{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T11:14:00Z","timestamp":1783509240340,"version":"3.55.0"},"reference-count":96,"publisher":"MDPI AG","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,9,1]]},"abstract":"\n Background:<\/jats:title>\n Juvenile idiopathic arthritis (JIA), a chronic, autoimmune, inflammatory joint disease, is the most common arthritis affecting children younger than 16 years. Children with JIA commonly experience lower-limb dysfunction and disability. We systematically reviewed the effectiveness of physical and mechanical therapies for lower-limb problems in JIA.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n Randomized controlled trials of physical and mechanical interventions for lower-limb problems in children with JIA were included. Primary outcome was pain. Secondary outcomes included disability, functional ability, and health-related quality of life. Several databases were searched for eligible studies. Authors of included studies and researchers in the field were contacted to identify additional studies.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n Two studies evaluating the effectiveness of customized\/custom foot orthoses in treating foot and ankle pain in children with JIA (N = 100) were included. One study also evaluated simple cushioned inserts. Meta-analyses for comparisons between custom\/customized foot orthoses and a control intervention after 3 months were not significant for the outcomes of pain (mean difference, \u20138.97; 95% confidence interval [CI], \u201318.01 to 0.07), child-rated health-related quality of life (mean difference, 4.38; 95% CI, \u20133.68 to 12.44), and parent-rated health-related quality of life (mean difference, 1.77; 95% CI, \u20136.35 to 9.90). Meta-analyses were supported by sensitivity analyses.<\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n There is a paucity of research evaluating physical and mechanical therapies for lower-limb problems in JIA. No physical therapy has been evaluated in randomized controlled trials, and mechanical therapy evaluation is limited to foot orthoses and shoe inserts for foot and ankle pain. The existing research is hampered by small sample sizes. Until further research is conducted, the effectiveness of mechanical and physical therapies for lower-limb problems in JIA remains unclear.<\/jats:p>\n <\/jats:sec>","DOI":"10.7547\/15-213","type":"journal-article","created":{"date-parts":[[2017,7,24]],"date-time":"2017-07-24T17:34:31Z","timestamp":1500917671000},"page":"399-412","source":"Crossref","is-referenced-by-count":12,"title":["Physical and Mechanical Therapies for Lower-Limb Problems in Juvenile Idiopathic Arthritis"],"prefix":"10.3390","volume":"107","author":[{"given":"Antoni","family":"Fellas","sequence":"first","affiliation":[{"name":"School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Ourimbah, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Coda","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Ourimbah, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiona","family":"Hawke","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Ourimbah, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"ref121","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1093\/jpepsy\/21.2.237","article-title":"Assessing chronic musculoskeletal pain associated with rheumatic disease: further validation of the pediatric pain questionnaire","volume":"21","author":"Gragg","year":"1996","journal-title":"J Pediatr Psychol"},{"key":"ref651","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1007\/s13312-014-0383-2","article-title":"Growth of children with juvenile idiopathic arthritis","volume":"51","author":"Mondal","year":"2014","journal-title":"Indian Pediatr"},{"key":"ref751","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1093\/jpepsy\/22.5.607","article-title":"Juvenile rheumatoid arthritis: benefits from massage therapy","volume":"22","author":"Field","year":"1997","journal-title":"J Pediatr Psychol"},{"key":"ref61","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1002\/art.22463","article-title":"Economic impact of juvenile idiopathic arthritis","volume":"57","author":"Bernatsky","year":"2007","journal-title":"Arthritis Care Res"},{"key":"ref561","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1002\/art.22463","article-title":"Economic impact of juvenile idiopathic arthritis","volume":"57","author":"Bernatsky","year":"2007","journal-title":"Arthritis Care Res"},{"key":"ref901","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1002\/acr.20085","article-title":"Promoting physical activity in children with juvenile idiopathic arthritis through an internet-based program: results of a pilot randomized controlled trial","volume":"62","author":"Lelieveld","year":"2010","journal-title":"Arthritis Care Res"},{"key":"ref281","doi-asserted-by":"crossref","DOI":"10.3310\/hta9390","article-title":"Is hydrotherapy cost-effective? A randomised controlled trial of combined hydrotherapy programmes compared with physiotherapy land techniques in children with juvenile idiopathic arthritis","volume":"9:","author":"Epps","year":"2005","journal-title":"Health Technol Assess"},{"key":"ref601","article-title":"Physical and mechanical therapies for lower limb problems in juvenile idiopathic arthritis: a systematic review (protocol)","volume":"2.","author":"Fellas","year":"2015","journal-title":"Appl Clin Res Clin Trials Regul Aff"},{"key":"ref521","first-page":"390","article-title":"International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001","volume":"31","author":"Petty","year":"2004","journal-title":"J Rheumatol"},{"key":"ref991","first-page":"S89","article-title":"Early predictors of outcome in juvenile idiopathic arthritis","volume":"21","author":"Ravelli","year":"2003","journal-title":"Clin Exp 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German paediatric rheumatologic database","volume":"27","author":"Minden","year":"2009","journal-title":"Clin Exp Rheumatol"},{"key":"ref811","doi-asserted-by":"crossref","first-page":"41","DOI":"10.3109\/09638289309165869","article-title":"A comparative study of orthoplast cock-up splints versus ready-made Droitwich work splints in juvenile chronic arthritis","volume":"15","author":"Eberhard","year":"1993","journal-title":"Disabil Rehabil"},{"key":"ref731","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/1546-0096-11-7","article-title":"Muscle strength, physical fitness and well-being in children and adolescents with juvenile idiopathic arthritis and the effect of an exercise programme: a randomized controlled trial","volume":"11","author":"Sandstedt","year":"2013","journal-title":"Pediatr Rheumatol Online J"},{"key":"ref301","first-page":"230","article-title":"Pool therapy compared with individual home exercise therapy for juvenile rheumatoid arthritic patients","volume":"58","author":"Baldwin","year":"1972","journal-title":"Physiotherapy"},{"key":"ref661","first-page":"CD006801","article-title":"Custom-made foot orthoses for the treatment of foot pain","volume":"3","author":"Hawke","year":"2008","journal-title":"Cochrane Database Syst Rev"},{"key":"ref191","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1136\/archdischild-2013-305166","article-title":"Foot orthoses in children with juvenile idiopathic arthritis: a randomised controlled trial","volume":"99","author":"Coda","year":"2014","journal-title":"Arch Dis Child"},{"key":"ref221","first-page":"S1","article-title":"A family based pedometer walking program in an adolescent population with juvenile idiopathic arthritis","volume":"64","author":"Stern","year":"2012","journal-title":"Arthritis Rheum"},{"key":"ref341","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1002\/1529-0131(200012)13:6<352::AID-ART4>3.0.CO;2-O","article-title":"The effect of static traction 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idiopathic arthritis: an exploratory trial","volume":"45","author":"Hendry","year":"2013","journal-title":"J Rehabil Med"},{"key":"ref631","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1097\/00005650-199902000-00003","article-title":"The PedsQL: measurement model for the pediatric quality of life inventory","volume":"37","author":"Varni","year":"1999","journal-title":"Med Care"},{"key":"ref41","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1136\/ard.2003.008516","article-title":"Burden and cost of illness in patients with juvenile idiopathic arthritis","volume":"63","author":"Minden","year":"2004","journal-title":"Ann Rheum Dis"},{"key":"ref151","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1007\/s13312-014-0383-2","article-title":"Growth of children with juvenile idiopathic arthritis","volume":"51","author":"Mondal","year":"2014","journal-title":"Indian Pediatr"},{"key":"ref371","first-page":"7","article-title":"A feasibility trial of multidisciplinary foot care for children and adolescents with juvenile idiopathic arthritis","volume":"42","author":"Hendry","year":"2012","journal-title":"Intern Med J"},{"key":"ref511","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/S0950-3579(98)80022-8","article-title":"Rehabilitation in children with juvenile chronic arthritis","volume":"12","author":"H\u00e4fner","year":"1998","journal-title":"Bailli\u00e8res Clin Rheumatol"},{"key":"ref441","first-page":"169","article-title":"Promoting physical activity in children with juvenile idiopathic arthritis through an Internet-based program: results of a pilot randomized controlled trial [in Dutch]","volume":"120","author":"van Brussel","year":"2010","journal-title":"Nederlands Tijdschrift Voor Fysiother"},{"key":"ref591","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1007\/s10067-011-1832-0","article-title":"The relationship between physical activity level, anxiety, depression, and functional ability in children and adolescents with juvenile idiopathic arthritis","volume":"30","author":"Tarakci","year":"2011","journal-title":"Clin Rheumatol"},{"key":"ref01","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1016\/S0140-6736(07)60363-8","article-title":"Juvenile idiopathic arthritis","volume":"369","author":"Ravelli","year":"2007","journal-title":"Lancet"},{"key":"ref471","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1002\/art.10095","article-title":"The PedsQL in pediatric rheumatology: reliability, validity, and responsiveness of the Pediatric Quality of Life Inventory Generic Core Scales and Rheumatology Module","volume":"46","author":"Varni","year":"2002","journal-title":"Arthritis Rheum"},{"key":"ref261","doi-asserted-by":"crossref","first-page":"2093","DOI":"10.1016\/j.apmr.2013.05.026","article-title":"Effects of Pilates exercises on health-related quality of life in individuals with juvenile idiopathic arthritis","volume":"94","author":"Mendonca","year":"2013","journal-title":"Arch Phys Med Rehabil"},{"key":"ref701","first-page":"943","article-title":"Efficacy of custom foot orthotics in improving pain and functional status in children with juvenile idiopathic arthritis: a randomized trial","volume":"32","author":"Powell","year":"2005","journal-title":"J Rheumatol"},{"key":"ref621","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1093\/jpepsy\/21.2.237","article-title":"Assessing chronic musculoskeletal pain associated with rheumatic disease: further validation of the pediatric pain questionnaire","volume":"21","author":"Gragg","year":"1996","journal-title":"J Pediatr Psychol"},{"key":"ref761","doi-asserted-by":"crossref","first-page":"2093","DOI":"10.1016\/j.apmr.2013.05.026","article-title":"Effects of Pilates exercises on health-related quality of life in individuals with juvenile idiopathic arthritis","volume":"94","author":"Mendonca","year":"2013","journal-title":"Arch Phys Med Rehabil"},{"key":"ref211","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1136\/annrheumdis-2012-eular.2933","article-title":"The efficacy of land-based home exercise program in patients with juvenile idiopathic arthritis: a randomized-controlled, single-blind study","volume":"71","author":"Tarakci","year":"2013","journal-title":"Ann Rheum Dis"},{"key":"ref331","doi-asserted-by":"crossref","first-page":"P177","DOI":"10.1186\/1546-0096-12-S1-P177","article-title":"Is there an evidence for the role of multidisciplinary team in the management of active juvenile idiopathic arthritis?","volume":"12","author":"Fingerhutova","year":"2014","journal-title":"Pediatr Rheumatol"},{"key":"ref131","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1097\/00005650-199902000-00003","article-title":"The PedsQL: measurement model for the pediatric quality of life inventory","volume":"37","author":"Varni","year":"1999","journal-title":"Med 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arthritis","volume":"23","author":"Baldwin","year":"1971","journal-title":"J Can Physiother Assoc"},{"key":"ref911","doi-asserted-by":"crossref","DOI":"10.1186\/1546-0096-9-S1-P208","article-title":"Does standard phisiotherapy influence the health-related quality of life of JIA patients?","author":"Mendonca","year":"2011","journal-title":"18th Pediatric Rheumatology European Society Congress"},{"key":"ref921","first-page":"947","article-title":"Lower extremity isometric strength in children with juvenile idiopathic arthritis","volume":"26","author":"Saarinen","year":"2008","journal-title":"Clin Exp Rheumatol"},{"key":"ref491","first-page":"S89","article-title":"Early predictors of outcome in juvenile idiopathic arthritis","volume":"21","author":"Ravelli","year":"2003","journal-title":"Clin Exp Rheumatol"},{"key":"ref691","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1136\/archdischild-2013-305166","article-title":"Foot orthoses in children with juvenile idiopathic 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Ther"},{"key":"ref781","doi-asserted-by":"crossref","DOI":"10.3310\/hta9390","article-title":"Is hydrotherapy cost-effective? A randomised controlled trial of combined hydrotherapy programmes compared with physiotherapy land techniques in children with juvenile idiopathic arthritis","volume":"9:","author":"Epps","year":"2005","journal-title":"Health Technol Assess"},{"key":"ref451","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1002\/art.10661","article-title":"Minimal difference in pain associated with change in quality of life in children with rheumatic disease","volume":"47","author":"Dhanani","year":"2002","journal-title":"Arthritis Care Res"},{"key":"ref361","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/1757-1146-2-21","article-title":"Protocol for the Foot in Juvenile Idiopathic Arthritis trial (FiJIA): a randomised controlled trial of an integrated foot care programme for foot problems in JIA","volume":"2","author":"Hendry","year":"2009","journal-title":"J Foot Ankle 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