Effect of physical or occupational therapy on participation and functioning in children born preterm: A systematic review and meta-analysis

Background: Preterm born children are at a higher risk of developing motor, cognitive and behavioural impairments than term born peers. This systematic review with meta-analysis aimed to assess the efficacy of post-discharge physical or occupational therapy compared to standard of care, no treatment or any other active intervention on functioning and participation during infancy and childhood in children born preterm. Methods: We systematically searched MEDLINE, PsycINFO, CINAHL, CENTRAL, and WHO ICTRP for randomized controlled trials (RCTs) published up to April 23, 2024. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane RoB 2 tool. Certainty of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Random-effects meta-analyses were performed for clinically and methodologically homogeneous studies. Results: Thirteen RCTs involving 697 children born preterm were included, with ten studies investigating physical therapy (n=453; 0-6 years) and three studies examining occupational therapy (n=244; 3-6 years). Physical therapy interventions comprised family-centered active learning programs, group-based therapy, muscle training, and task-oriented motor intervention. Meta-analyses indicated that physical therapy may slightly enhance cognitive development during infancy (MD 0.95, 95% CI -0.3 to 2.2; low certainty). However, effects on motor outcomes were inconsistent, and evidence regarding participation and quality of life was limited and inconclusive. Occupational therapy interventions included computer-based training and parent-child interaction programs. Outcomes measured were behaviour, participation, executive functioning, and parent-child interaction. No consistent benefits were observed across studies. One small study indicated a reduction in attention (MD -8.30, 95% CI -13.40 to -3.20) and internalizing problems (MD -11.70, 95% CI -17.78 to -5.62), though evidence certainty was low and very low. No studies examined quality of life or long-term healthcare use. Conclusions: While the effects of physical therapy on motor and participation outcomes remain uncertain, physical therapy in infancy may improve cognition. Evidence for occupational therapy on participation, behaviour, and parent-child interaction is limited. Therefore, generalizable conclusions are not possible. Studies rarely address participation, quality of life, or long-term outcomes and reveal research gaps emphasizing the need for future research. PROSPERO Protocols: CRD42024562290 and CRD42024562314.