Empowering parents in early motor interventions for infants born preterm: insights from the Norwegian physical therapy study in preterm infants through the lens of a critical interpretative synthesis

Background Infants born very preterm are at risk for motor impairments, highlighting the need for early interventions. The Norwegian Physical therapy study in Preterm Infants (NOPPI) investigated the effects of a parent-administered early motor intervention program in the Neonatal Intensive Care Unit and explored parents’ perceptions of administering the intervention, providing a foundation to explore both the potential and challenges of empowering parents in this role. Objective To develop a comprehensive understanding of the depth and complexity of implementing parent-administered interventions. Methods We applied a critical synthesis including five quantitative and one qualitative study of the NOPPI. Evidence was analyzed and combined to develop a conceptual framework. Results The synthesis highlighted the critical role of active parental involvement and sense-making processes in fostering the motor development of very preterm infants. Using enactive framework as a guiding lens, three interconnected concepts emerged as central to understanding and implementing parent-administered interventions: knowing, doing, and being/becoming. These three dimensions are deeply interwoven and cannot be fully understood in isolation. Together, they form a comprehensive framework that underscores the complexity of parent-administered interventions highlighting knowledge development through embodied interactions, the importance of practical actions and strategies, and the dynamic and evolving identities of parents, infants, and physical therapists. Conclusion The critical synthesis of the NOPPI highlights the need for early interventions to consider enactive concepts of knowing, doing, and being/becoming in the planning and implementation of early interventions to optimize outcomes for infants born very preterm and their parents.