Purpose: The purpose of this study was to investigate what treatment methods physiotherapists in Sweden use for infants 0-24 months hospitalised with acute breathing difficulties due to lower respiratory tract infections. Material and methods: We constructed an anonymous digital survey for paediatric physiotherapists in Sweden. It was distributed by e-mail and was posted on professional websites. Completed forms were obtained from all 21 counties in Sweden. Results: Eighty-eight physiotherapists replied and 52 worked with the target group. Different treatment methods were used, based on the situation and the individual's symptom. The most common methods involved physical activity and change of the body position. Conclusions: A variety of treatment methods are used by the Swedish physiotherapists. The most commonly used are treatment methods involving frequent changes of the body position and stimulation to physical activity. Thus, the praxis in Sweden seem to differ from methods described in the literature. Methods are chosen depending on the symptoms of the patients. No differences in the choice of treatment methods were found regarding the physiotherapists' background characteristics.

Background Every year, many infants are infected with the respiratory syncytial virus (RSV) or other agents and need hospitalisation due to bronchiolitis. The disease causes much suffering and high costs. Thus, it is important that the treatment methods are both effective and cost-efficient. The use of different physiotherapy treatment methods is debated, and not all methods are evaluated scientifically. The clinical praxis in Sweden that includes frequent changes of body position and stimulation to physical activity has not previously been evaluated. The aim of this clinical study is to evaluate this praxis. Methods This study is a clinical two-centre individually randomised controlled trial (RCT) with three parallel groups. The participants will be randomly assigned to an individualised physiotherapy intervention, a non-individualised intervention, or a control group. All three groups will receive the standard care at the ward, and the two intervention groups will receive additional treatment, including different movements of the body. The primary outcome measure is a clinical index based on determinants for hospitalisation. Baseline assessments will be compared with the assessments after 24 h. The secondary outcome measures include vital signs, the parents’ observations, time spent at the hospital ward, and referrals to an intensive care unit. We also want see if there is any immediate effect of the first intervention, after 20 min. Discussion This study will add knowledge about the effect of two physiotherapy interventions that are commonly in use in Swedish hospitals for infants with bronchiolitis or other acute lower respiratory tract infections. Trial registration ClinicalTrials.gov NCT03575091. Registered July 2, 2018—retrospectively registered.

Background The effect of a treatment that includes frequent changes of the body position for infants with bronchiolitis has not been evaluated, although it is often used in Swedish hospitals. Because of this, a randomised control trial (RCT) has begun with the aim to evaluate this treatment, comparing the effect of an individualised physiotherapy intervention, a non-individualised intervention, and standard care in a control group. The objective of this internal pilot study was to address uncertainties concerning the ongoing RCT and to determine whether the trial is feasible or not, possibly with adjustments to the protocol. Methods Descriptive analyses of the recruitment, retention, data supply for the primary end point, and the usability of the primary outcome measure in the full RCT were performed. A safety analysis was conducted by an independent analysis group. Results Ninety-one infants were included, 33 (36.3%), 28 (30.8%), and 30 (33.0%) in the respective allocation groups. Fifty-nine (64.8%) were boys. The median age was 2.5 (min–max 0.2–23.7) months. They remained in the study for a median of 46 hours (min–max 2–159). The recruitment rate was 19%. The data supply for the primary end point and for the primary outcome measure was lower than anticipated in the original sample size calculation. Difficulties concerning utilising the primary outcome measure were identified. The safety analysis detected no risks of harm related to participation in the study. Conclusions It is feasible to continue the RCT with modifications of the analysis plan. Participation in the study was not associated with any safety risks. Trial registration ClinicalTrials.gov NCT03575091. Registered 2 July 2018. Retrospectively registered.

Background: No definite consensus has yet been reached on the best treatment strategy for the large group of infants hospitalised with bronchiolitis or pneumonia. Minimal handling is often recommended, although not evaluated scientifically. There is a need to evaluate the management, as the infants often are critically affected, and the costs for society are high. The aim of this RCT was to evaluate the most common physiotherapy intervention in Sweden for this patient group, including frequent changes in body position and stimulation of physical activity, compared to standard care.Methods: Infants 0–24 months old, without previous cardiac or respiratory diagnoses and born in gestational week 35+, were recruited in two Swedish hospitals. The participants (n=109) were randomised to either interventions in addition to standard care (intervention group) or to standard care alone (control group). The primary outcome measure was time to improvement. The secondary outcomes were immediate changes in oxygen saturation, heart rate and respiratory rate, time to improved general condition (parents’ assessment), and lung complications.Results: The median time to improvement was 6 hours in both groups (p=0.54). The result was similar when we adjusted for age in months, sex, tobacco smoke exposure, heredity for asthma/atopic disease, and early stage of the infection (for those with RSV), p=0.69. Analyses of the immediate changes showed no significant differences either (p=0.49-0.89). Time to improved general condition was median 3 hours in the intervention group and 6 hours in the control group, p=0.76. No lung complications occurred.Conclusions: No statistically significant differences in outcomes were detected between the intervention group and the control group. Both strategies were found to be equally effective and safe, indicating that the current recommendation of minimal handling for these infants should be reconsidered. Furthermore, the findings suggest that this treatment can be safely continued.

Background: The effect of a treatment that includes frequent changes of the body position for infants with bronchiolitis has not been evaluated, although it is often used in Swedish hospitals. Because of this, a randomised control trial (RCT) has begun with the aim to evaluate this treatment, comparing the effect of an individualised physiotherapy intervention, a non-individualised intervention, and a control group receiving standard care. The objective of this internal pilot study was to address uncertainties concerning the ongoing RCT and to determine whether the trial is feasible or not, possibly with adjustments to the protocol.Methods: Descriptive analyses of the recruitment, retention, data supply for the primary end point and the usability of the primary outcome measure were performed. A safety analysis was conducted by an independent analysis group. Results: Ninety-one infants were included, 33 (36.3%), 28 (30.8%), and 30 (33.0%) in the respective allocation groups. Fifty-nine (64.8%) were boys. The median age was 2.5 (min-max: 0.2-23.7) months. They remained in the study for a median of 46 hours (min-max: 2-159). The recruitment rate was 19%. The data supply for the primary end point and for the primary outcome measure was lower than anticipated in the original sample size calculation. Difficulties concerning utilising the primary outcome measure were identified. The safety analysis detected no risks of harm related to participation in the study.Conclusions: It is feasible to continue the RCT with modifications of the analysis plan. Participation in the study was not associated with any safety risks.Trial registration: ClinicalTrials.gov NCT03575091. Registered 2 July 2018. Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03575091?term=NCT03575091&rank=1