Baird Lissa C, Klimo Paul, Flannery Ann Marie, Bauer David F, Beier Alexandra, Durham Susan, Lin Alexander Y, McClung-Smith Catherine, Mitchell Laura, Nikas Dimitrios, Tamber Mandeep S, Tyagi Rachana, Mazzola Catherine
*Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon; ‡Semmes-Murphey Neurologic & Spine Institute; Department of Neurosurgery, University of Tennessee Health Science Center; Le Bonheur Children's Hospital; Memphis, Tennessee; §Kids Specialty Center, Women's & Children's Hospital, Lafayette, Louisiana; ¶Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; ∥Division of Pediatric Neurosurgery, University of Florida Health Jacksonville, Jacksonville, Florida; #Division of Neurosurgery, University of Vermont Medical Center, Burlington, Vermont; **St. Louis Cleft-Craniofacial Center, SSM Health Cardinal Glennon Children's Hospital at Saint Louis University, Division of Plastic Surgery, Saint Louis University School of Medicine, St. Louis, Missouri; ‡‡Department of Neurosurgery, Palmetto Health University of South Carolina Medical Group, Columbia, South Carolina; §§Guidelines Department, Congress of Neurological Surgeons, Schaumburg, Illinois; ¶¶Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois; ‖‖Advocate Children's Hospital, Oak Lawn, Illinois; ##Department of Pediatric Neurological Surgery, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania; ***Department of Surgery, Division of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; ‡‡‡Goryeb Children's Hospital of Atlantic Health Systems Morristown, New Jersey.
Neurosurgery. 2016 Nov;79(5):E630-E631. doi: 10.1227/NEU.0000000000001429.
Evidence-based guidelines are not currently available for the treatment of positional plagiocephaly and, in particular, for the use of physical therapy for treatment.
To answer the question: "does physical therapy provide effective treatment for positional plagiocephaly?" Treatment recommendations are created based on the available evidence.
The PubMed and the Cochrane Library were queried using MeSH headings and key words relevant to the objective of this systematic review. Abstracts were reviewed, after which studies meeting the inclusion criteria were selected and graded according to their quality of evidence (Classes I-III). Evidentiary tables were constructed that summarized pertinent study results, and recommendations were made based on the quality of the literature (Levels I-III).
Three studies met criteria for inclusion. Two randomized, controlled trials (Class I and Class II) and 1 prospective study assessing plagiocephaly as a secondary outcome measure (Class III) were included.
Within the limits of this systematic review, physical therapy is significantly more effective than repositioning education as a treatment for positional plagiocephaly. There is no significant difference between physical therapy and a positioning pillow as a treatment for positional plagiocephaly. However, given the American Academy of Pediatrics' recommendation against soft pillows in cribs to ensure a safe sleeping environment for infants, physical therapy must be recommended over the use of a positioning pillow. The full guidelines document can be located at https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly/Chapter_4.
目前尚无基于证据的指南用于治疗体位性斜头畸形，尤其是关于物理治疗的应用。
回答问题：“物理治疗对体位性斜头畸形是否提供有效治疗？”根据现有证据制定治疗建议。
使用与本系统评价目标相关的医学主题词和关键词查询PubMed和Cochrane图书馆。对摘要进行审查，之后选择符合纳入标准的研究，并根据其证据质量（I - III级）进行分级。构建证据表总结相关研究结果，并根据文献质量（I - III级）提出建议。
三项研究符合纳入标准。包括两项随机对照试验（I级和II级）和一项将斜头畸形作为次要结局指标评估的前瞻性研究（III级）。
在本系统评价的范围内，作为体位性斜头畸形的治疗方法，物理治疗比重新定位教育显著更有效。物理治疗与定位枕作为体位性斜头畸形的治疗方法之间没有显著差异。然而，鉴于美国儿科学会建议婴儿床内不使用软枕以确保安全睡眠环境，必须推荐物理治疗而非使用定位枕。完整的指南文件可在https://www.cns.org/guidelines/guidelines - management - patients - positional - plagiocephaly/Chapter_4获取。
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