pREMS - pediatric regional examination of the musculoskeletal system - a practice and consensus based approach

Introduction: competent examination of the pediatric musculoskeletal (pMSK) system is a vital component of clinical assessment of children presenting with MSK complaints. The aim was to develop a regional MSK examination for school-aged children that is age appropriate and reflects clinical practice.Methods: qualitative and quantitative analyses involving video observation of clinical examination technique, systematic review, and expert consensus were employed to reveal descriptions, frequencies and variations in technique for joint regions in various clinical scenarios. Systematic review and data from clinical observation were combined with feedback from a group of pMSK experts through a web-based survey. All results were collated and discussed by consensus development groups to derive pREMS (the pediatric Regional Examination of the MSK System)Results: a total of 48 pMSK expert clinicians were involved to derive pREMS. Systematic review revealed a paucity of evidence about regional pMSK examination. Video observations of MSK examinations (a total of 2901 maneuvers) performed by pMSK experts (doctors n=11; therapists n=8) of 89 school-aged children attending outpatient clinics in 7 UK pediatric rheumatology centres, were followed by semi-structured interviews with 14/19 clinicians. Video observation showed variation in examination techniques, most frequently at the hip and knee in the context of mechanical and inflammatory clinical scenariosConclusions: pREMS is the first practice and consensus based regional pMSK examination for school aged children. The structured approach is an important step towards improved pMSK clinical skills relevant to clinical training