Validation of the GALS musculoskeletal screening exam for use in primary care: a pilot study

<p>Abstract</p> <p>Background</p> <p>As the proportion of the Canadian population ≥65 grows, so too does the prevalence of musculoskeletal (MSK) conditions. Approximately 20% of visits to family physicians occur as a result of MSK complaints. The GALS (Gait, Arms, Legs, and Spine) screening examination was developed to assist in the detection of MSK abnormalities. Although MSK exams are primarily performed by rheumatologists or other MSK specialists, expanding their use in primary health care may improve the detection of MSK conditions allowing for earlier treatment. The primary goal of this study was to evaluate the use of the GALS locomotor screen in primary care by comparing the results of assessments of family physicians with those of rheumatologists. The secondary goal was to examine the incidence of MSK disorders and assess the frequency with which new diagnoses not previously documented in patients' charts were identified.</p> <p>Methods</p> <p>Patients ≥65 years old recruited from an academic family health centre were examined by a rheumatologist and a family physician who recorded the appearance of each participant's gait and the appearance and movement of the arms, legs and spine by deeming them normal or abnormal. GALS scores were compared between physicians with the proportion of observed (P_obs), positive (P_pos) and negative (P_neg) agreement being the primary outcomes. Kappa statistics were also calculated. Descriptive statistics were used to describe the number of "new" diagnoses by comparing rheumatologists' findings with each patient's family practice chart.</p> <p>Results</p> <p>A total of 99 patients consented to participate (92 with previously diagnosed MSK conditions). Results showed reasonable agreement between family physicians and rheumatologists; P_obs= 0.698, P_pos= 0.614 and P_neg= 0.752. The coefficient of agreement (estimated Kappa) was 0.3675 for the composite GALS score. For individual components of the GALS exam, the highest agreement between family physicians and rheumatologists was in the assessment of gait and arm movement.</p> <p>Conclusion</p> <p>Previously reported increases in undiagnosed signs and symptoms of musculoskeletal conditions have highlighted the need for a simple yet sensitive screening exam for the identification of musculoskeletal abnormalities. Results of this study suggest that family physicians can efficiently use the GALS examination in the assessment of populations with a high proportion of musculoskeletal issues.</p

Accelerometry: A Feasible Method to Quantify Physical Activity in Ambulatory and Nonambulatory Adolescents with Cerebral Palsy

Objective. To determine the feasibility of physical activity monitoring in adolescents with cerebral palsy (CP). Methods. A convenience sample of ambulatory and non-ambulatory adolescents (N=23; 17 males, 6 females; mean age 13.5 y, SD 2.6 y; Gross Motor Function Classification System (GMFCS) distribution: n=9 Level I, n=5 Level II, n=5 Level III, n=4 Level IV) was recruited. Physical activity (PA) was objectively assessed using the ActiGraph GT1M activity monitor. Discomfort or adverse effects of wearing the accelerometers were recorded by participants. Levels of physical activity were determined as total PA, light PA (LPA), moderate PA (MPA), moderate-to-vigorous (MVPA), and vigorous PA (VPA) using cut-points recently validated for CP. Results. Most participants showed little reluctance. Mean daily MVPA for all participants was 30.7 minutes (SD 30.3), which corresponded to 2.7 (SD 2.4) minutes of MVPA per hour or 4.5% (SD 3.9) of the total monitoring time. Total PA and MVPA were greatest in ambulatory youth (GMFCS levels I and II) compared with youth who use a walking aid or wheelchair (GMFCS levels III and IV) (P<0.05). Conclusion(s). The results support the use of the accelerometer as a feasible and useful measure of activity in ambulatory and nonambulatory adolescents with CP

Exploring Accelerometer Versus Self-Report Sleep Assessment in Youth With Concussion

This study examines accelerometer-based and self-report assessment of sleep disturbance from a larger prospective cohort of youth 5 to 18 years of age with postconcussive injury. Twenty-one participants with self-reported sleep disturbance were evaluated using accelerometers. Participants completed the Pittsburgh Sleep Quality Index (PSQI) every 48 hours and also measured sleep via accelerometry. Correlations were conducted matching PSQI scores to accelerometry assessment. PSQI scores were significantly correlated only with “average number of awakenings” ( r = −0.21; P = .049). Accelerometer-measured mean (standard deviation) sleep efficiency was 79.9% (5.20%), with normal sleep defined as >85%. The mean (standard deviation) PSQI global score was 10.5 (3.78) out of 21, where scores of >5 indicate subjective insomnia. Results suggest the PSQI and accelerometers may be measuring different attributes of sleep. Both may be needed as actual sleep is important but so is perception of good sleep. These findings call for further validity testing of objective sleep assessment measures and commonly used self-report tools

Inflammatory and growth factor response to continuous and intermittent exercise in youth with cystic fibrosis

Background: Children with cystic fibrosis (CF) tend to suffer from chronic systemic inflammation and may have impaired growth associated with muscle catabolism. Therefore, investigating which type of exercise can elicit an anabolic response with minimal inflammation is of clinical value. Methods: Twelve children with CF (mean +/- SD; age: 14.7 +/- 2.3 years, predicted FEV1: 90.0 +/- 21.6%) and biological age-matched controls (age: 13.9 +/- 2.1 years) completed moderate-intensity, continuous exercise (MICE) and high-intensity, intermittent exercise (HIIE) on separate days. During each exercise, blood was drawn at various time points and analyzed for immune cells, inflammatory cytokines, and growth mediators. Results: At rest, children with CF had higher concentrations of neutrophils and IL-6 compared with controls. In children with CF, HUE did not affect immune cell subsets or cytokines: TNF-alpha, IL-6, and tumor necrosis factor-like weak inducer of apoptosis (TWEAK). All immune cell subsets and IL-6 increased significantly with MICE in both groups. Growth hormone (GH) increased with both types of exercise, with a greater change from rest during MICE. Conclusions: HIIE was a sufficient stimulus to increase OH in children with CF, without affecting systemic inflammation. (C) 2011 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved

Step count targets corresponding to new physical activity guidelines for the early years

Step Count Targets Corresponding to New Physical Activity Guidelines for the Early Years. Med. Sci. Sports Exerc., Vol. 45, No. 2, pp. 314-318, 2013. Purpose: New physical activity guidelines recommend that children age 3-4 yr should accumulate at least 180 min of physical activity at any intensity spread throughout the day, including progression toward at least 60 min of energetic play by 5 yr of age. Step count targets corresponding to these recommendations will help practitioners and researchers monitor physical activity. Methods: One hundred thirty-three preschoolers were instructed to wear accelerometers for seven consecutive days. Activity and step count data were recorded in 3-s epochs. Step count targets equivalent to physical activity recommendations were derived using prediction equations from regression analyses. Receiver operating curve analyses were conducted to compare the sensitivity and specificity of the derived thresholds as well as a range of other targets. Results: The daily step count target derived for 180 min of physical activity of any intensity was 6013 T 88, whereas the target for 180 min of physical activity of any intensity including at least 60 min of moderate-to-vigorous physical activity was 6191 T 103. The smallest discrepancy between days meeting physical activity guidelines and step count targets was found with a 6000-step-per-day target. Receiver operating curves confirmed a balanced sensitivity and specificity of this target. Conclusions: On the basis of our data, we suggest that a new step count target of 6000 steps per day should be used to determine whether 3-to 5-yr-old children are meeting physical activity recommendations