Pediatric Physical Therapy in Infancy: From Nightmare to Dream? A Two-Arm Randomized Trial

Background. Systematic reviews have suggested that early intervention by means of specific motor training programs and general developmental programs in which parents learn how to promote infant development may be the most promising ways to promote infant motor and cognitive development of infants with or at high risk for developmental motor disorders. Objective. The purpose of this study was to investigate the effects of a recently developed pediatric physical therapy intervention program (Coping With and Caring for Infants With Special Needs [COPCA]) on the development of infants at high risk for developmental disorders using a combined approach of a 2-arm randomized trial and process evaluation. Setting. The study was conducted at the University Medical Center Groningen in the Netherlands. Participants and Intervention. Forty-six infants at high risk for developmental disorders were randomly assigned to receive COPCA (a family-centered program) (n = 21) or traditional infant physical therapy (TIP) (n = 25) between 3 to 6 months corrected age (CA). Developmental outcome was assessed by blinded assessors at 3, 6, and 18 months CA with a neurological examination, the Alberta Infant Motor Scales, the Pediatric Evaluation of Disability Inventory, and the Mental Developmental Index (MDI) of the Bayley Scales of Infant Development. Contents of the intervention were analyzed by a quantitative video analysis of therapy sessions. Quantified physical therapy actions were correlated to evaluate associations between intervention and developmental outcome components. Results. The trial revealed that developmental outcome in both groups was largely identical. Process evaluation showed that typical COPCA actions-(1) family involvement and educational actions, (2) application of a wide variation in challenging the infant to produce motor behavior by himself or herself and allowing the infant to continue this activity, and (3) stimulation of motor behavior at the limit of the infant's capabilities-had positive correlations with developmental outcome at 18 months CA. The use of handling techniques was negatively associated with the Pediatric Evaluation of Disability Inventory outcome at 18 months CA. Limitations. Major limitations were the limited size of the groups studied and the differences between the groups in frequency and duration of physical therapy sessions. Conclusion. Extending the randomized trial with process evaluation was needed to obtain insight into associations between the components of intervention and developmental outcome. Specific therapist behaviors of parent coaching are associated with improved developmental outcome measures. Further studies are needed to examine whether these associations are caused by therapist behavior or whether therapist behavior is modified by children's motor skills.