G314(P) A scoping review to support the development of pgalsplus: a multi-professional tool and educational resource

Background Musculoskeletal (MSK) problems in children and young people (CYP) are common. The majority present to healthcare professionals in the community, but it can be challenging to identify those with serious disease. pGALS (paediatric Gait, Arms, Legs and Spine) was developed as a simple MSK clinical assessment to discern abnormal joints, initially within paediatric rheumatology and general paediatrics; pGALS can detect joint and functional problems in CYP with other serious conditions but alone is unlikely to be specific enough to diagnose definitive conditions or signpost referrals to orthopaedics, rheumatology, neurology or general paediatrics. Our aim was to scope the literature about MSK assessments applicable to CYP used in practice, focusing on evidence of validity in the context of diagnosis and assessment of Juvenile Idiopathic Arthritis (JIA), Mucopolysaccharidoses (MPS), Muscular Dystrophy (MD) and Developmental Coordination Disorder (DCD) as exemplar MSK conditions. Methods Scoping review using a Library search tool (including several databases), Google Scholar, and consulting NICE guidance/pathways. Search terms included dyspraxia, paediatric MSK assessment, screening tools, balance, rheumatology, assessment tools for MD, MPS, JIA. Studies cited within relevant articles were also checked. Results 32 articles were deemed appropriate, describing specific assessment or screening tools in the context of diagnosis. Within DCD, motor co-ordination batteries aid diagnosis as part of specialist assessment, but are regarded as too lengthy for the purpose of screening; a questionnaire may be a useful first-step diagnostic tool, along with assessment of static balance (found to be significantly worse in children with DCD). In paediatric rheumatology, pGALS is the only validated screening tool to discern normal from abnormal. For neuromuscular conditions the North Star Ambulatory Assessment is valid, reliable and practical as a functional assessment, and includes activities necessary to remain functionally ambulant. With regards to MPS, searches did not reveal specific MSK tests, but evidence suggests that skeletal malformations and joint problems are the most frequently presenting signs. pGALS performs well to identify abnormal joints with restriction within an MPS group. Conclusion This review supports the development of a ‘pGALSplus’ toolkit to facilitate identification of CYP with potentially serious disease. pGALSplus will be targeted at community-based clinicians and will likely include physical examination, questionnaire(s) and appropriate adjuncts.