Congenital Muscular Torticollis: Systematic Review To Inform Best Practice скачать в хорошем качестве

Congenital Muscular Torticollis: Systematic Review To Inform Best Practice

EXPERT INTERVIEWS ON: "Congenital Muscular Torticollis: Systematic Review To Inform Best Practice" LOS ANGELES, USA—Leading experts in pediatric physical therapy discuss their Systematic Review of recent real-world findings on the effectiveness of applying the 2018 Clinical Practice Guideline for physical therapy management of congenital muscular torticollis. Peter Goodwin visits two key centers of excellence to discuss the latest findings and recommendations: the University of Southern California Los Angeles and the Children’s Hospital Los Angeles. Based on an article in Pediatric Physical Therapy Volume 35 Issue 2, April 1, 2023: "Informing the Physical Therapy Management of Congenital Muscular Torticollis Clinical Practice Guideline: A Systematic Review" BY: Adrianna Castilla, PT, DPT; Mariah Gonzalez, PT, DPT; Lynn Kysh, MLIS, MPP; Barbara Sargent, PT, PhD, PCS INSTITUTIONS: Division of Pediatric Rehabilitation Medicine (Drs Castilla and Gonzalez), Children’s Hospital Los Angeles, Los Angeles, California; Division of Biokinesiology and Physical Therapy (Drs Castilla, Gonzalez, and Sargent), Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California; Institute for Nursing and Inter-professional Research (Ms Kysh), Children’s Hospital Los Angeles, Los Angeles, California. Purpose: To systematically review current evidence on the physical therapy assessment, intervention, and prognosis of congenital muscular torticollis (CMT) to inform the update to the 2018 CMT Clinical Practice Guideline (CPG). Methods: Six databases were searched for studies that informed assessment, intervention, and prognosis for physical therapy management of infants with CMT. Results: Fifteen studies were included. Four studies investigated the psychometric properties of new and established assessments. Six studies informed the feasibility and efficacy of first-choice and supplemental interventions including traditional Chinese medicine and neural and visceral manipulation. One qualitative study found that parents of infants with mild and severe CMT had different concerns. Five studies informed prognosis, including factors associated with treatment duration, clinical outcomes, and use of supplemental interventions. Conclusion: Newer evidence reaffirms 5 of 17 recommendations of the 2018 CMT CPG and could increase the recommendation strength to strong for neck passive range of motion. (Pediatr Phys Ther 2022;00:1–11) INTRODUCTION Congenital muscular torticollis (CMT) is a postural, musculoskeletal deformity evident at or shortly after birth. CMT is characterized by the shortening or stiffness of the sternocleidomastoid muscle (SCM) resulting in ipsilateral lateral flexion of the head with contralateral rotation. The incidence of CMT ranges from 3.9%1, 2 to 16%3 of newborns. Evidence supports that early referral and initiation of physical therapy (PT) leads to improved outcomes,4 , 5 shorter durations of care,4-6 and reduced need for surgical intervention.4 , 7-9 If an infant diagnosed with CMT begins PT before 1 month of age, the prognosis for full cervical range of motion (ROM) is 98% with 1.5 ± 0.3 months of PT.5 Beginning between 1 and 3 months of age, the prognosis for full cervical ROM declines to 89% with 5.9 ± 0.6 months of PT.5 Beginning between 3 and 6 months of age, the prognosis for full cervical ROM declines to 63% with 7.2 ± 0.6 months of PT, and beginning between 6 and 12 months of age, the prognosis for full cervical ROM declines to 19% with 9.8 ± 0.6 months of PT.5 Yet, a survey of pediatric physical therapists in the United States found that infants with CMT are most commonly referred to PT at 3 to 6 months of age.10 Therefore, it is imperative that infants with CMT are identified early and receive appropriate PT intervention to achieve optimal outcomes. The Physical Therapy Management of Congenital Muscular Torticollis Evidence-Based Clinical Practice Guideline (CPG) was originally published in 2013 (2013 CMT CPG)11 and revised in 2018 (2018 CMT CPG)12 by the American Physical Therapy Association Academy of Pediatric Physical Therapy. The 2018 CMT CPG reflected new research regarding referral, screening, examination and evaluation, diagnosis, prognosis, intervention, consultation, discharge, and follow-up of infants with CMT.12 Recommendations are organized into 17 action statements based on critical appraisal of the literature. Additionally, the Academy of Pediatric Physical Therapy Informing the Physical Therapy Management of CMT CPG 1 0898-5669/0000-0001 Pediatric Physical Therapy Copyright © 2022 Academy of Pediatric Physical Therapy of the American Physical Therapy Association Correspondence: Adrianna Castilla, PT, DPT, Division of Pediatric Rehabilitation Medicine, Children’s Hospital Los Angeles, 4650 Sunset Blvd, Mailstop 56, Los Angeles, CA 90027 ([email protected]).