2.1. Material
We analysed the outcomes of a three-month period of rehabilitation of infants suffering from CCD, which met the below-listed inclusion criteria, and were treated at NSZOZ MEDI-REH in Kalisz. The analysis involved archival materials (a retrospective study) from the medical histories of patients - children rehabilitated by one person - the leader of the study group - in the period from 1 January 2014 to 31 November 2019. Thanks to that it was possible to reduce the impact of the interfering factor, namely the skills of the therapist (the so-called human factor). Approval for the study was obtained from the Bioethics Committee of the Medical University of Wroclaw (consent number KB-108/2019).
The following inclusion criteria were applied:
- a score of 8 - 10 on the APGAR scale in the first minute of life, and no significant deterioration in the health of the child, significantly impairing the function of the neonate (e.g. sudden need for cardiac-pulmonary resuscitation), in the first 10 minutes of its life; changes other than decreasing the score obtained by the child by 1 point in a given time, if the neonate obtained 10 or 9 points in the APGAR scale, were considered to be a significant deterioration of its condition.
- no major birth defects that would significantly impair the development of the child and/or would require conducting genetic diagnosis.
- eligibility for rehabilitation confirmed by a medical rehabilitation physician at the centre;
- the age of the child at the time of the assessment of its eligibility for rehabilitation: 1-6 months (of life), calculated based on completed months of life.
- abnormal result of the Vojta test on admission to the centre, defined as at least 6 abnormal responses (marked as abnormal (AN), or delayed (OP) in the test report), with abnormal muscle tension, which indicates moderate to severe CCD;
- parental consent to the use of the medical history for the purposes of the project;
- available information from the first medical examination, the so-called initial visit (WW) and follow-up visit (1WK) on the determined date, maintaining the defined timeframe.
Exclusion criteria (medical history was excluded from the analysis if even one of the following was met):
- children who obtained a score of < 8 points on the APGAR scale in the first minute of life as well as those who obtained 8 - 10 points in the APGAR scale, but their condition deteriorated significantly in the first 10 minutes of life, considerably impairing their function (e.g. sudden need for cardiac and pulmonary resuscitation) and causing a decrease in the APGAR score by more than 1 point, compared to the starting point.
- diagnosis of major (significant) birth defects, information on a major birth defect, congenital defect syndrome (e.g. Down Syndrome, Sotos Syndrome) and/or indications for consultation at a Genetics Clinic,
- opinion of the physician indicating that there is no need to rehabilitate the child using the Vojta method despite attending the consultation, or selection of other rehabilitation method by the physician;
- age < 1 month or > 6 months ;
- < 6 abnormal responses during the Vojta test at first eligibility visit, which indicates mild or very mild CCD;
-- lack of parental consent to the use of documentation for the purposes of the study
2.2. Principles of rehabilitation and follow-up at the centre
The rehabilitation and evaluation of children was conducted on the basis of the standard protocol adopted by Non-public Specialist Healthcare Institution Medi-Reh in Kalisz for diagnostic evaluation and treatment. According to the plan, the neurokinesiological examination using the Vojta method is performed at the centre during the first eligibility visit (WW) and during the follow-up visits, the first of which takes place after 3 months (1WK), and each next - after every 3 months following the previous visit (2WK, 3WK etc.). For the purposes of the study, the authors used the results from first eligibility visit and 1st follow-up visit.
During first eligibility visit, after establishing the diagnosis and assessing the child's eligibility for rehabilitation, the specialist determines the aim of the treatment and the rehabilitation method (e.g. the Vojta method or the Vojta method combined with craniosacral treatment, which also concerned children whose histories were analysed). Depending on the outcomes, the method can be modified during subsequent visits. If, compared to first eligibility visit, the number of abnormal responses at 1st follow up visit is lower (the Vojta method), it indicates that there has been an improvement.
2.3. Analysed variables
For the purposes of basic characterization and grouping of factors potentially affecting the results of rehabilitation, the so-called "maternal factors" and "child factors" were distinguished in the first place.
The following maternal factors were analysed:
- mother's age at the time of delivery
- duration of breastfeeding, from the moment of birth until the completion of the therapy
provided in completed weeks.
The following were analysed among child-related factors:
- the APGAR score obtained in the first minute of the child's life
- the week of gestation (gestational age) in which the child was born (Hbd)
- the sex of the child
- birth weight (BW)
- the age of the child at first eligibility visit, which was equivalent to the beginning of rehabilitation - calculated based on the months completed since birth.
Subsequently, the authors took into the type of delivery (natural vs Caesarean section) as well as the rehabilitation method (the Vojta method only vs the Vojta method combined with craniosacral therapy).
2.4. Statistical analysis
Statistical analysis was conducted using Statistica 12 and Excel. Descriptive statistics were presented in tables, using measures of location: the mean, the median, the standard deviation, the minimum and the maximum. Distribution of variables was analysed using the Shapiro-Wilk W test. The impact of independent variables, including those encoded using the zero-one system, on variables of dichotomous type was verified using the single-factor logistic regression model, in which the Odds Ratio (OR) plays an important role. A p-value of ≤ 0.05 was deemed to be statistically significant. [61,62].