title: Extremity movements help occupational therapists identify stress responses in preterm infants in the neonatal intensive care unit: a systematic review.
abstract: BACKGROUND
  Accurate assessment and treatment of pain and stress in preterm infants in neonatal intensive care units (NICU) is vital because pain and stress responses have been linked to long-term alterations in development in this population.
  
  
  OBJECTIVE
  To review the evidence of specific extremity movements in preterm infants as observed during stressful procedures.
  
  
  METHODS
  Five on-line databases were searched for relevant studies. For each study, levels of evidence were determined and effect size estimates were calculated. Each study was also evaluated for specific factors that presented potential threats to its validity.
  
  
  RESULTS
  Eighteen studies were identified and seven comprised the review. The combined sample included 359 preterm infants. Six specific movements were associated with painful and intrusive procedures.
  
  
  CONCLUSIONS
  A set of specific extremity movements, when combined with other reliable biobehavioural measures of pain and stress, can form the basis for future research and development of a clinical stress scale for preterm infants.
authors.affiliation: Centre for Community Child Health Research, Child and Family Research Institute, Children's and Women's Health Centre of British Columbia, Canada. lholsti@cw.bc.ca
authors.forename: Liisa
authors.initials: L
authors.lastname: Holsti
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Grunau
mesh_terms: D005121:Extremities; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D009068:Movement; D009788:Occupational Therapy / Q000379:methods*; D010146:Pain / Q000175:diagnosis*; D013312:Stress, Physiological / Q000175:diagnosis*