Belinda Bateman

Poor sensitivity of musculoskeletal history in children

Objectives To demonstrate the sensitivity of musculoskeletal (MSK) history taking. Design Prospective study: consecutive children attending outpatient clinics. Setting and patients Paediatric rheumatology clinic (n=45; girls n=28; median age 12 years, range 3–18), acute general paediatric assessment unit (n=50; girls n=21; median age 8 years, range 3–16). Intervention Pro forma recording abnormal joint involvement from history taking and then following MSK examination completed by clinicians. Main outcome measures Sensitivity of MSK history taking compared with clinical examination. Results Paediatric rheumatology clinic: 135 abnormal joints identified in 34 children; 53/135 (39%) by history alone, 82/135 (61%) detected on examination resulting in MSK history sensitivity 53%, specificity 98%. Acute paediatric unit: 29 abnormal joints identified in 17 children; 18/29 identified on history (sensitivity 62%). Conclusions MSK history taking failed to identify a large number of abnormal joints which were detected on physical examination, emphasising the need for all joints to be examined as part of a screening examination as a minimum.

The Questionnaire of Young People's Participation (QYPP): a new measure of participation frequency for disabled young people

INTRODUCTION The concept of participation was introduced by the World Health Organisation in the International Classification of Functioning, Disability and Health, 2001. Instruments to measure participation have been developed for children and adults, but none specifically for adolescents. Adolescence is a life stage with distinct patterns of participation, and previous research has shown that young people with disabilities have poorer participation than the general population. The aim of this study was to develop a measure of participation frequency, covering all major domains, for young people with cerebral palsy (CP). CP was chosen as an exemplar because it is a significant cause of disability in young people, with affected individuals experiencing a range of different impairments of varying severity. METHODS A pool of 88 items was developed using the published literature, existing measures and qualitative data from young people. The item pool was revised following expert review by 17 experts. Cognitive interviews on the items were carried out with 12 young people and 12 carers; field-testing was then undertaken with 107 young people with CP aged 13-21 years, and 540 young people from the general population to enable item reduction and to examine reliability and construct validity. RESULTS The content review resulted in a 92-item draft questionnaire, content validity index of 93%. Cognitive interviews led to further wording changes. Following field-testing, the questionnaire was shortened to 45 items. Known-groups validity was demonstrated by correlation with impairment severity. Test-retest reliability was satisfactory for all domains. Internal consistency varied between domains. CONCLUSION This is the first instrument developed specifically to measure frequency of participation across multiple domains for young people with disability. Use of the questionnaire in research and clinical work will enable its properties to be better understood and its generalizability to wider groups to be clearer.

pGALS performs well in the hands of a medical student

Background pGALS (paediatric Gait, Arms, Legs and Spine) is a paediatric musculoskeletal (pMSK) screening examination validated for use in school-aged children [1], aimed at medical students. It is envisaged that pGALS will improve clinical skills and facilitate access to specialist care. Our aim was to assess the validity of pGALS in student hands and compare it to assessment by a consultant paediatric rheumatologist.