Catania H.1, Fortini V.2, Marchettini M.3, Maresca G.4, Cimaz R.5
1I.R.C.C.S. Fondazione Santa Lucia, Roma, Italy, 2University of Florence, Meyer Children's Hospital, Rehabilitation Department, Florence, Italy, 3Prato Hospital, Unit of Functional Rehabilitation, Prato, Italy, 4Freelance Physical Therapist, Rome, Italy, 5University of Florence, Meyer Children's Hospital, Rheumatology Unit, Florence, Italy
Background: In 2008 it was performed a Cochrane review which demonstrated that there are not efficacy evidences about exercise therapy: the authors highlight that the low number of available RCTs limits the generalizability and it's difficult to recommend exercise therapy as an effective treatment for Juvenile Idiopathic Arthritis (JIA). Many studies highlight benefits of exercise and physical activity, but the best therapeutic exercise programme for children with JIA is unknown. The need has emerged to research and analyse the information in literature following the publication of the Cochrane in 2008, in order to verify recent evidence on the efficacy of exercise therapy and physical activity and the consequent indications for treatment in children with JIA.
Purpose: This study aims at identifying if, since the 2008 Cochrane Review on Exercise therapy in juvenile idiopathic arthritis, specific studies have been published which demonstrate the efficacy of exercise therapy and physical activity for children with Juvenile idiopathic arthritis.
Methods: A systematic review has been conducted, identifying studies, published from 2008 onwards, which debate the use of physical activity and exercise therapy in the treatment of children and adolescents with JIA, except for the Cochrane Review. Two revisers individually analysed the results of the research to determine the eligibility of studies. The RCT study designs were evaluated using PEDro scales.
Results: 23 studies were collected: 7 RCT, 8 review, 1 uncontrolled experimental study, 2 analytical observational studies (case-control), 3 descriptive observational studies (2 case-reports and 1 editorial), 1 regional guideline and 1 national guideline. Almost the totality of RCT taken into account , the reinforcement exercise scored statistically significant improvements.
Conclusion(s): In addition to drug treatment, it emerges that an exercise therapy and physical activity program may be recommended to children/adolescents with this condition with demonstrated benefits such as the reduction of the number of inflamed active joints and intensity of pain as well as the improvement of the joint range, muscle strength, functional status and quality of life. This review shows the importance of the combination of strengthening, stretching, proprioceptive and balance exercises and activities in water. Many of the reviewed studies propose an intensive program of physical activity and exercise therapy, conducted 3 times a week for 12-weeks.
Implications: This review will be useful to physical therapists and rheumatologists as it is possible to predict the exercise therapy and physical activity in the treatment of children and adolescents with juvenile idiopathic arthritis.
Funding acknowledgements: None.
Topic: Paediatrics
Ethics approval: The ethics approval was not required.
All authors, affiliations and abstracts have been published as submitted.
