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. 2023 Apr 6;18(4):e0283646.
doi: 10.1371/journal.pone.0283646. eCollection 2023.

Parents' and healthcare professionals' perspectives on manual therapy in infants: A mixed-methods study

Femke Driehuis  1 , Annick Bakker-Jacobs  1 , J Bart Staal  1   2 , Rob A de Bie  3 , Maria W G Nijhuis-van der Sanden  1 , Thomas J Hoogeboom  1
Affiliations

Parents' and healthcare professionals' perspectives on manual therapy in infants: A mixed-methods study

Femke Driehuis et al. PLoS One. .

Abstract

Objectives: Manual therapy in infants is embedded in Dutch healthcare despite inconsistent evidence and ongoing debate about its safety and merits. This study examines decision-making in manual therapy in infants and explores parents' and healthcare professionals' perspectives on this treatment approach.

Methods: This mixed-methods study consisted of an online survey among manual physiotherapists and paediatric physiotherapists exploring decision-making on manual therapy in infants and interprofessional collaboration. These data prompted further exploration and were combined with data collected with semi-structured interviews exploring parents' and healthcare professionals' perspectives. Interviews were analysed using an inductive content analysis approach.

Results: 607 manual physiotherapists and 388 paediatric physiotherapists completed the online survey; 45% and 95% indicated they treat infants, respectively. Collaboration was reported by 46% of manual physiotherapists and 64% of paediatric physiotherapists for postural asymmetry, positional preference, upper cervical dysfunction, excessive crying, anxiety or restlessness. Reasons to not treat or collaborate were: limited professional competence, practice policy, not perceiving added value, lack of evidence and fear of complications. Analysis of interviews with 7 parents, 9 manual physiotherapists, 7 paediatric physiotherapists, 5 paediatricians and 2 maternity nurses revealed that knowledge and beliefs, professional norms, interpersonal relation, treatment experiences and emotions of parents influenced attitudes and decision-making towards choosing for manual therapy in infants.

Conclusion: Parents' and healthcare professionals' attitudes towards manual therapy in infants can be divided as 'in favour' or 'against'. Those who experienced a good interpersonal relation with a manual physiotherapist and positive treatment outcomes reported positive attitudes. Lack of evidence, treatment experience and related knowledge, safety issues due to publications on adverse events and professional norms led to negative attitudes. Despite lacking evidence, positive treatment experiences, good interpersonal relation and parents feeling frustrated and despaired can overrule negative attitudes and directly influence the decision-making process and choosing for manual therapy treatment.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Phases of inductive content analysis.
Fig 2
Fig 2. Conceptual model of factors related to attitude towards manual therapy in infants.
*Factor that solely count for healthcare professionals, **factor that solely count for parents.
See this image and copyright information in PMC

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