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Long-term motor outcomes after parent-administered early physiotherapy in children born very preterm
Henriette Paulsen1, Tordis Ustad2, Kristina Anna Djupvik Aakvik3
1Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Neurology and Rehabilitation, Vestfold Hospital Trust, Tønsberg, Norway.
Insights
Early physiotherapy for very preterm infants did not improve childhood motor skills compared to standard care. However, both preterm groups showed lower motor scores than term-born children, indicating a persistent developmental gap.
Area of Science:
- Pediatrics
- Developmental Neuroscience
- Physical Therapy
Background:
- Early life interventions are crucial for neurodevelopmental outcomes in preterm infants.
- Parent-administered physiotherapy aims to support motor development in high-risk neonates.
- Long-term motor outcomes in very preterm children require further investigation.
Purpose of the Study:
- To assess the association between early parent-administered physiotherapy and childhood motor outcomes.
- To compare motor outcomes in very preterm infants receiving early physiotherapy versus standard care.
- To compare motor outcomes between preterm infants and term-born controls.
Main Methods:
- Follow-up of a randomized controlled trial involving 153 very preterm infants (≤32 weeks gestation).
- Intervention group received early parent-administered physiotherapy; control group received standard care.
- Motor outcomes assessed at 7-10 years using the Movement Assessment Battery for Children-Second Edition (MABC-2).
- Statistical analysis included linear mixed models and odds ratios for MABC-2 percentiles.
Main Results:
- No significant difference in mean MABC-2 total scores between the early physiotherapy and standard care groups.
- Both preterm groups (intervention and standard care) had significantly lower MABC-2 scores than term-born controls.
- Adjusted odds ratios for scoring at or below the 5th or 15th percentile on the MABC-2 did not differ between preterm groups and controls.
Conclusions:
- Neonatal parent-administered physiotherapy does not appear to alter long-term motor outcomes at 7-10 years in very preterm children.
- Children born very preterm, regardless of early physiotherapy intervention, demonstrate poorer motor performance compared to their term-born peers.
- The findings highlight the need for continued support and monitoring of motor development in very preterm populations.
Objective:
This observational follow-up study investigated whether early parent-administered physiotherapy during the neonatal period was associated with motor outcomes in childhood, and compared these outcomes between two preterm groups and a term-born control group.
Study Design:
This is a follow-up of a pragmatic randomised controlled trial that initially included 153 infants born very preterm (≤32 weeks' gestation), randomised to either early parent-administered physiotherapy or standard care, between 34 and 37 weeks' gestation. At 7-10 years, motor outcomes were assessed in 92 children (intervention, n = 43; standard care, n = 49) and in 83 term-born controls. The primary outcome was the Movement Assessment Battery for Children-Second Edition (MABC-2). Group differences were analysed using linear mixed models adjusted for age, sex, and parental education. Odds ratios (ORs) were calculated for scores ≤5th and ≤ 15th percentiles to estimate the likelihood of having or being at risk for movement difficulties.
Results:
Mean MABC-2 total score was 9.0 (SD3.0) in the intervention group, 9.6 (SD3.0) in the standard care group, and 10.8 (SD2.9) in the control group. Adjusted mean difference between the intervention and the standard care groups did not differ but both the intervention and standard care groups had lower scores than the control group (-1.2; 95% CI: -2.3 to -0.2 and -0.6; 95% CI: -1.6 to 0.3, respectively). Adjusted ORs for scoring ≤5th or ≤15th percentile did not differ in either preterm group compared with the control group.
Conclusion:
At 7-10 years, motor outcomes did not differ between children born very preterm who received three-week parent-administered physiotherapy and those who received standard care during the neonatal period. However, both preterm groups had lower motor scores than term-born peers.
