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Early physiotherapy effects in preterm infant gross and fine motor development during the first 18 months of life
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The 4th European Congress of the ER-WCPT / Physiotherapy 102S (2016) eS67–eS282
Clinical Psychologist, GP with Special Interest in Pain Management and Chaplaincy Services. Approach/evaluation: Patients assessed by the Living with Pain Team, where Urdu was their first language and would benefit from increasing their understanding of selfmanagement of living with pain were referred into the pilot group. 6 patients started the 8 session PMP (1 male, 5 female). The PMP included an overview from the Trust’s Muslim Chaplain of his role on the PMP, and how Islamic teachings promote self-management, compassion, physical activity and dispelling of cultural myths. The GP discusses pain medication management within holistic care, the physiotherapist emphasises the biopsychosocial approach of the PMP, including gentle increases in exercise. Psychology sessions focussed on how pain can affect patients emotionally and emphasised how patients could increase their self-kindness. As literacy is a common problem, audio and video material in Urdu were utilised which supported the education of standard PMP concepts. SEQ and HADS outcome measures were administered pre and post PMP. No ethics approval required. Outcomes: Patients made improvements in self-efficacy, anxiety and depression following the programme. There was a statistically significant change in anxiety (t(3) = 4.7, P < 0.01), depression (t(3) = 5, P < 0.01), and self-efficacy (t(3) = −8.18, P < 0.001) following the programme. The Reliable Change Index (RCI) was used, and this found that 25% of patients made a reliable change in anxiety and 75% of patients made a reliable change in depression. Subjectively patients reported that they had understood their persistent pain for the first time within their cultural context. Discussion and conclusions: Preliminary results suggest there is value in delivering a language specific and culturally adapted MDT led PMP for the South Asian community. It has been able to engage patients to break down cultural barriers but also increase awareness of the cultural perception and experience of persistent pain. There is a recognition that further clinical research is needed into the long term effectiveness of this approach on self-efficacy, anxiety and depression. Impact and implications: Cultural competency is an important factor to consider when working with patients of a different background. Accepted for British Pain Society Annual Scientific Meeting May 2016. Funding acknowledgement: No external funding was required, formed part of the authors normal working role. http://dx.doi.org/10.1016/j.physio.2016.10.240
POS183 Early physiotherapy effects in preterm infant gross and fine motor development during the first 18 months of life F.J. Fernández Rego 1,2 , A. Gomez-Conesa 3,∗ , J. Pérez López 4 1 University
of Murcia, Physical Therapy Department, Murcia, Spain 2 Early Intervention Centre ‘Fina Navarro López’, Lorca, Spain 3 University of Murcia, Physical Therapy Department, Espinardo-Murcia, Spain 4 University of Murcia, Department of Developmental and Educational Psychology, Murcia, Spain Relevance: Forty per cent of preterm infants suffer disorders in their development. Early Intervention with physiotherapy treatments promotes the motor development and the prevention of disabilities in this population. Purpose: To compare the effect of Vojta method with other physiotherapy treatments on gross and fine motor development of preterm infants during the first 18 months of life. Methods/analysis: 84 preterm infants diagnosed with motor delay, with a gestational age mean (GA) of 30.87 weeks (SD = 3.01) and birth weight (BW) of 1491.35 g (SD = 528.54) were allocated into two study groups: an experimental group with Vojta therapy (EG, n = 47 participants) and a control group with other physiotherapy treatments (CG, n = 37 participants). Both groups had similar GA [EG = 31.24 (SD = 2.94) weeks; CG = 30.39 (SD = 3.07) weeks; P-value = 0.205] BW [EG = 1570.49 (SD = 519.42) g; CG = 1390.81 (SD = 529.86) g; P-value = 0.124] and gender distributions [P-value = 0.908]. Both groups received two weekly 50-minute sessions of physical therapy, EG with Vojta and CG with other physical therapy methods (Le Métayer and Bobath). Four measurements were performed: during the first trimester of life (3M), at 6 (6M), 12 (12M) and 18 (18M) months of corrected age, using the Bayley Scales of Infant and Toddler Development 3rd edition (BSID-III) for gross and fine motor capacities. A t-Student test was carried out for independent samples among the gross scalar score (GS), the fine scalar (FS) and the composite score (CS) of the BSID-III between both groups, at the different time points. Additionally, effect size was calculated using d statistics. Results: We observed significant differences at 3M and at 6M, between both groups. The CG had better performance in the motor scales of the BSID-III at all three levels: FS (3M: P-value = 0.004, 6M: P-value = 0.044), GS (3M: Pvalue < 0.001, 6M: P = 0.004) and CS (3M: P-value < 0.001, 6M: P = 0.010). Additionally, at 18M, EG was superior in the FS (P-value < 0.001) and CS level (P-value = 0.004).
The 4th European Congress of the ER-WCPT / Physiotherapy 102S (2016) eS67–eS282
The control group had large effect size for EG and CS at 3M (0.91 and 0.86) and moderate for FS (0.65); at 6M a low size for FS (0.45) and moderate for GS and CS (0.65 and 0.60). Whereas Vojta therapy demonstrated had high effect FS (0.93), moderate for CS (0.65) and low the GS (0.40) at 18M. Discussion and conclusions: Infants treated with Vojta therapy had improved scores during every assessment despite starting at lower scores in the first time points. Using the BSID-III motor scale, preterm infants treated with Vojta showed a superior motor development at 18 months, especially in the fine motor skills, compared to infants treated with other modalities of physical therapy. Impact and implications: Vojta method is effective in promoting motor development of preterm infants receiving during the first 18 months of corrected age. Additionally, it contributes to improve the protocol of physical therapy interventions and prevent future disabilities in this population. Funding acknowledgement: It is not funding. No acknowledgement is required. http://dx.doi.org/10.1016/j.physio.2016.10.241 POS184 Vojta therapy in the reduction of perinatal risk in preterm infants with respiratory distress syndrome and bronchopulmonary dysplasia A. Gomez-Conesa 1,∗ , F.J. Fernández Rego 1 , J.J. Agüera Arenas 2 1 University
of Murcia, Physical Therapy Department, Espinardo-Murcia, Spain 2 Virgen de la Arrixaca University Hospital, Neonatal Intensive Care Unit, Murcia, Spain Relevance: Preterm infants are at increased risk of suffering respiratory problems and concomitant diseases due to the immaturity of their systems, increasing the days of hospitalization and the risk of disorders in their development. Purpose: To study if Vojta therapy can reduces the perinatal risk and decrease the days of hospitalization of preterm infants with Respiratory Distress Syndrome (RDS) and Bronchopulmonary Dysplasia (BPD). Methods/analysis: Sixty preterm infants with gestational age (GE) ≤ 32 weeks and a diagnosis of RDS were randomly allocated into two groups: experimental group (EG, n = 32 preterm infants; 15 girls and 17 boys), and a control group (CG, n = 28 preterm infants; 11 girls and 17 boys). Both groups received standard of care in the neonatal intensive care unit (NICU), additionally the EG received two daily sessions of 10 minutes during 30 days of Vojta physiotherapy. There were no significant differences between the groups in GE [EG: 28.2 weeks, CG: 28.9weeks, P-value = 0.218], birth weight [EG: 1122.56 g, CG: 1160.35 g, P-value = 0.630] and gender distribution [P-value = 0.554].
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All infants were assessed with the Perinatal Risk Inventory (PERI) when discharged. Two t-Student tests were carried out of mean differences for independent samples between the scores of perinatal risk and of the days of hospitalization of both groups. D statistic was calculated to determine the effect size. Results: Our findings reveal significant differences between both groups, with significantly better outcome among the infants who received Vojta Therapy; infants in EG obtained lower PERI scores [P-value < 0.001] and were less days in hospital [P = 0.001] when compared to the CG. The effect size was large among the EG in the reduction of perinatal risk (d = 0.95) and of the days in hospital (d = 1.86). Discussion and conclusions: The Vojta method has high clinical relevance; it is effective in reducing perinatal risk scores and days of hospitalization of preterm infants with RDS and BPD. Impact and implications: Early treatment with Vojta method in the NICU can be effective in reducing perinatal risk and the days of hospitalization in preterm infants with RDS and BPD. This reduction in risk can lead to a better development of these infants, decreasing the possibilities of future disabilities. Applying Vojta methods in the NICU may lead to reduced health, social and educational expenses generated by this population. Funding acknowledgement: It is not funding. No acknowledgement is required. http://dx.doi.org/10.1016/j.physio.2016.10.242 POS185 The development of a specialist model of care for transitional paediatric neuromuscular patients: collaboration between respiratory, neurological and neuro-rehabilitation specialties R. Moses 1,∗ , A. Vyas 1 , D. Shakespeare 2 , C. Degoode 3 1 Lancashire
Teaching Hospitals, Respiratory Medicine, Preston, United Kingdom 2 Lancashire Teaching Hospitals, Neuro-Rehabilitation, Preston, United Kingdom 3 Lancashire Teaching Hospitals, Paediatric Neurology, Preston, United Kingdom Relevance: Physiotherapy has an integral role in ensuring the development of children with complex health care needs. As children transition into adult services they will experience a number of physical, emotional, social and behavioural changes. The impact on this can have huge implications on their physical and mental health. Often these children have complex needs that necessitate a high demand on a number of services. The physiotherapists working with these chil-
The 4th European Congress of the ER-WCPT / Physiotherapy 102S (2016) eS67–eS282
Clinical Psychologist, GP with Special Interest in Pain Management and Chaplaincy Services. Approach/evaluation: Patients assessed by the Living with Pain Team, where Urdu was their first language and would benefit from increasing their understanding of selfmanagement of living with pain were referred into the pilot group. 6 patients started the 8 session PMP (1 male, 5 female). The PMP included an overview from the Trust’s Muslim Chaplain of his role on the PMP, and how Islamic teachings promote self-management, compassion, physical activity and dispelling of cultural myths. The GP discusses pain medication management within holistic care, the physiotherapist emphasises the biopsychosocial approach of the PMP, including gentle increases in exercise. Psychology sessions focussed on how pain can affect patients emotionally and emphasised how patients could increase their self-kindness. As literacy is a common problem, audio and video material in Urdu were utilised which supported the education of standard PMP concepts. SEQ and HADS outcome measures were administered pre and post PMP. No ethics approval required. Outcomes: Patients made improvements in self-efficacy, anxiety and depression following the programme. There was a statistically significant change in anxiety (t(3) = 4.7, P < 0.01), depression (t(3) = 5, P < 0.01), and self-efficacy (t(3) = −8.18, P < 0.001) following the programme. The Reliable Change Index (RCI) was used, and this found that 25% of patients made a reliable change in anxiety and 75% of patients made a reliable change in depression. Subjectively patients reported that they had understood their persistent pain for the first time within their cultural context. Discussion and conclusions: Preliminary results suggest there is value in delivering a language specific and culturally adapted MDT led PMP for the South Asian community. It has been able to engage patients to break down cultural barriers but also increase awareness of the cultural perception and experience of persistent pain. There is a recognition that further clinical research is needed into the long term effectiveness of this approach on self-efficacy, anxiety and depression. Impact and implications: Cultural competency is an important factor to consider when working with patients of a different background. Accepted for British Pain Society Annual Scientific Meeting May 2016. Funding acknowledgement: No external funding was required, formed part of the authors normal working role. http://dx.doi.org/10.1016/j.physio.2016.10.240
POS183 Early physiotherapy effects in preterm infant gross and fine motor development during the first 18 months of life F.J. Fernández Rego 1,2 , A. Gomez-Conesa 3,∗ , J. Pérez López 4 1 University
of Murcia, Physical Therapy Department, Murcia, Spain 2 Early Intervention Centre ‘Fina Navarro López’, Lorca, Spain 3 University of Murcia, Physical Therapy Department, Espinardo-Murcia, Spain 4 University of Murcia, Department of Developmental and Educational Psychology, Murcia, Spain Relevance: Forty per cent of preterm infants suffer disorders in their development. Early Intervention with physiotherapy treatments promotes the motor development and the prevention of disabilities in this population. Purpose: To compare the effect of Vojta method with other physiotherapy treatments on gross and fine motor development of preterm infants during the first 18 months of life. Methods/analysis: 84 preterm infants diagnosed with motor delay, with a gestational age mean (GA) of 30.87 weeks (SD = 3.01) and birth weight (BW) of 1491.35 g (SD = 528.54) were allocated into two study groups: an experimental group with Vojta therapy (EG, n = 47 participants) and a control group with other physiotherapy treatments (CG, n = 37 participants). Both groups had similar GA [EG = 31.24 (SD = 2.94) weeks; CG = 30.39 (SD = 3.07) weeks; P-value = 0.205] BW [EG = 1570.49 (SD = 519.42) g; CG = 1390.81 (SD = 529.86) g; P-value = 0.124] and gender distributions [P-value = 0.908]. Both groups received two weekly 50-minute sessions of physical therapy, EG with Vojta and CG with other physical therapy methods (Le Métayer and Bobath). Four measurements were performed: during the first trimester of life (3M), at 6 (6M), 12 (12M) and 18 (18M) months of corrected age, using the Bayley Scales of Infant and Toddler Development 3rd edition (BSID-III) for gross and fine motor capacities. A t-Student test was carried out for independent samples among the gross scalar score (GS), the fine scalar (FS) and the composite score (CS) of the BSID-III between both groups, at the different time points. Additionally, effect size was calculated using d statistics. Results: We observed significant differences at 3M and at 6M, between both groups. The CG had better performance in the motor scales of the BSID-III at all three levels: FS (3M: P-value = 0.004, 6M: P-value = 0.044), GS (3M: Pvalue < 0.001, 6M: P = 0.004) and CS (3M: P-value < 0.001, 6M: P = 0.010). Additionally, at 18M, EG was superior in the FS (P-value < 0.001) and CS level (P-value = 0.004).
The 4th European Congress of the ER-WCPT / Physiotherapy 102S (2016) eS67–eS282
The control group had large effect size for EG and CS at 3M (0.91 and 0.86) and moderate for FS (0.65); at 6M a low size for FS (0.45) and moderate for GS and CS (0.65 and 0.60). Whereas Vojta therapy demonstrated had high effect FS (0.93), moderate for CS (0.65) and low the GS (0.40) at 18M. Discussion and conclusions: Infants treated with Vojta therapy had improved scores during every assessment despite starting at lower scores in the first time points. Using the BSID-III motor scale, preterm infants treated with Vojta showed a superior motor development at 18 months, especially in the fine motor skills, compared to infants treated with other modalities of physical therapy. Impact and implications: Vojta method is effective in promoting motor development of preterm infants receiving during the first 18 months of corrected age. Additionally, it contributes to improve the protocol of physical therapy interventions and prevent future disabilities in this population. Funding acknowledgement: It is not funding. No acknowledgement is required. http://dx.doi.org/10.1016/j.physio.2016.10.241 POS184 Vojta therapy in the reduction of perinatal risk in preterm infants with respiratory distress syndrome and bronchopulmonary dysplasia A. Gomez-Conesa 1,∗ , F.J. Fernández Rego 1 , J.J. Agüera Arenas 2 1 University
of Murcia, Physical Therapy Department, Espinardo-Murcia, Spain 2 Virgen de la Arrixaca University Hospital, Neonatal Intensive Care Unit, Murcia, Spain Relevance: Preterm infants are at increased risk of suffering respiratory problems and concomitant diseases due to the immaturity of their systems, increasing the days of hospitalization and the risk of disorders in their development. Purpose: To study if Vojta therapy can reduces the perinatal risk and decrease the days of hospitalization of preterm infants with Respiratory Distress Syndrome (RDS) and Bronchopulmonary Dysplasia (BPD). Methods/analysis: Sixty preterm infants with gestational age (GE) ≤ 32 weeks and a diagnosis of RDS were randomly allocated into two groups: experimental group (EG, n = 32 preterm infants; 15 girls and 17 boys), and a control group (CG, n = 28 preterm infants; 11 girls and 17 boys). Both groups received standard of care in the neonatal intensive care unit (NICU), additionally the EG received two daily sessions of 10 minutes during 30 days of Vojta physiotherapy. There were no significant differences between the groups in GE [EG: 28.2 weeks, CG: 28.9weeks, P-value = 0.218], birth weight [EG: 1122.56 g, CG: 1160.35 g, P-value = 0.630] and gender distribution [P-value = 0.554].
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All infants were assessed with the Perinatal Risk Inventory (PERI) when discharged. Two t-Student tests were carried out of mean differences for independent samples between the scores of perinatal risk and of the days of hospitalization of both groups. D statistic was calculated to determine the effect size. Results: Our findings reveal significant differences between both groups, with significantly better outcome among the infants who received Vojta Therapy; infants in EG obtained lower PERI scores [P-value < 0.001] and were less days in hospital [P = 0.001] when compared to the CG. The effect size was large among the EG in the reduction of perinatal risk (d = 0.95) and of the days in hospital (d = 1.86). Discussion and conclusions: The Vojta method has high clinical relevance; it is effective in reducing perinatal risk scores and days of hospitalization of preterm infants with RDS and BPD. Impact and implications: Early treatment with Vojta method in the NICU can be effective in reducing perinatal risk and the days of hospitalization in preterm infants with RDS and BPD. This reduction in risk can lead to a better development of these infants, decreasing the possibilities of future disabilities. Applying Vojta methods in the NICU may lead to reduced health, social and educational expenses generated by this population. Funding acknowledgement: It is not funding. No acknowledgement is required. http://dx.doi.org/10.1016/j.physio.2016.10.242 POS185 The development of a specialist model of care for transitional paediatric neuromuscular patients: collaboration between respiratory, neurological and neuro-rehabilitation specialties R. Moses 1,∗ , A. Vyas 1 , D. Shakespeare 2 , C. Degoode 3 1 Lancashire
Teaching Hospitals, Respiratory Medicine, Preston, United Kingdom 2 Lancashire Teaching Hospitals, Neuro-Rehabilitation, Preston, United Kingdom 3 Lancashire Teaching Hospitals, Paediatric Neurology, Preston, United Kingdom Relevance: Physiotherapy has an integral role in ensuring the development of children with complex health care needs. As children transition into adult services they will experience a number of physical, emotional, social and behavioural changes. The impact on this can have huge implications on their physical and mental health. Often these children have complex needs that necessitate a high demand on a number of services. The physiotherapists working with these chil-