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Physical Therapist Interventions for Infants With Nonsynostotic Positional Head Deformities: A Systematic Review
Irene Cabrera-Martos1, Salvador Jesús Ortigosa-Gómez1, Laura López-López1
1Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain.
Insights
Physical therapist interventions show promise for infant positional head deformities, improving cranial asymmetry and motor skills. However, current evidence is limited by high risk of bias in studies, necessitating more rigorous research.
Area of Science:
- Pediatrics
- Physical Therapy
- Developmental Pediatrics
Background:
- Nonsynostotic positional head deformities are common in infants, requiring effective management strategies.
- Physical therapist interventions are increasingly explored for their potential role in addressing these deformities.
- The existing evidence base requires critical appraisal to guide clinical practice and future research.
Purpose of the Study:
- To evaluate the methodological quality of clinical trials on physical therapist interventions for infant nonsynostotic positional head deformities.
- To synthesize the evidence regarding the effectiveness of these interventions on cranial asymmetry and motor development.
Main Methods:
- A systematic search of multiple electronic databases (PubMed/MEDLINE, ScienceDirect, CINAHL, Scopus, PEDro, Web of Science) was conducted.
- Included studies were randomized and non-randomized clinical trials, with data extraction performed by two independent authors.
- Risk of bias was assessed using the Downs and Black Scale and the Cochrane Collaboration's tool.
Main Results:
- Six articles met the inclusion criteria, detailing interventions such as parent education on positioning, manual therapy, and motor stimulation.
- The included trials generally suffered from small sample sizes, inadequate statistical power, and a high risk of bias.
- Key limitations included a lack of blinding and restricted external validity, impacting the reliability of findings.
Conclusions:
- Physical therapist interventions suggest potential benefits for improving cranial asymmetries and motor development in infants with nonsynostotic positional head deformities.
- However, the conclusions drawn are limited by the significant risk of bias present in the majority of the reviewed trials.
- Further high-quality research, particularly randomized controlled trials with larger sample sizes, is essential to establish definitive efficacy.
Objective:
This study sought to examine the methodological quality and summarize the evidence from clinical trials that examined the effectiveness of physical therapist interventions in the management of nonsynostotic positional head deformities in infants.
Methods:
The following electronic databases were searched: PubMed/MEDLINE, ScienceDirect, CINAHL, Scopus, PEDro, and Web of Science. Two different authors conducted the searches and completed the data extraction. Randomized and non-randomized clinical trials were included. The risk of bias was assessed using the Downs and Black Scale and the Cochrane Collaboration's tool.
Results:
Six articles were finally included. The main features of interventions included education to parents about positioning, manual therapy, and motor stimulation. The small sample sizes were not adequately powered and methodological quality showed a high risk of bias, mainly from a lack of blinding and limited external validity.
Conclusion:
There are indicators that suggest that physical therapist interventions may be useful for infants with nonsynostotic head deformities at improving cranial asymmetries and motor development. However, the validity of such conclusion is limited because most trials included had a high risk of bias. More rigorous research on physical therapy, including randomized controlled trials with larger sample sizes, is required in this area.
Impact:
The high prevalence and incidence of nonsynostotic positional head deformities in infants calls for the development of effective interventions. Physical therapists have a promising role in the improvement of cranial asymmetry and motor development. The most reported interventions involved educating parents about positioning and manual therapy. Some studies show that changes obtained after physical therapist intervention were comparable with those obtained after helmet therapy.
Lay Summary:
Early referral to physical therapy may help to prevent or reduce the severity of nonsynostotic positional head deformities. Education about positioning is important to prevent and improve the asymmetry of the baby's head when there is nonsynostotic positional head deformity. Physical therapist interventions can improve motor development in infants with nonsynostotic positional head deformity who have motor delays.
