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The hip trial: psychosocial consequences for mothers of using ultrasound to manage infants with developmental hip dysplasia
  1. F Gardner1,
  2. C Dezateux2,
  3. D Elbourne3,
  4. A Gray4,
  5. A King5,
  6. A Quinn5,
  7. on behalf of the Collaborative Hip Trial Group
  1. 1Department of Social Policy and Social Work, University of Oxford, Oxford, UK
  2. 2Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, UK
  3. 3Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, UK
  4. 4Health Economics Research Centre, Department of Public Health, University of Oxford
  5. 5National Perinatal Epidemiology Unit, University of Oxford
  1. Correspondence to:
    Dr Gardner
    Department of Social Policy and Social Work University of Oxford,, Barnett House, Wellington Square, Oxford OX1 2ER, UK;


Background: The hip trial aimed to assess clinical effectiveness, economic and psychosocial costs, and benefits of ultrasound imaging (US) compared with conventional clinical assessment alone to guide the management of infants with neonatal hip instability.

Objective: To report on psychosocial consequences for mothers and the developing mother-child relationship of US, and associations between abduction splinting and maternal psychosocial distress.

Design: Multicentre randomised controlled trial.

Setting: Thirty three hospitals in the United Kingdom and Ireland.

Participants, interventions: A total of 629 infants with neonatal hip instability randomised to US examination or clinical assessment alone before treatment decision. Questionnaires were completed by 561 (89%) mothers at 8 weeks and 494 (79%) at 1 year.

Main outcome measures: Anxiety, postnatal depression, parenting stress assessed by standardised questionnaires. Maternal concerns about hip problems were assessed using the Infant hip worries inventory.

Results: At 8 weeks, there were no differences between US and non-US groups of the trial in maternal anxiety (mean difference (MD) −1.2, 95% confidence interval (CI) −3.2 to 0.8), depression (MD 0.0, 95% CI −0.7 to 0.8), parenting stress (MD −1.2, 95% CI −2.8 to 0.4), or other measures. The same pattern was evident at 1 year. In an explanatory analysis, early splinting was associated with increased anxiety at 8 weeks (MD 3.8, 95% CI 1.7 to 5.9) and increased level of hip worries at 8 weeks (MD 6.8, 95% CI 5.6 to 7.9) and 1 year (MD 1.3, 95% CI 0.3 to 2.4).

Conclusions: Although early splinting is associated with maternal anxieties, US is not associated with any increase or reduction in psychosocial effects on mothers. Together with the clinical findings, this suggests that the use of US allows reduction in splinting rates without increased risk of adverse clinical or psychosocial outcomes.

  • DDH, developmental dysplasia of the hip
  • EPDS, Edinburgh postnatal depression scale
  • NHI, neonatal hip instability
  • PSI, parenting stress index
  • STAI, Spielberger state-trait anxiety inventory
  • abduction splinting
  • hip instability
  • maternal depression 
  • psychosocial 
  • ultrasound

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  • Competing interests: none declared

  • Writing committee: C Dezateux, D Elbourne, F Gardner, A Gray, A King, A Quinn

    Trial steering committee: R Arthur, S Bird, NMP Clarke, C Dezateux, D Elbourne, F Gardner, A Gray, A King, M MacLean (MRC), C Normand (chair), A Quinn, G Russell

    Data monitoring committee: D Field, W Gillespie, I Leck, J Whitehead

    Imaging panel: R Arthur, J Fairhurst, D Pilling

    Hip trial team Oxford: H Ashurst, S Ayers, C Bowen, L Brandon, J Fooks, A King, J MacLennan, L Morgan, M Marques, A Quinn, A Wrotchford

    Hip centres: Alder Hey and Liverpool Women’s Hospitals, Liverpool (RWI Cooke, S Crawford, R Davis, R Massey, D Pilling, B Yoxhall, Dorgan, C Bruce); Altnagelvin Area Hospital, Londonderry (S Elliott, R Wray); Broomfield and St John’s Hospitals, Chelmsford (AP Lipscomb, S Rao, J Tuite); East Glamorgan NHS Trust, Pontypridd (C Davies, J Moorcraft, J Murray); North Staffordshire Hospital, Stoke-on-Trent (DSK Brookfield, D Edwards, J Egginton, P Roberts, JSM Dwyer); Newcastle General Hospital, Freeman Hospital and Royal Victoria Infirmary, Newcastle (MP Ward Platt, AJ Chippindale, R Hornby, AP Kenna, AJ Grainger); North Tees General Hospital, Stockton-on-Tees (J Jani, W Thompson, CJ Tulloch, IG Verber); Royal Bournemouth Hospital, Bournemouth and Poole Hospital, Poole (V Arnett, J Brailsford, N J Fiddian, Z Parrott); Queen Elizabeth Hospital, Gateshead (J Hall, S Shanker, A Steele, M Higgs); Queen’s Medical Centre, Nottingham (R Dove, J Hunter, P Twining); Royal Aberdeen Children’s Hospital, Aberdeen (L Gomersall, J McLauchlan, JA Reid); Royal Belfast Hospital for Sick Children, Belfast (H Cowie, L Sweeney, T Taylor); Royal Devon and Exeter Hospital, Exeter (D Jameson Evans, J Harington, M Quinn); Royal Hospital for Sick Children, Glasgow (J Gray, E Loomes, DAK Parker, J Sherlock, A Hollman (deceased)); Royal Shrewsbury Hospital, Shrewsbury and The Robert Jones/Agnes Hunt Orthopaedic Hospital, Oswestry (J Morris, A Roberts, H Watson, RJ Welch); Southampton General Hospital, Southampton (NMP Clarke, J Fairhurst); Southmead Hospital, Bristol (T Chambers, E Loveday, M Simmonds, M Hubble); St Mary’s/Queen Alexandra, Portsmouth (M Ashton, RH Richards); St Michael’s Hospital, Bristol (D Grier, G Russell); Sunderland Royal Hospital, Sunderland (R Checketts, J Connor, M Otterburn, S Richmond); Taunton and Somerset Hospital, Taunton (D Challacombe, P Ewings, C Ogilvie); University Hospital of Wales, Cardiff and Llandough Hospital, Penarth (M Abouharb, PHT Cartlidge, G Graham, K Lyons, G Pask, M Alfaham, L Ottery); The General Infirmary at Leeds (R Arthur, AB Gill, P Scott, JM Abberton); Whittington and The Royal Free Hospitals, London (D Eastwood, J Haddock, H Mackinnon, V Van Someren, A Washington); University College Hospital, Galway (B Curtin, B Loftus, C Nolan, D O’Keeffe); Wexham Park Hospital, Slough and Heatherwood Hospital, Ascot (C Luck, J Scrutton, R Jones, M Swan, Mr Unwin, B Wobi); Walsall Trust Hospital, Walsall (H Batra, D Drew, L Holland, R Hodgson); Wycombe General, High Wycombe (C Charlesworth, A Earley, KSH Wise)

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