Ottawa Panel Evidence-Based Clinical Practice Guidelines for Structured Physical Activity in the Management of Juvenile Idiopathic Arthritis

Sabrina Cavallo; Lucie Brosseau; Karine Toupin-April; George A Wells; Christine A Smith; Arlanna G Pugh; Jennifer Stinson; Roanne Thomas; Sara Ahmed; Ciarán M Duffy; Prinon Rahman; Inmaculada C Àlvarez-Gallardo; Laurianne Loew; Gino De Angelis; Debbie Ehrmann Feldman; Annette Majnemer; Isabelle J Gagnon; Désirée Maltais; Marie-Ève Mathieu; Glen P Kenny; Susan Tupper; Kristi Whitney-Mahoney; Sarah Bigford

doi:10.1016/j.apmr.2016.09.135

Ottawa Panel Evidence-Based Clinical Practice Guidelines for Structured Physical Activity in the Management of Juvenile Idiopathic Arthritis

Arch Phys Med Rehabil. 2017 May;98(5):1018-1041. doi: 10.1016/j.apmr.2016.09.135. Epub 2016 Dec 6.

Authors

Sabrina Cavallo¹, Lucie Brosseau², Karine Toupin-April³, George A Wells⁴, Christine A Smith⁵, Arlanna G Pugh⁶, Jennifer Stinson⁷, Roanne Thomas², Sara Ahmed⁸, Ciarán M Duffy⁹, Prinon Rahman¹⁰, Inmaculada C Àlvarez-Gallardo¹¹, Laurianne Loew², Gino De Angelis², Debbie Ehrmann Feldman¹², Annette Majnemer⁸, Isabelle J Gagnon⁸, Désirée Maltais¹³, Marie-Ève Mathieu¹⁴, Glen P Kenny¹⁵, Susan Tupper¹⁶, Kristi Whitney-Mahoney¹⁷, Sarah Bigford¹⁸

Affiliations

¹ Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: scavallo@uottawa.ca.
² Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada.
³ Department of Pediatrics, Faculty of Medicine, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
⁴ Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada; Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
⁵ Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁶ Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
⁷ Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
⁸ School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
⁹ Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
¹⁰ Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
¹¹ Department of Physical Education and Sport, University of Granada, Granada, Spain.
¹² School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; School of Public Health, Option Epidemiology, Université de Montréal, Montreal, Quebec, Canada.
¹³ Department of Rehabilitation, Allied Health Science and Physiotherapy, Université de Laval, Quebec City, Quebec, Canada.
¹⁴ Department of Kinesiology, Université de Montréal, Centre d'Éducation Physique et des Sports de l'Université de Montréal, Montreal, Quebec, Canada.
¹⁵ School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiological Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
¹⁶ Saskatoon Health Region, School of Physical Therapy, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
¹⁷ Rehabilitation Services, The Hospital for Sick Children, Toronto, Ontario, Canada.
¹⁸ Department of Physiotherapy, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.

PMID: 27932265
DOI: 10.1016/j.apmr.2016.09.135

Abstract

Objective: To create guidelines focused on the use of structured physical activity (PA) in the management of juvenile idiopathic arthritis (JIA).

Data sources: A systematic literature search was conducted using the electronic databases Cochrane Central Register of Controlled Trials, MEDLINE (Ovid), EMBASE (Ovid), and Physiotherapy Evidence Database for all studies related to PA programs for JIA from January 1966 until December 2014, and was updated in May 2015.

Study selection: Study selection was completed independently by 2 reviewers. Studies were included if they involved individuals aged ≤21 years diagnosed with JIA who were taking part in therapeutic exercise or other PA interventions for which effects of various disease-related outcomes were compared with a control group (eg, no PA program or activity of lower intensity).

Data extraction: Two reviewers independently extracted information on interventions, comparators, outcomes, time period, and study design. The statistical analysis was reported using the Cochrane Collaboration methods. The quality of the included studies was assessed according to the Physiotherapy Evidence Database Scale.

Data synthesis: Five randomized controlled trials (RCTs) fit the selection criteria; of these, 4 were high-quality RCTs. The following recommendations were developed: (1) Pilates for improving quality of life, pain, functional ability, and range of motion (ROM) (grade A); (2) home exercise program for improving quality of life and functional ability (grade A); (3) aquatic aerobic fitness for decreasing the number of active joints (grade A); and (4) and cardio-karate aerobic exercise for improving ROM and number of active joints (grade C+).

Conclusions: The Ottawa Panel recommends the following structured exercises and physical activities for the management of JIA: Pilates, cardio-karate, home and aquatic exercises. Pilates showed improvement in a higher number of outcomes.

Keywords: Arthritis, juvenile; Exercise; Exercise therapy; Practice guideline; Rehabilitation.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Arthritis, Juvenile / rehabilitation*
Exercise Therapy / methods*
Humans
Pain Management
Practice Guidelines as Topic
Quality of Life*
Randomized Controlled Trials as Topic
Range of Motion, Articular