Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Physiotherapy. 2011 Sep;97(3):196-202. doi: 10.1016/j.physio.2010.11.008. Epub 2011 Feb 2.
To evaluate the sensitivity, specificity and reliability of the gait, arms, legs and spine (GALS) examination to detect signs and symptoms of rheumatoid arthritis when used by physiotherapy students and physiotherapists.
Two physiotherapy students and two physiotherapists were trained to perform the GALS examination by viewing an instructional DVD and attending a workshop. Two rheumatologists familiar with the GALS examination also participated in the workshop. All healthcare professionals performed the GALS examination on 25 participants with rheumatoid arthritis recruited through a rheumatology practice and 23 participants without any arthritides recruited from a primary care centre. Each participant was assessed by one rheumatologist, one physiotherapist and one physiotherapy student. Abnormalities of gait, arms, legs and spine, including their location and description, were recorded, along with whether or not a diagnosis of rheumatoid arthritis was suspected. Healthcare professionals understood the study's objective to be their agreement on GALS findings and were unaware that half of the participants had rheumatoid arthritis. Sensitivity, specificity and likelihood ratios were calculated to determine the ability of the GALS examination to screen for rheumatoid arthritis.
Using rheumatologists' findings on the study day as the standard for comparison, sensitivity and specificity were 71 to 86% and 69 to 93%, respectively. Positive likelihood ratios ranged from 2.74 to 10.18, while negative likelihood ratios ranged from 0.21 to 0.38.
The GALS examination may be a useful tool for physiotherapists to rule out rheumatoid arthritis in a direct access setting. Differences in duration and type of experience of each healthcare professional may contribute to the variation in results. The merits of introducing the GALS examination into physiotherapy curricula and practice should be explored.
评估步态、手臂、腿部和脊柱（GALS）检查在理疗学生和理疗师中用于检测类风湿关节炎体征和症状的敏感性、特异性和可靠性。
两名理疗学生和两名理疗师通过观看教学 DVD 和参加研讨会接受 GALS 检查培训。两名熟悉 GALS 检查的风湿病专家也参加了研讨会。所有医疗保健专业人员对 25 名通过风湿病诊所招募的类风湿关节炎患者和 23 名从初级保健中心招募的无任何关节炎患者进行了 GALS 检查。每位参与者由一名风湿病专家、一名理疗师和一名理疗学生进行评估。记录步态、手臂、腿部和脊柱的异常情况，包括其位置和描述，以及是否怀疑类风湿关节炎的诊断。医疗保健专业人员了解研究的目的是他们对 GALS 发现的一致性，并且不知道一半的参与者患有类风湿关节炎。计算了敏感性、特异性和似然比，以确定 GALS 检查筛查类风湿关节炎的能力。
使用研究日风湿病专家的发现作为比较标准，敏感性和特异性分别为 71%至 86%和 69%至 93%。阳性似然比范围为 2.74 至 10.18，而阴性似然比范围为 0.21 至 0.38。
GALS 检查可能是理疗师在直接访问环境中排除类风湿关节炎的有用工具。每个医疗保健专业人员的经验持续时间和类型的差异可能导致结果的差异。应该探讨将 GALS 检查引入理疗课程和实践的优点。
