The effect of positioning prematurely born infants in the neonatal intensive care unit (NICU) was investigated by critically appraising 31 studies conducted from 1975 to 1993. The studies were divided in two groups. The direct positioning group consisted of studies in which the effects of prone lying, sidelying, supine lying, hemitra and head up tilting were examined. The indirect positioning group included studies in which the effects of equipment such as waterbeds, water pillows, rocking beds and air mattresses were assessed. The studies were evaluated using Sackett's theoretical framework. Sackett's five levels of evidence and three grades of recommendation weigh the evidence with regard to the methodological design of the study. The review indicates that the evidence is stronger for the use of indirect positioning than for direct positioning as a treatment strategy for infants born prematurely in the NICU. Physical therapists and occupational therapists are able critically to support or refute their treatment strategies beyond their own clinical decision by utilizing Sackett's theoretical framework.
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