{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T15:01:45Z","timestamp":1785337305090,"version":"3.55.0"},"reference-count":38,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatr. Rep.","Pediatric Reports"],"abstract":"<jats:p>Background\/Objectives: Preterm birth is associated with increased risk of motor delay and broader neurodevelopmental vulnerability. Existing reviews have examined neonatal therapy, family-centered care, or early developmental intervention broadly, but the independent evidence for physiotherapy-based interventions in which parents actively deliver or support motor or sensorimotor activities remains uncertain. This review evaluated the effects of early physiotherapy with structured, guided parental involvement on motor development in preterm infants and examined intervention content, parental burden, safety, adherence, and durability of effects. Methods: The review followed PRISMA 2020 and a prespecified PICO framework. The original PubMed, Scopus, and PEDro search was updated through 9 July 2026 using PubMed\/MEDLINE, PEDro, Cochrane CENTRAL, ClinicalTrials.gov, backward and forward citation tracking, and linked-report searches. Eligible studies were randomized controlled trials of early physiotherapy, motor, or structured sensorimotor intervention with an active parent-delivered or parent-supported component and a validated motor or neurodevelopmental outcome. Multiple publications from the same randomized cohort were linked and participants were counted once. Risk of bias was evaluated with Cochrane RoB 2, intervention reporting with TIDieR, and certainty with GRADE. Results: Ten reports represented five independent randomized cohorts and 393 unique randomized infants. The Norwegian Parent-Administered Physical Therapy Intervention (NOPPI) produced a moderate short-term improvement in TIMP performance at term-equivalent age, but no consistent advantage in general movements, motor performance at 3 or 24 months, or school-age motor outcomes. COPCA and a NICU-to-home physiotherapy program produced developmental improvement over time or selected short-term gains, without consistent superiority over active or developmental care comparators. A parent-administered sensorimotor intervention by Fucile et al. improved oral-feeding outcomes but not TIMP motor performance, and its linked 18-month follow-up did not demonstrate a clear developmental advantage. Badura et al. found no significant effect of a 10-week parent-delivered general-movement-based program on MOS-R or Bayley-III motor outcomes; adherence was variable, and a transient increase in maternal depressive symptoms at discharge highlighted the importance of treatment burden. Conclusions: Guided parental involvement is feasible and may enhance short-term motor performance when activities are individualized, active, cue-responsive, and closely supervised. However, current evidence does not establish sustained superiority over well-structured usual or traditional care, developmental normalization, or benefit from passive sensorimotor input alone. Clinical implementation should combine competency-based parent training, explicit infant stress cues and stopping rules, realistic dose targets, ongoing professional support, and monitoring of adherence, parental well-being, and adverse events.<\/jats:p>","DOI":"10.3390\/pediatric18040100","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T13:53:31Z","timestamp":1785333211000},"page":"100","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of Early Physiotherapy Interventions with Guided Parental Involvement on Motor Development in Preterm Infants: A Systematic Review"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-0222-8973","authenticated-orcid":false,"given":"Georgios","family":"Grammatikou","sequence":"first","affiliation":[{"name":"Health Assessment and Quality of Life Research Lab, Department of Physiotherapy, University of Thessaly, 3rd km Old National Road Lamia-Athens, 35132 Lamia, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1542-0070","authenticated-orcid":false,"given":"Efterpi","family":"Pavlidou","sequence":"additional","affiliation":[{"name":"Department of Speech and Language Therapy, University of Ioannina, 4th km of Ioannina-Athens National Road, 45500 Ioannina, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1287-1028","authenticated-orcid":false,"given":"Nikolaos","family":"Strimpakos","sequence":"additional","affiliation":[{"name":"Health Assessment and Quality of Life Research Lab, Department of Physiotherapy, University of Thessaly, 3rd km Old National Road Lamia-Athens, 35132 Lamia, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6050-4559","authenticated-orcid":false,"given":"Konstantinos","family":"Chandolias","sequence":"additional","affiliation":[{"name":"Health Assessment and Quality of Life Research Lab, Department of Physiotherapy, University of Thessaly, 3rd km Old National Road Lamia-Athens, 35132 Lamia, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2026, July 09). Preterm Birth. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/preterm-birth."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2235","DOI":"10.1001\/jama.2009.1708","article-title":"Motor development in very preterm and very low-birth-weight children from birth to adolescence: A meta-analysis","volume":"302","author":"Piek","year":"2009","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/S1474-4422(08)70294-1","article-title":"Brain injury in premature infants: A complex amalgam of destructive and developmental disturbances","volume":"8","author":"Volpe","year":"2009","journal-title":"Lancet Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1542\/peds.2007-0440","article-title":"Motor and executive function at 6 years of age after extremely preterm birth","volume":"120","author":"Marlow","year":"2007","journal-title":"Pediatrics"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1080\/87565641.2011.540541","article-title":"Educational outcomes in extremely preterm children: Neuropsychological correlates and predictors of attainment","volume":"36","author":"Johnson","year":"2011","journal-title":"Dev. Neuropsychol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1001\/jamapediatrics.2017.1689","article-title":"Early, accurate diagnosis and early intervention in cerebral palsy: Advances in diagnosis and treatment","volume":"171","author":"Novak","year":"2017","journal-title":"JAMA Pediatr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1111\/dmcn.13105","article-title":"Effectiveness of motor interventions in infants with cerebral palsy: A systematic review","volume":"58","author":"Morgan","year":"2016","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_8","first-page":"CD005495","article-title":"Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants","volume":"2","author":"Orton","year":"2024","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1053\/j.semperi.2016.09.006","article-title":"The role of early developmental intervention to influence neurobehavioral outcomes of children born preterm","volume":"40","author":"Spittle","year":"2016","journal-title":"Semin. Perinatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e8","DOI":"10.1111\/j.1469-8749.2010.03876.x","article-title":"Does physiotherapeutic intervention affect motor outcome in high-risk infants? An approach combining a randomized controlled trial and process evaluation","volume":"53","author":"Hielkema","year":"2011","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1111\/j.1469-8749.2005.tb01165.x","article-title":"A systematic review of the effects of early intervention on motor development","volume":"47","year":"2005","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1111\/dmcn.14485","article-title":"Effect of neonatal therapy on the motor, cognitive, and behavioral development of infants born preterm: A systematic review","volume":"62","author":"Khurana","year":"2020","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e20160147","DOI":"10.1542\/peds.2016-0147","article-title":"Motor development interventions for preterm infants: A systematic review and meta-analysis","volume":"138","author":"Hughes","year":"2016","journal-title":"Pediatrics"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.pedhc.2024.06.005","article-title":"Early parenting interventions to enhance development in infants and children born prematurely: A systematic review and meta-analysis","volume":"38","author":"Oh","year":"2024","journal-title":"J. Pediatr. Health Care"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1080\/01942638.2024.2449387","article-title":"Effect of family-centered care interventions on motor and neurobehavior development of very preterm infants: A systematic review and meta-analysis","volume":"45","author":"Raghupathy","year":"2025","journal-title":"Phys. Occup. Ther. Pediatr."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"De Bruyn, N., Hanssen, B., Mailleux, L., Van den Broeck, C., and Samijn, B. (2025). Early intervention including an active motor component in preterms with varying risks for neuromotor delay: A systematic review and narrative synthesis. J. Clin. Med., 14.","DOI":"10.3390\/jcm14041364"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Dusing, S.C., Tripathi, T., Marcinowski, E.C., Thacker, L.R., Brown, L.F., and Hendricks-Mu\u00f1oz, K.D. (2018). Supporting play exploration and early developmental intervention versus usual care to enhance development outcomes during the transition from the neonatal intensive care unit to home: A pilot randomized controlled trial. BMC Pediatr., 18.","DOI":"10.1186\/s12887-018-1011-4"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"105172","DOI":"10.1016\/j.earlhumdev.2020.105172","article-title":"Supporting play, exploration, and early development intervention (SPEEDI) for preterm infants: A feasibility randomized controlled trial in an Australian context","volume":"151","author":"Finlayson","year":"2020","journal-title":"Early Hum. Dev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1093\/ptj\/pzaa077","article-title":"Efficacy of Supporting Play Exploration and Early Development Intervention (SPEEDI) in the first months of life for infants born very preterm: 3-arm randomized clinical trial protocol","volume":"100","author":"Dusing","year":"2020","journal-title":"Phys. Ther."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Badura, A., Dietz, A., Zeman, F., Klarner, S., Ammon, L., Waltner-Romen, M., Griesmaier, E., Wellmann, M., Lehnerer, V., and Wellmann, S. (2026). General movement based therapy to support neurodevelopment of preterm infants: A randomized clinical trial. Pediatr. Res.","DOI":"10.1038\/s41390-025-04734-2"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/j.jclinepi.2010.04.026","article-title":"GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables","volume":"64","author":"Guyatt","year":"2011","journal-title":"J. Clin. Epidemiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"g1687","DOI":"10.1136\/bmj.g1687","article-title":"Better reporting of interventions: Template for intervention description and replication (TIDieR) checklist and guide","volume":"348","author":"Hoffmann","year":"2014","journal-title":"BMJ"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e20160271","DOI":"10.1542\/peds.2016-0271","article-title":"Early parent-administered physical therapy for preterm infants: A randomized controlled trial","volume":"138","author":"Ustad","year":"2016","journal-title":"Pediatrics"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.earlhumdev.2017.06.008","article-title":"Does a parent-administrated early motor intervention influence general movements and movement character at 3 months of age in infants born preterm?","volume":"112","author":"Ustad","year":"2017","journal-title":"Early Hum. Dev."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1093\/ptj\/pzaa014","article-title":"Effects of a parent-administered exercise program in the neonatal intensive care unit: Dose does matter\u2014A randomized controlled trial","volume":"100","author":"Girolami","year":"2020","journal-title":"Phys. Ther."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"105680","DOI":"10.1016\/j.earlhumdev.2022.105680","article-title":"Two-year motor outcomes associated with the dose of NICU-based physical therapy: The NOPPI RCT","volume":"174","author":"Campbell","year":"2022","journal-title":"Early Hum. Dev."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"106615","DOI":"10.1016\/j.earlhumdev.2026.106615","article-title":"Long-term motor outcomes after parent-administered early physiotherapy in children born very preterm","volume":"222","author":"Paulsen","year":"2026","journal-title":"Early Hum. Dev."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"101","DOI":"10.17712\/nsj.2019.2.20180001","article-title":"The role of the family in early intervention of preterm infants with abnormal general movements","volume":"24","author":"Kara","year":"2019","journal-title":"Neurosciences"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Ochandorena-Acha, M., Terradas-Monllor, M., L\u00f3pez Sala, L., Cazorla S\u00e1nchez, M.E., Fornaguera Mart\u00ed, M., Mu\u00f1oz P\u00e9rez, I., Agut-Quijano, T., Iriondo, M., and Casas-Baroy, J.C. (2022). Early physiotherapy intervention program for preterm infants and parents: A randomized, single-blind clinical trial. Children, 9.","DOI":"10.3390\/children9060895"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1111\/dmcn.16046","article-title":"A parent-administered sensorimotor intervention for oral feeding in infants born preterm: A randomized clinical study","volume":"67","author":"Fucile","year":"2025","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"106171","DOI":"10.1016\/j.earlhumdev.2024.106171","article-title":"Longitudinal outcomes of a parent-administered sensorimotor intervention in preterm infants at 4 and 18 months","volume":"201","author":"Smith","year":"2025","journal-title":"Early Hum. Dev."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1111\/dmcn.15901","article-title":"Predictive value of the General Movements Assessment and Standardized Infant NeuroDevelopmental Assessment in infants at high risk of neurodevelopmental disorders","volume":"66","author":"Tacke","year":"2024","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Ustad, T., Brandal, M., Campbell, S.K., Girolami, G.L., Sinding-Larsen, C., and \u00d8berg, G.K. (2023). Concurrent and predictive validity of the Alberta Infant Motor Scale and the Peabody Developmental Motor Scales-2 administered to infants born preterm in Norway. BMC Pediatr., 23.","DOI":"10.1186\/s12887-023-04402-6"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Welch, M.G., Hofer, M.A., Brunelli, S.A., Stark, R.I., Andrews, H.F., Austin, J., and Myers, M.M. (2012). Family Nurture Intervention Trial Group. Family nurture intervention (FNI): Methods and treatment protocol of a randomized controlled trial in the NICU. BMC Pediatr., 12.","DOI":"10.1186\/1471-2431-12-14"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1111\/jcpp.12405","article-title":"Family Nurture Intervention in the neonatal intensive care unit improves social-relatedness, attention, and neurodevelopment of preterm infants at 18 months in a randomized controlled trial","volume":"56","author":"Welch","year":"2015","journal-title":"J. Child Psychol. Psychiatry"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1007\/s00737-015-0502-7","article-title":"Depression and anxiety symptoms of mothers of preterm infants are decreased at 4 months corrected age with Family Nurture Intervention in the NICU","volume":"19","author":"Welch","year":"2016","journal-title":"Arch. Womens Ment. Health"}],"container-title":["Pediatric Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2036-7503\/18\/4\/100\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T14:10:55Z","timestamp":1785334255000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2036-7503\/18\/4\/100"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,29]]},"references-count":38,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["pediatric18040100"],"URL":"https:\/\/doi.org\/10.3390\/pediatric18040100","relation":{},"ISSN":["2036-7503"],"issn-type":[{"value":"2036-7503","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,29]]}}}