Focus on Research
Screening for Signs and Symptoms
of Rheumatoid Arthritis by Family
Physicians and Nurse Practitioners
Using the Gait, Arms, Legs, and
Spine Musculoskeletal Examination
1
2
KAREN A. BEATTIE, NORMA J. MACINTYRE, AND ALFRED CIVIDINO
1
1
University, Hamilton, Ontario, Canada, 2 Institute for Applied Health Sciences, Hamilton, Ontario, Canada.
O
bjective. To evaluate the sensitivity and specificity of the Gait, Arms, Legs,
and Spine (GALS) examination to screen for signs and symptoms of rheumatoid
arthritis (RA) when used by family physicians and nurse practitioners.
Methods. Participating health care professionals (2
rheumatologists, 3 family physicians, and 3 nurse practitioners)
were trained to perform the GALS examination by viewing an
instructional DVD and attending a training workshop. One
week after training, the health care professionals performed
the GALS examination on 20 individuals with RA and 21
individuals without RA. All participants were recruited through
2 rheumatology practices, and each participant was assessed
by 4 health care professionals. The health care professionals
were asked to record whether observed signs and symptoms
were potentially consistent with a diagnosis of RA. The health
care professionals understood the study objective to be their
agreement on GALS findings among one another and were
unaware that one-half of the participants had RA. Sensitivity
and specificity were calculated to determine the ability of the
GALS examination to screen for RA using the rheumatologist
as the standard for comparison. Results. Sensitivity and
specificity values varied from 60–100% and 70–82%,
respectively, for the 3 family physicians, and 60–90% and
73–100%, respectively, for the 3 nurse practitioners.
physicians and nurse practitioners appeared to be able to
use the GALS examination as a screening tool for RA signs
and symptoms, particularly for identifying an individual with
positive results who will benefit from further investigation or
rheumatology referral.
Conclusion. Following a very short training period, family
Limited education and training in MSK medicine may be
Introduction
Given the increasing size of the older population and an
increasingly prevalent sedentary lifestyle, it is not surprising
that the number of musculoskeletal (MSK) conditions is
expected to increase. Reports of MSK symptoms comprise
10–30% of patient visits to family physicians’ offices (1). It is
well recognized that these symptoms are a significant cause of
pain and disability for the individual and account for significant
financial and health care burdens at the population level (2,3).
Despite this,