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Does Timing Matter? A Clinical Trial of Supporting Play Exploration and Early Development Intervention for Infants
Stacey Dusing1, Jennifer Burnsed2, Christine Spence3
1Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA; Division of Developmental Behavioral Pediatrics, Department of Developmental Pediatrics, Keck School of Medicine and Children's Hospital of Los Angeles, Los Angeles, CA; College of Health Professions, Virginia Commonwealth University, Richmond, VA.
Insights
Early physical therapy for very preterm infants improves long-term development. Starting the SPEEDI intervention in the neonatal intensive care unit (NICU) led to better cognitive and motor outcomes by 24 months compared to delayed intervention.
Area of Science:
- Neonatal Development
- Pediatric Physical Therapy
- Developmental Pediatrics
Background:
- Infants born very preterm face developmental challenges.
- Early intervention is crucial for optimizing outcomes in this population.
- The impact of intervention timing on developmental trajectories requires further investigation.
Purpose of the Study:
- To evaluate the efficacy of an early-delivered physical therapy intervention for very preterm infants.
- To determine if the timing of physical therapy affects developmental outcomes.
- To assess the impact on parent-child interaction.
Main Methods:
- A multisite, three-arm trial compared SPEEDI Early (NICU start), SPEEDI Late (delayed start), and usual care.
- Participants included 83 infants born very preterm (mean gestational age 26.5 weeks).
- Development was measured using the Bayley Scales and parent-child interaction via the Emotional Availability Scale.
Main Results:
- No overall difference between combined SPEEDI groups and usual care.
- Infants in SPEEDI Early showed significantly better cognitive scores than SPEEDI Late at 24 months.
- SPEEDI Early also led to higher gross motor scores, with changes in parent-child interaction supporting the intervention's model.
Conclusions:
- Early, parent-engaged physical therapy in the NICU promotes long-term developmental improvements in very preterm infants.
- Delaying intervention by as little as 3 months may reduce its efficacy.
- Parent-child interaction is a potential mechanism for the intervention's success.
Objective:
To evaluate the efficacy of an early-delivered physical therapy intervention and to determine whether the timing of the intervention affects developmental outcomes.
Study Design:
This multisite, 3-arm, intervention-controlled trial compared the efficacy of Supporting Play, Exploration, and Early Development Intervention (SPEEDI) Early (neonatal intensive care unit start), SPEEDI_Late (starting 15 weeks later), and usual care to improve development, measured with the Bayley Scales of Infant and Toddler Development, third edition, and parent-child dyadic interaction on the Emotional Availability Scale. SPEEDI is a motor-based, problem-solving intervention provided by an interventionist in collaboration with a caregiver.
Results:
Eighty-three infants born very preterm, with a mean gestational age at birth of 26.5 ± 2.0 weeks, were enrolled between 35 and 42 weeks of corrected gestational age. Combining SPEEDI groups, there was no difference between SPEEDI and usual care. However, infants in the SPEEDI_Early group had significantly better cognitive scaled scores than infants in the SPEEDI_Late group through 24 months of age. Adjusting for baseline motor skills, infants in the SPEEDI_Early group had higher gross motor scaled scores through 24 months of age. A change in parent-child interaction in response to SPEEDI supports the intervention's theoretical model and provides a possible mechanism of action.
Conclusions:
An intervention that engages parents in supporting development in infants born very preterm may result in long-term developmental improvements when started in the neonatal intensive care unit. Delaying services by even 3 months appears to reduce the efficacy of the intervention.
Trial Registration:
https://clinicaltrials.gov/study/NCT03518736.
