Out of the 444 infants available for analyses, 244 (55%) were recruited by physiotherapists in different MCUs in Bergen and Trondheim and 196 (44 %) by manual therapists specialized in treating infants, working in different communities in Norway.
Total number (%) of boys was 257 (58) and no gender and age difference were found among infants at examination (Table 1).
Table 1 Descriptive data on 444 infants treated by physiotherapists (PT) and manual therapists (MT)
Number (%)
|
Mean age (SD) in weeks, at examination
|
Gender, Boy (%)
|
Born at due date (>GW37), yes (%)
|
Total (%)
|
MT
|
16(11)
|
116 (59)
|
177 (90)
|
196 (44)
|
PT at MCU
|
17 (10)
|
141 (59)
|
167 (67)
|
248 (52)
|
Total
|
16 (10)
|
257 (59)
|
344 (77)
|
444 (100)
|
Abbreviations: SD, Standard Deviation, MCU, Maternity Care Unit, GW, gestation week, >, more than
Most of the infants (84%) treated by the physiotherapists at MCUs were referred from other health personnel at the same MCU. A total of 54% of all the infants treated by the manual therapists were also referred from personnel (including physiotherapists) at the MCU (Table 2). A larger fraction of the infants treated by manual therapists came without being referred by a health personnel i.e., they came because of parental concern (28% versus 1% respectively) (Table 2).
Table 2 Who referred/recommended the infant to treatment/examination?
Referred from
|
Personnel at MCU
|
PT at MCU
|
GP
|
Pediatric PT
|
Parents own initiative
|
Specialist health care
|
Missing data
|
Total (%)
|
Referred to
|
|
|
|
|
|
|
|
|
MT
|
50 (26)
|
55 (28)
|
7 (4)
|
22 (11)
|
54 (28)
|
1 (0.5)
|
7 (4)
|
196 (44)
|
PT at MCU
|
208 (84)
|
3 (1)
|
7 (3)
|
2 (0.8)
|
2 (0.8)
|
16 (6)
|
10 (4)
|
248 (56)
|
Total
|
258 (58)
|
58 (13)
|
14 (3)
|
24 (5)
|
56 (13)
|
17 (4)
|
17 (4)
|
444 (100)
|
Abbreviations: MCU, Maternity Care Unit, PT, physiotherapist, MT, manual therapist, GP, general practitioner
Insert Table 2 about here
We also found differences in the cause of the referrals to the physiotherapists and manual therapists. The main differences were that most of the premature babies, all infants with neurological conditions, and all infants with need of parental advice as reason for the referral, were referred to the physiotherapist at the MCUs (Table 3). Few infants were referred because of colic and breastfeeding problems, all of them were seen by a manual therapist.
Insert table 3 about here
Table 3 Cause for referring infants to physiotherapists (PT) and manual therapists (MT)
|
Motor development
|
Asymmetries/asymmetric movements
|
Orthopedic conditions
|
Neurological conditions
|
Premature birth
|
Restlessness/sleep problems
|
Breastfeeding problems
|
Colic
|
Needs advice
|
Other
|
Total
|
MT
|
16 (8)
|
131 (67)
|
2 (1)
|
0 (0)
|
1 (0.5)
|
27 (14)
|
6 (3)
|
9 (5)
|
0 (0)
|
4 (2)
|
196 (44)
|
PT at MCU
|
17 (7)
|
140 (56)
|
4 (16)
|
7 (28)
|
28 (11)
|
0 (0)
|
0 (0)
|
0 (0)
|
24 (10)
|
28 (11)
|
248 (56)
|
Total
|
33 (7)
|
271 (61)
|
6 (1)
|
7 (1.5)
|
29 (7)
|
27 (6)
|
6 (1)
|
9 (2)
|
24 (5)
|
32 (7)
|
444 (100)
|
Abbreviations: MCU, Maternity Care Unit
A total of 28 infants (6%) were examined within the first four weeks after birth, 36% between 5 and 12 weeks and 58% after 12 weeks. Among the 28 infants examined within the first 4 week, 61% were referred due to asymmetries. Among the 271 infants with asymmetries 94% were examined between week 5 and one year after birth (Table 4).
Table 4 Referral causes distributed on the time for examination.
Referral cause
|
Week 1-4
|
Week 5-12
|
Week 13 -52
|
Total
|
Motor development
|
1 (3)
|
14 (42)
|
18 (55)
|
33 (100)
|
Asymmetry/asymmetric movements
|
17 (6)
|
101 (37)
|
153 (56)
|
271 (100)
|
Orthopedic conditions
|
1 (17)
|
2 (33)
|
3 (50)
|
6 (100)
|
Neurologic conditions
|
3 (43)
|
1 (14)
|
3 (43)
|
7 (100)
|
Premature birth
|
0 (0)
|
6 (21)
|
23 (79)
|
29 (100)
|
Restlessness/sleep problems
|
0 (0)
|
13 (48)
|
14 (52)
|
27 (100)
|
Breastfeeding problems
|
1 (17)
|
4 (67)
|
1 (17)
|
6 (100)
|
Colic
|
1 (11)
|
8 (89)
|
0 (0)
|
9 (100)
|
Needs advice
|
1 (4)
|
1 (4)
|
22 (92)
|
24 (100)
|
Other
|
4 (13)
|
7 (22)
|
21 (65)
|
32 (100)
|
Total
|
28 (6)
|
158 (36)
|
258 (58)
|
444 (100)
|
Concerning planned interventions, the use of manual techniques was mainly reported by manual therapists, but not as single interventions. More often in combination with advice and/or handling the baby. (Table 5) For two infants, the reported treatment included manipulation. Both the physiotherapists and the manual therapists reported to use handling and stimulation in their treatment of the infants. More of the physiotherapists reported to have a focus on advice related to the child’s development including the use of prone play (Table 5).
Table 5 Planned interventions
|
Advice information guidance
|
Joint mob
|
Combined advice/ joint mob
|
Handling stimulation
|
Stretching
|
Combined joint mob /handling
|
Tummy position
|
Improve motor de-velopment
|
Massage muscle energy technique
|
Unknown/ missing
|
Total
|
MT
|
4 (2)
|
9 (5)
|
38 (19)
|
30 (15)
|
2 (1)
|
27* (14)
|
2 (1)
|
3 (2)
|
0
|
81 (41)
|
196 (44)
|
PT at MCU
|
5 (2)
|
0
|
0
|
55 (22)
|
2 (1)
|
0
|
116 (47)
|
35 (14)
|
11 (4)
|
24 (10)
|
248 (56)
|
Total
|
9 (2)
|
9 (2)
|
38 (9)
|
85 (19)
|
4 (1)
|
27 (6)
|
118 (27)
|
38 (9)
|
11 (2)
|
105 (24)
|
444 (100)
|
Abbreviations: Mob, mobilization, MT, manual therapist, PT, physiotherapist
* For two of these infants the planned intervention was manipulation
Insert Table 5 about here
For 54% of the infants, it was not planned any follow-up from the actual therapist, for 66% no further referrals to other health practitioners were planned, and for 2% it was planned a referral to specialist health care.