Investigation of the efficacy of self-management supported telerehabilitation in children and adolescents with juvenile idiopathic arthritis: A randomized controlled study

Children with Juvenile Idiopathic Arthritis (JIA) experience problems such as pain, stiffness and fatigue, which impairs their exercise capacity and quality of life. They also spend less time in physical activities compared to their healthy peers. Due to the chronic nature of the disease, it is very important that children learn to manage their health and cope with problems. The aim of this study was to investigate the effectiveness of synchronous and asynchronous telerehabilitation-based exercise methods in addition to self-management training on pain, disease activity, functional status, fatigue, quality of life, psychosocial status and self-efficacy in children and adolescents with JIA. 26 children and adolescents with JIA (synchronous exercise group n=13, mean age = 13.23±2.58 years; asynchronous exercise group n=13, mean age = 13.15±2.76 years) were included in the study. After demographic and disease-related data were recorded, pain (numeric rating scale), disease activity (Juvenile Idiopathic Arthritis Disease Activity Score-JADAS), functional status (Childhood Health Assessment Questionnaires-CHAQ), lower extremity muscle strength and performance (sit-to-stand test), quality of life (Pediatric Quality of Life Inventory 3. 0 Arthritis Module-PedsQL), fatigue (Pediatric Quality of Life Inventory Multidimensional Fatigue Scale-PedsQL-F), self-efficacy (Self-Efficacy to Manage Chronic Disease 6-item Scale-SE), and psychosocial status (Juvenile Arthritis Biopsychosocial Scale-JAB-Q) were assessed at baseline and after intervention. Self-management and exercise programs were administered in real time to the synchronous group and via video to the asynchronous group. The telerehabilitation-based exercise program was performed 3 days a week for 12 weeks in both groups. When the pre-treatment and post-treatment data were analyzed within the groups, a significant difference was observed in PedsQL-anxiety, sit-to-stand test and SE scores in the synchronous exercise group, while a significant difference was observed in JADAS, CHAQ-dressing-related functional status, PedsQL-activities of daily living and sit-to-stand test scores in the asynchronous exercise group (p<0.05). When the delta data were compared, a statistically significant difference was observed in favor of the synchronous group in the sit-and-stand and self-efficacy parameters, while a statistically significant difference was observed in favor of the asynchronous group in the functional status parameters related to pain, disease activity and dressing (p<0.05). Self-management supported telerehabilitation-based exercise interventions have positive effects on disease-related parameters of JIA.