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Ottawa Panel Evidence-Based Clinical Practice Guidelines for Foot Care in the Management of Juvenile Idiopathic
Lucie Brosseau1, Karine Toupin-April2, George Wells3
1Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada.
Insights
Customized foot orthotics and shoe inserts effectively manage pain and improve function in children with juvenile idiopathic arthritis (JIA). These interventions offer significant benefits for foot pain and activity limitations in JIA patients.
Area of Science:
- Rheumatology
- Pediatrics
- Orthopedics
Background:
- Juvenile idiopathic arthritis (JIA) commonly affects children and adolescents, often leading to foot pain and functional limitations.
- Effective management strategies are crucial for improving the quality of life in young patients with JIA.
Purpose of the Study:
- To develop evidence-based guidelines for foot care interventions in the management of JIA.
- To evaluate the efficacy of various foot care and orthotic interventions for JIA patients aged 0-18 years.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (MEDLINE, EMBASE, Cochrane CENTRAL, clinicaltrials.gov) up to May 2015.
- High-quality studies meeting Ottawa Panel criteria were selected, with data extracted by two independent reviewers.
- Intervention outcomes were analyzed using Cochrane Collaboration methodology, with clinical significance defined as ≥30% improvement.
Main Results:
- Included studies focused on multidisciplinary foot care, custom foot orthotics, and shoe inserts for JIA management.
- Custom-made foot orthotics and prefabricated shoe inserts demonstrated the most significant improvements in pain intensity, activity limitation, and disability (Grades A, C+).
Conclusions:
- Customized foot orthotics and prefabricated shoe inserts are recommended as effective options for managing foot pain and improving function in JIA.
- These interventions show promise in addressing key symptoms and functional deficits associated with JIA in the pediatric population.
Objective:
To create evidence-based guidelines evaluating foot care interventions for the management of juvenile idiopathic arthritis (JIA).
Data Sources:
An electronic literature search of the following databases from database inception to May 2015 was conducted: MEDLINE (Ovid), EMBASE (Ovid), Cochrane CENTRAL, and clinicaltrials.gov.
Study Selection:
The Ottawa Panel selection criteria targeted studies that assessed foot care or foot orthotic interventions for the management of JIA in those aged 0 to ≤18 years. The Physiotherapy Evidence Database scale was used to evaluate study quality, of which only high-quality studies were included (score, ≥5). A total of 362 records were screened, resulting in 3 full-text articles and 1 additional citation containing supplementary information included for the analysis.
Data Extraction:
Two reviewers independently extracted study data (intervention, comparator, outcome, time period, study design) from the included studies by using standardized data extraction forms. Directed by Cochrane Collaboration methodology, the statistical analysis produced figures and graphs representing the strength of intervention outcomes and their corresponding grades (A, B, C+, C, C-, D+, D, D-). Clinical significance was achieved when an improvement of ≥30% between the intervention and control groups was present, whereas P>.05 indicated statistical significance. An expert panel Delphi consensus (≥80%) was required for the endorsement of recommendations.
Data Synthesis:
All included studies were of high quality and analyzed the effects of multidisciplinary foot care, customized foot orthotics, and shoe inserts for the management of JIA. Custom-made foot orthotics and prefabricated shoe inserts displayed the greatest improvement in pain intensity, activity limitation, foot pain, and disability reduction (grades A, C+).
Conclusions:
The use of customized foot orthotics and prefabricated shoe inserts seems to be a good choice for managing foot pain and function in JIA.
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