Effects of Active Action Observation on Cognitive, Emotional, Motor, and Somatosensory Outcomes in Adolescents With Juvenile Idiopathic Arthritis: A Prospective Exploratory Case Series

Enrique Carrasco González¹Guillermo Ceniza-Bordallo²Daniel Clemente Garulo³Clara Udaondo⁴Sergio Lerma^1*Roy La Touche Arbizu¹

• ¹La Salle Centro Universitario, Madrid, Spain
• ²Harvard University, Cambridge, United States
• ³Hospital Infantil Universitario Nino Jesus, Madrid, Spain
• ⁴Hospital Universitario La Paz, Madrid, Spain

Background: Juvenile Idiopathic Arthritis (JIA) is a heterogeneous pediatric rheumatic disease characterized by persistent pain, functional limitations, and psychosocial difficulties that frequently persist despite optimized pharmacological treatment. Active Action Observation (AAO), which involves observing and then executing goal-directed movements, has been shown to engage mirror-neuron and visuomotor networks. This approach has shown promise in neurological and orthopedic rehabilitation, but has not been studied in adolescents with JIA. Objective: To assess the feasibility, acceptability, and preliminary clinical effects of an eight-week home-based AAO telerehabilitation program in adolescents with JIA. Methods: A prospective exploratory case series included 10 adolescents with JIA (11–17 years). The participants completed an eight-week AAO protocol delivered via weekly pre-recorded YouTube videos and brief online follow-up sessions. Outcomes were assessed at baseline, week 4, and week 8 and included pain interference (PROMIS), stress (SSI-SM), self-efficacy (GSES), fear of pain (FOPQ-III), Timed Up and Go (TUG), hand-grip strength, 6-minute walk test (6MWT), and cervical pressure pain thresholds (PPT). The analyses focused on descriptive statistics, change scores, percentage change, and robust estimators (Hodges–Lehmann, Kendall's W). Results: AAO was feasible and well accepted, with no participants withdrawing, and only mild and transient adverse effects reported. From baseline to week 8, the median changes were −42.1% for pain interference, −22.2% for stress, +18.8% for self-efficacy, and −25.7% for fear of pain/movement. While functional mobility (TUG) showed improvement, handgrip strength and 6-minute walk test responses were found to be heterogeneous, and cervical PPT exhibited a pattern of increased sensitivity. In line with AAO's neurocognitive framework, the observed reduction in fear of pain, coupled with increased self-efficacy and reduced stress, may indicate an update in threat-related motor representations. This update disrupts the previously formed "movement = danger" association, thereby enabling safer functional engagement and less pain interference. Conclusion: AAO delivered at home via telerehabilitation appears to be a feasible, acceptable, and potentially beneficial adjunct for adolescents with JIA, particularly for pain-related and psychological outcomes. These preliminary findings support the feasibility of AAO and justify future controlled trials to establish its efficacy and elucidate the underlying mechanisms.