Effects of manual therapy on treatment duration and motor development in infants with severe nonsynostotic plagiocephaly: a randomised controlled pilot study.

PURPOSE: Despite growing evidence regarding nonsynostotic plagiocephaly and their repercussions on motor development, there is little evidence to support the use of manual therapy as an adjuvant option. The aim of this study was to evaluate the effects of a therapeutic approach based on manual therapy as an adjuvant option on treatment duration and motor development in infants with severe nonsynostotic plagiocephaly. METHODS: This is a randomised controlled pilot study. The study was conducted at a university hospital. Forty-six infants with severe nonsynostotic plagiocephaly (types 4-5 of the Argenta scale) referred to the Early Care and Monitoring Unit were randomly allocated to a control group receiving standard treatment (repositioning and an orthotic helmet) or to an experimental group treated with manual therapy added to standard treatment. Infants were discharged when the correction of the asymmetry was optimal taken into account the previous clinical characteristics. The outcome measures were treatment duration and motor development assessed with the Alberta Infant Motor Scale (AIMS) at baseline and at discharge. RESULTS: Asymmetry after the treatment was minimal (type 0 or 1 according to the Argenta scale) in both groups. A comparative analysis showed that treatment duration was significantly shorter (p < 0.001) in the experimental group (109.84 ± 14.45 days) compared to the control group (148.65 ± 11.53 days). The motor behaviour was normal (scores above the 16th percentile of the AIMS) in all the infants after the treatment. CONCLUSIONS: Manual therapy added to standard treatment reduces the treatment duration in infants with severe nonsynostotic plagiocephaly.

The effects of a physiotherapy programme on patients with a pleural effusion: a randomized controlled trial.

OBJECTIVE: To investigate the effects of a physiotherapy protocol on patients with pleural effusion. DESIGN: Randomized controlled trial. SETTING: University hospital. PARTICIPANTS: A total of 104 consecutive inpatients with a medical diagnosis of pleural effusion. INTERVENTION: Patients were randomly allocated to a control group receiving standard treatment (medical treatment and drainage) or an intervention group treated with physiotherapy added to standard treatment. The physiotherapy programme included deep breathing exercises, mobilizations and incentive spirometry. MAIN OUTCOME MEASURES: Spirometric predicted values and chest radiographs were measured before treatment and at discharge and the length of hospital stay was recorded. Assessors were blinded to the intervention. RESULTS: A comparative analysis showed a significant improvement of spirometric parameters in the intervention group; pre-to-post hospitalization predicted values showed significant changes in vital capacity (73.1 ± 12.6% to 72.13 ± 13.7 %, P<0.001 ), forced expiratory volume in first second (72.13 ± 13.7% to 78.98 ± 16.9%, P<0.001) and forced expiratory flow at 25-75 % (64.8 ± 35.1% to 76.78 ± 35.3%, P=0.198) compared to the control group that showed no significant changes across treatment. The radiographic findings showed better scores on the affected side of the thorax at discharge in the physiotherapy group. Length of hospital stay was also significantly (P=0.014) shorter in the intervention group (26.7 ± 8.8 days) compared to the control group (38.6 ± 10.7 days). CONCLUSIONS: A physiotherapy programme added to standard treatment improves the spirometric parameters and the radiological findings and reduces the hospital stay in patients with a pleural effusion.