Patient education and foot disability in juvenile idiopathic arthritis : A physiotherapy perspective

Sammanfattning: Introduction: Juvenile idiopathic arthritis (RA) influences the child in different aspects and needs multi-professional treatment. Physical therapists' major goal is to maintain or increase physical activity, e.g. with education programs and custom-made foot orthoses. Assessment of treatment effects requires valid and reliable measurement that is sensitive to change. Aims: The major aim of the present work was to assess the effects of an education program among parents of children with JIA and among adolescent with JIA, and the effects of custom-made foot orthoses among children/adolescents with JIA. A further aim was to develop and test measurement methods for assessing treatment. Methods: Two new questionnaires were developed to cover relevant aspects concerning perception about managing the disease JIA, and concerning foot related disability. The validity and test-retest reliability of these methods were tested. The effects of an eight-hour multi-professional education program were assessed. An intervention group with 55 parents of children with JIA, and 11 adolescents, completed a questionnaire before, directly after and four months after the program. A comparison group with 18 parents and five adolescents completed the questionnaire twice times with a four-month interval. The effects of foot orthoses were studied in 48 children/adolescents with JIA with standardized tests of daily activities: here pain and/or capacity were assessed. The tests were performed with and without foot orthoses in two sets, respectively, in a randomized order. Analyses were also calculated for the different diagnostic subgroups and different foot malalignments. Results: The questionnaire on perception of managing the disease had acceptable content validity, as was partly indicated in a factor analysis of medical, exercise, pain and socialsupport factors. This medical, exercise, pain and social support (MEPS) questionnaire seemed to be stable over time and sensitive to change to detect effects of the education program. The questionnaire on foot-related disability appeared to cover relevant aspects of domain of interest, appeared valid in terms of the underlying theoretical constructs and was stable over time. The education program had a significantly positive outcome in the groups of parents, most expressed in the medical and pain aspects. The effects were also significantly improved in relation to the comparison group. In the adolescents group, only minor improvements were found after the education program. Using foot orthoses resulted in significantly reduction of pain after standing, stairclimbing, walking and running, improved balance capacities and faster self-estimated walking speed than without foot orthoses. Conclusions: In summary, the present investigation, including the special developed measurement instruments, demonstrated beneficial effects of the education program as well as of the use of foot orthoses. It is hoped that these methods will come to be included as a selfevident part of the treatment of JIA, in this way contributing to enhanced physical activity and decreased disability.