Rheumatology 2004; 43: 537
Rheumatology Vol. 43 No. 4 (c) British Society for Rheumatology 2004; all rights reserved
Letter to the Editor |
Reply: Musculoskeletal assessment of general medical in-patients
Department of Rheumatology, Addenbrookes Hospital, Cambridge, UK
Correspondence to: M. S. Lillicrap. E-mail: mark.lillicrap{at}nnuh.nhs.uk
SIR, We read with interest the comments of Dr Dubey on our paper on the musculoskeletal assessment of general medical in-patients [1].
We agree that the study highlights the potential discrepancies between competence-based assessment and performance-based assessment. If the work-based assessments they discuss were to be implemented, auditing their impact on locomotor assessment in clinical practice would certainly be an interesting follow-up study.
We note the modifications made by the Sheffield group to the original GALS (gait, arms, legs spine) locomotor screen [2]. It is important to emphasize that the original screen was not developed just on the basis of individual opinions as to what measures were useful screening measures. The components of the original GALS screen were validated and shown to have good sensitivity for the detection of important locomotor abnormalities [3]. It was through this process that the minimal musculoskeletal screen that is known as GALS was developed. As we comment in our paper, the purpose of the GALS assessment is as a screen and it does not substitute for more detailed locomotor examination. It does, however, enable the user to reliably determine whether any further assessments are required. To incorporate additional measures into the GALS screen, such as the prayer sign or a question regarding the neck, one should undertake studies to demonstrate that these measures improve the sensitivity of the screen. By contrast, removing components may reduce the screen's sensitivity and one should really demonstrate that this was not the case before such omissions were made. We agree that temporo-mandibular joint assessment should be excluded from a routine screen and jaw movements are not included in the GALS screen [1, 2].
References
- Lillicrap MS, Byrne E, Speed CA. Musculoskeletal assessment of general medical in-patients—joints still crying out for attention. Rheumatology 2003;42:951–4.
[Abstract/Free Full Text] - Doherty M, Dacre JE, Clark CL, Scotland AD. The ‘GALS’ locomotor screen. Ann Rheum Dis 1992;51:1165–9.
[Abstract/Free Full Text] - Jones A, Ledingham J, Regan M, Doherty M. A proposed minimal rheumatological screening history and examination: the joint answers back. J R Coll Physicians Lond 1991;25:111–15.[Medline]
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