| 제목 |
Factors contributing to treatment outcome in infants with postural torticollis |
| 소속 |
Catholic University of Daegu School of Medicine, 1. Department of Rehabilitation Medicine1 |
| 저자 |
Dong Rak Kwon1†, Gi Young Park1, Kang Lip Kim1* |
Objective. The aim of this study is to investigate the clinical factors contributing to the treatment outcome in infants with postural torticollis.
Methods.
Seven hundred one infants had visited at our outpatient clinic for head tilt from March 2013 to December 2019. Among those infants, 155 infants, who received manual stretching program and completed a full course of treatment, were included in this study. The exclusion criteria were as follows: (1) age over two years; (2) congenital muscular torticollis; (3) ocular torticollis; (4) congenital anomalies of the cervical spine; and (5) neurodevelopmental disorders, such as cerebral palsy or intellectual disability. Gender, age at presentation, side of the torticollis, birth history and presence of plagiocephaly were assessed. All patients underwent ultrasonography to exclude congenital muscular torticollis (Figure 1). The stretching treatment was performed every day at home by the parents who had learned the stretching treatment techniques in a course provided by the hospital. Compliance levels of stretching treatment were classified as high (> 50 times/day), average (20-50 times/day), and low (< 20 times/day).
Resolution was defined when there was no head tilt and rotation at sitting. Group 1 comprised 84 infants who had resolution within 4 months after treatment and group 2 (n = 71) consisted of patients with resolution after 4 months. Independent T-test, Chi-square test, and Pearson correlation were used to statistical analysis. Statistical significance level was determined at p < 0.05.
Results.
This study included 155 patients (82 males and 73 females) with a mean corrected age (at presentation) of 3.9 months (Table 1). Sixty-nine of 84 patients (82.1%) in group 1 and 46 of 71 patients (64.8%) in group 2 were high compliance. High compliance was significantly greater in group 1 than that in group 2 (p = .01, Table 1). There were no significant differences between the two groups in the birth weight, birth week, caesarean history and the proportion of the first baby (p > .05, Table 1). There was no significant difference between the two groups for the presence of plagiocephaly (p > .05, Table 1). Postural torticollis was found on the left side in 61.9% (n = 96) of the patients and on the right side in 38.1% (n = 59). Time to resolution was negatively correlated with age at presentation and birth week (p< .05, Table 2).
Conclusion. The present study showed that compliance was the most important factor contributing to the treatment outcome in infants with postural torticollis. The treatment outcome may be influenced by age at presentation and birth week. Future research should target development of improving compliance strategy.
Keywords: Postural torticollis; Manual stretching program; Compliance; Resolution.
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Figure 1. A 3-month-old infant with torticollis on the right side. This infant’s head tilted toward the right SCM muscle (A) with the face rotated in the left direction (B). The infant underwent USG, and there was no tumor or muscle thickening lesion at both SCM muscles. There was also no definite difference of SCM muscle thickness between both sides. (C: middle part of the left SCM muscle, D: middle part of right SCM muscle). Abbreviations are SCM, sternocleidomastoid; USG, ultrasonography.
Values are presented as mean ± standard deviation or number (%), Group 1, patients with resolution within 4 months; Group 2, patients with resolution after 4 months; C-sec, caesarean section. *p < .05
Pearson correlations between time to resolution and clinical parameters of the infants (n=155). *p < .05
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