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Physical and Mechanical Therapies for Lower-Limb Problems in Juvenile Idiopathic ArthritisA Systematic Review with
Insights
Research on physical and mechanical therapies for lower-limb issues in juvenile idiopathic arthritis (JIA) is limited. Current evidence on foot orthoses shows no significant improvement in pain or quality of life for children with JIA.
Area of Science:
- Pediatric Rheumatology
- Physical Therapy
- Biomechanical Engineering
Background:
- Juvenile idiopathic arthritis (JIA) is a common chronic autoimmune inflammatory joint disease in children.
- Lower-limb dysfunction and disability are frequent complications of JIA in pediatric patients.
- Systematic review focused on the efficacy of physical and mechanical interventions for lower-limb problems in JIA.
Purpose of the Study:
- To systematically review the effectiveness of physical and mechanical therapies for lower-limb dysfunction in children with JIA.
- To assess the impact of interventions on pain, disability, functional ability, and quality of life.
- To identify gaps in current research for future investigation.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) involving physical and mechanical interventions for lower-limb issues in JIA.
- Inclusion criteria focused on studies measuring pain, disability, functional ability, and health-related quality of life.
- Comprehensive literature search across multiple databases, supplemented by contacting study authors and field experts.
Main Results:
- Only two RCTs evaluating custom/customized foot orthoses for foot and ankle pain in JIA patients (N=100) were identified.
- Meta-analyses revealed no significant differences in pain, child-rated, or parent-rated quality of life between foot orthoses and control interventions after three months.
- Sensitivity analyses supported the meta-analysis findings, indicating robustness of the results.
Conclusions:
- There is a significant lack of research on physical and mechanical therapies for lower-limb problems in JIA.
- Current evidence is limited to foot orthoses and shoe inserts for foot and ankle pain, with no RCTs on physical therapy interventions.
- Small sample sizes in existing studies hinder definitive conclusions, underscoring the need for further high-quality research.
Background:
Juvenile idiopathic arthritis (JIA), a chronic, autoimmune, inflammatory joint disease, is the most common arthritis affecting children younger than 16 years. Children with JIA commonly experience lower-limb dysfunction and disability. We systematically reviewed the effectiveness of physical and mechanical therapies for lower-limb problems in JIA.
Methods:
Randomized controlled trials of physical and mechanical interventions for lower-limb problems in children with JIA were included. Primary outcome was pain. Secondary outcomes included disability, functional ability, and health-related quality of life. Several databases were searched for eligible studies. Authors of included studies and researchers in the field were contacted to identify additional studies.
Results:
Two studies evaluating the effectiveness of customized/custom foot orthoses in treating foot and ankle pain in children with JIA (N = 100) were included. One study also evaluated simple cushioned inserts. Meta-analyses for comparisons between custom/customized foot orthoses and a control intervention after 3 months were not significant for the outcomes of pain (mean difference, -8.97; 95% confidence interval [CI], -18.01 to 0.07), child-rated health-related quality of life (mean difference, 4.38; 95% CI, -3.68 to 12.44), and parent-rated health-related quality of life (mean difference, 1.77; 95% CI, -6.35 to 9.90). Meta-analyses were supported by sensitivity analyses.
Conclusions:
There is a paucity of research evaluating physical and mechanical therapies for lower-limb problems in JIA. No physical therapy has been evaluated in randomized controlled trials, and mechanical therapy evaluation is limited to foot orthoses and shoe inserts for foot and ankle pain. The existing research is hampered by small sample sizes. Until further research is conducted, the effectiveness of mechanical and physical therapies for lower-limb problems in JIA remains unclear.
