Home-based, early intervention with mechatronic toys for preterm infants at risk of neurodevelopmental disorders (CARETOY): a RCT protocol

Abstract

Background: Preterm infants are at risk for neurodevelopmental disorders, including motor, cognitive or behavioural problems, which may potentially be modified by early intervention. The EU CareToy Project Consortium (http://www.caretoy.eu) has developed a new modular system for intensive, individualized, home-based and family-centred early intervention, managed remotely by rehabilitation staff. A randomised controlled trial (RCT) has been designed to evaluate the efficacy of CareToy training in a first sample of low-risk preterm infants.

Methods/design: The trial, randomised, multi-center, evaluator-blinded, parallel group controlled, is designed according to CONSORT Statement. Eligible subjects are infants born preterm without major complications, aged 3-9 months of corrected age with specific gross-motor abilities defined by Ages & Stages Questionnaire scores. Recruited infants, whose parents will sign a written informed consent for participation, will be randomized in CareToy training and control groups at baseline (T0). CareToy group will perform four weeks of personalized activities with the CareToy system, customized by the rehabilitation staff. The control group will continue standard care. Infant Motor Profile Scale is the primary outcome measure and a total sample size of 40 infants has been established. Bayley-Cognitive subscale, Alberta Infants Motor Scale and Teller Acuity Cards are secondary outcome measures. All measurements will be performed at T0 and at the end of training/control period (T1). For ethical reasons, after this first phase infants enrolled in the control group will perform the CareToy training, while the training group will continue standard care. At the end of open phase (T2) all infants will be assessed as at T1. Further assessment will be performed at 18 months corrected age (T3) to evaluate the long-term effects on neurodevelopmental outcome. Caregivers and rehabilitation staff will not be blinded whereas all the clinical assessments will be performed, videotaped and scored by blind assessors. The trial is ongoing and it is expected to be completed by April 2015.

Discussion: This paper describes RCT methodology to evaluate CareToy as a new tool for early intervention in preterm infants, first contribution to test this new type of system. It presents background, hypotheses, outcome measures and trial methodology.

Trial registration: ClinicalTrials.gov: NCT01990183. EU grant ICT-2011.5.1-287932.

Figure 1

CareToy for Home and CareToy for Clinics. A, 1) Set up of CareToy for Home (CareToy H). It is delivered at home and used to promote infants’ motor and perceptual development, through individualized goal directed activities (rehabilitation packages of CareToy training). 2) Kit of sensorized toys. 3) The four modules of CareToy H (Gym, Vision, Mat and Tele-rehabilitation). B, 1) CareToy for Clinics (CareToy C), installed at the rehabilitation centres. 2) Reconstruction of the gaze of an infant during the observation tasks.

Figure 2

Flow-chart of CareToy study according to CONSORT guidelines. NICU: Neonatal Intensive Care Unit; GA: Gestational Age; IMP: Infant Motor Profile; AIMS: Alberta Infant More Scale; BSID-III Cog: Bayley Scales of Infant Development III- Cognitive Subscale; Teller: Teller Acuity Cards; CTC: CareToy for Clinics; ASQ-3: Ages & Stages Questionnaire Third Edition; S-E BSDI-III: Social-Emotional Scale of Bayley III; PSI: Parenting Stress Index; CA: Corrected Age.