Effects of a Parent-Administered Exercise Program in the Neonatal Intensive Care Unit: Dose Does Matter-A Randomized Controlled Trial.

BACKGROUND: Despite the risk of delayed motor development in infants born preterm, knowledge about interventions in the neonatal intensive care unitt (NICU) and the effects of dosing is sparse. OBJECTIVE: The objectives of this study were to examine the effectiveness of a parent-administered exercise program in the NICU on motor outcome at 3 months corrected age (CA) and the effect of dosing on motor performance. DESIGN: This was a randomized clinical trial. SETTING: The study was conducted at 3 university hospitals in Tromsø, Trondheim, and Oslo, Norway. PARTICIPANTS: A total of 153 infants with gestational age <32 weeks at birth were randomly assigned to intervention or control groups. INTERVENTION: A 3-week parent-administered intervention designed to facilitate movements in preterm infants was performed in the NICU. Parents were asked to administer the intervention 10 minutes twice a day. MEASUREMENTS: Test of Infant Motor Performance (TIMP) was used to assess short-term outcome at 3 months CA. RESULTS: No significant difference in the TIMP z-score was found between intervention and control groups at follow-up 3 months CA, but a significant positive relationship was found between total intervention dose and TIMP z-scores. The adjusted odds of having a clinical z-score < 0 at 3 months CA was about 6 times higher for infants with less than median intervention time than for infants with a longer intervention time. LIMITATIONS: The number of infants born before 28 weeks was small. A spillover effect in favor of the control group was possible. We do not know if the infants received physical therapy after discharge from the hospital. CONCLUSIONS: There was no difference in motor performance between the intervention group and the control group at 3 months CA. However, an increased intervention dose was positively associated with improved motor outcome.

High intra- and inter-rater chance variation of the movement assessment battery for children 2, ageband 2.

The aim of the present study was to evaluate the intra- and inter-tester reliability of the movement assessment battery for children-second edition (MABC-2), ageband 2. We wanted to analyze the collected data, with adequate statistical methods, to provide relevant recommendations for physical therapists who are interpreting changes in the context of daily clinical practice. Forty-five healthy children, 23 girls and 22 boys with a mean age of 8.7±0.7 years, participated in the study, the inter-tester procedures were performed the same day and the intra-tester procedures within a one to two week interval. The statistical methods used were intra-class correlation coefficient (ICC), standard error of measurement (SEM), and smallest detectable change (SDC). The children had no failed items during the tests. The ICC values ranged from 0.23 to 0.76. The items "treading lace" and "one-board balance" showed the highest measurement errors both for the intra- and inter-rater reliability. The SDC(90%) values were 9.7 and 18.5 for the intra- and inter-rater reliability, respectively. The present study showed high intra- and inter-rater chance variation MABC-2, ageband 2. A change of more than ±9.7 and ±18.5 on the total test score (TTS) should be required to state (with a 90% confidence) that a real change in a single individual has occurred, for intra- and inter-rater testing, respectively. These findings may indicate that the MABC-2 might be more suitable for diagnostic or clinical decision making purposes, than for evaluation of change over time.