(3) Early MSK Management Studies

This section of the site is dedicated to brief synopses of our ongoing research projects

Our Mission

To promote academic excellence by pursuing innovative research ideas, conducting high quality research studies, fostering multidisciplinary collaborations and facilitating the education and success of students and young investigators.





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GALS - Gait, Arms, Legs, Spine

Dr. Karen Beattie

Despite the frequent occurrence of bone and muscle complaints, the detection of musculoskeletal conditions in primary care is relatively poor.  Reasons that have been cited for this include a lack of training in musculoskeletal conditions and physical examination and a lack of confidence in assessing the musculoskeletal system.  To address this, we have conducted 3 studies investigating the use of the GALS (gait, arms, legs and spine) musculoskeletal screening exam in primary care. 

Our first study was carried out to assess the consistency in identifying musculoskeletal abnormalities when comparing the findings of family physicians to rheumatologists using the rheumatologists’ findings as the gold standard.  Family physicians participated in a training workshop and were given the GALS training DVD to view.  Results from this study showed that indeed, family doctors could employ the GALS exam to detect musculoskeletal conditions.  These findings were published in 2008 in BMC Musculoskeletal Disorders.



As a follow up to this study, we received funding from the Canadian Initiative for Outcomes in Rheumatology Care (CIORA) to investigate whether the use of the GALS exam could be taught to a group of family doctors, nurses practitioners, physiotherapists and physiotherapy students and to further determine whether this screening tool could be used to improve the detection inflammatory arthritis. Using rheumatologists as the gold standard, we have assessed the sensitivity and specificity of the detection of inflammatory arthritis when using the GALS exam.  In other words, we have determined whether the family physicians, nurse practitioners, physiotherapists and physiotherapy students can use the GALS exam can correctly identify patients who have inflammatory arthritis. In so doing, we hope to be able to relieve some of the time constraints on family practitioners by using other health care professionals to screen for joint problems early in the development of disease, improve detection of inflammatory joint disease and promote increased awareness of inflammatory joint conditions.

We have recently published the results of the study with physiotherapists and physiotherapy students in Physiotherapy (2011).   Results from the portion of the study including nurse practitioners and family physicians will be presented at the 2011 American College of Rheumatology Annual Scientific Conference.


The FRAX Tool - Implementation in Primary Health Care

Dr. Karen Beattie

Despite the availability of diagnostic and treatment guidelines for osteoporosis, a disturbingly small proportion of individuals who experience an osteoporosis-related fracture are diagnosed with osteoporosis and even fewer are ever treated. This is referred to as the osteoporosis care gap.  These data are particularly concerning given the availability of osteoporosis medications which are effective in reducing fracture risk by 40-70%. 

The presence of the osteoporosis care gap suggests that there are significant barriers to the application of clinical guidelines.  We have received funding from the Canadian Institutes of Health Research (Bone Catalyst Grant) to conduct a study aimed at improving the identification of individuals who would benefit from osteoporosis therapy and more accurately predicting who is at risk for fracture using a new fracture risk prediction tool known as FRAX. 

FRAX Canadian Tool. Full features available at: http://www.shef.ac.uk/FRAX/tool.jsp?country=19 - Made possible by Kanis J et al, the IOF and the WHO using data from Canadian population cohort studies. 


Developed and adapted by the World Health Organization, this tool combines information about risk factors for fracture and bone mineral density measurements to yield a 10-year likelihood of fracturing (Click here for FRAX tool).  In this study, we will introduce family physicians to this new tool and determine the extent to which it facilitates family physicians’ treatment decision making as compared to current reports.  We hypothesize that the FRAX tool will help family physicians to identify people who should be treated for osteoporosis and increase the treatment rate of individuals at risk for fracturing who would benefit from treatment.  Recruitment for this study is currently underway in London, Ontario and is being conducted in collaboration with the Hand and Upper Limb Centre.


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