TY - JOUR
T1 - Pediatric regional examination of the musculoskeletal system
T2 - A practice- and consensus-based approach
AU - Foster, Helen
AU - Kay, Lesley
AU - May, Carl
AU - Rapley, Tim
N1 - Research Funding:
Arthritis Research UK. Grant Number: 16516
Northumberland
Tyne
Wear Comprehensive Local Research Network
PY - 2011/11
Y1 - 2011/11
N2 - Objective Competent examination of the pediatric musculoskeletal (MSK) system is a vital component of clinical assessment of children with MSK presentations. The aim was to develop a regional MSK examination for school-age children that is age appropriate and reflects clinical practice. Methods Qualitative and quantitative analyses involving video observation of clinical examination technique, systematic review, and expert consensus were employed to reveal descriptions, frequencies, and variations in technique for joint regions in various clinical scenarios. Systematic review and data from clinical observation were combined with feedback from a group of pediatric MSK experts through a web-based survey. All results were collated and discussed by consensus development groups to derive the pediatric Regional Examination of the Musculoskeletal System (pREMS). Results A total of 48 pediatric MSK expert clinicians were involved to derive pREMS. Systematic review revealed a paucity of evidence about regional pediatric MSK examination. Video observations of MSK examinations (a total of 2,901 maneuvers) performed by pediatric MSK experts (n = 11 doctors and 8 therapists) of 89 school-age children attending outpatient clinics in 7 UK pediatric rheumatology centers were followed by semistructured interviews with 14 of 19 clinicians. Video observation showed variation in examination techniques, most frequently at the hip and knee in the context of mechanical and inflammatory clinical scenarios. Conclusion pREMS is the first practice- and consensus-based regional pediatric MSK examination for school-age children. The structured approach is an important step toward improved pediatric MSK clinical skills relevant to clinical training.
AB - Objective Competent examination of the pediatric musculoskeletal (MSK) system is a vital component of clinical assessment of children with MSK presentations. The aim was to develop a regional MSK examination for school-age children that is age appropriate and reflects clinical practice. Methods Qualitative and quantitative analyses involving video observation of clinical examination technique, systematic review, and expert consensus were employed to reveal descriptions, frequencies, and variations in technique for joint regions in various clinical scenarios. Systematic review and data from clinical observation were combined with feedback from a group of pediatric MSK experts through a web-based survey. All results were collated and discussed by consensus development groups to derive the pediatric Regional Examination of the Musculoskeletal System (pREMS). Results A total of 48 pediatric MSK expert clinicians were involved to derive pREMS. Systematic review revealed a paucity of evidence about regional pediatric MSK examination. Video observations of MSK examinations (a total of 2,901 maneuvers) performed by pediatric MSK experts (n = 11 doctors and 8 therapists) of 89 school-age children attending outpatient clinics in 7 UK pediatric rheumatology centers were followed by semistructured interviews with 14 of 19 clinicians. Video observation showed variation in examination techniques, most frequently at the hip and knee in the context of mechanical and inflammatory clinical scenarios. Conclusion pREMS is the first practice- and consensus-based regional pediatric MSK examination for school-age children. The structured approach is an important step toward improved pediatric MSK clinical skills relevant to clinical training.
UR - http://www.scopus.com/inward/record.url?scp=80055085258&partnerID=8YFLogxK
U2 - 10.1002/acr.20569
DO - 10.1002/acr.20569
M3 - Review article
C2 - 21954040
AN - SCOPUS:80055085258
SN - 2151-4658
VL - 63
SP - 1503
EP - 1510
JO - Arthritis Care and Research
JF - Arthritis Care and Research
IS - 11
ER -