title: Development of a tool for early referral of children and adolescents with signs and symptoms suggestive of chronic arthropathy to pediatric rheumatology centers.
abstract: OBJECTIVE
  To develop an easy, time-efficient tool to identify children and adolescents with signs and symptoms suggestive of chronic arthropathies, and to evaluate its interobserver reproducibility and reliability.
  
  
  METHODS
  The instrument used standardized techniques as required for the development of health-related instruments, targeting parents of apparently healthy children and adolescents ages 1-16 years. A multidisciplinary team was involved in the design of the instrument.
  
  
  RESULTS
  Each health professional generated 10-15 questions addressing musculoskeletal complaints that they considered to be the most relevant. A total of 60 questions were listed. During the reduction step, each health professional scored questions from 1 to 4 according to the question's relevance. The tool comprised 12 questions and was administered to the parents of 3 groups: patients with juvenile idiopathic arthritis (JIA; n = 48), children with diffuse musculoskeletal pain (n = 39), and a healthy control group (n = 42). The JIA group achieved the highest scores, followed by the diffuse musculoskeletal pain group and the control group. Nine (18.7%) of 48 patients with JIA and 2 (5.1%) of 39 children with musculoskeletal pain had a score of 5. The interobserver reproducibility was confirmed. All 12 questions were included in the final version of the instrument. We determined that children and adolescents with a score > or =5 should be referred for a rheumatologic evaluation (cluster analysis and logistic regression).
  
  
  CONCLUSIONS
  Our questionnaire seems to be a useful tool for the early detection of musculoskeletal problems in children that may need a referral for a rheumatologic evaluation.
authors.affiliation: Escola Paulista de Medicina, Universidade Federal de São Paulo, Avenida Brigadeiro Faria Lima 1826 cj 205, São Paulo, SP CEP 01451-001, Brazil. len.cl@terra.com.br
authors.forename: Claudio Arnaldo
authors.initials: CA
authors.lastname: Len
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Terreri
authors.forename: Rosana F
authors.initials: RF
authors.lastname: Puccini
authors.forename: Rudolf
authors.initials: R
authors.lastname: Wechsler
authors.forename: Edina Koga
authors.initials: EK
authors.lastname: Silva
authors.forename: Leda M
authors.initials: LM
authors.lastname: Oliveira
authors.forename: Cássia M Passarelli
authors.initials: CM
authors.lastname: Barbosa
authors.forename: Glaura César
authors.initials: GC
authors.lastname: Pedroso
authors.forename: Maria Odete E
authors.initials: MO
authors.lastname: Hilário
mesh_terms: D000293:Adolescent; D001171:Arthritis, Juvenile / Q000175:diagnosis* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D042241:Early Diagnosis; D005194:Family Practice; D006801:Humans; D007223:Infant; D008403:Mass Screening / Q000379:methods*; D010146:Pain / Q000175:diagnosis / Q000503:physiopathology; D010372:Pediatrics / Q000379:methods*; D011237:Predictive Value of Tests; D012017:Referral and Consultation; D012219:Rheumatology; D011795:Surveys and Questionnaires