Objective: The aim of the study was to compare the effects of two different task-oriented activity training programs on activity performance and participation in children/adolescents with juvenile idiopathic arthritis. Design: Sixty-two patients were randomized into group I and group II for task-oriented activity training. In group I, activities of daily living were practiced using real materials from daily life, and in group II, activities of daily living were practiced using video-based games (Xbox 360 Kinect) for 3 d/wk for 8 wks. Pain by the Numeric Rating Scale, upper limb muscle, grip, and pinch strengths by a dynamometer, activity performance and participation by the Childhood Health Assessment Questionnaire, Canadian Occupational Performance Measure, and Duruoz Hand Index were evaluated. Results: After treatment in both groups, significant changes were found in the Numeric Rating Scale, muscle strength, grips strength, Childhood Health Assessment Questionnaire, Canadian Occupational Performance Measure, and Duruoz Hand Index (P < 0.05). Group II was statistically superior to group I in changes of almost all upper limb muscle strengths, palmar pinch strength, Canadian Occupational Performance Measure satisfaction, and Duruoz Hand Index scores (P < 0.05). Conclusion: Video games–based task-oriented activity training is an alternative and feasible treatment for children/adolescents with juvenile idiopathic arthritis. This new method may have widespread applicability in future research, given the rapidly growing interest in virtual reality–based therapy in rehabilitation. To Claim CME Credits: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME Objectives: Upon completion of this article, the reader should be able to: (1) Understand the rehabilitation benefits of task–oriented activity in patients with neurologic and musculoskeletal conditions; (2) Appreciate the role of video games-based task oriented activity in rehabilitation; and (3) Appropriately incorporate video games-based task oriented activity in the rehabilitation program of individuals with Juvenile Idiopathic Arthritis. Level: Advanced Accreditation: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

The aim of this study was to investigate the effects of two exercise programs on lower extremity function in patients with juvenile idiopathic arthritis. Thirty patients with juvenile idiopathic arthritis participated in this study. Pain, passive range of motion, muscle strength, balance, and functional abilities were assessed with the Numeric Rating Scale, goniometer, handheld dynamometer, Flamingo Balance Test, Functional Reach Test, 10-meter walking test, 10-stair climbing test, and Childhood Health Assessment Questionnaire. Participants were randomly assigned to the strengthening exercise group (group 1, n = 15) or the proprioceptive-balance exercise group (group 2, n = 15). Intragroup analysis showed statistically significant improvements in all outcome measures except muscle strength in the hip and ankle after strengthening exercises in group 1. However, statistically significant improvements were found in all outcome measures after the proprioceptive-balance exercises in group 2. Intergroup analysis showed statistically significant improvement in all outcome measures in group 2 except for the Numeric Rating Scale, Childhood Health Assessment Questionnaire, and passive range of motion scores and hip extension and knee flexion muscle strengths. This study demonstrates that exercise treatment significantly improves musculoskeletal symptoms in patients with juvenile idiopathic arthritis. However, balance-proprioceptive exercises prove to be effective more than strengthening exercises for improving lower extremity function such as walking, climbing stairs, and balance in patients with juvenile idiopathic arthritis.

Background/aim: The aims of this study were to primarily investigate fatigue and sleep and to secondarily examine possible relationships between disease activity, pain, and functional ability in children and adolescents with juvenile idiopathic arthritis (JIA). Materials and methods: Ninety-six patients were enrolled in the study. Disease activity, functional ability, fatigue symptoms, fatigue severity, and sleep quality were assessed with the Juvenile Arthritis Disease Activity Score (JADAS), Childhood Health Assessment Questionnaire (CHAQ), Pediatric Quality of Life Inventory-Multidimensional Fatigue Scale (PedsQL-F), visual analog scale (VAS), and Pittsburgh Sleep Quality Index (PSQI), respectively. Results: Fatigue severity was moderate to high in 75% of patients with JIA and sleep quality was poor in 40% of them. VAS-fatigue was correlated with VAS-pain, VAS-wellbeing, PSQI, and sleep duration (P < 0.001). Significant relationships were found between the PedsQL-F and all other parameters except JADAS (P < 0.05). VAS-fatigue, CHAQ, and PSQI were identified as significant predictors of PedsQL-F (P < 0.05). Sleep quality, pain, and sleep duration were also significant predictors of fatigue severity (P < 0.05). Conclusion: This study suggests that fatigue and sleep problems are common problems in JIA. If underlying factors of fatigue and sleep are understood, strategies for improving sleep/fatigue paradox may develop in JIA.