Physiotherapy reduces the risk of deformational plagiocephaly in infants who have a preferred head position when lying supine

Abstract

Question: Does physiotherapy reduce the risk of severe deformational plagiocephaly in infants who exhibit a preferred head position while in supine lying? Design: Randomised controlled trial with concealed allocation and blinded assessors. Setting: General hospital in the Netherlands. Participants: Infants at 7 weeks post-gestational age who exhibited head rotation to either the right or the left side when in the supine position for approximately three-quarters of the time of observation, without active rotation of the head over the full range of 180 deg (minimal time of observation, 15 minutes). Torticollis, dysmorphisms and syndromes were exclusion criteria. Randomisation of 65 infants allotted 33 to the physiotherapy group and 32 to a control group. Interventions: Parents of the infants in both groups received a leaflet describing basic preventive measures for plagiocephaly and advice from health care providers at well-child clinics. The control group did not receive any further intervention. The physiotherapy group also received up to eight sessions of physiotherapy at least a week apart before babies reached the age of 6 months. These sessions included exercises to reduce positional preference and to stimulate motor development, parental counselling about counterpositioning, handling, nursing, and the causes of positional preference. Greater playing time in the prone position when awake was encouraged. Sessions were ceased when positional preference disappeared, parents had incorporated the advice about handling and there were no signs of motor developmental delay or asymmetry. Outcome measures: The primary outcome was severe deformational plagiocephaly, defined as a ratio of the longest:shortest oblique diameter of the head of 1.04 or greater. Secondary outcomes included symmetry in posture and active movements, motor development, and passive range of motion of the cervical spine. All outcomes were measured at 6 and 12 months of age. Results: All infants completed the 6-month assessment and data were carried forward for three (5%) who then deviated from their allocated treatment. Physiotherapy significantly reduced the risk of severe deformational plagiocephaly at 6 months (Relative Risk (RR) 0.54, 95% CI 0.30 to 0.98) and at 12 months (RR 0.43, 95% CI 0.22 to 0.85). This indicates that for every 3 infants with positional preference treated with physiotherapy, one case of severe deformational plagiocephaly at 12 months will be prevented (95% CI 2 to 12). The groups did not differ significantly on the secondary outcomes. Conclusion: In infants with positional preference, physiotherapy intervention in addition to usual care reduced the risk of severe deformational plagiocephaly at one year.

[95% CI for the number needed to treat calculated by the CAP Co-ordinator.]