title: Effect of early intervention on functional outcome at school age: Follow-up and process evaluation of a randomised controlled trial in infants at risk.
abstract: The long-term effect of early intervention in infants at risk for developmental disorders is unclear. The VIP project (n=46, originally) evaluated by means of a randomised controlled trial the effect of the family centred early intervention programme COPCA (Coping with and Caring for infants with special needs) in comparison to that of traditional infant physiotherapy (TIP).
  
  
  
  To evaluate the effect of early intervention on functional outcome at school age.
  
  
  
  Parents of 40 children (median age 8.3years) participated in this follow-up study. Outcome was assessed with a standardised parental interview (Vineland Adaptive Behaviour Scale) and questionnaires (Developmental Coordination Disorder Questionnaire, Child Behaviour Checklist, Utrechtse Coping List, and questions on educational approach). Quantified video information on physiotherapeutic actions during infancy was available.
  
  
  
  Child functional outcome in the two randomised groups was similar. Process evaluation revealed that some physiotherapeutic actions were associated with child mobility and parental educational approach at follow-up: e.g., training and instructing were associated with worse mobility.
  
  
  
  Functional outcome at school age after early intervention with COPCA is similar to that after TIP. However, some specific physiotherapeutic actions, in particular the physiotherapist's approach, are associated with outcome.
  
  
  
  Early intervention is generally applied in infants at risk for developing disorders, with the aim of improving overall functional outcome. However, little is known on the long-term effect. The VIP project evaluated by means of a randomised controlled trial the effect of the family centred early intervention programme COPCA (Coping with and Caring for infants with special needs) in comparison to that of traditional infant physical therapy (TIP). Outcome at 18months corrected age was virtually similar. Process evaluation of the physiotherapy actions revealed that some characteristics of COPCA were associated with improved developmental outcome at 18months. This paper presents data on functional outcome at school age (median 8.3years) in 87% of the original participants. Outcome of infants who received three months of COPCA and that of infants who received three months of TIP was similar. Yet, parents of families who had received the COPCA intervention still more often used a trial and error approach when the child learned a new skill than parents of children who had received TIP. Process evaluation showed that more time spent on caregiver training and strict instructions during early intervention was associated with worse mobility. Four other physiotherapeutic actions were associated with parental educational approach. None of the neuromotor actions were associated with child outcome at school age. We conclude that long-term outcome after three months of COPCA or TIP is similar. However, our study does suggest that the professional approach of the physiotherapist can make a difference.
authors.affiliation: University of Groningen, University Medical Centre Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, The Netherlands.
authors.forename: Elisa G
authors.initials: EG
authors.lastname: Hamer
authors.affiliation: University of Groningen, University Medical Centre Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, The Netherlands; University of Groningen, University Medical Centre Groningen, Department of Rehabilitation Medicine, Centre for Rehabilitation, Groningen, The Netherlands.
authors.forename: Tjitske
authors.initials: T
authors.lastname: Hielkema
authors.affiliation: University of Groningen, University Medical Centre Groningen, Department of Paediatrics, Division of Neonatology, Groningen, The Netherlands.
authors.forename: Arend F
authors.initials: AF
authors.lastname: Bos
authors.affiliation: University of Groningen, University Medical Centre Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, The Netherlands.
authors.forename: Tineke
authors.initials: T
authors.lastname: Dirks
authors.affiliation: University of Groningen, University Medical Centre Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, The Netherlands.
authors.forename: Siebrigje J
authors.initials: SJ
authors.lastname: Hooijsma
authors.affiliation: University of Groningen, University Medical Centre Groningen, Department of Rehabilitation Medicine, Centre for Rehabilitation, Groningen, The Netherlands; Rehabilitation Centre 'Revalidatie Friesland', Beetsterzwaag, The Netherlands.
authors.forename: Heleen A
authors.initials: HA
authors.lastname: Reinders-Messelink
authors.affiliation: University of Groningen, University Medical Centre Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, The Netherlands; University of Groningen, University Medical Centre Groningen, Department of Rehabilitation Medicine, Centre for Rehabilitation, Groningen, The Netherlands.
authors.forename: Rivka F
authors.initials: RF
authors.lastname: Toonen
authors.affiliation: University of Groningen, University Medical Centre Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, The Netherlands. Electronic address: m.hadders-algra@umcg.nl.
authors.forename: Mijna
authors.initials: M
authors.lastname: Hadders-Algra
mesh_terms: D000328:Adult; D002648:Child; D002657:Child Development; D002658:Developmental Disabilities / Q000628:therapy*; D018479:Early Intervention, Educational / Q000379:methods*; D061345:Early Medical Intervention / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D026741:Physical Therapy Modalities / Q000009:adverse effects
keywords: Early intervention; Family; Functional outcome; High-risk infants; Long-term follow-up