Development of a family-centred core outcome set for infants with developmental dysplasia of the hip treated with a brace

Listen to Simon and Amy discuss the paper 'Development of a family-centred core outcome set for infants with developmental dysplasia of the hip treated with a brace' published in the January 2025 issue of Bone & Joint Open.

Click here to read the paper.

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Transcript

[00:00:00] Welcome back to another episode of AI Talks with Bone & Joint, brought to you by the publishers of Bone & Joint Open. Today we delve into the protocol 'Development of a family-centred core outcome set for infants with developmental dysplasia of the hip treated with a brace', published in January 2025 by J. Craven, O. O'Malley, and D. C. Perry. 

I am Simon, and I'm joined by my co-host, Amy. 

Hello, Simon. It's lovely to be here. This topic is genuinely fascinating and vitally important for families dealing with developmental dysplasia of the hip, or DDH. To begin, Simon, could you explain why this research is being undertaken?

Of course, Amy. The main goal behind this research is to develop a family-centred core outcome set, or COS, specifically for infants undergoing brace treatment for DDH. This is important because, while the effectiveness of various brace treatments has been examined, the impact on families has often been overlooked in randomized controlled trials.

Indeed DDH [00:01:00] affects roughly 1% of children and ranges from mild dysplasia to complete dislocation. If not successfully treated, it can result in early arthritis and the need for joint replacement. In infants, the primary treatment is nonoperative splinting with a brace. However, there are still many questions about the best practices for this treatment.

Yes, there's a need for high-quality research to address key questions, such as the effectiveness of splinting for stable dysplastic hips, the optimal timing for starting treatment, and the best type of splint to use. Notably, the Cochrane review highlighted a lack of evidence from randomized controlled trials in this area.

It's intriguing how this study aims to address these gaps by focusing not only on clinical outcomes but also on the family experience. This marks a shift from the traditional focus of randomized controlled trials that mainly consider clinical perspectives. 

The impact of brace treatment on the family shouldn't be underestimated. Families have reported significant challenges and stress related to daily brace use. [00:02:00] By including family-centred outcomes in the core outcome set, the aim is to ensure these aspects are systematically reported and considered in future research. 

Let's discuss the methods described in this protocol. Firstly, the researchers will conduct a literature review and a scoping survey that involves parents, healthcare professionals and researchers. They will then use a two-stage modified Delphi process to rate the importance of the identified outcomes. 

The Delphi process is quite thorough. Initially, all potentially relevant outcomes are identified and then rated using a nine-point Likert scale. This methodology ensures that a broad range of opinions is gathered and considered. 

It's interesting to note that relevant outcomes will be identified not only from new qualitative interviews, but also from reviewing existing literature. This approach helps build on existing work and ensures the study is comprehensive.

That's a good point, Amy. They're aiming to avoid redundancy and leverage existing knowledge. The scoping [00:03:00] survey allows additional outcomes to be suggested, ensuring inclusivity. All these inputs will then be presented in the Delphi exercise for rating. 

And after two rounds of the Delphi process, a final consensus meeting will be held. This meeting, involving at least 24 participants from all stakeholder groups, aims to finalise the core outcome set. 

What's compelling about this set up is their structured approach, which includes anonymous scoring for outcomes that have not yet achieved consensus, followed by group discussions. This ensures a transparent and thorough review process.

One of the main takeaways here is that by systematically including family-centred outcomes, the research aims to standardize the reporting of family experiences alongside clinical outcomes. This will likely enhance parent satisfaction, trust and compliance with treatment. 

Yes, integrating these family-centred outcomes within a broader COS for DDH could ultimately lead to more holistic and high-quality care for infants undergoing brace treatment. This protocol sets a precedent for future [00:04:00] research in this area. 

Absolutely. Developing a COS that includes family perspectives is innovative and necessary. It ensures that the voices of families who are directly affected by the treatment are heard and considered in clinical decision-making. 

In summary, this study by Craven and colleagues will pave the way for more inclusive research practices in paediatric orthopaedics. By developing a family-centered core outcome set for DDH in infants, they address a significant gap in existing research. 

A much needed development indeed, Simon, and I'm sure many will be looking forward to the future results and impact of implementing this COS in clinical trials. Thanks for this enlightening discussion.

Thank you, Amy, and thanks to our listeners for tuning in to this episode of AI Talks with Bone & Joint. Stay tuned for more discussions on groundbreaking research in orthopaedics. Until next time, take care.