Children with juvenile idiopathic arthritis may benefit from fitted foot orthoses

By Lorraine L. Janeczko

NEW YORK (Reuters Health) - Prefabricated fitted foot orthoses may reduce pain and improve quality of life among children with juvenile idiopathic arthritis (JIA), new research suggests.

Children with JIA tolerate inexpensive prefabricated customized foot orthoses (FOs) well, and they can be fitted on the same day as their first biomechanical assessment, the authors reported online March 17 in Archives of Disease in Childhood.

"This study is the first conducted with such a big sample size and using this high-level methodology. We were extremely surprised at how well the children responded to wearing the foot orthoses," wrote lead author Dr. Andrea Coda of the University of Newcastle in Ourimbah, New South Wales, Australia, in an email to Reuters Health.

As to which children with JIA would benefit most from FOs, Dr. Gordon J. Hendry, a musculoskeletal rehabilitation lecturer at Glasgow Caledonian University in Scotland, wrote in an email, "None of the trials to date suggest that there are any subgroups of JIA that will benefit from FOs more than others." Dr. Hendry was not involved in the study.

To test whether prefabricated FOs fitted at the time of assessment are more effective at reducing pain and improving quality of life than sham control orthoses made with leather board with no correction in children with JIA, Dr. Coda and his colleagues conducted a single-blind randomized controlled trial in two UK medical centers over one year.

They included children with JIA, lower extremity joint involvement with disease onset between five and 18 years, previous failure of orthotic management with no use of FOs for at least three months, the ability to walk at least 15 meters without assistive devices, and who had started taking disease-modifying antirheumatic drugs at least six months earlier.

They excluded children who could not walk barefoot or with shoes, had accompanying musculoskeletal disease, central or peripheral nerve disease, or an endocrine disorder, and children who had had previous foot surgery or for whom FOs were contraindicated.

Sixty children were randomized to one of the two types of orthoses. At baseline, the groups were statistically similar, with a mean age of around 11 years.

The researchers measured changes in pain using a visual analog scale and quality of life using the Pediatric Quality of Life questionnaire. They assessed the children at baseline, three months, and six months.

Over all three intervals, children in the fitted FOs group had significantly greater pain reduction than children in the control group (baseline to three months, p=0.30; three months to six months, p=0.002; baseline to six months, p=0.029).

Children in the fitted FOs group also had better clinical improvement in quality of life (baseline to three months, p=0.001; baseline to six months, p=0.001).

The authors roughly estimated that, compared with custom-made FOs that may cost between $250 and $350 (£160-£230) per pair, the customized chair-side FOs used in the current study ranged from £10 to £15.

Dr. Paul Sponseller, an orthopedic surgeon at Johns Hopkins Children's Center in Baltimore, Maryland, who was not involved in the study, wrote in an email, "This study shows that inexpensive, immediately available orthotics can function well in children with juvenile arthritis and lower extremity involvement."

"Gait was shown to improve; however, longer-term follow up will be needed to see if the effect is maintained. It would also be important to compare this intervention with others," he wrote.

Dr. Hendry said, "This trial is effectively the non-pharmacological equivalent of a placebo-controlled drug trial. It suggests that modest improvements in pain may be achieved in the short-term with foot orthoses compared with a sham device (effectively no treatment/placebo)."

"It provides some evidence to justify focus on a larger scale, longer-term, definitive trial, including a full economic evaluation, of foot orthoses for the management of foot problems in JIA," he added.

But, Dr. Hendry observed, "This trial (has) some major limitations. Prefabricated orthoses may be effective in the short term for pain relief in some children with JIA. But because the inclusion criteria were vague, this study does not provide information on what specific foot pathologies would benefit from orthotic therapy."

The authors suggested that a double-blind or triple-blind randomized methodology would have been more robust. And they recommended further research into the effects of FOs, including studies of more children with JIA over a longer period of time.

Dr. Coda and all other authors and independent experts stated that they had no conflicts of interest related to the study.

SOURCE: http://bit.ly/1eoAwaf

Arch Dis Child 2014.

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