).6 pGALS is a conclusive proof-based method to specific evaluation in pMSK which helps to distinguish normal from abnormal by a non-specialist in pMSK medicine.1 pGALS can be conducted successfully throughout the new generation, outpatient kids but analysts would indeed be deceitful, awaiting child collaboration and consideration. A musculoskeletal test device pGALS will have outstanding quality, will be easy for administration, So appropriate for children along with parental / custodians of school age.2 pGALS begins by watching the child enter the room, engaging with the family members or profession, and demonstrate his interest in playing or doing stuff like brushes or crayons.3. Learning pGALS and basic knowledge is a valuable way of better understanding joint conditions, encouraging early detection of joint issues and timely access to clinical outcome optimized for specialist teams.3 pGALS is an essential part of the basic clinical skill that all doctors who may be interested in child care should learn.3 It has been demonstrated that pGALS is highly sensitive to detect anomalies, implements basic maneuvers that take an average of two minutes to complete and are frequently used in clinical practice and are easy to do.3 Chan, Mercedes O, et al stated that pGALS may be an effective apparatus for sensing changes in MSK. This was the first research in which MSK anomalies in children are identified employing Pgals as a systematic and established clear MSK assessment device.2 Foster, Helen E, et al identified that the pGALS muscle-skeletal screening test has extremely good reliability, it will be simple to enforce and extends to toddler age parents / guardians along with kids.3 Rami Raad Al Ani1*, et al concluded that our figures are low, but studies have reported a lack of faith in pediatric musculoskeletal assessments. Teaching pGALS inhabitants has increased their confidence and ability to identify musculoskeletal derangement.1 Iain Goff, et al have shown that pGALS is practical and acceptable to perform in acute pediatric assessment performed by a non-musculoskeletal medicine expert.4 The need of this study is to find out musculoskeletal disorder and there affect in the functional activities by using pgals examination.

II. OBJECTIVES This study intends to conduct musculoskeletal examination in the three mentioned schools that is School of Scholar, Alphonsa Sr. Sec. School, Sant Chavara School Sawangi Meghe, Wardha.

III. METHODOLOGY This study will be conducted in three schools in the School of Scholars, Alphonsa Sr. Sec. School, Sant Chavara School Sawangi Meghe, Wardha. Written consent will be taken from parents in order to participate in the study. Ethical clearance will be taken from Institutional ethical committee of Datta Meghe Medical College, Sawangi, Wardha. The subjects were included at random irrespective of any musculoskeletal discomfort, pyrexia, and any inflammatory joint disorder, clumsy child as referred to by parents, or any neurological problems. Children younger than 5 years of age and older than 12 years, who suffered from fever or otherwise during their studies, were excluded from understanding and performance of pGALs, and who suffered evident trauma and/or any congenital abnormalities. At school premises the pGALs whole analysis will be completed.

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Children with positive results will be subjected to a comprehensive history-taking and regional clinical review during pGALS screening. These children will be referred to the paediatric rheumatology clinic if necessary. Three screening questions were initially put to children thus included. 1. Do you have any joint, muscle or back pain or stiffness? 2. Are you trouble dressing up without any assistance? 3. Will you find it difficult to get up and down stairs? Children are then asked to perform pGAL through imitation exam. Musculoskeletal Examination will be conducted using pGALS in school childrens. A video demonstration of pGALS will be provided and also practice period will be given.

IV. OUTCOME MEASURES pGALS examination tool The pGALS is reliable and valid tool in children to identify musculoskeletal disorder with r=0.9 ,sensitivity 97% and specificity 93%.

Inclusion Criteria 1)Age group: 5-12 years 2)Girls and Boys who are willing to participate

Exclusive Criteria: 1)The child is not willing to participate in activity. 2)Child with recent fractures, any disorder will not participate in activity. 3)Patient of mental retardation, illness is not to be taken. Study design: Observational study Study Setting: Three high school level schools will be taken in Sawangi Meghe, Wardha after the approval from Institutional Ethics Committee of Datta Meghe Institute of Medical Sciences, Deemed to be University. 1)School of Scholars 2)Alphonsa Sr. Sec. School 3) Sant Chavara School Participant: Girls and boys aged between 5 and 12 years Sample Size:- The sample size is 300 children’s including girls and boys. Study Duration: 6 months

V. EXPECTED RESULTS The expected outcome include the detection of musculoskeletal abnormalities and problems facing while performing day-to-day to day activities in school children. Once the study result is complete, statistical analysis will be analyzed using paired T-test and presented in the form of research paper.

VI. DISCUSSION To find out musculoskeletal disorder in boys and girls using pGALs that is the aim of the study. This research will help to decide how pGALS is used to evaluate musculoskeletal issues in children with age group of 5-12 yrs. This study shows that it is suitable to both parents and children and in an acute pediatric scenario a non-expert in

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musculoskeletal medicine can perform pGALs. In routine pediatric clinical practice as a core clinical ability the important finding supports the use of pGALS. In children, pGALS is chosen as it is a systematic way to perform a musculoskeletal examination in this study. To get a more detailed picture of musculoskeletal pathologies, evaluate the entire musculoskeletal system. The pGALS test was originally adapted from adult Gait Arms Legs and Spine exam.

VII. REFERENCES [1] Ani, Rami Raad Al, Mustafa Al Maini, and Khulood Khawaja.The Confidence of Pediatric Trainees in Performing Musculoskeletal Screening Examination in Children in the Emirate of Abu Dhabi.EC orthopaedics.2017;(7.6):248-255 [2] Chan, Mercedes O, Ethan S Sen, Elizabeth Hardy, Pauline Hensman, Edmond Wraith, Simon Jones, Tim Rapley, and Helen E Foster.Assessment of Musculoskeletal Abnormalities in Children with Mucopolysaccharidoses Using PGALS.” Pediatric Rheumatology. 2014;12(32):1-9 [3] Foster, Helen E, and Sharmila Jandial. PGALS – Paediatric Gait Arms Legs and Spine: A Simple Examination of the Musculoskeletal System. Pediatric Rheumatology. 2013;11(4):1-7 [4] Iain Goff, Belinda Bateman, DM, Andrea Myers and Helen Foster. Acceptability and Practicality of Musculoskeletal Examination in Acute General Paediatric Assessment. 2010;156(4);657-662 [5] Tapas Kumar SABUI, Moumita SAMANTA, Rakesh Kumar MONDAL, Indira BANERJEE, Abhishek SAREN and Avijit HAZRA. Survey of musculoskeletal abnormalities in school- going children of hilly and foothill regions of Eastern Himalayas using the pediatric Gait, Arms, Legs, Spine screening method. 2016;21(5);1127-1134 [6] Luis Antonio Moreno-Torres, Adolfo Gabriel Hernandez-Garduno, Carmen Araceli Arellano-Valdes, Aaron Salinas-Rodriguez, Nadina Rubio-Perez, Ingris PElaez-Ballestas. Cross-cultural validation of the paediatric Gait, Arms, Legs, Spine (pGALS) tool for the screening of musculoskeletal disorders in Mexican children. 2016;36;495-503

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