Physical and mechanical therapies for lower limb problems in children with juvenile idiopathic arthritis: a systematic review with meta-analysis

Abstract

Objective To systematically review the evidence for physical (for e.g. strengthening) and mechanical (for e.g. foot orthoses) therapies for lower limb problems in children with juvenile idiopathic arthritis (JIA).

Methods Randomised clinical trials of physical and mechanical interventions for lower limb problems in children with JIA were included. The primary outcome was pain and secondary outcomes included disability, functional ability, and quality of life. Electronic databases were searched for eligible studies. Authors of included studies and researchers in the field were contacted to identify additional studies.

Results Two authors independently screened 4876 titles and abstracts. Eleven randomised clinical trials were ultimately included. Four studies explored the effect of foot orthoses and seven physical therapies. Studies evaluating the effect of foot orthoses on foot and ankle pain were pooled in a meta-analysis. Results showed that foot orthoses were statistically and clinically significant in reducing both parent (−11.08 [−20.25, −1.90]) and child (−21.45 [−30.18, −12.73]) reported foot and ankle pain after 3 months compared to the control. This significant effect was sustained post 3 months. Physical therapies such as Pilates and underwater exercises were statistically and clinically significant in reducing lower limb pain after 3 months of intervention.

Conclusion Foot orthoses can be prescribed to significantly reduce foot and ankle pain for children with JIA. Physical therapies appear to reduce pain during 3 months of intervention versus the control but are currently hampered by lack of blinding. Further research is also required to determine the effect of physical therapies past 3 months.