# Focus on physiotherapy and manual therapy for infants in Norway, a cross-sectional study on referral practice, and planned interventions

## TL;DR

This study explores how infants in Norway are referred to physiotherapy and manual therapy, and what interventions are planned.

## Contribution

The study provides insights into referral patterns and planned interventions for infant physiotherapy and manual therapy in Norway.

## Key findings

- Most infants referred to physiotherapists are referred by other health personnel, while manual therapists receive more referrals from parents.
- Infants with motor development problems are equally referred to both physiotherapists and manual therapists.
- Premature infants are exclusively referred to physiotherapists.

## Abstract

The Norwegian health care system has a mandatory program for close and systematically follow-up on all children, starting in early infancy through the Child Health Care Centers in the municipalities. Additionally, some infants are referred to physiotherapists and manual therapists for several reasons. Little is known about who is referring them and the cause for the referral. In Norway, physiotherapists working with infants can be employed in the communities or work in outpatient clinics, both are within the primary health care system. The main purpose of the present study was to explore the referral practice of infants to physiotherapy and compare those treated by physiotherapists and manual therapists in primary health care in Norway. Furthermore, to describe the planned interventions.

Cross-sectional study including 444 infants (age under 12 months) referred to physiotherapists or manual therapists working in primary health care in Norway.

Median age (range) of the infants was 14 (1, 52) weeks and 344 were born at due date. Most infants examined by a physiotherapist were referred from other health personnel and more of the referrals to manual therapists were from parents due to their concern. Age at examination was between week 1–12 for 42% of the participants. Infants referred for motor development problems were equally distributed between the physiotherapists and manual therapists. All premature infants were referred to the physiotherapists. Concerning the interventions, both physiotherapists and manual therapists planned to use advice, handling, and stimulation. More of the physiotherapists reported to focus on advice related to motor development and the use of prone play.

The infants in Norway are referred to physiotherapists and/or manual therapists for numerous reasons, and the distribution of diagnoses between the therapists seem reasonable. Infants are mostly referred by other health personnel but also because of parents’ own concern. Based on recommendations, some infants with asymmetries should be examined earlier.

ClinicalTrials.gov Identifier NCT03626389. Registered on August 13th, 2018 (retrospectively registered).