Parental preferences for brace weaning in developmental dysplasia of the hip: a discrete choice experiment

To elicit and quantify parental preferences for brace weaning strategies in the treatment of developmental dysplasia of the hip (DDH) and explore how parents trade between treatment burden and the risk of further intervention.

A discrete choice experiment (DCE) was developed to assess preferences for timing and duration of weaning, alongside trade-offs related to the risk of further treatment. Parents of infants treated for DDH were recruited via STEPS Worldwide, a patient charity. Parents completed 16 hypothetical scenarios comparing different weaning regimens with immediate cessation. Data were analyzed using conditional logit models. A secondary analysis excluded participants with irrational or disengaged responses. Subgroup analysis explored whether preferences varied by experience.

A total of 195 respondents completed the survey. In the primary analysis, night-time brace wear was preferred over immediate cessation, even when risk remained equal. In the secondary analysis, which excluded internally inconsistent responses, all weaning strategies were significantly less preferred than immediate cessation under equal risk conditions. Parents were willing to accept longer durations of treatment in exchange for reduced risk of subsequent intervention. The minimum acceptable risk reduction required for parents to accept four additional weeks of brace wear, compared with immediate cessation, was 5.8% (night-time bracing), 7.5% (night-time and naps bracing), 8.4% (gradual brace reduction), and 10.0% (daytime bracing). Preferences varied by experience, especially age at diagnosis and prior weaning.

Night-time-only weaning was the most acceptable weaning strategy. Parents were willing to trade longer brace treatment for a lower risk of further intervention. We were able to quantify the size of the benefit required by families, which may inform research investigating the effectiveness of weaning strategies.