Use and Implementation of Standardized Neurodevelopmental Assessment Tools by Physiotherapists in Neonatal Care and High-Risk Infant Follow-Up: A Systematic Review

Introduction: Physiotherapists contribute to neurodevelopmental surveillance in neonatal care and high-risk infant follow-up, yet the extent to which standardized assessment tools are integrated into routine practice remains unclear. This systematic review synthesized evidence on tool use, training, confidence, and implementation determinants.

Methods: The review was reported in accordance with PRISMA 2020, and the protocol was prospectively registered in PROSPERO (CRD420261448789). PubMed/MEDLINE, Scopus, CINAHL Ultimate, Web of Science Core Collection, PEDro, ProQuest Dissertations & Theses Global, Google Scholar, professional websites, and citation sources were searched from inception to 12 July 2026. Studies were eligible if they reported physiotherapist-specific data on named standardized neurodevelopmental, neurological, neuromotor, or neurobehavioral assessments used in neonatal care or high-risk infant follow-up. Two reviewers independently screened records and appraised methodological quality using design-appropriate JBI tools. Findings were synthesized narratively according to SWiM guidance.

Results: Eleven studies from eight countries were included: eight cross-sectional surveys, one observational telehealth study, one qualitative study, and one implementation study. Reported use ranged from 8.5% of neonatal physiotherapy services in South Korea to 89.1% of physiotherapists working in high-risk infant follow-up programs in the United Kingdom. Frequently used tools included the General Movements Assessment, Hammersmith Infant Neurological Examination, Hammersmith Neonatal Neurological Examination, Alberta Infant Motor Scale, Test of Infant Motor Performance, and Bayley Scales. Greater use was associated with tool-specific training, specialist neonatal physiotherapy input, longer appointments, and peer or multidisciplinary support. Common barriers included insufficient training, cost, limited time, workload, and restricted access to resources or guidelines. Caregiver-recorded videos for the General Movements Assessment appeared feasible, whereas synchronous remote examinations were more demanding.

Conclusions: Standardized neonatal assessment is limited less by tool availability than by uneven implementation capacity. Sustainable uptake requires competency-based training, protected time, specialist support, clear protocols, coordinated referral pathways, and organizational commitment.