- Title
- Podiatric intervention in juvenile idiopathic arthritis
- Creator
- Fellas, Antoni
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2021
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children and adolescents before the age of 16. Lower limb involvement in JIA is common clinical manifestation. Despite advancements in pharmaceutical care children with JIA may still experience prolonged disease in their lower limb and particularly their feet and ankles. The first step to effective management is early recognition of disease in joints and surrounding structures. The next step is to prescribe rapid, evidence-based therapies that aim to supress active joint disease and reduce secondary physical problems. The overall aim of this thesis has been to investigate the clinical effectiveness of podiatric based interventions in the overall management of lower limb problems in children with JIA. The first study was to investigate if there are physical examination tools that may be used by allied health professionals such as podiatrists in diagnosing pathological lower limb joints in JIA. The result of this scoping review revealed a lack of comprehensive lower limb tools which introduced the need for study two. The second study in this thesis presented a pilot diagnostic accuracy study proposing a newly modified physical examination tool that may be used to detect and monitor a comprehensive count of lower limb joints in JIA. Results of the study suggests that lower limb clinical assessments between podiatrists and PR can be reliable. However, validity of the PE tool requires further research and methodological improvements as low percentage agreements were observed between radiological assessments as well as radiological and clinical joint examinations. The third and final study in this thesis is one of the largest and longest randomised clinical trials exploring a podiatric intervention alone in children with JIA. It is also the first clinical trial investigating a physical or mechanical based therapy for children with JIA in Australia. Foot orthoses (FOs) are prescribed by podiatrists on a daily basis across the globe for many types of lower limb problems. The clinical trial conducted in this thesis investigated the effect of customised preformed FOs that were dispensed on the same day participants were screened for lower limb problems. Statistical analysis revealed participants in the trial group experienced significantly reduced pain within 4-weeks post intervention compared to the control group. This statistically and clinically significant effect translated to the trial group also experiencing significantly reduced tender ankle and midfoot joints 6 months post intervention. Customised preformed FOs were also statistically effective in altering plantar pressure distribution in favour of the trial group. This translated to significantly less peak and pressure time spent in heels and lateral forefoot areas. Overall, this thesis has provided novel evidence supporting the role of a podiatrist in the management of children and adolescents with JIA suffering from lower extremity disease. The studies conducted in this PhD hope to inform clinicians, policies, paediatric rheumatology teams and governments in the ability of a podiatrist to detect lower limb problems in patients with JIA and manage them with non-invasive, evidence-based, inexpensive and effective mechanical therapies.
- Subject
- podiatry; juvenile idiopathic arthritis; foot orthoses; lower limb; paediatric rheumatology
- Identifier
- http://hdl.handle.net/1959.13/1502832
- Identifier
- uon:55270
- Rights
- Copyright 2021 Antoni Fellas
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 19 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 259 KB | Adobe Acrobat PDF | View Details Download |