Physiotherapy for Infants With Bronchiolities

Physiotherapy Including Frequent Changes of Body Position and Stimulation to Physical Activity for Infants With Bronchiolitis and Other Acute Respiratory Infections - a Randomized Controlled Trial

Children who are in a hospital with respiratory distress often have difficulty breathing, have thick mucus, and may find it hard to eat normally. Sometimes physical therapy is used to treat these children, but it is not entirely known which methods help the children's condition. The aim of this study is to evaluate the most common physiotherapy treatment method that is currently in use in Sweden for infants who are hospitalized with a lower respiratory infection.

All children under 2 years of age who are admitted to the hospital for a respiratory infection and who have previously been essentially healthy are asked to participate. The infants will be randomized to 3 groups, 1 control group and 2 intervention groups. The infants in the control group will receive the standard care at the clinic. In one intervention group the parents will receive instructions how to vary their child body position regularly, and in the other intervention group the child will receive physiotherapy regularly and the parents will carry out some treatment. Further actions in the form of inhalations or stimulation of deep breathing, will be used when needed. The children will be observed following a structured observational protocol regularly throughout the hospital stay.

Randomisation is carried out with sealed envelopes that are only opened just before intervention starts. There are different care givers who carry out the observations and who perform the interventions.

The parents will be guided manually by the nursing staff and receive written information about how to change body positions of their child regularly throughout the hospital stay.

The infant will receive frequent changes of body positions, stimulation to physical activity, and stimulation to deep breathing while bouncing on a large ball in the arms of an adult. Additional light chest compressions and inhalations may be given. A physiotherapist will perform the intervention at least once daily, and the parents will be manually guided and receive written information about how to change body positions of their child regularly in a similar way throughout the hospital stay.

First improvement regarding any of the following: Wang respiratory score, use of supplemented oxygen, use of supplemented high air flow, use of tube feeding, hospital stay

Baseline, after 20 minutes, and every third hour up to discharge from hospital, no more than two weeks

Baseline and second assessment, directly following the first intervention (or interval) after 20 minutes

Baseline and second assessment, directly following the first intervention (or interval) after 20 minutes

Baseline and second assessment, directly following the first intervention (or interval) after 20 minutes

Inclusion Criteria: Infants hospitalized because of respiratory infections such as bronchiolitis, pneumonia or other airway obstructions. Age 0-24 months Born in gestation week 35 or later. Guardians understand written Swedish, English, Arabic or Persian Exclusion Criteria: Previous cardiac or respiratory disease hospitalized more than 24 hours on this occasion

Andersson-Marforio S, Lundkvist Josenby A, Hansen C, Ekvall Hansson E. Physiotherapy interventions encouraging frequent changes of the body position and physical activity for infants hospitalised with bronchiolitis: an internal feasibility study of a randomised control trial. Pilot Feasibility Stud. 2022 Mar 30;8(1):76. doi: 10.1186/s40814-022-01030-2. Erratum In: Pilot Feasibility Stud. 2022 May 19;8(1):104.

Andersson-Marforio S, Lundkvist Josenby A, Ekvall Hansson E, Hansen C. The effect of physiotherapy including frequent changes of body position and stimulation to physical activity for infants hospitalised with acute airway infections. Study protocol for a randomised controlled trial. Trials. 2020 Sep 21;21(1):803. doi: 10.1186/s13063-020-04681-9.