Strengthening Versus Balance Exercises for Juvenile Idiopathic Arthritis

The American Journal of Physical Medicine and Rehabilitation published research on 30 children with juvenile idiopathic arthritis (JIA) comparing the effects of muscle strengthening exercises versus proprioceptive-balance exercises on lower extremity function.

Each child was evaluated for pain, passive range of motion, muscle strength, balance, and functional abilities using the Numeric Rating Scale, goniometer, handheld dynamometer, Flamingo Balance Test, Functional Reach Test, 10-meter walking test, 10-stair climbing test, and Childhood Health Assessment Questionnaire. The participants were randomly assigned to the strengthening exercise group or the proprioceptive-balance exercise group.

The results indicated the following:

1.  statistically significant improvements in all outcome measures were recorded except muscle strength in the hip and ankle after strengthening exercises.

2.  statistically significant improvements were found in all outcome measures after the proprioceptive-balance exercises.

3.  Intergroup analysis showed statistically significant improvement in all outcome measures in the proprioceptive-balance exercise group except for the Numeric Rating Scale, Childhood Health Assessment Questionnaire, and passive range of motion scores and hip extension and knee flexion muscle strengths.

The researchers concluded that exercise treatment significantly improves musculoskeletal symptoms in children with juvenile idiopathic arthritis. Balance-proprioceptive exercises were shown to be more effective than strengthening exercises for improving lower extremity function such as walking, climbing stairs, and balance in children with juvenile idiopathic arthritis.

Reference:  Baydogan, Saime Nilay MSc, PT; Tarakci, Ela PhD, PT; Kasapcopur, Ozgur MD.  Effect of Strengthening Versus Balance-Proprioceptive Exercises on Lower Extremity Function in Patients with Juvenile Idiopathic Arthritis: A Randomized, Single-Blind Clinical Trial. American Journal of Physical Medicine & Rehabilitation.  Published ahead on print on 3/24/15. doi: 10.1097/PHM.0000000000000279

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Foot Orthotics in Children with Juvenile Idiopathic Arthritis

Archives of Disease in Childhood published randomized controlled trial research on the use of foot orthoses in children with juvenile idiopathic arthritis (JIA).   Sixty children randomly received  either ‘fitted’ foot orthotics with customized chair-side corrections or ‘control’ foot orthotics made without corrections.  Changes in pain and quality of life for the children with JIA was assessed at baseline, 3 months and 6 months.

The following results were recorded:

1.  a statistically significant greater difference in pain reduction (baseline—6 months) was seen for the group with fitted foot orthotics

2.  the reduction in pain in the fitted foot orthotics group was clinically important (8 mm).

3.  significant differences in quality of life was seen in the fitted foot orthotic group as measured by the children and independently by their parents/carers.

The researchers concluded that fitted foot orthotics may reduce pain and improve quality of life in selected children with JIA.

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Reference:  Andrea Coda, Peter W Fowlie, Joyce E Davidson, Jo Walsh, Tom Carline, Derek Santos. Foot orthoses in children with juvenile idiopathic arthritis: a randomised controlled trial. Arch Dis Child archdischild-2013-305166Published Online First: 17 March 2014 doi:10.1136/archdischild-2013-305166

Exercise and Juvenile Idiopathic Arthritis

Current Opinion in Rheumatology recently published a review on the use of exercise therapy in the management of juvenile idiopathic arthritis (JIA). Previous studies indicate that children with JIA have significantly impaired aerobic and anaerobic exercise capacity. This can result in deconditioning and disability. Girls with polyarticular rhematoid factor positive subtype are at the great risk for disability. The authors state that

"Recent trials suggest that structured aerobic training or low-intensity programs do not exacerbate arthritis and can lead to improved physical fitness, quality of life and functional abilities in children and adolescents with JIA".

Reference: Long, Amy R; Rouster-Stevens, Kelly A The role of exercise therapy in the management of juvenile idiopathic arthritis

Current Opinion in Rheumatology

2010 doi: 10.1097/BOR.0b013e328335d1a2