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||Kuntze, G., Nesbitt, C., Whittaker, J. L., Nettel-Aguirre, A., Toomey, C., Esau, S., Doyle-Baker, P. K., . . . Emery, C. A. (2018). Exercise therapy in juvenile idiopathic arthritis: A systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation, 99(1), 178-193, 193.e1.
||Arthritis, children, exercise, intervention, literature reviews, musculoskeletal disorders, outcomes, physical therapy, quality of life, therapeutic training, youth
||This review evaluated the efficacy of exercise interventions in improving outcomes across domains of functioning and disability in children and adolescents with juvenile idiopathic arthritis (JIA). Seven electronic databases were systematically searched up to November 16, 2016 for studies that evaluated a physical therapy-led exercise intervention, included children and adolescents with JIA, and assessed functional, structural, activity, participation, or quality of life outcomes. Two authors screened search results, and discrepancies were resolved by consensus. Of 5,037 potentially relevant studies, 9 randomized controlled trials (RCTs) and 1 cohort study were included and scored. 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 RCTs were moderate-quality intervention studies. Interventions included aquatic, strengthening, proprioceptive, aerobic, and Pilates exercises. Pediatric activity capacity (Child Health Assessment Questionnaire) improved with exercise. Furthermore, descriptive summaries indicated improved activity capacity, body function and structure (pain and muscle strength), and quality of life outcomes. 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.
|Full-Text Availability Options:||https://www.ncbi.nlm.nih.gov/pubmed/28729171|