PHYSIOTHERAPY AND OCCUPATIONAL THERAPY FOR JUVENILE CHRONIC ARTHRITIS: CUSTOM AND PRACTICE IN FIVE CENTRES IN THE UK, USA AND CANADA

Physiotherapy and occupational therapy are widely accepted asbeing of central importance for the treatment of juvenile chronicarthritis (JCA). However, these approaches have rarely beensubject to critical scrutiny. The aims of this report are tohighlight some of the inter-centre similarities and differencesobserved in the implementation of physical and occupationaltherapy for JCA, and to emphasize the need for scientificallycontrolled research in this area. During a series of visitsto several paediatric rheumatology units in the UK, USA andCanada, three aspects of the service were noted: treatment philosophy,physical interventions used for the treatment of JCA and quality-of-lifeand independence training activities. There was general consensuswith the philosophy that early physical intervention was a vitalpart of the treatment plan for JCA, although all therapistswere concerned that compliance with treatment modalities waspoor. Differences between units in the approach to acute arthritis,the use of foot orthoses and wrist splints, the treatment ofjoint contractures and the use of general quality-of-life trainingactivities were noted. Although it was widely recognized thatcontrolled research into the efficacy of physical interventionwas needed, no centre had a co-ordinated plan for such investigations. KEY WORDS: Juvenile chronic arthritis, Physiotherapy, Occupational therapy