title: The effectiveness of a multidisciplinary foot care program for children and adolescents with juvenile idiopathic arthritis: an exploratory trial.
abstract: OBJECTIVE
  To evaluate the effectiveness of multidisciplinary foot-care, and to evaluate the methodological considerations of a trial of multidisciplinary care in juvenile idiopathic arthritis.
  
  
  METHODS
  Exploratory randomised controlled trial.
  
  
  METHODS
  Children/adolescents with juvenile idio-pathic arthritis and inflammatory joint disease affecting the foot/ankle.
  
  
  METHODS
  Standard medical care was compared with a 12 month program of multidisciplinary foot-care informed by musculoskeletal ultrasound. This program was centred on strict disease control through rigorous examination and interventions delivered by a team comprised of a paediatric rheumatologist, podiatrist, physiotherapist and musculoskeletal ultrasonographer. Patients were assessed on foot impairment and disability scores using the Juvenile Arthritis Foot Disability Index.
  
  
  RESULTS
  Forty-four participants, aged 3-17 years were randomly assigned to receive the experimental (n = 21) or usual care (n = 23) interventions. There was an overall improvement in levels of foot related impairments in both groups over 12 months. Between-group differences in change scores for the Juvenile Arthritis Foot Disability Index were not statistically significant at 6 or 12 month follow-ups.
  
  
  CONCLUSIONS
  The integrated multidisciplinary foot care interventions described in this trial were safe, but did not improve foot impairment levels relative to usual care. This trial identified several methodological challenges including recruitment/retention, difficulties with outcome tools and potential confounders.
authors.affiliation: School of Health & Life Sciences, Institute of Applied Health Research, Glasgow Caledonian University, G4 OBA Glasgow, UK. gordon.hendry@uws.edu.au
authors.forename: Gordon J
authors.initials: GJ
authors.lastname: Hendry
authors.forename: Gordon F
authors.initials: GF
authors.lastname: Watt
authors.forename: Mhairi
authors.initials: M
authors.lastname: Brandon
authors.forename: Lorraine
authors.initials: L
authors.lastname: Friel
authors.forename: Debbie E
authors.initials: DE
authors.lastname: Turner
authors.forename: Paula K
authors.initials: PK
authors.lastname: Lorgelly
authors.forename: Janet
authors.initials: J
authors.lastname: Gardner-Medwin
authors.forename: Roger D
authors.initials: RD
authors.lastname: Sturrock
authors.forename: James
authors.initials: J
authors.lastname: Woodburn
mesh_terms: D000293:Adolescent; D001171:Arthritis, Juvenile / Q000150:complications*; D002648:Child; D005260:Female; D005534:Foot Diseases / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D010348:Patient Care Team