Craven Joanna, Davies Ioan, Perry Daniel C
University of Liverpool, Liverpool, UK.
Wales Deanery, Cardiff, UK.
Bone Jt Open. 2025 Jun 11;6(6):685-690. doi: 10.1302/2633-1462.66.BJO-2025-0053.R1.
In infants aged under six months with developmental dysplasia of the hip (DDH), the use of a removable brace is considered the gold-standard treatment. However, considerable variation exists for brace removal after 'successful' treatment. Some clinicians support immediate cessation, while others prefer weaning of the brace. This study aimed to explore clinicians' understanding of weaning, and to identify current practices and the rationale behind different approaches, in order to inform the design of a future randomized controlled trial (RCT).
A survey was developed using Google Forms and disseminated via professional networks, social media, and the British Society of Children's Orthopaedic Surgery mailing list. It targeted clinicians involved in DDH care, gathering information on demographics, treatment protocols, criteria for removal, and weaning practices. Quantitative and qualitative data were analyzed to identify patterns and variability.
In total, 139 clinicians from 25 countries responded, with 50% from the UK. Most respondents (87.8%) followed a protocol for brace treatment, with considerable variation in definition and implementation of weaning. 'Weaning' was most commonly defined as a gradual reduction in brace wear over time (n = 103, 74.1%). Overall, 47.4% of respondents (n = 65) reported never weaning, 39.4% (n = 54) always wean, and 13.1% (n = 18) varied their approach. Among clinicians who always wean, the most common approach involved gradually reducing the hours per day over several weeks (n = 28, 51.9%). However, for those who sometimes wean, the most frequent practice was night-time only wear (n = 8, 44.4%). Durations of weaning differed, although the majority of clinicians reported weaning periods from two to six weeks. There is broad support for a future RCT, with 75.9% (n = 105) expressing a willingness to participate.
This survey highlights considerable variability in weaning practices for brace treatment in DDH, and underscores the need for standardized terminology and protocols. These findings provide a foundation for designing a RCT to evaluate weaning compared with immediate brace cessation, ultimately informing evidence-based guidelines.
对于6个月以下发育性髋关节发育不良（DDH）的婴儿，使用可移除支具被认为是金标准治疗方法。然而，在“成功”治疗后支具移除的情况存在很大差异。一些临床医生支持立即停止使用，而另一些则倾向于逐渐减少支具使用。本研究旨在探讨临床医生对逐渐减少支具使用的理解，确定当前的做法以及不同方法背后的原理，以便为未来的随机对照试验（RCT）设计提供参考。
使用谷歌表单开发了一项调查问卷，并通过专业网络、社交媒体和英国儿童骨科学会邮件列表进行传播。该问卷针对参与DDH治疗的临床医生，收集有关人口统计学、治疗方案、移除标准和逐渐减少支具使用做法的信息。对定量和定性数据进行分析以确定模式和变异性。
共有来自25个国家的139名临床医生做出回应，其中50%来自英国。大多数受访者（87.8%）遵循支具治疗方案，但在逐渐减少支具使用的定义和实施方面存在很大差异。“逐渐减少支具使用”最常见的定义是随着时间推移逐渐减少支具佩戴时间（n = 103，74.1%）。总体而言，47.4%的受访者（n = 65）报告从未逐渐减少支具使用，39.4%（n = 54）总是进行逐渐减少支具使用，13.1%（n = 18）的做法有所不同。在总是进行逐渐减少支具使用的临床医生中，最常见的方法是在几周内逐渐减少每天佩戴的小时数（n = 28，51.9%）。然而，对于有时进行逐渐减少支具使用的医生来说，最常见的做法是仅在夜间佩戴（n = 8，44.4%）。逐渐减少支具使用的持续时间各不相同，尽管大多数临床医生报告逐渐减少支具使用的时间为2至6周。对于未来的随机对照试验有广泛支持，75.9%（n = 105）表示愿意参与。
这项调查突出了DDH支具治疗中逐渐减少支具使用做法的显著变异性，并强调了标准化术语和方案的必要性。这些发现为设计一项随机对照试验以评估逐渐减少支具使用与立即停止使用支具相比提供了基础，最终为基于证据的指南提供参考。
