Brosseau Lucie, Toupin-April Karine, Wells George, Smith Christine A, Pugh Arlanna G, Stinson Jennifer N, Duffy Ciarán M, Gifford Wendy, Moher David, Sherrington Catherine, Cavallo Sabrina, De Angelis Gino, Loew Laurianne, Rahman Prinon, Marcotte Rachel, Taki Jade, Bisaillon Jacinthe, King Judy, Coda Andrea, Hendry Gordon J, Gauvreau Julie, Hayles Martin, Hayles Kay, Feldman Brian, Kenny Glen P, Li Jing Xian, Briggs Andrew M, Martini Rose, Feldman Debbie Ehrmann, Maltais Désirée B, Tupper Susan, Bigford Sarah, Bisch Marg
Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada.
Department of Pediatrics, Faculty of Medicine, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
Arch Phys Med Rehabil. 2016 Jul;97(7):1163-1181.e14. doi: 10.1016/j.apmr.2015.11.011. Epub 2015 Dec 18.
To create evidence-based guidelines evaluating foot care interventions for the management of juvenile idiopathic arthritis (JIA).
An electronic literature search of the following databases from database inception to May 2015 was conducted: MEDLINE (Ovid), EMBASE (Ovid), Cochrane CENTRAL, and clinicaltrials.gov.
The Ottawa Panel selection criteria targeted studies that assessed foot care or foot orthotic interventions for the management of JIA in those aged 0 to ≤18 years. The Physiotherapy Evidence Database scale was used to evaluate study quality, of which only high-quality studies were included (score, ≥5). A total of 362 records were screened, resulting in 3 full-text articles and 1 additional citation containing supplementary information included for the analysis.
Two reviewers independently extracted study data (intervention, comparator, outcome, time period, study design) from the included studies by using standardized data extraction forms. Directed by Cochrane Collaboration methodology, the statistical analysis produced figures and graphs representing the strength of intervention outcomes and their corresponding grades (A, B, C+, C, C-, D+, D, D-). Clinical significance was achieved when an improvement of ≥30% between the intervention and control groups was present, whereas P>.05 indicated statistical significance. An expert panel Delphi consensus (≥80%) was required for the endorsement of recommendations.
All included studies were of high quality and analyzed the effects of multidisciplinary foot care, customized foot orthotics, and shoe inserts for the management of JIA. Custom-made foot orthotics and prefabricated shoe inserts displayed the greatest improvement in pain intensity, activity limitation, foot pain, and disability reduction (grades A, C+).
The use of customized foot orthotics and prefabricated shoe inserts seems to be a good choice for managing foot pain and function in JIA.
制定基于证据的指南，以评估用于青少年特发性关节炎（JIA）管理的足部护理干预措施。
对以下数据库从建库至2015年5月进行了电子文献检索：MEDLINE（Ovid）、EMBASE（Ovid）、Cochrane CENTRAL和clinicaltrials.gov。
渥太华小组的选择标准针对评估0至18岁JIA患者足部护理或足部矫形器干预措施的研究。使用物理治疗证据数据库量表评估研究质量，仅纳入高质量研究（评分≥5）。共筛选362条记录，最终纳入3篇全文文章和1篇包含补充信息的额外引文用于分析。
两名审阅者使用标准化数据提取表从纳入研究中独立提取研究数据（干预措施、对照、结局、时间段、研究设计）。按照Cochrane协作方法，统计分析得出代表干预结局强度及其相应等级（A、B、C+、C、C-、D+、D、D-）的图表。当干预组与对照组之间改善幅度≥30%时具有临床意义，而P>0.05表示具有统计学意义。推荐意见需经专家小组德尔菲共识（≥80%）认可。
所有纳入研究质量均较高，分析了多学科足部护理、定制足部矫形器和鞋垫对JIA管理的效果。定制足部矫形器和预制鞋垫在疼痛强度、活动受限、足部疼痛和残疾减轻方面显示出最大改善（等级A、C+）。
使用定制足部矫形器和预制鞋垫似乎是管理JIA患者足部疼痛和功能的良好选择。
