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A Randomized Controlled Trial

Leo A. van Vlimmeren, PhD, PT; Yolanda van der Graaf, MD, PhD; Magda M. Boere-Boonekamp, MD, PhD; Monique P. L’Hoir, PhD; Paul J. M. Helders, PhD, PT; Raoul H. H. Engelbert, PhD, PT

Arch Pediatr Adolesc Med. 2008;162(8):712-718.

Objective  To study the effect of pediatric physical therapy on positional preference and deformational plagiocephaly.

Design  Randomized controlled trial.

Setting  Bernhoven Hospital, Veghel, the Netherlands.

Participants  Of 380 infants referred to the examiners at age 7 weeks, 68 (17.9%) met criteria for positional preference, and 65 (17.1%) were enrolled and followed up at ages 6 and 12 months.

Intervention  Infants with positional preference were randomly assigned to receive either physical therapy (n = 33) or usual care (n = 32).

Main Outcome Measures  The primary outcome was severe deformational plagiocephaly assessed by plagiocephalometry. The secondary outcomes were positional preference, motor development, and cervical passive range of motion.

Results  Both groups were comparable at baseline. In the intervention group, the risk for severe deformational plagiocephaly was reduced by 46% at age 6 months (relative risk, 0.54; 95% confidence interval, 0.30-0.98) and 57% at age 12 months (0.43; 0.22-0.85). The numbers of infants with positional preference needed to treat were 3.85 and 3.13 at ages 6 and 12 months, respectively. No infant demonstrated positional preference at follow-up. Motor development was not significantly different between the intervention and usual care groups. Cervical passive range of motion was within the normal range at baseline and at follow-up. When infants were aged 6 months, parents in the intervention group demonstrated significantly more symmetry and less left orientation in nursing, positioning, and handling.

Conclusion  A 4-month standardized pediatric physical therapy program to treat positional preference significantly reduced the prevalence of severe deformational plagiocephaly compared with usual care.

Clinical Trial Registration  isrctn.org Identifier: ISRCTN84132771

Author Affiliations: Department of Physical Therapy, Bernhoven Hospital, Veghel (Dr van Vlimmeren); Julius Center for Health Sciences and Primary Care, Department of Clinical Epidemiology (Dr van der Graaf), and Departments of Medical Psychology (Dr L’Hoir) and Pediatric Physical Therapy and Exercise Physiology (Drs Helders and Engelbert), University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht; and Division of Science, Technology, Health and Policy Studies, University of Twente, Enschede (Dr Boere-Boonekamp), the Netherlands.

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