Juvenile Idiopathic Arthritis:

A Systematic Review of Occupational Therapy Interventions

Carla Floyd Slabaugh, OTD, CBIS
Jeanine Beasley, EdD, OTR, CHT, FAOTA, Claudia Leiras, PhD, MS
Meredith Aja, OTS, Kate Cole, OTS, Trenton Warning, OTS
Authors Affiliation: Grand Valley State University

Abstract Methods Results

Records identified through database
Background: The purpose of this systematic review is to describe the current role of search Interventions (All were Statistically Significant Clinically Significant Results Improvement

Identification
combination Results
occupational therapy (OT) in the treatment of Juvenile Idiopathic Arthritis (JIA). JIA is an interventions)
CINAHL PUBMED Aqua/pool exercise LE AROM: Bacon et al. (1991) ROM, pain, QOL: Fragala-Pinkham, et mobility and strength: Baldwin (1972)
umbrella term that encompasses six subtypes of the disease. JIA is one of the most LE strength, Pain: Elnagger &
Elshafey (2016)
al. (2009) exercise program was safe: Takken, et al. (2003)
QOL, pain: Takken, et al. (2001)
common childhood chronic diseases and can be accompanied by symptoms such as N=2659
O2 Consumption (fitness): Singh-Grewal et al. (2006)
Wrist extension: Barden et al. (1995)

pain, stiffness, and loss of function, as well as psychosocial impacts. Individuals with JIA Not in English: Removal of PROM/ Stretching/ AROM QOL, Cardiopulmonary exercise
test: Drogu Apti, et al. (2014)
ROM and pain: Fragala-Pinkham, et al.
(2009)
C-HAQ (fitness): Singh-Grewal et al. (2007)
QOL, Pain: Takken et al. (2001)
N=2242 417 LE AROM: Bacon et al. (1991) wrist extension: Barden, et al. (1995)
generally receive medical interventions in combination with therapeutic interventions.
Occupational therapists are uniquely suited to deliver therapeutic interventions due to Aerobic exercise AROM, QOL, Cardiopulmonary
exercise test: Drogu Apti, et al. (2014)
knee ROM, pain: Fragala-Pinkham, et al.
(2009)
QOL, pain: Takken, et al. (2001)
O2 Consumption (fitness): Singh-Grewal, et al. (2006)
Title and abstract review excluded = 2168
the holistic nature of the profession. No Rehab. interventions: 1267
Play LE AROM: Bacon et al. (1991) ROM: Brennan, et al. (1956)
QOL, pain: Takken, et al. (2001)

Methods: PRISMA guidelines facilitated the search using the PubMed and CINAHL Outside age range: 76
Descriptive only: 118 Interferential LE strength, pain: Elnagger &
Elshafey (2016)
databases. The OTPF-3 guided the systematic review identifying the scope of Only drug therapy: 430

Screening
Outside scope of OT: 25 Paraffin wrist extension: Barden, et al. (1995)
occupational therapy practice. Fourteen studies were identified based on the identified N=74
Review Article: 252 Orthotic/casts ROM: Brennan, et al. (1956)
grip strength, maintained ROM: Silver, et al. (1982)
inclusion and exclusion criteria. wrist extension: Barden, et al. (1995)
wrist extension wrist ulnar deviation dexterity opposition:
Eberhard, et al. (1992)
Results: After analyzing the data several interventions were identified. All of the Removal of duplicates= 27
Massage anxiety pain: Field, et al. (1997)
wrist extension: Barden, et al. (1995)
interventions were found to be done in combination with other interventions which Relaxation anxiety, pain: Field, et al. (1997).

NMES wrist extension: Barden, et al. (1995)

needs to be considered when interpreting these results. Statistically and clinically N=47
Strengthening O2 Consumption (fitness): Singh-Grewal, et al. (2006)
significant interventions included aquatic/pool therapy, active range of Excluded with full text review=33

Eligibility
Qigong (Tia Chi) C-HAQ(fitness): Singh-Grewal, et al. (2007)
No Rehab. interventions: 6
motion/stretching/passive range of motion, and aerobic exercise. Statistically Outside age range: 9 Abbreviations: LE= lower extremity C-HAQ: Child Health Assessment Questionnaire AROM= active range of motion QOL=quality of life ROM= range of motion O2= oxygen

Descriptive only: 8
significant findings were found for play and the modalities of interferential current and Outside scope of OT: 7
hot packs.
Conclusions: This systematic review identified interventions within the scope of
Review article: 3
Conclusions

Included
occupational therapy practice that have the potential to be effective in treatment for
Included for Systematic Review= 14
Statistically and clinically significant interventions included
individuals with JIA. Further research is needed to evaluate these interventions in to aquatic/pool therapy, active range of motion/stretching/passive
determine effectiveness.
range of motion, and aerobic exercise.
Statistically significant findings were found for play and the modality
Research Question Level of Evidence: Color key and number of articles of interferential current.
Improvements were found with the interventions of: Paraffin,
What is the current evidence for the role of Occupational Therapy orthotic/casts, massage, relaxation, NMES, strengthening and
in the treatment of individuals with JIA? Qigong (Tia Chi).
2a=3
This systematic review identified possible interventions within the
Terms 2b=2 scope of occupational therapy practice that have the potential to be
effective in treatment for those who have JIA
Further research is needed to evaluate these interventions to
Search Terms: Juvenile idiopathic arthritis, therapy, rehabilitation, splints,
determine effectiveness.
quality of life, modalities, exercise, exercise therapy (and appropriate Mesh
terms).
Limitations
References Limited amount of research studies available and 7 of the 14 were written prior to the
Cincinnati Children's Hospital Medical Center. (2017). Evidence evaluation tools and resources. year 2000
A full list of references can be obtained by emailing: Retrieved from https://www.cincinnatichildrens.org/service/j/anderson-center/evidence-based- Limited amount of occupational therapy-specific interventions studied in these studies.
[email protected] care/legend All articles included were combination studies