CLINICAL BOTTOM LINE
“How could I apply this information?”
The authors set out to explore the feasibility and efficacy of a physical therapy–based early intervention (EI) program intended to improve neurodevelopmental outcomes in infants with congenital heart disease who underwent cardiac surgery before 28 days of age. The authors identified numerous and significant barriers that prompted the cessation of the study, noting infeasibility to evaluate efficacy outcomes in the present cohort within the current program model. Challenges ranged from a limited sample size, parental willingness and/or preparation to participate, to the difficulties associated with a less established referral mechanism and limited participation and/or integration of primary care centers into the cardiac neurodevelopmental (CND) program. Physical therapists must remain cognizant of these challenges and recall the important components supporting successful design and delivery of EI programs. Brosig et al1 have recently published recommendations for CND follow-up programs that provide insight into the challenges faced by the authors and offer suggestions for improving the implementation of EI programs in this patient population. These include a multidisciplinary team and strong lines of communication to make clear the importance of each individual component to the outcomes of the child, the need for psychosocial support of the parent/caregiver and sensitivity to their concerns for participation, the establishment of support groups to reinforce the efforts of the CND team, and a strong commitment from community physicians and physical therapists, schools, and primary care settings to partner in these tertiary-based efforts.
“What should I be mindful about when applying this information?”
Although the study could neither confirm nor refute the efficacy of EI programs to improve neurodevelopmental outcomes in infants with congenital heart disease, clinicians are nonetheless reminded of the challenges faced when designing a program of this nature. Strategies aimed at optimizing participation need to be explored further and CND research registries should be further expanded to facilitate the evaluation of EI programming.1
Nicole Irizarry, PT, DPT, CCS
Jesus F. Dominguez, PT, MPT, PhD
University of Southern California, Los Angeles
1. Brosig C, Butcher J, Butler S, et al. Monitoring developmental risk and promoting success for children with congenital heart disease: recommendations for cardiac neurodevelopmental follow-up programs. Clin Pract Pediatr Psychol. 2014;2(2):153–165.