pGALS Training Increases Canadian and Kenyan Physicians' Confidence in Examining the Musculoskeletal System in Children

Document Type

Conference Paper


Paediatrics and Child Health (East Africa)


Background/Purpose: pGALS (paediatric Gait Arms Legs Spine) is a simple, validated musculoskeletal (MSK) assessment tool for the school-aged child. Studies have shown physicians lack confidence in the pediatric MSK examination. We evaluated the effect of a pGALS teaching session on enhancing physicians’ confidence in examining the MSK system in children. We compared the impact of the intervention on two culturally distinct groups of physicians. We explored preferred methods of learning and applying pGALS in clinical practice.

Methods: Physicians enrolled in a pGALS workshop in Canada (Quebec) and Kenya (Nairobi) completed anonymous questionnaires on-site before and after the teaching session. Canadian participants were also asked to complete an anonymous electronic follow-up survey 6 months later.

Results: A total of 103 physicians completed the questionnaires (51 Canadian; 52 Kenyan); 68.4% were family physicians (FP), 31.6% were pediatricians (P). Among Canadians, FP and P were similar in number (P 53.2%, FP 46.8%); most Kenyan participants were FPs (88.2%) (p< 0.001). Canadian participants had more years of practice (Canadian:17.2±10.3 vs Kenyan:4.3±3.6, p< 0.0001). MSK examination was previously taught in 98/103 (95.2%); however only 60.8% were taught the MSK exam in children (Canadian:66% vs Kenyan:55.8%, p=n.s). Before the workshop, only 26.5% (26/98) felt ‘confident’ or ‘very confident’ in evaluating the pediatric MSK system (Canadian:28.3% vs. Kenyan:25%, p=n.s). Confidence in examining the MSK exam was significantly lower than that of the following systems: cardiovascular, respiratory or abdominal. Following the teaching session, increased level of confidence was seen, with 88.8% feeling ‘confident’ and ‘very confident” (Canadian:80.4% vs Kenyan:96.2%, p=0.014). Most common barrier identified for its use was that it was time-consuming (Canadian:37.3% vs Kenyan:53.9%, p=n.s). More Kenyan physicians reported that an office poster could facilitate pGALS use (Canadian:51% vs Kenyan:71.2%, p=0.041); a pocket card was suggested equally (Canadian:67.4% vs Kenyan:50%, p=n.s). Over half of participants agreed that web-based demonstrations (Canadian:55.3% vs Kenyan:57.7%; p=n.s) could improve confidence in pediatric MSK examination; workshops were preferred by Canadians (Canadian:72.3% vs Kenyan:46.2%; p=0.004). Only 27.5% (14/51) of Canadian participants responded to a follow-up survey. Among those, improved confidence was maintained in 92.9% (13/14). Most respondents (78.6%, 11/14) were using pGALS in clinical practice and 75% found it ‘useful’ or ‘very useful’ in evaluating MSK symptoms.

Conclusion: Self-perceived confidence in examining the pediatric MSK system was low in both Canadian and Kenyan physicians. pGALS training improved practitioners’ confidence regardless of type of physician, experience or culture. pGALS reminders may be useful to ensure pGALS implementation into clinical practice.

Publication (Name of Journal)

Arthritis Rheumatology