Seven cohort studies were included (n=881). The number of children in each treatment group ranged from 10 to 176. Five prospective, one retrospective and one study with a prospective repositioning group and a retrospective molding group were included.
All studies included consecutive infants. Flaws included allocation based on physician or patient preference, cross-over from repositioning to molding, inadequate details of co-interventions, lack of reporting of masked outcome assessment, molding offered to older or more severely affected infants and a high drop-out rate.
Five studies with comparable data reported that success rates were higher in infants treated with molding compared to repositioning therapy. Of the other two studies, the average treatment time for reposition was much greater than the duration of molding time and the other did not use the same anatomical landmarks to assess outcomes in both groups.
The only study (n=335) for which the author felt able to calculate the magnitude to treatment effect reported that treatment success was significantly more common in the molding compared to the repositioning group; RR 1.3 (95% CI: 1.2, 1.4); NNT 5 (95% CI: 4, 7). Reasons for exclusion of other studies included inadequate data or information about treatments, significant measurement bias and recruitment only of children who failed repositioning.