Ottawa Panel Evidence-Based Clinical Practice Guidelines for Foot Care in the Management of Juvenile Idiopathic Arthritis

Arch Phys Med Rehabil. 2016 Jul;97(7):1163-1181.e14. doi: 10.1016/j.apmr.2015.11.011. Epub 2015 Dec 18.


Objective: To create evidence-based guidelines evaluating foot care interventions for the management of juvenile idiopathic arthritis (JIA).

Data sources: An electronic literature search of the following databases from database inception to May 2015 was conducted: MEDLINE (Ovid), EMBASE (Ovid), Cochrane CENTRAL, and

Study selection: 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.

Data extraction: 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.

Data synthesis: 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+).

Conclusions: The use of customized foot orthotics and prefabricated shoe inserts seems to be a good choice for managing foot pain and function in JIA.

Keywords: Arthritis, juvenile; Orthotic devices; Pediatrics; Physical therapy modalities; Podiatry; Rehabilitation; Rheumatology.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Arthritis, Juvenile / rehabilitation*
  • Delphi Technique
  • Evidence-Based Practice
  • Foot Orthoses*
  • Humans
  • Pain Management / methods*
  • Physical Therapy Modalities*
  • Randomized Controlled Trials as Topic
  • Shoes