Does Timing Matter? A Clinical Trial of Supporting Play Exploration and Early Development Intervention (SPEEDI) for Infants Born Preterm in the First Months of Life.

Abstract

To evaluate the efficacy of an early delivered physical therapy intervention and to determine if timing of the intervention affects developmental outcomes. This multisite, three-arm, intervention-controlled trial compared the efficacy of SPEEDI Early (NICU start), SPEEDI_Late (starting 15 weeks later), and usual care (UC) to improve development, measured with the Bayley Scales of Infant and Toddler Development, 3^rd edition, and parent-child dyadic interaction on the Emotional Availability Scale. SPEEDI is a motor-based, problem-solving intervention provided by an interventionist in collaboration with a caregiver. Eighty-three infants born very preterm with mean gestational age at birth of 26.5 ± 2.0 weeks were enrolled between 35-42 weeks of corrected gestational age. Combining SPEEDI groups, there was no difference between SPEEDI and UC. However, infants in SPEEDI_Early had significantly better cognitive scaled scores than infants in the SPEEDI_Late group through 24 months of age. Adjusting for baseline motor skills, infants in SPEEDI_Early had higher gross motor scaled scores through 24 months of age. A change in parent-child interaction in response to SPEEDI supports the intervention's theoretical model and provides a possible mechanism of action. Intervention which engages parents in supporting development in infants born very preterm may result in long-term developmental improvements when started in the neonatal intensive care unit. Delaying services by even 3 months appears to reduce efficacy of the intervention.