Approximately 10% of all infants in Germany suffer from infantile postural asymmetry, which is treated with a wide variety of treatments. Worldwide there are only few efficacy studies, mostly covering the disorders plagiocephaly and torticollis. Furthermore, there are also inadequate studies with large samples. Some of the treatments that are used have been barely evaluated. This is also why doctors still tend to wait for possible improvements without prescribing physical therapy. The purpose of this study, using the Delphi method, is to obtain agreement among international experts concerning the efficacy of different therapy treatments for infantile postural asymmetry. These outcomes can be used to promote additional, research and to justify treatment decisions. A consensus is achieved when more than 80% of all experts are either pro or contra a specific treatment. Using the Delphi method type 4 (Consensus Delphi), there will be four survey rounds aiming for a consensus. International experts were chosen by literature research. Those experts were exclusively physical therapists. In round 1, we collected treatments used by the experts; in round 2 we quantified these treatments using a Likert-type scale. Furthermore, in round 3, we collected arguments for and against each treatment from the experts and presented these to them in round 4. In this last round the experts again judged the efficacy of each treatment and evaluated their use for the future. We collected a total of 22treatments. For three of them a positive consensus could be confirmed. Those treatments are prevention - parental training concerning day and night positioning (95% consensus), prevention - parental training concerning handling, (90% consensus) prevention – parental training concerning motoric development (86% consensus).
The evaluation of the international experts represents the lack of clarity on efficacy of therapies for infantile posturale asymmetry. This could be the reason why preventive methods have been evaluated better then curative methods. Preventive treatments have been used by all experts and should be part of a comprehensive program in prenatal classes to prevent consequential disorders. Retrospectively one could evaluate whether the programs reduce the incidence of infantile posturale asymmetry. According to stretching exercises, an RCT could be used to evaluate efficacy. Therefore, possible side effects must be observed. Even though all experts use stretching exercises, no consensus was reached.
Congenital Muscular Torticollis, Infantile Postural Asymmetry, Physiotherapy, Delphi study, Non-operative treatment