Clinical Bottom Line
“How should I apply this information?”
Children with juvenile idiopathic arthritis (JIA) can be limited in their ambulation, mobility, and exercise tolerance. Balance can play an important role during physical activities. This article provides information on impaired leg balance in children with JIA compared with their peers who are healthy. The results show an increasing balance problem with progressive instability of the balance platform, especially in single-leg balance. Finding balance impairment in children with JIA might provide an indication that these children will face difficulties in activities where these skills are needed, for example, in sports and leisure activities or walking over an uneven surface.
“What should I be mindful about when applying this information?”
The balance system used in this study is a test used in a laboratory setting. Therefore, the clinical relevance of the finding of impaired leg balance should be further investigated in a more ecological context. The mean differences in balance scores between the children with JIA and controls that were found are not very distinct. Although the differences were statistically significant, this significance is possibly due to the smaller standard deviations in the control group.
From a clinical standpoint, correlations between muscle strength and impaired balance are a bit far-fetched. Muscle strength of the knee extensors, important to stabilize the knee (the most affected joint), was not related to balance abilities while strength of other muscles was. Last, most of the children with JIA were in clinical remission with little to no disease activity. It might be that the children with active disease or restrictions in joint function of the lower limb have greater problems with their balance than the children with rheumatoid arthritis included in this study.
Patrick van der Torre, MSc, PCS
Janjaap van der Net, PhD, PCS
University Children's Hospital, University Medical Center Utrecht
Utrecht, the Netherlands