Musculoskeletal assessment of general medical in-patients--joints still crying out for attention

Abstract

Objectives: The aim of this study was to assess the extent of musculoskeletal assessment (history and examination) amongst medical in-patients and to determine the effects that GALS (gait, arms, legs, spine) teaching has had on this.

Methods: General medical in-patients were interviewed and examined. Case notes were reviewed to determine diagnoses and assess documentation of clinical signs and/or symptoms. Doctors were interviewed to determine whether they had been taught the GALS locomotor screen, assess their confidence in examining the musculoskeletal system and explore their attitudes to musculoskeletal problems.

Results: The presence or absence of locomotor symptoms was recorded in 50% of the 100 patients, whilst signs were recorded in 20%; 63% of all the patients had locomotor symptoms and/or signs. Relevant musculoskeletal history was missed in 49% of the patients, whilst signs were missed in 78%; 42% of those with musculoskeletal conditions would have benefited from additional treatment. Teaching of the GALS screen significantly increased doctors' confidence in examination of the locomotor system.

Conclusions: Active musculoskeletal problems are seen frequently amongst medical in-patients. There is a significant discrepancy between the number of patients with clinical symptoms and signs and the frequency with which they are detected and treated.