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Physiotherapy Educational Intervention for Occipital Positional Plagiocephaly Prevention: a Multicentre Randomised Controlled Trial

Fortini V, Picone F, Giustini S, Fanzaghi P, Santoni M, Calistri M, Guarise R, Ferri N

2026

400 participants

Abstract

Questions: What is the effectiveness of a prenatal educational physiotherapy intervention in reducing the prevalence of positional occipital plagiocephaly (POP) and POP-associated disorders in infants at 3 months of age?

Design: Two-arm assessor-blind multicentre, randomised controlled trial.

Participants: 400 pregnant women

Intervention: The experimental group received specific physiotherapy educational session on POP prevention strategies during the regular antenatal education class meeting. The oblique diameter difference index (ODDI) is the primary outcome. Secondary outcomes included musculoskeletal POP-associated conditions.

Results: Three hundred twenty-eight newborns completed the study. The ODDI scores showed no statistically significant difference between the groups at 3 months (mean difference −0.28 [95% CI: −0.72 to 0.17; p = 0.218]). The prevalence of POP did not differ between the two groups (21.1% in the intervention group, 22.2% in the control group), which is lower than data reported in the literature (37.8%–46.6%). No statistically significant between-group differences were found in secondary outcomes, except for spinal postural asymmetry (aRR = 0.95; 95% CI: 0.90 to 0.99; p = 0.031). There were no significant differences in the caregiving strategies adopted during the first three months of life.

Conclusion: A low POP prevalence was observed, with no statistically significant differences between groups, as both groups adopted preventive strategies. The lack…

How strong is the evidence?

Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 400 participants or records.

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