A mixed method investigation into the relationship between physical activity, nutritional status, dietary intake, symptoms, and health-related quality of life in children and young people with juvenile idiopathic arthritis
Introduction Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease of unknown aetiology in childhood. JIA is an umbrella term for arthritis of unknown origin, lasting for >6 weeks and with onset at <16 years of age. JIA negatively affects physical and mental health and well-being through direct pathology and the secondary impact on lifestyle. Moreover, JIA exerts a long-term impact on social and occupational opportunities and quality of life. Despite several medical interventions available for treating JIA (1,2), studies on the impact of lifestyle interventions remain limited (3). Nevertheless, evidence from other clinical groups concerning lifestyle management (4) strongly suggests the potential benefits of lifestyle management in the context of JIA. Considering the long-term impact of the disease, and the impact on lifestyle, there is a need to develop a broader range of behavioural interventions, alongside drug therapies, to support healthier lifestyle in children and young people with JIA. To address the determinants that improve the negative effect of the JIA symptoms early, when symptoms and side effects of the treatments are emerging, lifestyle interventions are required. Research supports targeted physical activity (PA) (5) and lifestyle interventions including healthy dietary habits (6) may improve the symptoms of JIA and overall quality of life (QoL) (7). However, the potential impact of behavioural influence interventions on JIA symptoms has yet to be fully explored. The thesis sets out to consider current evidence to develop a targeted behavioural lifestyle intervention for people living with JIA and their families. When considering PA, a number of systematic reviews support exercise interventions (8), with less evidence for diet (9) and lifestyle management interventions (10). To date, there is limited understanding of the relationship between PA, food patterns, activity management and physical and mental health-related quality of life (HRQoL) in children and young people with JIA (11). Here we set out to develop a bespoke lifestyle intervention for children and young people with JIA. Aim This study aims to describe the evidence for PA, dietary patterns, and lifestyle factors in relation to the management of symptoms and HRQoL in children and young people with JIA. Secondarily, to identify optimal ways to support young people and their families, thereby informing the development of a theory-based lifestyle intervention centred on PA and dietary considerations for children and young individuals with JIA. Methodology Informed by the Intervention Mapping Framework (12), a four-study, sequential, mixed-method project was conducted. Study one entailed a literature review, aimed at delineating the evidence of current PA lifestyle interventions in children and young people with JIA and identifying any existing gaps in the literature. Study two employed a systematic review to investigate the evidence for a correlation between nutritional status, dietary intake, JIA symptoms, disease activity, and HRQoL in children and young people with JIA considering both observational and interventional studies separately. Study three delved into the subjective perspectives of stakeholders, encompassing children and young people with JIA (aged 9-18 years), parents/caregivers, and healthcare professionals (HCPs), regarding their views on important domains of PA, diet, and HRQoL to support children and young people with JIA, utilising a qualitative thematic analysis method. The insights garnered from the initial three studies informed a structured consultation consensus Delphi study (study four), designed to prioritise emerging lifestyle determinants for incorporation into an intervention.
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