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Effect of physical therapy on bone remodelling in preterm infants: a multicenter randomized controlled clinical trial
Galaad Torró-Ferrero1, Francisco Javier Fernández-Rego2,3, María Rosario Jiménez-Liria4
1International School of Doctorate of the University of Murcia (EIDUM), University of Murcia, 30100, Murcia, Spain. galaad.torro@um.es.
Insights
Reflex locomotion therapy significantly improved bone formation in preterm infants compared to other physiotherapy methods. This therapy is a promising approach for preventing and treating osteopenia of prematurity.
Area of Science:
- Neonatal Medicine
- Developmental Pediatrics
- Physical Therapy
Background:
- Preterm infants exhibit lower bone mineralization than term infants due to reduced calcium incorporation late in gestation.
- Osteopenia of prematurity is a significant concern in neonatal care.
- Understanding interventions to enhance bone health in preterm neonates is crucial.
Purpose of the Study:
- To evaluate the impact of reflex locomotion therapy on bone modeling and growth in preterm infants.
- To compare the efficacy of reflex locomotion therapy with other physiotherapy modalities for bone health.
Main Methods:
- A multicenter randomized controlled trial involving 106 preterm infants (26-34 weeks gestation).
- Infants were assigned to reflex locomotion therapy (EGrlt), passive mobilizations with joint compression (EGpmc), or massage (CG) for one month.
- Bone formation and resorption were assessed using bone biomarkers, with osteocalcin as a key indicator.
Main Results:
- The study included 38 infants in the EGrlt group, 32 in the EGpmc group, and 36 in the CG group.
- All groups were comparable in gender, gestational age, and birth weight.
- Significant improvements in bone formation, measured by osteocalcin levels, were observed in the EGrlt group compared to the other groups (p=0.013).
Conclusions:
- Reflex locomotion therapy demonstrated superior effectiveness in enhancing bone formation among preterm infants.
- This therapy presents a valuable option for the prevention and management of osteopenia of prematurity.
- Further research may explore long-term bone health outcomes associated with this intervention.
Background:
Preterm infants have a low level of bone mineralization compared to those born at term, since 80% of calcium incorporation occurs at the end of pregnancy. The purpose of the present study was to investigate the effect of reflex locomotion therapy on bone modeling and growth in preterm infants and to compare its effect with those of other Physiotherapy modalities.
Methods:
A multicentre randomized controlled clinical trial was conducted (02/2016 - 07/2020). 106 preterm infants born at the Virgen de la Arrixaca University Clinical Hospital, the General University Hospital of Elche and the Torrecárdenas University Hospital of Almería, between 26 and 34 weeks with hemodynamic stability, complete enteral nutrition and without any metabolic, congenital, genetic, neurological or respiratory disorders were evaluated for inclusion. Infants were randomly assigned to three groups: one group received reflex locomotion therapy (EGrlt); another group received passive mobilizations with gentle joint compression (EGpmc); and the control group received massage (CG). All treatments were carried out in the neonatal units lasting one month. The main outcome measure was bone formation and resorption measured with bone biomarkers. A mixed ANOVA was used to compare the results of bone biomarkers, and anthropometric measurements.
Results:
Infants were randomized to EGrlt (n = 38), EGpmc (n = 32), and CG (n = 36). All groups were similar in terms of gender (p = 0.891 female 47.2%), gestational age (M = 30.753, SD = 1.878, p = 0.39) and birth weight (M = 1413.45, SD = 347.36, p = 0.157). At the end of the study, significant differences were found between the groups in their interaction in bone formation, measured with osteocalcin [F (2,35) = 4.92, p = 0.013, ηp2 = 0.043], in benefit of the EGrlt.
Conclusions:
Reflex locomotion therapy has been effective in improving bone formation, more so than other Physiotherapy modalities. Therefore, reflex locomotion therapy could be considered one of the most effective physiotherapeutic modalities for the prevention and treatment of osteopenia of prematurity.
Trial Registrstion:
Trial retrospectively registered at ClinicalTrials.gov. First posted on 22/04/2020.
Registration Number:
NCT04356807 .
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