Exercise Therapy in Juvenile Idiopathic Arthritis: A Systematic Review and Meta-analysis

Publication date: Available online 18 July 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Gregor Kuntze, Colleen Nesbitt, Jackie L. Whittaker, Alberto Nettel-Aguirre, Clodagh Toomey, Shane Esau, Patricia K. Doyle-Baker, Jena Shank, Julia Brooks, Susanne Benseler, Carolyn A. Emery
ObjectiveTo conduct a systematic review to evaluate the efficacy of exercise interventions on improving outcomes across domains of functioning and disability in children and adolescents with Juvenile Idiopathic Arthritis (JIA).Data SourcesSeven electronic databases were systematically searched up to December 2016.Study SelectionOriginal 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 ExtractionTwo authors screened search results and discrepancies were resolved by consensus. Of 5037 potentially relevant studies, nine randomized controlled trials (RCT) and one cohort study, were included and scored.Data SynthesisStudy quality [Downs and Black (DB)] and level of evidence (Oxford Centre of Evidence-Based Medicine model) was assessed and meta-analysis conducted where appropriate. Alternatively, a descriptive summary approach was chosen. All RCTs were moderate quality intervention studies [level 2b evidence; median DB score 20/32 (range 15–27)]. Interventions included aquatic, strengthening, proprioceptive, aerobic, and Pilates exercises. Pediatric activity capacity (Child Health Assessment Questionnaire) improved with exercise (median MD 0.45 [95% CI 0.05, 0.76]). Further, descriptive summaries indicated improved activity capacity, body function and structure (pain and muscle strength), and quality of life outcomes.ConclusionsExercise 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.



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