Treatment adherence in infants with developmental dysplasia of the hip: a review of medical and psychosocial aspects

The effectiveness of conservative treatment of developmental dysplasia of the hip in infants during the first year of life directly depends on strict adherence to the prescribed orthotic regimen. Parental adherence remains a relevant issue in clinical practice, and its causes are often underestimated or interpreted in an oversimplified manner. This review analyzes current publications addressing factors that influence parental adherence to orthotic treatment in the conservative management of developmental dysplasia of the hip in infants. Analysis of the published data made it possible to identify three key groups of factors shaping adherence: medical, socioeconomic, and psychological. It is shown that parents’ subjective perception of disease severity and the risks of its long-term consequences often has a stronger influence on adherence to the treatment regimen than objective clinical and radiographic data. A U-shaped relationship is described for the risk of treatment refusal, characteristic of both mild and severe forms of the condition. Special attention is given to the identified adherence paradoxes, which have not previously been discussed in the Russian publications. In particular, it is shown that a high level of parental awareness and education is not always accompanied by strict compliance with medical prescriptions and, in some cases, may contribute to increased anxiety, selective adherence to recommendations, and the phenomenon of doctor shopping. In conclusion, it is emphasized that adherence to the treatment in infants with developmental dysplasia of the hip is a multifactorial phenomenon extending beyond the purely clinical characteristics of the disease. This review offers a new perspective on the causes of ineffective conservative treatment and substantiates the need to take the psychosocial profile of the family into account when choosing a patient management strategy and the type of orthopedic device.