Parental engagement in early intervention for infants with cerebral palsy-A realist synthesis.
Phillip Antony Harniess, Deanna Gibbs, Jeff Bezemer and 1 others
PMID 34622968WHAT IT FOUND
Weekly face-to-face coaching and accessible home materials help parents stick with infant therapy.
However, home programmes do not consistently improve infant motor skills, and parents often find the process stressful despite high adherence.
Key findings
01Regular weekly therapy sessions are critical for parent adherence to home programmes, as monthly visits led to poor compliance in one trial.
02Coaching approaches that build parent autonomy are associated with increased parental self-efficacy and reduced worry over time, compared to traditional directive therapy.
03Several trials showed no significant difference in infant motor outcomes between parent-delivered home programmes and standard care, despite high parent engagement.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
Only one reviewer performed the initial literature search, which may have missed relevant studies. Many included studies had small sample sizes and poor methodological rigour. The review excluded children aged 2-4 years, limiting applicability to older infants. Parent adherence was largely self-reported, which may overestimate actual home practice. The review could not definitively separate the effects of coaching from other intervention components due to complex programme designs.
Declared interests
The authors declared no competing interests. The study was supported by a non-U.S. government grant.
The easy way to misread this
Do not interpret high parent adherence or satisfaction as evidence that the home programme improved the infant's motor skills. Several trials showed parents engaged well but infant outcomes did not differ from standard care.