Newcastle University Medicine Malaysia

Paediatric Musculoskeletal Research

Paediatric Musculoskeletal Research

Paediatric Musculoskeletal Research masthead

Project Lead

Professor Helen Foster

Project Brief

Musculoskeletal (MSK) conditions in children includes rheumatology, orthopaedics and neuromuscular diseases.

Delay in diagnosis and access to specialist care is a widespread problem around the world and for many children the delay results in adverse clinical outcomes. The shortage of MSK and specialist care in the most populated and least resourced countries means that most CYP with these diseases are unlikely to receive the equivalent care to children living in well-resourced countries. 
The paediatric MSK research programme at Newcastle, has for many years focused on ‘access to the right care’ through identifying, describing and understanding barriers to care. We have used this information to develop strategic interventions with a focus on education and training for the workforce: targeting medical students and doctors in general paediatrics, primary & community care and emergency services who are often the first clinicians to encounter children with musculoskeletal problems.

Key themes have emerged and been developed with a global perspective involving partnerships in Malaysia, South East Asia and further afield through the Paediatric Task Force for Global MSK Health (launched 2018).

1. Describing the global prevalence of childhood MSK conditions

  • Through analysis of World Bank Data and using exemplar MSK conditions to describe many millions of children, mostly in Asia and Africa. The work has been submitted for publication. Collaborators (Prof Mark Pearce and Prof Judith Rankin, Institute Health and Society, Newcastle University, UK). Further work is in progress to include the health economic ‘cost’ and impact.

2. Musculoskeletal pathways of care for children 

  • RightPath (www.rightpath.solutions) is a novel model of care, based in the community in the UK, to enable paediatric physiotherapists to effectively and safely triage children with MSK presentations and identify those who do and do not require referral to specialist care (paper submitted for publication). The model has informed NICE guidance (2019) targeting primary care and is now being developed for use in other countries. RightPath received Best Practice Award from the British Society Rheumatology 2018 and was a finalist in the Health Service Journal Awards 2019.  Collaborators: Dr Sharmila Jandial, Dr Nicola Smith and Ms Vicky Mercer Newcastle University, UK and Pennine Musculoskeletal Primary Care, Oldham UK
  • pGALSplus is a portfolio of clinical MSK assessments for primary care to be used by paediatric physiotherapists and is being piloted currently in the UK with plans to test in other health care contexts around the world. Collaborators: Newcastle University, UK Paediatric Rheumatology – Dr Sharmila Jandial, Dr Nicola Smith, Ms Vicky Mercer; Paediatric Neuromuscular Medicine - Dr Michela Guglieri; Neurodisability: Prof Jeremy Parr. Manchester Children’s NHS Trust and Manchester University (Dr Simon Jones, Metabolic Medicine).  
  • Limping child pathway. A descriptive audit conducted by NUMed child health team is underway to describe pathways of care in Johor Bahru and will be used to inform a limping child pathway of care for Malaysia. Collaborators Dr San Thidar and Dr Siri Gautem, NUMed.
  • A survey of current paediatric rheumatology care in South East Asia to describe barriers, challenges and to inform priorities for change, has been completed (and submitted for publication). Collaborators in Bangkok Thailand (Dr Sirikarn Tangcheewinsirikul, Prof Soamarat Vilaiyuk, Dr Sirirat Charuvanij, Dr Maynart Sukharomana1), Kuala Lumpur Malaysia (Dr Swee-Ping Tang) and Cape Town South Africa (Prof Christiaan Scott).

3. Educational resources portfolio to facilitate teaching and learning of clinical skillsCollaborators: Newcastle University, UK Paediatric Rheumatology – Dr Sharmila Jandial, Dr Nicola Smith, Ms Vicky Mercer

  • Novel MSK clinical skills tools including pGALS (paediatric Gait Arms Legs Spine) as a simple musculoskeletal examination and pREMS (paediatric Regional Examination of the Musculoskeletal System). Paediatric MSK skills and knowledge are embedded in undergraduate and postgraduate education and examinations, both in the UK and internationally. pGALS has been validated in clinical practice with many language translations (including those relevant to South East Asia) are available through the pGALS app and have been developed by staff and students at NUMed. 
  • Paediatric Musculoskeletal Matters (PMM) – www.pmmonline.org – a free online resource, endorsed by NICE and RCPCH and further developed with global partners to optimise the relevance of the content around the world. PMM includes e-modules targeting medical students, allied health, paediatricians and primary care https://cpd.ncl.ac.uk. PMM has had reach to  >210 countries with >550,000 ‘hits’ since launch in 2014.
  • E-Evaluate is an ongoing study to assess the impact of e-resources on teaching and learning and is involving global partners and NUMed staff.

4. Paediatric Task Force Global Musculoskeletal Health(Chair Helen Foster) is a partnership with the Pediatric Rheumatology European Society (PReS), The International Pediatric Orthopedic Society (IPOS), Paediatric Musculoskeletal Matters (PMM) and the Global Alliance for Musculoskeletal Health (Bone and Joint Decade and aligned with WHO). More information visit https://gmusc.com/musculoskeletal-problems-in-children-and-young-people/.

Key recent publications