Assessment of the Clinical Effects of Aquatic-Based Exercises in the Treatment of Children With Juvenile Dermatomyositis: A 2x2 Controlled-Crossover Trial

Abstract

Objectives: This study aims to compare the effect of aquatic-based exercises (AQBEs) and land-based exercises (LBEs) on muscle strength, fatigue and quality of life (QoL), and skin disease activity in children with juvenile dermatomyositis (JDM). Patients and methods: The design of the study was an assessor-blinded, controlled 2x2 crossover trial. Fourteen children (4 boys, 10 girls; mean age 11.7±2.2 years; range, 10 to 16 years) were evaluated. AQBEs and LBEs were applied through two treatment sequences as half of the children received AQBEs first while the second half received LBEs first. Isometric muscle strength, fatigue level and QoL (Pediatric Quality of Life Inventory Multidimensional Fatigue Scale [PedsQL-MFS]), and skin disease activity score (DASskin) were measured at four occasions for each treatment sequence. Results: The AQBEs had significant superiority over LBEs with improved hip flexors' strength (p=0.007) and hip abductors' strength (p=0.001), while both types of treatment had the same effect in increasing strength of shoulder flexors and abductors (p<0.05). AQBEs improved PedsQL-MFS, and DASskin significantly more than LBEs (p<0.001). For all outcome measures, there was no significant difference in the treatment sequence the children received first. Conclusion: Supervised AQBEs are more effective in improving muscle strength, fatigue and QoL, and skin disease activity than LBEs in children with JDM. Furthermore, the treatment sequence had no significant effect on measured variables.

Efficacy of aqua‐based plyometric exercises in the rehabilitation of patients with juvenile dermatomyositis: A randomized crossover pilot study

“…The water offers therapeutic effects that are unattainable on land 43 . Preceding studies on patients with JDM and juvenile idiopathic arthritis suggest that aquatic interventions have favorable effects on pain, muscle strength, fatigue levels, and JDM disease activity 27,44 . On that basis, it may be inferred that implementing plyometric exercises in an aquatic environment can be more conducive in re‐establishing strength, minimizing fatigue, and enhancing functional ability in patients with JDM.…”

“…The SoC program was generally aiming to prevent/correct muscle contractures, enhance muscle strength, promote aerobic fitness, and improve functional performance 27 . The program consisted of a combination of flexibility, resistance, and aerobic exercises, which were supervised by a pediatric physical therapist.…”

Reducing fatigue in pediatric rheumatic conditions: a systematic review

“…Table 1 shows the demographics of the included studies. Five studies were Randomized Controlled Trials (RCT) [ 27 , 30 , 31 , 33 , 36 ], two studies were controlled trials [ 29 , 35 ], two studies were a pre-post intervention trial [ 28 , 34 ] and one study was a quasi-experimental study with a post-test-only comparison group design [ 32 ]. Four of the ten studies included children or adolescents with JIA (total n = 120) [ 28 , 31 – 33 ], two studies included adolescents with cSLE ( n = 34) [ 30 , 34 ], three studies included children and adolescents with JDM ( n = 26) [ 27 , 35 , 36 ] and one study used the more general (and older) term juvenile rheumatic arthritis (JRA) ( n = 13) [ 29 ].…”

“…Five studies were Randomized Controlled Trials (RCT) [ 27 , 30 , 31 , 33 , 36 ], two studies were controlled trials [ 29 , 35 ], two studies were a pre-post intervention trial [ 28 , 34 ] and one study was a quasi-experimental study with a post-test-only comparison group design [ 32 ]. Four of the ten studies included children or adolescents with JIA (total n = 120) [ 28 , 31 – 33 ], two studies included adolescents with cSLE ( n = 34) [ 30 , 34 ], three studies included children and adolescents with JDM ( n = 26) [ 27 , 35 , 36 ] and one study used the more general (and older) term juvenile rheumatic arthritis (JRA) ( n = 13) [ 29 ]. Three studies evaluated land-based exercise therapy as their intervention [ 27 , 28 , 33 ], one study used aquatic-based exercise therapy [ 36 ], three studies evaluated medication/nutritional supplements as an intervention [ 29 , 30 , 35 ], two studies examined a psychological/cognitive behavioral intervention [ 31 , 34 ] and one study investigated the results of a transition program into an adult rheumatology program [ 32 ].…”

“…In all included studies fatigue was assessed with a self-report questionnaire. Four studies used the Pediatric Quality of Life Multidimensional fatigue scale (PEDsQL-MFS) [ 27 , 28 , 35 , 36 ], two studies used the Kids Fatigue Severity Scale (K-FSS) [ 30 , 33 ], one the Multidimensional Fatigue Inventory (MFI-20) [ 32 ], one the Checklist for Individual Strength (CIS-20) [ 31 ], one the PROMIS fatigue self-report form [ 34 ] and one a ten cm visual analogue scale (VAS) [ 29 ]. In all studies the sample size was small (five to 23 participants per group).…”