O2123: What Are the Psychosocial Impacts of Pavlik Harness Treatment? A Prospective Study on Family Function & Maternal-fetal Bonding

Background: A Pavlik harness is the most common treatment for infants with developmental dysplasia of the hip. Although success rates are high when used appropriately, brace treatment may impact family function and parental bonding. The purpose of this study was to determine these effects through a prospective survey design.

Methods: This is a prospective, single-surgeon study at a tertiary-care, urban, academic children’s hospital between November 2022 and March 2023. All patients newly diagnosed with hip dysplasia and treated with a Pavlik were approached at the time of harness initiation. Caregivers were administered the Postpartum Bonding Questionnaire and the Revised Impact on Family Scale at the baseline visit, 2-weeks, and 6-weeks following treatment initiation via automated text messages. Demographic and treatment-specific information were collected through surveys and retrospective chart review. The Area Deprivation Index, a validated composite measure of socioeconomic deprivation, was used to quantify the socioeconomic deprivation for each family. Descriptive and univariate comparative statistics were used to summarize data.

Results: 64 caregiver-child dyads were enrolled. Of these, 55 families completed the baseline survey and at least one follow-up survey and were therefore included in the final analysis. Most patients were female (89%) and first born (73%). 40 (73%) hips were diagnosed as having stable dysplasia and 15 (27%) as dislocated/reducible (i.e., Ortolani positive). On average, bracing was started at day 50 of life and continued for 75 days (range, 25-117). Average Bonding scores improved steadily over time between baseline (6.80) and 6 weeks (5.93). Family impact also improved over the treatment period (baseline, 1.67; 6 weeks, 0.59). Statistical analyses did not find any demographic or treatment-specific variables associated with worse parental bonding or family impact, including age of treatment initiation, birth order, 24-hour vs. 23-hour wear or socioeconomic disadvantage. Relative to other pediatric diseases, impact scores were similar to cleft lip/palate but less than cancer and diabetes.

Conclusion: In spite of prevailing concerns, Pavlik treatment did not significantly impact maternal-fetal bonding and family dynamics, with steadily improving scores over the study period. As Pavlik harness treatment is a widely used treatment for infantile developmental dysplasia of the hip, this study provides information that clinicians may use to more accurately counsel families and assuage parental concerns.