Hooijsma, S.J. (Siebrigje) (2014) Fysiotherapie bij baby’s. Verschil tussen het vroege interventie programma ‘COPing with and CAring for infants with special needs – a family centered program’ (COPCA) en de traditionele kinderfysiotherapie (TIP) bij baby’s met een hoog risico op het ontwi. thesis, Medicine.
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Abstract
Introduction: Cerebral palsy (CP) is a relatively frequent pediatric neurological disorder resulting in impaired posture and motility. Early intervention, i.e., intervention when the brain is very plastic, seems warranted. However, little evidence exists for the efficiency of current interventions on cognitive and motor development. Therefore, a new intervention program has been developed, called COPCA (Coping with and Caring for infants with special needs – a family centered program). Previously, COPCA was evaluated in a randomized controlled trial (RCT). A minimal advantage for COPCA was demonstrated at RCT-level; in addition, characteristics of COPCA were associated with better quantitative outcomes in development. In this study COPCA again is evaluated against traditional infant physiotherapy in The Netherlands, with the aim to gain insight in the contents of both therapies, to evaluate the reliability of the quantification of the contents of the therapies and, to evaluate the effect of these therapies on the family’s empowerment and motor development in children at very high risk for CP. Material and Methods: 23 infants aged 0-9 months were included (16 boys; 7 girls); all had a clear lesion of the brain indicating a high risk for CP. The children were block-randomized into two groups, where one group received COPCA-therapy (n=12) and the other group traditional infant physiotherapy (TIP) (n=11). For one year both groups received once a week physiotherapy. These sessions were videotaped one month (n=21), six months (n=21) and twelve months (n=17) after the start of the study. Also, after six months and after twelve months family empowerment and motor outcome were evaluated with the Family Empowerment Scale (FES) and the Infant Motor Profile (IMP), respectively. The physiotherapeutic actions were analyzed quantitatively with the ‘Groningen Observation Protocol’ (outcome measure: percentage of time spent on a certain action), an interrater-reliability-test was performed on ten randomly selected videotapes, and correlations between physiotherapeutic actions and the FES and the IMP were evaluated. Results: The intra-class correlations (ICC) of the interrater-reliability-test of the physiotherapeutic actions were always, except for two (out of over 50) correlations, between the 0.649 and the 1.000. Further analysis showed that the contents of COPCA and TIP differed significantly in various aspects; COPCA consisted of ‘Coaching’ and ‘Challenging the infant, whereas TIP consisted of ‘Training’ the use of ‘facilitation techniques’. After six months, the IMP scores of the TIP and COPCA therapy groups differed significantly (TIP performing better than COPCA). However, after twelve months this difference had disappeared. The physiotherapeutic actions were hardly associated with the FES. But, some physical therapeutic action were associated with the IMP; in which the associations in children who developed CP (n=12) and in those without CP (n=11) differed. For example, the COPCA related way of ‘Coaching’ children with CP was associated with a better motor development in the IMP domain ‘performance’; the TIP related action ‘facilitation’ in children with CP was associated with a better result in the IMP domain ‘symmetry’. Conclusion and Discussion: Physiotherapeutic actions during COPCA and TIP can be quantified sufficiently reliable with the ‘Groningen Observation Protocol’. Analysis of the quantified data showed that at one hand the COPCA-therapy was clearly different from the TIP-therapy, and - on the other hand – that part of the physiotherapeutic actions of both therapies overlap. The associations between therapeutic actions and outcome of child and family do not allow for the conclusion that the COPCA is associated with a better development than TIP.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Hadders-Algra, Prof. dr. M. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:07 |
| Last Modified: | 25 Jun 2020 11:07 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2669 |
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