Powell Mary, Seid Michael, Szer Ilona S
Department of Physical Therapy, Children's Hospital and Health Center, San Diego, California 92123, USA.
J Rheumatol. 2005 May;32(5):943-50.
. To compare the clinical efficacy of custom foot orthotics, prefabricated "off-the-shelf" shoe inserts, and supportive athletic shoes worn alone, on reducing pain and improving function for children with juvenile idiopathic arthritis (JIA).
Children with JIA and foot pain (n = 40) were randomized to one of 3 groups receiving: (1) custom-made semirigid foot orthotics with shock absorbing posts (n = 15), (2) off-the-shelf flat neoprene shoe inserts (n = 12), or (3) supportive athletic shoes with a medial longitudinal arch support and shock absorbing soles worn alone (n = 13). Foot pain and functional limitations were measured using the Pediatric Pain Questionnaire-visual analog scale (VAS), Timed Walking, Foot Function Index (FFI), and the Physical Functioning Subscale of the Pediatric Quality of Life Inventory (PedsQL). Measures were administered by personnel blinded to group status at baseline (before wearing the assigned intervention) and at 3 months' followup.
Children in the orthotics group showed significantly greater improvements in overall pain (p = 0.009), speed of ambulation (p = 0.013), activity limitations (p = 0.002), foot pain (p = 0.019), and level of disability (p = 0.024) when compared with the other 2 groups. Both children and parents in the orthotics group reported clinically meaningful improvement in child health-related quality of life, although the group by time interaction did not show statistical significance. Except for a reduction in pain for supportive athletic shoes (paired t test, p = 0.011), neither the off-the-shelf shoe inserts nor the supportive athletic shoes worn alone showed significant effect on any of the evaluation measures.
In children with JIA, custom-made semirigid foot orthotics with shock-absorbing posts significantly improve pain, speed of ambulation, and self-rated activity and functional ability levels compared with prefabricated off-the-shelf shoe inserts or supportive athletic shoes worn alone.
比较定制足部矫形器、预制“现成”鞋垫以及单独穿着的支撑性运动鞋，对减轻幼年特发性关节炎（JIA）患儿疼痛和改善功能的临床疗效。
40名患有JIA且足部疼痛的儿童被随机分为3组，分别接受：（1）带有减震柱的定制半刚性足部矫形器（n = 15），（2）现成的扁平氯丁橡胶鞋垫（n = 12），或（3）单独穿着的带有内侧纵弓支撑和减震鞋底的支撑性运动鞋（n = 13）。使用儿童疼痛问卷视觉模拟量表（VAS）、定时步行、足部功能指数（FFI）以及儿童生活质量量表（PedsQL）的身体功能子量表来测量足部疼痛和功能受限情况。在基线（佩戴指定干预措施之前）和3个月随访时，由对分组情况不知情的人员进行测量。
与其他两组相比，矫形器组儿童在总体疼痛（p = 0.009）、步行速度（p = 0.013）、活动受限（p = 0.002）、足部疼痛（p = 0.019）和残疾程度（p = 0.024）方面有显著更大的改善。矫形器组的儿童和家长均报告儿童健康相关生活质量有临床意义的改善，尽管组间与时间的交互作用未显示出统计学意义。除了支撑性运动鞋能减轻疼痛（配对t检验，p = 0.011）外，现成鞋垫和单独穿着的支撑性运动鞋对任何评估指标均未显示出显著效果。
对于JIA患儿，与预制现成鞋垫或单独穿着的支撑性运动鞋相比，带有减震柱的定制半刚性足部矫形器能显著改善疼痛、步行速度以及自我评定的活动和功能能力水平。
