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Exercise Therapy in Juvenile Idiopathic Arthritis

OBJECTIVE: To conduct a systematic review to evaluate the efficacy of exercise
interventions in improving outcomes across domains of functioning and disability
in children and adolescents with juvenile idiopathic arthritis (JIA). DATA SOURCES: Seven electronic databases were systematically searched up to November
16, 2016. STUDY SELECTION: Original data, analytic prospective design, physical
therapy-led exercise intervention evaluation, children and adolescents with JIA,
and assessment of functional, structural, activity, participation, or quality of
life outcomes. DATA EXTRACTION: Two authors screened search results, and
discrepancies were resolved by consensus. Of 5037 potentially relevant studies, 9
randomized controlled trials and 1 cohort study were included and scored. DATA
SYNTHESIS: 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 randomized controlled trials were moderate-quality
intervention studies (level 2b evidence; median Downs and Black score, 20 out of
32; range, 15-27). Interventions included aquatic, strengthening, proprioceptive,
aerobic, and Pilates exercises. Pediatric activity capacity (Child Health
Assessment Questionnaire) improved with exercise (mean difference, .45; 95%
confidence interval, .05-.76). Furthermore, descriptive summaries indicated
improved activity capacity, body function and structure (pain and muscle
strength), and quality of life outcomes. CONCLUSIONS: 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.
CI - Copyright (c) 2016 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS

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