Guidance strategies for infantile asymmetry prevention: a systematic review.

Background: Infantile asymmetries of posture, movement and/or shape are common. Coincidence in the presentation of asymmetrical features can lead to a broad spectrum of descriptors. Published guidelines on prevention strategies are not currently available. The objective of this systematic review was to find, evaluate, and synthesise the available evidence regarding the effectiveness of prevention strategies for infantile asymmetries, specifically strategies involving paediatric screening and/or guidance to parents.

Methods: This review has been reported based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and the review protocol was prospectively registered on the Open Science Framework, ( https://osf.io/rgzev/ ). Searches were conducted on Ovid Medline, Ovid AMED, and PEDro. Inclusion criteria of articles were infants < 28 weeks old who had received either an early musculoskeletal screen and/or education to parents on home care guidance/exercises to prevent asymmetry development. Any primary research was included. There was no limit placed upon date of publication. Data were screened, extracted and appraised in duplicate by at least two blinded reviewers. The Cochrane Collaboration's tool for assessing risk of bias available as part of Covidence was used by two reviewers independently.

Results: Of the 878 papers retrieved, 19 studies were included: 9 randomised controlled trials, 6 cohort studies and 4 non-randomised experimental studies. The presenting conditions included head shape asymmetry in 16/19 studies, cervical range of motion in 10 studies and positional preference in 3. Due to a lack of homogeneity between all the studies, it was not possible to pool the data and conduct meta-analysis. Guidance strategies show better outcomes in asymmetry prevention when provided early (< 3 months) and under supervision of a healthcare professional. The overall risk of bias for cohort and non-randomised experimental studies was considered to be 'low', and 'adequate' or 'low' for randomised controlled trials. The GRADE level of evidence was found to be 'very low'.

Conclusion: Early parental guidance may prevent infantile asymmetry when supervised by a trained healthcare professional and with good adherence from parents. Further studies with a higher methodological rigour are needed to identify and perform comparative interventions.

Clinical trial number: Not applicable. OSF NUMBER: https://doi.org/10.17605/OSF.IO/RGZEV .