START-Play Physical Therapy Intervention Impacts Motor and Cognitive Outcomes in Infants with Neuromotor Disorders: A Multisite Randomized Clinical Trial
Harbourne, Regina T.; Dusing, Stacey C; Lobo, Michele A.; McCoy, Sarah W.; Koziol, Natalie A.; Hsu, Lin-Ya; Willett, Sandra; Marcinowski, Emily C.; Babik, Iryna; Cunha, Andrea B.; An, Mihee; Chang, Hui-Ju; Bovaird, James A.; Sheridan, Susan M. (2020). Physical Therapy Journal v101 p1-11. Retrieved from: https://eric.ed.gov/?id=ED611838
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examining112Students, gradePK
Single Study Review
Review Details
Reviewed: March 2022
- Single Study Review (findings for Sitting Together And Reaching To Play (START-Play))
- Randomized Controlled Trial
- Meets WWC standards without reservations because it is a randomized controlled trial with low attrition.
This review may not reflect the full body of research evidence for this intervention.
Evidence Tier rating based solely on this study. This intervention may achieve a higher tier when combined with the full body of evidence.
Findings
|
Outcome measure |
Comparison | Period | Sample |
Intervention mean |
Comparison mean |
Significant? |
Improvement index |
Evidence tier |
|
|---|---|---|---|---|---|---|---|---|---|
|
Bayley Scales of Infant and Toddler Development, Third Edition: Cognition Scale |
Sitting Together And Reaching To Play (START-Play) vs. Business as usual |
0 Days |
Full sample;
|
35.94 |
33.61 |
No |
-- | ||
|
Assessment of Problem Solving in Play (APSP) |
Sitting Together And Reaching To Play (START-Play) vs. Business as usual |
0 Days |
Full sample;
|
64.54 |
59.22 |
No |
-- | ||
| Show Supplemental Findings | |||||||||
|
Bayley Scales of Infant and Toddler Development, Third Edition: Cognition Scale |
Sitting Together And Reaching To Play (START-Play) vs. Business as usual |
0 Days |
Significant motor delay at baseline;
|
N/A |
N/A |
Yes |
|
||
|
Assessment of Problem Solving in Play (APSP) |
Sitting Together And Reaching To Play (START-Play) vs. Business as usual |
0 Days |
Significant motor delay at baseline;
|
N/A |
N/A |
Yes |
|
||
|
Assessment of Problem Solving in Play (APSP) |
Sitting Together And Reaching To Play (START-Play) vs. Business as usual |
9 Months |
Full sample;
|
90.72 |
81.95 |
No |
-- | ||
|
Bayley Scales of Infant and Toddler Development, Third Edition: Cognition Scale |
Sitting Together And Reaching To Play (START-Play) vs. Business as usual |
9 Months |
Mild motor delay at baseline;
|
N/A |
N/A |
No |
-- | ||
|
Assessment of Problem Solving in Play (APSP) |
Sitting Together And Reaching To Play (START-Play) vs. Business as usual |
9 Months |
Mild motor delay at baseline;
|
N/A |
N/A |
No |
-- | ||
|
Bayley Scales of Infant and Toddler Development, Third Edition: Cognition Scale |
Sitting Together And Reaching To Play (START-Play) vs. Business as usual |
0 Days |
Mild motor delay at baseline;
|
N/A |
N/A |
No |
-- | ||
|
Assessment of Problem Solving in Play (APSP) |
Sitting Together And Reaching To Play (START-Play) vs. Business as usual |
0 Days |
Mild motor delay at baseline;
|
N/A |
N/A |
Yes |
|
||
|
Outcome measure |
Comparison | Period | Sample |
Intervention mean |
Comparison mean |
Significant? |
Improvement index |
Evidence tier |
|
|---|---|---|---|---|---|---|---|---|---|
|
Bayley Scales of Infant and Toddler Development, Third Edition: Expressive communication |
Sitting Together And Reaching To Play (START-Play) vs. Business as usual |
0 Days |
Full sample;
|
12.52 |
11.59 |
No |
-- | ||
| Show Supplemental Findings | |||||||||
|
Bayley Scales of Infant and Toddler Development, Third Edition: Expressive communication |
Sitting Together And Reaching To Play (START-Play) vs. Business as usual |
0 Days |
Significant motor delay at baseline;
|
N/A |
N/A |
No |
-- | ||
|
Bayley Scales of Infant and Toddler Development, Third Edition: Expressive communication |
Sitting Together And Reaching To Play (START-Play) vs. Business as usual |
9 Months |
Mild motor delay at baseline;
|
N/A |
N/A |
No |
-- | ||
|
Bayley Scales of Infant and Toddler Development, Third Edition: Expressive communication |
Sitting Together And Reaching To Play (START-Play) vs. Business as usual |
0 Days |
Mild motor delay at baseline;
|
N/A |
N/A |
No |
-- | ||
|
Outcome measure |
Comparison | Period | Sample |
Intervention mean |
Comparison mean |
Significant? |
Improvement index |
Evidence tier |
|
|---|---|---|---|---|---|---|---|---|---|
|
Gross Motor Function Measure (GMFM): Sitting dimension |
Sitting Together And Reaching To Play (START-Play) vs. Business as usual |
0 Days |
Full sample;
|
34.96 |
31.35 |
No |
-- | ||
|
Bayley Scales of Infant and Toddler Development, Third Edition: Fine motor |
Sitting Together And Reaching To Play (START-Play) vs. Business as usual |
0 Days |
Full sample;
|
25.00 |
23.45 |
No |
-- | ||
|
Bayley Scales of Infant and Toddler Development, Third Edition: Gross Motor Scale |
Sitting Together And Reaching To Play (START-Play) vs. Business as usual |
0 Days |
Full sample;
|
31.65 |
30.10 |
No |
-- | ||
|
Researcher-developed reaching assessment |
Sitting Together And Reaching To Play (START-Play) vs. Business as usual |
0 Days |
Full sample;
|
13.14 |
13.05 |
No |
-- | ||
| Show Supplemental Findings | |||||||||
|
Gross Motor Function Measure (GMFM): Sitting dimension |
Sitting Together And Reaching To Play (START-Play) vs. Business as usual |
0 Days |
Significant motor delay at baseline;
|
N/A |
N/A |
No |
-- | ||
|
Bayley Scales of Infant and Toddler Development, Third Edition: Fine motor |
Sitting Together And Reaching To Play (START-Play) vs. Business as usual |
0 Days |
Significant motor delay at baseline;
|
N/A |
N/A |
Yes |
|
||
|
Bayley Scales of Infant and Toddler Development, Third Edition: Gross Motor Scale |
Sitting Together And Reaching To Play (START-Play) vs. Business as usual |
0 Days |
Significant motor delay at baseline;
|
N/A |
N/A |
No |
-- | ||
|
Researcher-developed reaching assessment |
Sitting Together And Reaching To Play (START-Play) vs. Business as usual |
9 Months |
Full sample;
|
16.46 |
15.03 |
No |
-- | ||
|
Bayley Scales of Infant and Toddler Development, Third Edition: Fine motor |
Sitting Together And Reaching To Play (START-Play) vs. Business as usual |
0 Days |
Mild motor delay at baseline;
|
N/A |
N/A |
No |
-- | ||
|
Gross Motor Function Measure (GMFM): Sitting dimension |
Sitting Together And Reaching To Play (START-Play) vs. Business as usual |
0 Days |
Mild motor delay at baseline;
|
N/A |
N/A |
No |
-- | ||
|
Gross Motor Function Measure (GMFM): Sitting dimension |
Sitting Together And Reaching To Play (START-Play) vs. Business as usual |
9 Months |
Full sample;
|
47.13 |
44.88 |
No |
-- | ||
|
Bayley Scales of Infant and Toddler Development, Third Edition: Fine motor |
Sitting Together And Reaching To Play (START-Play) vs. Business as usual |
9 Months |
Mild motor delay at baseline;
|
N/A |
N/A |
No |
-- | ||
|
Bayley Scales of Infant and Toddler Development, Third Edition: Gross Motor Scale |
Sitting Together And Reaching To Play (START-Play) vs. Business as usual |
0 Days |
Mild motor delay at baseline;
|
N/A |
N/A |
No |
-- | ||
|
Gross Motor Function Measure (GMFM): Sitting dimension |
Sitting Together And Reaching To Play (START-Play) vs. Business as usual |
9 Months |
Mild motor delay at baseline;
|
N/A |
N/A |
No |
-- | ||
|
Researcher-developed reaching assessment |
Sitting Together And Reaching To Play (START-Play) vs. Business as usual |
9 Months |
Mild motor delay at baseline;
|
N/A |
N/A |
No |
-- | ||
|
Bayley Scales of Infant and Toddler Development, Third Edition: Gross Motor Scale |
Sitting Together And Reaching To Play (START-Play) vs. Business as usual |
9 Months |
Mild motor delay at baseline;
|
N/A |
N/A |
No |
-- | ||
|
Outcome measure |
Comparison | Period | Sample |
Intervention mean |
Comparison mean |
Significant? |
Improvement index |
Evidence tier |
|
|---|---|---|---|---|---|---|---|---|---|
|
Bayley Scales of Infant and Toddler Development, Third Edition: Receptive communication |
Sitting Together And Reaching To Play (START-Play) vs. Business as usual |
0 Days |
Full sample;
|
12.78 |
11.47 |
No |
-- | ||
| Show Supplemental Findings | |||||||||
|
Bayley Scales of Infant and Toddler Development, Third Edition: Receptive communication |
Sitting Together And Reaching To Play (START-Play) vs. Business as usual |
0 Days |
Mild motor delay at baseline;
|
N/A |
N/A |
Yes |
|
||
|
Bayley Scales of Infant and Toddler Development, Third Edition: Receptive communication |
Sitting Together And Reaching To Play (START-Play) vs. Business as usual |
9 Months |
Mild motor delay at baseline;
|
N/A |
N/A |
No |
-- | ||
|
Bayley Scales of Infant and Toddler Development, Third Edition: Receptive communication |
Sitting Together And Reaching To Play (START-Play) vs. Business as usual |
0 Days |
Significant motor delay at baseline;
|
N/A |
N/A |
No |
-- | ||
Evidence Tier rating based solely on this study. This intervention may achieve a higher tier when combined with the full body of evidence.
Sample Characteristics
Characteristics of study sample as reported by study author.
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Female: 43%
Male: 57% -
Urban
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Delaware, Nebraska, Pennsylvania, Virginia, Washington
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Race Black 10% Other or unknown 20% White 70% -
Ethnicity Hispanic 18% Not Hispanic or Latino 82%
Study Details
Setting
The study took place in five clinical sites across the United States. The clinical sites were located in Seattle, WA; Omaha, NE; Pittsburgh, PA; Newark, DE; and Richmond, VA.
Study sample
A total of 112 infants aged 7-16 months with motor delays were included in the study (57 in the intervention group and 55 in the comparison group). Infants were eligible for participation if they had difficulty transitioning in and out of sitting; had gross motor delays, defined as a gross motor score 1 standard deviation below the mean on the gross motor subtest of the Bayley Scales of Infant and Toddler Development, Third Edition; had a neuromotor disorder such as cerebral palsy; had an increased risk for cerebral palsy due to prematurity or brain damage around birth; or had a motor delay of an unknown origin. Study participants also had to be able to sit propped up on their arms for at least 3 seconds and make spontaneous movement of their arms. Infants were excluded from participating if they had medical complications that limited their participation in assessments and the intervention; a primary diagnosis of autism, Down syndrome, or spinal cord injury; a diagnosed uncontrolled seizure disorder; or a neurodegenerative disorder. Approximately 43% of participants were female. About 70% were White, 10% were Black, and 20% were another race. Eighteen percent were Hispanic or Latino.
Intervention Group
Sitting Together and Reaching to Play (START-Play) is a set of practices designed to improve early motor skills and problem-solving skills among young infants with motor delays. The practices are intended to engage infants in physical activities that also incorporate problem solving skills, such as finding a hidden toy, reaching a toy that is out of reach, and exploring the properties and uses of objects. The START-Play intervention was provided by a trained, licensed physical therapist in conjunction with at least one parent or caregiver for 3 months (up to 24 visits). The intervention was performed with one infant at a time in a setting chosen by the caregiver at the start of the study, such as the home, daycare setting, or an assessment site. The average session length was 51.5 minutes, with a range between 40.8 to 60 minutes. Infants received START-Play in addition to their usual care and early intervention services.
Comparison Group
Infants in the comparison group received business-as-usual intervention services as mandated by law in the United States through the Individuals with Disability Education Improvement Act. Services provided by the infant's usual interventionist may have included early intervention and outpatient therapy for infants with developmental delays.
Support for implementation
The study authors trained the physical therapists who provided the intervention during individual sessions over three days. The physical therapists then viewed follow-up intervention videos until the therapist reached adequate levels of implementation fidelity. The training included a review of theoretical evidence supporting the intervention, in-person, hands-on training with infants, critique and feedback on treatment sessions, and refresher training.
An indicator of the effect of the intervention, the improvement index can be interpreted as the expected change in percentile rank for an average comparison group student if that student had received the intervention.
For more, please see the WWC Glossary entry for improvement index.
An outcome is the knowledge, skills, and attitudes that are attained as a result of an activity. An outcome measures is an instrument, device, or method that provides data on the outcome.
A finding that is included in the effectiveness rating. Excluded findings may include subgroups and subscales.
The sample on which the analysis was conducted.
The group to which the intervention group is compared, which may include a different intervention, business as usual, or no services.
The timing of the post-intervention outcome measure.
The number of students included in the analysis.
The mean score of students in the intervention group.
The mean score of students in the comparison group.
The WWC considers a finding to be statistically significant if the likelihood that the finding is due to chance alone, rather than a real difference, is less than five percent.
The WWC reviews studies for WWC products, Department of Education grant competitions, and IES performance measures.
The name and version of the document used to guide the review of the study.
The version of the WWC design standards used to guide the review of the study.
The result of the WWC assessment of the study. The rating is based on the strength of evidence of the effectiveness of the intervention. Studies are given a rating of Meets WWC Design Standards without Reservations, Meets WWC Design Standards with Reservations, or >Does Not Meet WWC Design Standards.
A related publication that was reviewed alongside the main study of interest.
Study findings for this report.
Based on the direction, magnitude, and statistical significance of the findings within a domain, the WWC characterizes the findings from a study as one of the following: statistically significant positive effects, substantively important positive effects, indeterminate effects, substantively important negative effects, and statistically significant negative effects. For more, please see the WWC Handbook.
The WWC may review studies for multiple purposes, including different reports and re-reviews using updated standards. Each WWC review of this study is listed in the dropdown. Details on any review may be accessed by making a selection from the drop down list.
Tier 1 Strong indicates strong evidence of effectiveness,
Tier 2 Moderate indicates moderate evidence of effectiveness, and
Tier 3 Promising indicates promising evidence of effectiveness,
as defined in the
non-regulatory guidance for ESSA
and the regulations for ED discretionary grants (EDGAR Part 77).