The Best Start Trial: A randomised controlled trial of ultra-early parent-administered physiotherapy for infants at high risk of cerebral palsy or motor delay.

When babies are born very early or at high risk of cerebral palsy, clinicians and families often wonder whether starting physiotherapy as soon as possible, even while still in neonatal intensive care, could help motor development. This pilot trial compared ultra-early, parent-delivered physiotherapy started from around 34 weeks post-menstrual age with usual care in 30 infants, measuring motor skills at 16 weeks corrected age using a standard infant motor scale. The trial found no clinically worthwhile difference between groups on this primary motor measure, and most other outcomes were similarly unremarkable. Interestingly, parents in the intervention group reported feeling the treatment had helped and that they noticed change in their infant, though this was a secondary finding.

Because the sample was small, the infants varied widely in their conditions, and the motor scale used may not be sensitive enough to detect subtle changes, the authors caution against concluding the approach is ineffective, suggesting a larger trial is needed.

If you have a baby who was born early or is considered at higher risk for cerebral palsy or delayed motor development, you may have heard about starting physiotherapy very early, even during a neonatal intensive care stay. This study looked at whether parents delivering this kind of early physiotherapy made a meaningful difference to babies' motor skills by around four months, compared to standard care. In this small trial of 30 infants, the early physiotherapy group did not show a clinically meaningful improvement in motor skills compared to the usual care group.

However, parents who did the early physiotherapy tended to feel it had helped their baby and that they noticed positive changes, even though the formal motor test didn't confirm a difference. Because this was a small, early-stage study, and the test used to measure motor skills may not pick up small changes well, these findings shouldn't be taken as proof the approach doesn't work. The researchers say a larger study is needed before drawing firmer conclusions.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This pilot trial addresses whether commencing parent-administered physiotherapy during neonatal intensive care, rather than waiting until after discharge, offers a motor development advantage for infants at high risk of cerebral palsy or motor delay. As a pilot study with 30 participants, its primary purpose was to establish feasibility and acceptability of ultra-early intervention, and it reports the intervention was feasible for infants and acceptable to parents, which is itself a useful contribution given the logistical and clinical complexity of delivering therapy in the neonatal unit setting.

On the exploratory clinical outcome, the Alberta Infant Motor Scale at 16 weeks corrected age showed no clinically worthwhile between-group difference (mean difference -0.2, 95% CI -2.4 to 2.0), and secondary outcomes including parent stress measures and 12-month Bayley scores were largely unremarkable, though parents' perceptions of treatment effectiveness and change favoured the intervention group, an isolated finding among several outcomes tested. The authors explicitly caution against interpreting this null result as evidence of no effect, citing the small sample, participant heterogeneity, and the limited responsiveness of the motor scale to detect change. The abstract does not report adverse events.

This study does not establish effectiveness of ultra-early physiotherapy and instead informs the design of a future, adequately resourced trial.