Browsing by Person "Clapham, Matthew"

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Effect of customised preformed foot orthoses on gait parameters in children with juvenile idiopathic arthritis: A multicentre randomised clinical trial
(Elsevier, 2022-04-22) Fellas, Antoni; Singh-Grewal, Davinder; Chaitow, Jeffrey; Santos, Derek; Clapham, Matthew; Coda, Andrea
Background Children with juvenile idiopathic arthritis (JIA) can experience significant physical impairment of the lower extremity. Prolonged joint disease and symptoms may cause gait alterations such as reduced walking speed and increased plantar pressures in diseased areas of their feet. There is limited robust clinical trials investigating the effect of non-invasive mechanical therapies such as foot orthoses (FOs) on improving gait parameters in children with JIA.
Effect of preformed foot orthoses in reducing pain in children with juvenile idiopathic arthritis: A multicentre randomised clinical trial
(Oxford University Press, 2021-10-14) Fellas, Antoni; Singh-Grewal, Davinder; Chaitow, Jeffrey; Santos, Derek; Clapham, Matthew; Coda, Andrea
Objectives The aim of this study is to investigate the effect of customised preformed foot orthoses on pain, quality of life, swollen and tender lower joints and foot and ankle disability in children with juvenile idiopathic arthritis (JIA). Methods Parallel group design. Children diagnosed with JIA were recruited from the three children’s hospital in NSW, Australia. Participants were randomly assigned to a control group receiving a standard flat innersole (sham) with no corrective modifications. The trial group were prescribed a preformed device that was customised based on biomechanical assessments. Pain was the primary outcome and was followed up to 12-months post intervention. Secondary outcomes include quality of life, foot and ankle disability and swollen and tender joints. A linear mixed model was used to assess the impact of the intervention at each time point. Results 66 participants were recruited. Child reported pain was reduced statistically and clinically significant at 4-weeks and 3 months post intervention in favour of the trial group. Statistically significance was not reached at 6 and 12-month follow-ups. Quality of life and foot and ankle disability were not statistically significant at any follow-up; however, tender midfoot and ankle joints were significantly reduced 6-months post intervention. Conclusion Results of this clinical trial indicate customised preformed foot orthoses can be effective in reducing pain and tender joints in children with JIA exhibiting foot and ankle symptoms. Long-term efficacy of foot orthoses remains unclear. Overall, the trial intervention was safe, inexpensive and well tolerated by paediatric patients. Trial registry Australian New Zealand Clinical Trials Registry (ANZCTR): 12616001082493
Physical examination tool for swollen and tender lower limb joints in juvenile idiopathic arthritis: A pilot diagnostic accuracy study
(MDPI, 2022-04-08) Fellas, Antoni; Singh-Grewal, Davinder; Chaitow, Jeffrey; Warner, Denise; Onikul, Ella; Santos, Derek; Clapham, Matthew; Coda, Andrea
Background: Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children, with lower limb involvement highly prevalent. Recent evidence has highlighted the lack of specific lower limb physical examination (PE) tools for clinicians assisting the paediatric rheumatology team in identifying lower extremity disease in patients with JIA. Early clinical detection may lead to more prompt and targeted interventions to reduce lower limb problems in children with JIA. The aim of this pilot study is to provide preliminary data on the diagnostic accuracy of a lower limb PE tool in JIA. Methods: Children with JIA requiring magnetic resonance imaging (MRI) on their lower limb joints per their usual care were eligible. Lower limb joint counts were conducted clinically by a podiatrist and paediatric rheumatologist using the proposed twenty joint per side, PE tool. The PE were compared to MRI assessments completed by two independent paediatric radiologists. Data were analysed using agreement (observed, positive and negative) and Cohen’s kappa with 95% CIs. Results: Fifteen participants were recruited into the study in which 600 lower limb joints were clinically examined. Statistical analysis showed excellent inter-rater reliability between podiatrist and paediatric rheumatologist for both joint swelling and tenderness. Results of the intra-rater reliability of the podiatrist using the PE tool indicated excellent percentage agreements (98.5−100%) and substantial kappa coefficients (0.93−1). The inter-rater reliability between radiological assessments contrasted the PE results, showing low agreement and poor reliability. Comparisons between PE and MRI resulted in poor kappa coefficients and low agreement percentages. The most agreeable joint between MRI and PE was the ankle joint, while the worst performing joint was the sub-talar joint. Conclusion: Results indicate potential clinical reliability; however, the validity and diagnostic accuracy of the proposed PE tool remains unclear due to low kappa coefficients and inconsistent agreements between PE and MRI results. Further research will be required before the tool may be used in a clinical setting.