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OBJECTIVE: To investigate the short-term effect of parent-administered physical therapy in the preterm period on motor performance in medically stable infants. METHODS:This study was a pragmatic, multicenter, randomized controlled trial including 153 infants born at gestational age ≤32 weeks and randomized to an intervention (n = 74) or a control (n = 79) group. The intervention promoted postural control, head control, and midline orientation. Parents, supervised by a physical therapist, conducted the intervention 10 minutes twice a day for 3 weeks from 34 to 36 weeks' postmenstrual age (PMA). The control group received usual care. The Test of Infant Motor Performance Screening Items was used at baseline and the Test of Infant Motor Performance postintervention (week 37 PMA). Linear mixed models were used to assess change in motor performance between groups from 34 to 37 weeks' PMA by using z scores. Effect size was measured by using Cohen's d. RESULTS:The mean baseline z score was 0.06 (95% confidence interval, -0.48 to 0.60). After the intervention, there was a significant group difference, indicating a change in motor performance from week 34 to 37 PMA favoring the intervention group. The estimated difference in z scores was 0.42 (95% confidence interval, 0.13 to 0.72; P = .005), and the effect size was 0.40.CONCLUSIONS: Parent-administered physical therapy conducted before term-equivalent age improved motor performance at 37 weeks' PMA more than conventional care. All infants will be followed up until 2 years' corrected age to evaluate the long-term effects of this brief intervention. Mrs Ustad participated in planning the study, baseline and postintervention assessments, statistical analyses, and drafting of the manuscript; Dr Evensen was involved in supervision of statistical analyses and preparation of the manuscript; Drs Campbell and Girolami participated in planning the study, in preparation of the manuscript, and in proofreading; Dr Helbostad supervised the statistical analyses and preparation of the manuscript; Drs Kaaresen and Jørgensen participated in planning the study and in preparation of the manuscript; and Dr Øberg was responsible for design and planning the study and participated in postintervention assessments from video recordings, statistical analyses, and preparation of the manuscript. All authors approved the fi nal manuscript as submitted and agree to be accountable for all aspects of the work. WHAT'S KNOWN ON THIS SUBJECT: Studies on early intervention to improve motor function in preterm infants have failed to show large effects. Interventions involving parents seem to be more effective than when therapists conduct the intervention. WHAT THIS STUDY ADDS:Three weeks of parentadministered physical therapy implemented before term-equivalent age in very preterm infants improved short-term motor performance more than in the control group. The intervention was feasible and well tolerated by the infants.by guest on May 10, 2018 http://pediatrics.aappublications.org/ Downloaded from U...

Blocks of intensive therapy can be an alternative to regular dosage of physiotherapy, but until further studies are conducted, the physiotherapy intervention, intensity, and frequency should be tailored to meet the needs of each individual infant and family.

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BackgroundKnowledge about early physiotherapy to preterm infants is sparse, given the risk of delayed motor development and cerebral palsy.Methods/DesignA pragmatic randomized controlled study has been designed to assess the effect of a preventative physiotherapy program carried out in the neonatal intensive care unit. Moreover, a qualitative study is carried out to assess the physiotherapy performance and parents' experiences with the intervention. The aim of the physiotherapy program is to improve motor development i.e. postural control and selective movements in these infants. 150 infants will be included and randomized to either intervention or standard follow-up. The infants in the intervention group will be given specific stimulation to facilitate movements based on the individual infant's development, behavior and needs. The physiotherapist teaches the parents how to do the intervention and the parents receive a booklet with photos and descriptions of the intervention. Intervention is carried out twice a day for three weeks (week 34, 35, 36 postmenstrual age). Standardized tests are carried out at baseline, term age and at three, six, 12 and 24 months corrected age. In addition eight triads (infant, parent and physiotherapist) are observed and videotaped in four clinical encounters each to assess the process of physiotherapy performance. The parents are also interviewed on their experiences with the intervention and how it influences on the parent-child relationship. Eight parents from the follow up group are interviewed about their experience. The interviews are performed according to the same schedule as the standardized measurements. Primary outcome is at two years corrected age.DiscussionThe paper presents the protocol for a randomized controlled trial designed to study the effect of physiotherapy to preterm infants at neonatal intensive care units. It also studies physiotherapy performance and the parent's experiences with the intervention.Trial registrationClinicalTrials.gov NCT01089296