Abstract
Objective
To conduct a systematic review to evaluate the efficacy of exercise interventions
in improving outcomes across domains of functioning and disability in children and
adolescents with juvenile idiopathic arthritis (JIA).
Data Sources
Seven electronic databases were systematically searched up to November 16, 2016.
Study Selection
Original data, analytic prospective design, physical therapy–led exercise intervention
evaluation, children and adolescents with JIA, and assessment of functional, structural,
activity, participation, or quality of life outcomes.
Data Extraction
Two authors screened search results, and discrepancies were resolved by consensus.
Of 5037 potentially relevant studies, 9 randomized controlled trials and 1 cohort
study were included and scored.
Data Synthesis
Study quality (Downs and Black quality assessment tool) and level of evidence (Oxford
Centre of Evidence-Based Medicine model) were assessed and meta-analysis conducted
where appropriate. Alternatively, a descriptive summary approach was chosen. All randomized
controlled trials were moderate-quality intervention studies (level 2b evidence; median
Downs and Black score, 20 out of 32; range, 15–27). Interventions included aquatic,
strengthening, proprioceptive, aerobic, and Pilates exercises. Pediatric activity
capacity (Child Health Assessment Questionnaire) improved with exercise (mean difference,
.45; 95% confidence interval, .05–.76). Furthermore, descriptive summaries indicated
improved activity capacity, body function and structure (pain and muscle strength),
and quality of life outcomes.
Conclusions
Exercise therapy appears to be well tolerated and beneficial across clinically relevant
outcomes in patients with JIA. The paucity of high-quality evidence and study heterogeneity
limited the ability to provide conclusive, generalizing evidence for the efficacy
of exercise therapy and to provide specific recommendations for clinical practice
at this time. Future research evaluating exercise program implementation using validated
outcomes and detailed adherence and safety assessment is needed to optimize clinical
decision pathways in patients with JIA.
Keywords
List of abbreviations:
CHAQ (Child Health Assessment Questionnaire), CI (confidence interval), DB (Downs and Black), HRQOL (health-related quality of life), JAFAS (Juvenile Arthritis Functional Assessment Scale), JIA (juvenile idiopathic arthritis), MD (mean difference), MeSH (Medical Subject Headings), mp (multipurpose), PedsQL (Pediatric Quality of Live Inventory), QOL (quality of life), RCT (randomized controlled trial)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 17, 2017
Footnotes
Supported through a Chair in Pediatric Rehabilitation (Alberta Children's Hospital Foundation) and through the Vi Riddell Pediatric Rehabilitation Research Program.
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
