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Abstract
BACKGROUND The purposes of this study were to analyze the trends in Oxford level of evidence (LOE), LOE of most-cited articles, and association between LOE and journal impact factor (IF) and SCImago Journal Rank (SJR) over a 10-year period (2009-2018) in 3 prominent hand surgery journals, specifically HAND, Journal of Hand Surgery (American Volume) (JHS), and Journal of Hand Surgery (European Volume) (JHSE). METHODS All articles published from 2009 to 2018 in HAND, JHS, and JHSE were reviewed for assigned or available LOE. Data were pooled and analyzed for trends in LOE; relationship among IF, SJR, and LOE; and citation density. RESULTS A total of 3921 total publications were tabulated from 2009 to 2018, with the majority of studies being level V (1700, 43%) and fewer studies being level I (146, 4%). Over the 10-year study period, there was no significant change in frequency of level I studies for any journal. HAND trended significantly toward higher LOE, JHS trended toward higher LOE, and JHSE trended toward decreased LOE without significance. Among all journals, the annual number of articles and the average LOE were independent significant predictors of IF and SJR. Statistically significant correlations were found between citation density and LOE for JHS and HAND. CONCLUSIONS Higher quality evidence is becoming more prevalent in the hand surgery literature over the past 10 years. Annual articles, average LOE, and level I and II and level IV articles were significant predictors of increasing IF and SJR.
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Affiliation(s)
- Reid E. Tompkins
- William Beaumont Army Medical Center, El Paso, TX, USA
- Texas Tech University Health Sciences Center, El Paso, USA
| | | | - Kyle J. Klahs
- William Beaumont Army Medical Center, El Paso, TX, USA
| | | | | | - John C. Dunn
- William Beaumont Army Medical Center, El Paso, TX, USA
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Harris D, Baker E, Svacina J, Funderburk L. A Systematic Approach to Evidence-Based Design for Measurable Health and Wellness Outcomes: Curating and Translating Evidence to Practice. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024; 17:17-29. [PMID: 37919935 DOI: 10.1177/19375867231209335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
OBJECTIVES Evaluating evidence from peer-review literature for use in evidence-based design is often challenging for the design disciplines, requiring access to the peer-reviewed literature, expertise in evaluating methods and findings, and translating the results into actionable design and operational recommendations. PURPOSE The purpose of this methods paper is to elucidate the process for systematic evaluation of research to translate evidence into practical application to improve design for occupant health and wellness. BACKGROUND Researchers have found strong connections in environmental design influence on health and wellness that have proven to be substantiative in the effort to improve health and well-being. Design has the capacity to encourage healthy choices and decisions within the built environment. Translation of evidence into applied design solutions may improve public health. METHODS A protocol is presented that culminates in the translation of evidence into design recommendations focused on improving occupant health. The protocol includes preparation for the literature search and review, search strategy, study selection, data analysis, and development of the literature review. RESULTS After evaluation of the evidence is completed, there were several positive findings in the example that stakeholders could utilize to improve the health of building occupants with programs and design to support nutrition, physical activity, and circadian entrainment. CONCLUSIONS There are a variety of software tools and processes to utilize in the curation of evidence to improve the built environment with relevant design recommendations and operational considerations affecting the personal, social, and economic health of our society.
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Affiliation(s)
- Debra Harris
- Interior Design, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA
| | - Erich Baker
- Department of Computer Science, School of Engineering and Computer Science, Baylor University, Waco, TX, USA
| | | | - LesLee Funderburk
- Nutrition Sciences, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA
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Shah A, Hoit G, Lan L, Whelan DB. Assessment of 30 Years of Randomized Controlled Trials in The American Journal of Sports Medicine: 1990-2020. Orthop J Sports Med 2023; 11:23259671231161293. [PMID: 37213657 PMCID: PMC10192813 DOI: 10.1177/23259671231161293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/19/2023] [Indexed: 05/23/2023] Open
Abstract
Background Randomized controlled trials (RCTs) stand atop the evidence-based hierarchy of study designs for their ability to arrive at results with the lowest risk of bias. Even for RCTs, however, critical appraisal is essential before applying results to clinical practice. Purpose To analyze the quality of reporting of RCTs published in The American Journal of Sports Medicine (AJSM) from 1990 to 2020 and to identify trends over time and areas of improvement for future trials. Study Design Systematic review; Level of evidence, 1. Methods We queried the AJSM database for RCTs published between January 1990 and December 2020. Data pertaining to study characteristics were recorded. Quality assessments were conducted using the Detsky quality-of-reporting index and the modified Cochrane risk-of-bias (mROB) tool. Univariate and multivariable models were generated to establish factors with associations to study quality. The Fragility Index was calculated for eligible studies. Results A total of 277 RCTs were identified with a median sample size of 70 patients. A total of 19 RCTs were published between 1990 and 2000 (t1); 82 RCTs between 2001 and 2010 (t2); and 176 RCTs between 2011 and 2020 (t3). From t1 to t3, significant increases were observed in the overall mean-transformed Detsky score (from 68.2% ± 9.8% to 87.4% ± 10.2%, respectively; P < .001) and mROB score (from 4.7 ± 1.6 to 6.9 ± 1.6, respectively; P < .001). Multivariable regression analysis revealed that trials with follow-up periods of <5 years clearly stated primary outcomes, and a focus on the elbow, shoulder, or knee were associated with higher mean-transformed Detsky and mROB scores. The median Fragility Index was 2 (interquartile range, 0-5) for trials with statistically significant. Studies with small sample sizes (<100 patients) were more likely to have low Fragility Index scores and less likely to have a statistically significant finding in any outcome. Conclusion The quantity and quality of published RCTs published in AJSM increased over the past 3 decades. However, single-center trials with small sample sizes were prone to fragile results.
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Affiliation(s)
- Ajay Shah
- Division of Orthopaedic Surgery,
Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Graeme Hoit
- Division of Orthopaedic Surgery,
Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management
and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lucy Lan
- Michael G. DeGroote School of Medicine,
Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Daniel B. Whelan
- Division of Orthopaedic Surgery,
Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, Saint
Michael’s Hospital, Unity Health, Toronto, Ontario, Canada
- Daniel B. Whelan, MD, MSc,
Division of Orthopaedic Surgery, Department of Surgery, University of Toronto,
149 College Street, Room 508-a, Toronto, Ontario, M5T 1P5, Canada (
)
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Pellarin M, Youmbi CT, Lotchuang J, Tejpal T, Thangathurai G, Khan A, Cohen D, Simunovic N, Duong A, Ayeni OR. From Protocol to Definitive Study-The State of Randomized Controlled Trial Evidence in Sports Medicine Research: A Systematic Review and Survey Study. Clin J Sport Med 2023; 33:e44-e70. [PMID: 36652662 DOI: 10.1097/jsm.0000000000001117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate the progression, quality, and challenges associated with conducting and publishing randomized controlled trials (RCTs) in sports medicine. DESIGN Systematic review and survey. SETTING MEDLINE and Embase were searched for all publications before September 17, 2021. A targeted search of clinicaltrials.gov , BMC Musculoskeletal Disorders, PubMed, and Google Scholar were also conducted. The survey was administered to authors using REDCap. PARTICIPANTS Where the systematic search revealed no corresponding published definitive trial, authors of the published pilots were surveyed. INTERVENTIONS Survey assessing limitations to definitive trials. MAIN OUTCOME MEASURES Protocol/method articles, pilot articles, and relevant clinical trial registry records with corresponding definitive trials were pooled. RESULTS Our literature search yielded 27 006 studies; of which, we included 208 studies (60 (28.8%) pilot RCTs, 84 (40.4%) protocol/method articles, and 64 (30.8%) trial registry records). From these, 44 corresponding definitive RCTs were identified. Pilot study and definitive RCT methodological quality increased on average most significantly during the duration of this review (30.6% and 8.2%). Of the 176 authors surveyed, 59 (33.5%) responded; 24.6% (14/57) stated that they completed an unpublished definitive trial, while 52.6% (30/57) reported having one underway. CONCLUSIONS The quality and number of RCT publications within the field of sports medicine has been increasing since 1999. The number of sports medicine-related protocol and pilot articles preceding a definitive trial publication showed a sharp increase over the past 10 years, although only 5 pilot studies have progressed to a definitive RCT.
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Affiliation(s)
- Mitchell Pellarin
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Cheikh Tchouambou Youmbi
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Joyce Lotchuang
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Tushar Tejpal
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Gowtham Thangathurai
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Abdullah Khan
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Dan Cohen
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada; and
| | - Nicole Simunovic
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada; and
| | - Andrew Duong
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada; and
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada; and
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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Hodel S, Selman F, Mania S, Maurer SM, Laux CJ, Farshad M. A systematic analysis of preprints in Trauma & Orthopaedic surgery. Bone Jt Open 2022; 3:582-588. [PMID: 35848996 PMCID: PMC9350703 DOI: 10.1302/2633-1462.37.bjo-2022-0060.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aims Preprint servers allow authors to publish full-text manuscripts or interim findings prior to undergoing peer review. Several preprint servers have extended their services to biological sciences, clinical research, and medicine. The purpose of this study was to systematically identify and analyze all articles related to Trauma & Orthopaedic (T&O) surgery published in five medical preprint servers, and to investigate the factors that influence the subsequent rate of publication in a peer-reviewed journal. Methods All preprints covering T&O surgery were systematically searched in five medical preprint servers (medRxiv, OSF Preprints, Preprints.org, PeerJ, and Research Square) and subsequently identified after a minimum of 12 months by searching for the title, keywords, and corresponding author in Google Scholar, PubMed, Scopus, Embase, Cochrane, and the Web of Science. Subsequent publication of a work was defined as publication in a peer-reviewed indexed journal. The rate of publication and time to peer-reviewed publication were assessed. Differences in definitive publication rates of preprints according to geographical origin and level of evidence were analyzed. Results The number of preprints increased from 2014 to 2020 (p < 0.001). A total of 38.6% of the identified preprints (n = 331) were published in a peer-reviewed indexed journal after a mean time of 8.7 months (SD 5.4 (1 to 27)). The highest proportion of missing subsequent publications was in the preprints originating from Africa, Asia/Middle East, and South America, or in those that covered clinical research with a lower level of evidence (p < 0.001). Conclusion Preprints are being published in increasing numbers in T&O surgery. Depending on the geographical origin and level of evidence, almost two-thirds of preprints are not subsequently published in a peer-reviewed indexed journal after one year. This raises major concerns regarding the dissemination and persistence of potentially wrong scientific work that bypasses peer review, and the orthopaedic community should discuss appropriate preventive measures. Cite this article: Bone Jt Open 2022;3(7):582–588.
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Affiliation(s)
- Sandro Hodel
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Farah Selman
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Sylvano Mania
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Steven M. Maurer
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christoph J. Laux
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Declining Quality of Systematic Reviews in Orthopaedic Sports Medicine: An Updated Systematic Review. Arthrosc Sports Med Rehabil 2022; 4:e789-e795. [DOI: 10.1016/j.asmr.2021.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 11/11/2021] [Indexed: 11/23/2022] Open
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Impact of Level of Evidence on Citation of Orthopaedic Articles. J Am Acad Orthop Surg 2021; 29:e1274-e1281. [PMID: 33826545 DOI: 10.5435/jaaos-d-20-00733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 03/08/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Level of evidence grading has become widely used in orthopaedics. This study reviewed clinical research articles published in leading orthopaedic journals to describe the association between level of evidence and number of future citations, which is one measure of an article's impact in the field. METHODS The first 100 clinical research articles published in 2014 by each of the Journal of Bone and Joint Surgery, Clinical Orthopaedics and Related Research, and the American Journal of Sports Medicine were reviewed for level of evidence and article characteristics. Web of Science was used to identify the number of citations of each article over the following 5 years. Univariable analyses and multivariable linear regression were used to describe the associations. RESULTS Three hundred articles were evaluated. Univariable analysis revealed no association between level of evidence and number of citations, with a median number of citations for level 1 articles of 23 (interquartile range [IQR], 14-49), level 2 articles 24 (IQR, 13-47), level 3 articles 22 (IQR, 13-40), and level 4 or 5 articles 20 (IQR, 10-36). Univariable analyses showed weak associations between other article characteristics and citations. Even after adjusting for other variables, the standardized regression coefficient for level 1 versus level 4 or 5 was only 0.14 and the overall model had a poor fit with an R2 of 0.18. CONCLUSIONS Among clinical research articles published in leading orthopaedic journals, no notable association was found between level of evidence and future citations. CLINICAL RELEVANCE Readers of the orthopaedic literature should understand that no association was found between level of evidence and future citations. Additional work is needed to better understand the effect level of evidence has on clinicians and researchers.
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Marder RS, Poonawala H, Pincay JI, Nguyen F, Cleary PF, Persaud CS, Naziri Q, Zikria BA. Acute Versus Delayed Surgical Intervention in Multiligament Knee Injuries: A Systematic Review. Orthop J Sports Med 2021; 9:23259671211027855. [PMID: 34671686 PMCID: PMC8521434 DOI: 10.1177/23259671211027855] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/02/2021] [Indexed: 01/13/2023] Open
Abstract
Background: The optimal timing of surgical intervention for multiligament knee injuries remains controversial. Purpose: To review the clinical and functional outcomes after acute and delayed surgical intervention for multiligament knee injuries. Study Design: Systematic review; Level of evidence, 4. Methods: We performed a search of the PubMed, Embase, Cochrane Library, and Web of Science databases from inception to September 2020. Eligible studies reported on knee dislocations, multiligament knee injuries, or bicruciate ligament injuries in adult patients (age, ≥18 years). In addition to comparing outcomes between acute and delayed surgical intervention groups, we conducted 3 subgroup analyses for outcomes within isolated knee injuries, knee injuries with concomitant polytrauma/fractures, and high-level (level 2) studies. Results: Included in the analysis were 31 studies, designated as evidence level 2 (n = 3), level 3 (n = 8), and level 4 (n = 20). These studies reported on 2594 multiligament knee injuries sustained by 2585 patients (mean age, 25.1-65.3 years; mean follow-up, 12-157.2 months). At the latest follow-up timepoint, the mean Lysholm (n = 375), International Knee Documentation Committee (IKDC) (n = 286), and Tegner (n = 129) scores for the acute surgical intervention group were 73.60, 67.61, and 5.06, respectively. For the delayed surgical intervention group, the mean Lysholm (n = 196), IKDC (n = 172), and Tegner (n = 74) scores were 85.23, 72.32, and 4.85, respectively. The mean Lysholm (n = 323), IKDC (n = 236), and Tegner (n = 143) scores for our isolated subgroup were 83.7, 74.8, and 5.0, respectively. By comparison, the mean Lysholm (n = 270), IKDC (n = 236), and Tegner (n = 206) scores for the polytrauma/fractures subgroup were 83.3, 64.5, and 5.0, respectively. Conclusion: The results of our systematic review did not elucidate whether acute or delayed surgical intervention produced superior clinical and functional outcomes. Although previous evidence has supported acute surgical intervention, future prospective randomized controlled trials and matched cohort studies must be completed to confirm these findings.
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Affiliation(s)
- Ryan S Marder
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York, USA
| | - Husain Poonawala
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York, USA
| | - Jorge I Pincay
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York, USA
| | - Frank Nguyen
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York, USA
| | - Patrick F Cleary
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York, USA
| | - Christine S Persaud
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York, USA
| | - Qais Naziri
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York, USA
| | - Bashir A Zikria
- Department of Orthopaedic Surgery, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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Twenty Five-Year Publication Trends in Foot and Ankle Literature: Improved Methodological Quality and Internationality With Time. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202102000-00004. [PMID: 33570869 PMCID: PMC7884299 DOI: 10.5435/jaaosglobal-d-20-00154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/18/2020] [Indexed: 11/25/2022]
Abstract
Background: Methodological quality and author internationality are increasing in orthopaedic surgery. The purpose of this study was to evaluate the methodological quality and author geography trends from 1994 to 2019 in high-quality foot and ankle journals. Methods: Analyses of 1,242 foot and ankle publications in Foot and Ankle International, American Journal of Bone and Joint Surgery, and American Journal of Sports Medicine were done for 1994, 1999, 2004, 2009, 2014, and 2019. Articles were classified according to study type, level of evidence (LOE), and author's country of publication. Results: The most common clinical study was therapeutic (65.4). Significant increases were noted in the proportion of therapeutic (P < 0.01) and prognostic (P < 0.01) articles. The average LOE increased from 3.96 ± 1.01 to 3.19 ± 0.97 (P < 0.01). The proportion of Level I (P = 0.29) and level IV articles (P = 0.21) remained constant, level II (P < 0.01) and level III (P < 0.01) articles increased, and level V (P < 0.01) articles decreased. United States authorship decreased from 78.1% in 1994 to 44.8% in 2009, then remained constant through 2019 (P < 0.01). Conclusion: This study demonstrated an improvement in LOE of foot and ankle publications across a 25-year period in three high-quality orthopaedic journals. Increasing internationality was also observed.
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Büttner F, Toomey E, McClean S, Roe M, Delahunt E. Are questionable research practices facilitating new discoveries in sport and exercise medicine? The proportion of supported hypotheses is implausibly high. Br J Sports Med 2020; 54:1365-1371. [PMID: 32699001 DOI: 10.1136/bjsports-2019-101863] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2020] [Indexed: 11/03/2022]
Abstract
Questionable research practices (QRPs) are intentional and unintentional practices that can occur when designing, conducting, analysing, and reporting research, producing biased study results. Sport and exercise medicine (SEM) research is vulnerable to the same QRPs that pervade the biomedical and psychological sciences, producing false-positive results and inflated effect sizes. Approximately 90% of biomedical research reports supported study hypotheses, provoking suspicion about the field-wide presence of systematic biases to facilitate study findings that confirm researchers' expectations. In this education review, we introduce three common QRPs (ie, HARKing, P-hacking and Cherry-picking), perform a cross-sectional study to assess the proportion of original SEM research that reports supported study hypotheses, and draw attention to existing solutions and resources to overcome QRPs that manifest in exploratory research. We hypothesised that ≥ 85% of original SEM research studies would report supported study hypotheses. Two independent assessors systematically identified, screened, included, and extracted study data from original research articles published between 1 January 2019 and 31 May 2019 in the British Journal of Sports Medicine, Sports Medicine, the American Journal of Sports Medicine, and the Journal of Orthopaedic & Sports Physical Therapy We extracted data relating to whether studies reported that the primary hypothesis was supported or rejected by the results. Study hypotheses, methodologies, and analysis plans were preregistered at the Open Science Framework. One hundred and twenty-nine original research studies reported at least one study hypothesis, of which 106 (82.2%) reported hypotheses that were supported by study results. Of 106 studies reporting that primary hypotheses were supported by study results, 75 (70.8%) studies reported that the primary hypothesis was fully supported by study results. The primary study hypothesis was partially supported by study results in 28 (26.4%) studies. We detail open science practices and resources that aim to safe-guard against QRPs that bely the credibility and replicability of original research findings.
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Affiliation(s)
- Fionn Büttner
- School of Public Health, Physiotherapy and Sports Science, University College Dublin-National University of Ireland, Dublin, Ireland
| | - Elaine Toomey
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Shane McClean
- School of Public Health, Physiotherapy and Sports Science, University College Dublin-National University of Ireland, Dublin, Ireland
| | - Mark Roe
- School of Public Health, Physiotherapy and Sports Science, University College Dublin-National University of Ireland, Dublin, Ireland
| | - Eamonn Delahunt
- School of Public Health, Physiotherapy and Sports Science, University College Dublin-National University of Ireland, Dublin, Ireland.,Institute for Sport and Health, University College Dublin, Dublin, Ireland
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Büttner F, Winters M, Delahunt E, Elbers R, Lura CB, Khan KM, Weir A, Ardern CL. Identifying the 'incredible'! Part 2: Spot the difference - a rigorous risk of bias assessment can alter the main findings of a systematic review. Br J Sports Med 2020; 54:801-808. [PMID: 31871014 DOI: 10.1136/bjsports-2019-101675] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2019] [Indexed: 01/11/2023]
Affiliation(s)
- Fionn Büttner
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Marinus Winters
- Center for General Practice at Aalborg University, Aalborg, Denmark
| | - Eamonn Delahunt
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Institute for Sport & Health, University College Dublin, Dublin, Ireland
| | - Roy Elbers
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Carolina B Lura
- Center for General Practice at Aalborg University, Aalborg, Denmark
| | - Karim M Khan
- Department of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam Weir
- Sports Groin Pain Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Department of Orthopaedics, Erasmus MC University Medical Center for Groin Injuries, Rotterdam, The Netherlands
- Sport Medicine and Exercise Clinic Haarlem (SBK), Haarlem, The Netherlands
| | - Clare L Ardern
- Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
- Department of Medicine and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden
- Division of Physiotherapy, Karolinska Institute, Stockholm, Sweden
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The extent of pediatric orthopaedic research in low- and middle-income countries and the impact of academic collaboration on research quality: a scoping review. Pediatr Surg Int 2019; 35:397-411. [PMID: 30413920 DOI: 10.1007/s00383-018-4412-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2018] [Indexed: 12/23/2022]
Abstract
INTRODUCTION This review aims to (1) assess the breadth of pediatric orthopaedic research in low- and middle-income countries (LMICs) and (2) determine the impact of academic collaboration (an LMIC and a non-LMIC investigator) in published LMIC research. METHODS Pediatric orthopaedic clinical studies conducted in LMICs from 2004 to 2014 were extracted from Embase, Cochrane, and Pubmed databases. Of 22,714 searched studies, 129 met inclusion criteria. RESULTS 85% generated low-quality evidence (level IV or lower). 21% were collaborative, and these were more likely than non-collaborative papers to generate level III evidence or higher (25% vs 13%, p = 0.141). DISCUSSION Pediatric orthopaedic research produced by LMICs rarely achieves level I-III evidence, but collaborative studies are associated with higher levels of evidence. LEVEL OF EVIDENCE N/A.
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13
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LeBrun DG, Tran T, Wypij D, Kocher MS. Statistical Analysis of Dependent Observations in the Orthopaedic Sports Literature. Orthop J Sports Med 2019; 7:2325967118818410. [PMID: 30637265 PMCID: PMC6317150 DOI: 10.1177/2325967118818410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Orthopaedic research may involve multiple observations from the same patient because of bilateral joint involvement, multiple disease sites, or recurrent disease episodes. These situations violate statistical independence and need to be accounted for via appropriate statistical techniques. Failing to account for nonindependence may lead to biased and overly precise effect estimates. Purpose: To determine the degree to which orthopaedic sports medicine studies analyze dependent observations and the proportion of these failing to account for nonindependence. Study Design: Cross-sectional study. Methods: Clinical studies published in The American Journal of Sports Medicine from 2012 to 2017 were reviewed. Studies reporting nonindependent observations because of multiple extremity involvement or multiple disease episodes were identified. Methods to account for nonindependence were recorded. Studies violating the assumption of independence were identified and stratified by study design, level of evidence, body part involved, and inclusion of a statistician coauthor. Univariate logistic regression was used to determine whether these factors were associated with violations of statistical independence. Results: After screening 1016 articles, 886 clinical studies were reviewed. A total of 135 (15%) studies analyzed dependent observations, and 111 (82%) of these failed to account for nonindependence. Relative to the knee, studies of the hip (odds ratio [OR], 0.21; P = .02) and the thigh or leg (OR, 0.03; P = .004) were less likely to violate statistical independence. Study design (P = .03) was also associated with violations of statistical independence. Among studies that analyzed dependent observations, the median proportion of dependent observations relative to the total number of observations in each study was 0.07 (interquartile range, 0.04-0.12). Conclusion: The analysis of dependent observations is common in the orthopaedic sports literature, but most studies do not adjust for nonindependence in these situations. Investigators should be aware of incorrect inferences arising from nonindependence and how to statistically adjust for dependent data.
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Affiliation(s)
- Drake G LeBrun
- Hospital for Special Surgery, New York, New York, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Tram Tran
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.,Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - David Wypij
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Mininder S Kocher
- Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
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14
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Donnally CJ, Butler AJ, Rush AJ, Bondar KJ, Wang MY, Eismont FJ. The most influential publications in cervical myelopathy. JOURNAL OF SPINE SURGERY 2018; 4:770-779. [PMID: 30714009 DOI: 10.21037/jss.2018.09.08] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Management of cervical myelopathy (CM) has continued to evolve through a better understanding of the long-term outcomes of this diagnosis as well as improved diagnostic guidelines. More recent literature continues to expand the field, but certain publications can be distinguished from others due to their lasting impact. Using the Clarivate Analytics Web of Science, search phrases were used to identify publications pertaining to CM. The fifty most cited articles were isolated. The frequency of citations, year of publication, country of origin, journal of publication, level of evidence (LOE), article type, as well as contributing authors and institutions were recorded. We also highlighted the five most cited articles (per year) from the past 10 years. Publications included ranged from 1952-2011, with the plurality of articles published during 2000-2009 (n=21; 42%). The most cited paper was Hillibrand's 1999 reporting of adjacent segment disease rates following cervical fusions, followed by Hirabayashi's 1983 review of his cervical laminoplasty outcomes. The third most cited was Brain's 1952 review of the manifestations of cervical spondylosis. Spine contributed the most publications (n=26; 52%). A LOE of III was the most common (n=30; 60%). Clinical outcome articles were the most frequent type (n=28; 56%). Osaka University (Japan) and Kazou Yonenobu had the most contributions. Ames or Fehlings were the first or last author in each of the five most influential articles from the past 10 years. This bibliometric citation analysis identifies the most influential articles regarding CM. There are few publications with a high LOE, and more high powered studies are needed. Knowledge of these "classic" publications allows for a better overall understanding of the diagnosis, treatment, and future direction of research of CM.
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Affiliation(s)
- Chester J Donnally
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, FL, USA
| | - Alexander J Butler
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, FL, USA
| | - Augustus J Rush
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, FL, USA
| | - Kevin J Bondar
- Department of Education, The University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Michael Y Wang
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Frank J Eismont
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, FL, USA
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15
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Carver TJ, Kraeutler MJ, Amer KB, McCarty EC. Manuscript Submission Patterns of Authors Publishing in Orthopaedic Sports Medicine Journals. Orthop J Sports Med 2018; 6:2325967118791758. [PMID: 30151404 PMCID: PMC6104215 DOI: 10.1177/2325967118791758] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Previous studies have examined the most cited articles in orthopaedic sports medicine research and the journals in which they were published. Purpose To analyze the manuscript submission patterns of authors who published manuscripts in various orthopaedic sports medicine journals. Study Design Cross-sectional study. Methods All articles published in the March 2017 and April 2017 issues of Arthroscopy, the American Journal of Sports Medicine (AJSM), Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA), and the Orthopaedic Journal of Sports Medicine (OJSM) were searched. In addition, the past 50 sports medicine-related articles published in the Journal of Bone and Joint Surgery (JBJS) dating back from April 2017 to May 2015 were searched. The corresponding author of each article was asked whether the publishing journal was the first journal of submission. If the article was previously submitted elsewhere, authors were asked which other journals, the dates of submission, and the order of submission. The proportion of articles that were initially submitted to each journal, the mean number of submissions prior to publication, and the mean duration from initial submission to date of publication were calculated for each journal. Results A total of 298 articles were included in this study, and 221 (74%) corresponding authors responded to the survey. The mean number of submissions before acceptance was 1.05 for AJSM, 1.18 for JBJS, 1.20 for KSSTA, 1.38 for Arthroscopy, and 2.19 for OJSM. The percentage of articles that were submitted to their accepting journal first (ie, not previously submitted elsewhere) was 95% for AJSM, 85% for JBJS, 82% for KSSTA, 68% for Arthroscopy, and 13% for OJSM. Conclusion Among the orthopaedic sports medicine journals included in this study, articles published in AJSM have the highest percentage of first submissions.
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Affiliation(s)
- Trevor J Carver
- Department of Orthopedics, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Matthew J Kraeutler
- Department of Orthopaedic Surgery, Seton Hall-Hackensack Meridian School of Medicine, South Orange, New Jersey, USA
| | - Keenan B Amer
- Department of Orthopedics, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Eric C McCarty
- Department of Orthopedics, School of Medicine, University of Colorado, Aurora, Colorado, USA
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16
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Kostrubiak DE, Cattell RF, Momoli F, Schweitzer ME. Has the Objective Quality of Evidence in Imaging Papers Changed Over the Last 20 Years? Acad Radiol 2018; 25:1070-1074. [PMID: 29395797 DOI: 10.1016/j.acra.2017.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 12/01/2017] [Accepted: 12/27/2017] [Indexed: 11/15/2022]
Abstract
RATIONALE AND OBJECTIVES We aimed to determine if both evidence level (EL) as well as clinical efficacy (CE) of imaging manuscripts have changed over the last 20 years. MATERIALS AND METHODS With our review of medical literature, Institutional Review Board approval was waived, and no informed consent was required. Using Web of Science, we determined the 10 highest impact factor imaging journals. For each journal the 10 most cited and 10 average cited papers were compared for the following years: 1994, 1998, 2002, 2006, 2010, and 2014. EL was graded using the same criteria as the Journal of Bone and Joint Surgery (Wright et al., 2003). CE was graded using the criteria of Thornbury and Fryback (1991). Statistical software R and package lme4 were used to fit mixed regression models with fixed effects for group, year, and a random effect for journal. RESULTS EL has improved -0.03 every year on average (P < .001). The more cited papers had better ELs (group effect = -0.23, SE 0.09, P = .011). CE is lower in top cited compared to average cited articles, although the differences were not statistically significant (group effect = -0.14, SE = 0.09, P = .16). CE level increased modestly in both groups over this 20-year time period (0.06 per year, SE = 0.007, P < .001). CONCLUSION Over the last 20 years, imaging journal articles have improved modestly in quality of evidence, as measured by EL and CE.
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Affiliation(s)
| | - Renee F Cattell
- Department of Radiology, Health Sciences Center, Stony Brook University School of Medicine, Stony Brook, New York
| | - Franco Momoli
- Centre for Practice-Changing Research, University of Ottawa, Ottawa, Ontario, Canada
| | - Mark E Schweitzer
- Department of Radiology, Health Sciences Center, Stony Brook University School of Medicine, Stony Brook, New York
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17
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Grassi A, Zaffagnini S. Meta-analysis of the Risk of Infections After Anterior Cruciate Ligament Reconstruction by Graft Type: Letter to Editor. Am J Sports Med 2018; 46:NP20-NP21. [PMID: 29601240 DOI: 10.1177/0363546518761597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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18
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Judy RP, Shin JJ, McCrum C, Ayeni OR, Samuelsson K, Musahl V. Level of evidence and authorship trends of clinical studies in knee surgery, sports traumatology, arthroscopy, 1995-2015. Knee Surg Sports Traumatol Arthrosc 2018; 26:9-14. [PMID: 29138917 DOI: 10.1007/s00167-017-4801-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 11/08/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE There is increasing emphasis on publication quality and internationalization of author groups in orthopaedic literature. The purpose of this review was to evaluate the type of studies and the level of evidence (LOE) published in knee surgery, sports traumatology, arthroscopy (KSSTA) from 1995 to 2015. The secondary aim was to analyze trends in authorship characteristics in KSSTA. METHODS Two reviewers reviewed the table of contents of KSSTA and identified original papers from 1995, 2000, 2005, 2010, and 2015. The reviewers graded LOE from Levels I to IV using guidelines from the University of Oxford's Centre for Evidence-Based Medicine. For each article, the total number of authors and country of author group were also analyzed. RESULTS A total of 880 papers were analyzed. The proportions in LOE have stayed consistent throughout the study period (n.s.). There has been a significant increase in the number of published articles and the number of Level I and II studies (P < 0.01). Therapeutic articles were the most common type. The mean number of authors per KSSTA article significantly increased from 3.9 to 5.7 over the 20-year period (P < 0.01). The number of represented countries increased yearly and academic institutions from 40 different nationalities published articles in the Journal. Of the examined years, the percent of articles with international collaboration was 17.6%. CONCLUSION The proportion of LOE I and II articles published in KSSTA remains consistently high. Therapeutic studies are the most frequently published articles. There is an increase in international groups publishing in KSSTA. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ryan P Judy
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA. .,University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA, 15213, USA.
| | - Jason J Shin
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Christopher McCrum
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Kristian Samuelsson
- Department of Orthopaedics, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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Yasui Y, Ramponi L, Seow D, Hurley ET, Miyamoto W, Shimozono Y, Kennedy JG. Systematic review of bone marrow stimulation for osteochondral lesion of talus - evaluation for level and quality of clinical studies. World J Orthop 2017; 8:956-963. [PMID: 29312855 PMCID: PMC5745439 DOI: 10.5312/wjo.v8.i12.956] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 05/27/2017] [Accepted: 08/16/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To clarify the quality of the studies indicating lesion size and/or containment as prognostic indicators of bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLT).
METHODS Two reviewers searched the PubMed/MEDLINE and EMBASE databases using specific terms on March 2015 in accordance with the Preferred Reporting Items for Systemic Reviews and Meta-Analyses guidelines. Predetermined variables were extracted for all the included studies. Level of evidence (LOE) was determined using previously published criteria by the Journal of Bone and Joint Surgery and methodological quality of evidence (MQOE) was evaluated using the Modified Coleman Methodology Score.
RESULTS This review included 22 studies. Overall, 21 of the 22 (95.5%) included studies were level IV or level III evidences. The remaining study was a level II evidence. MQOE analysis revealed 14 of the 22 (63.6%) included studies having fair quality, 7 (31.8%) studies having poor quality and only 1 study having excellent quality.
CONCLUSION The evidence supporting the use of lesion size and containment as prognostic indicators of BMS for OLTs has been shown to be of low quality.
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Affiliation(s)
- Youichi Yasui
- 2nd Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo 173-8606, Japan
- Hospital for Special Surgery, New York, NY 10021, United States
| | - Laura Ramponi
- Hospital for Special Surgery, New York, NY 10021, United States
- 2nd Rizzoli Orthopaedic Institute, Bologna 4136, Italy
| | - Dexter Seow
- Hospital for Special Surgery, New York, NY 10021, United States
- 2nd Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Eoghan T Hurley
- Hospital for Special Surgery, New York, NY 10021, United States
- 2nd Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Wataru Miyamoto
- Hospital for Special Surgery, New York, NY 10021, United States
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo 173-8606, Japan
| | | | - John G Kennedy
- Hospital for Special Surgery, New York, NY 10021, United States
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20
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Marquez-Lara A, Stone AV, Luo TD, Parker BR, Sharma A, Freehill MT. Top 50 cited journal articles on overhead throwing athletes: a bibliographic analysis. JSES OPEN ACCESS 2017; 1:55-62. [PMID: 30675541 PMCID: PMC6340857 DOI: 10.1016/j.jses.2017.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background The frequency of citations for a journal article is a reflection of its academic impact. The purpose of this study was to identify and characterize the top 50 cited journal articles related to overhead throwing athletes in the published literature. Methods The Web of Science database was searched on January 18, 2016, using the terms "throwing athlete," "baseball," and "pitcher" to identify the top 50 cited articles related to overhead throwing athletes using the all-database function. The type of study, country of origin, publishing journal, and year published were reviewed for each article. Results The top 50 articles identified were cited between 95 and 471 times and were published in 13 journals between 1969 and 2011. Most of the articles were small case series or nonsystematic literature reviews. The shoulder was the most common body region studied in the top 50 articles (33 of 50 [66%]). Among original studies (n = 43), there was a good representation of surgical management of shoulder and elbow pathology in overhead athletes (9 of 43 [20.9%]); however, most of the articles reported on shoulder and elbow kinematics (19 of 43 [44.2%]) and pathoanatomy (15 of 43 [34.9%]). Conclusion The greater prevalence of nonsurgical articles may reflect a continued effort to better understand the different pathologies specific to overhead throwing athletes. An understanding of the variable content and quality of frequently cited articles on overhead throwing athletes may serve as a stepping stone for future studies to advance the diagnosis and management of complex elbow and shoulder injuries in these high functional individuals.
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Affiliation(s)
- Alejandro Marquez-Lara
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Austin V Stone
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - T David Luo
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Benjamin R Parker
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Aman Sharma
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Michael T Freehill
- Department of Orthopaedic Surgery, University of Michigan Health System, Ann Arbor, MI, USA
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21
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Ramponi L, Yasui Y, Murawski CD, Ferkel RD, DiGiovanni CW, Kerkhoffs GMMJ, Calder JDF, Takao M, Vannini F, Choi WJ, Lee JW, Stone J, Kennedy JG. Lesion Size Is a Predictor of Clinical Outcomes After Bone Marrow Stimulation for Osteochondral Lesions of the Talus: A Systematic Review. Am J Sports Med 2017; 45:1698-1705. [PMID: 27852595 DOI: 10.1177/0363546516668292] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The critical lesion size treated with bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLTs) has been 150 mm2 in area or 15 mm in diameter. However, recent investigations have failed to detect a significant correlation between the lesion size and clinical outcomes after BMS for OLTs. PURPOSE To systematically review clinical studies reporting both the lesion size and clinical outcomes after BMS for OLTs. STUDY DESIGN Systematic review. METHODS A systematic search of the MEDLINE and EMBASE databases was performed in March 2015 based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included studies were evaluated with regard to the level of evidence (LOE), quality of evidence (QOE), lesion size, and clinical outcomes. RESULTS Twenty-five studies with 1868 ankles were included; 88% were either LOE 3 or 4, and 96% did not have good QOE. The mean area was 103.8 ± 10.2 mm2 in 20 studies, and the mean diameter was 10.0 ± 3.2 mm in 5 studies. The mean American Orthopaedic Foot and Ankle Society score improved from 62.4 ± 7.9 preoperatively to 83.9 ± 9.2 at a mean 54.1-month follow-up in 14 studies reporting both preoperative and postoperative scores with a mean follow-up of more than 2 years. A significant correlation was found in 3 studies, with a mean lesion area of 107.4 ± 10.4 mm2, while none was reported in 8 studies, with a mean lesion area of 85.3 ± 9.2 mm2. The lesion diameter significantly correlated with clinical outcomes in 2 studies (mean diameter, 10.2 ± 3.2 mm), whereas none was found in 2 studies (mean diameter, 8.8 ± 0.0 mm). However, the reported lesion size measurement method and evaluation method of clinical outcomes widely varied among the studies. CONCLUSION An assessment of the currently available data does suggest that BMS may best be reserved for OLT sizes less than 107.4 mm2 in area and/or 10.2 mm in diameter. Future development in legitimate prognostic size guidelines based on high-quality evidence that correlate with outcomes will surely provide patients with the best potential for successful long-term outcomes.
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Affiliation(s)
| | - Youichi Yasui
- Hospital for Special Surgery, New York, New York, USA.,Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | - Christopher D Murawski
- Hospital for Special Surgery, New York, New York, USA.,University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Richard D Ferkel
- Southern California Orthopedic Institute, Van Nuys, California, USA
| | - Christopher W DiGiovanni
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Academic Center for Evidence Based Sports Medicine, Amsterdam, the Netherlands.,Amsterdam Collaboration on Health and Safety in Sports, Amsterdam, the Netherlands
| | | | - Masato Takao
- Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | | | - Woo Jin Choi
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Woo Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - James Stone
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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22
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Lerman DM, Cable MG, Thornley P, Evaniew N, Slobogean GP, Bhandari M, Healey JH, Randall RL, Ghert M. Has the Level of Evidence of Podium Presentations at the Musculoskeletal Tumor Society Annual Meeting Changed Over Time? Clin Orthop Relat Res 2017; 475:853-860. [PMID: 26920571 PMCID: PMC5289162 DOI: 10.1007/s11999-016-4763-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Level of evidence (LOE) framework is a tool with which to categorize clinical studies based on their likelihood to be influenced by bias. Improvements in LOE have been demonstrated throughout orthopaedics, prompting our evaluation of orthopaedic oncology research LOE to determine if it has changed in kind. QUESTIONS/PURPOSES (1) Has the LOE presented at the Musculoskeletal Tumor Society (MSTS) annual meeting improved over time? (2) Over the past decade, how do the MSTS and Orthopaedic Trauma Association (OTA) annual meetings compare regarding LOE overall and for the subset of therapeutic studies? METHODS We reviewed abstracts from MSTS and OTA annual meeting podium presentations from 2005 to 2014. Three independent reviewers evaluated a total of 1222 abstracts for study type and LOE; there were 577 abstracts from MSTS and 645 from OTA. Changes in the distributions of study type and LOE over time were evaluated by Pearson chi-square test. RESULTS There was no change over time in MSTS LOE for all study types (p = 0.13) and therapeutic (p = 0.36) study types during the reviewed decade. In contrast, OTA LOE increased over this time for all study types (p < 0.01). The proportion of Level I therapeutic studies was higher at the OTA than the MSTS (3% [14 of 413] versus 0.5% [two of 387], respectively), whereas the proportion of Level IV studies was lower at the OTA than the MSTS (32% [134 of 413] versus 75% [292 of 387], respectively) during the reviewed decade. The proportion of controlled therapeutic studies (LOE I through III) versus uncontrolled studies (LOE IV) increased over time at OTA (p < 0.021), but not at MSTS (p = 0.10). CONCLUSIONS Uncontrolled case series continue to dominate the MSTS scientific program, limiting progress in evidence-based clinical care. Techniques used by the OTA to improve LOE may be emulated by the MSTS. These techniques focus on broad participation in multicenter collaborations that are designed in a comprehensive manner and answer a pragmatic clinical question.
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Affiliation(s)
- Daniel M Lerman
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Matthew G Cable
- Sarcoma Services, Primary Children's Hospital & Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Faculty of Health Sciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Patrick Thornley
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, HHS Hamilton General Hospital, 711 Concession Street Hamilton, Hamilton, ON, L8V 1C3, Canada
| | - Nathan Evaniew
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, HHS Hamilton General Hospital, 711 Concession Street Hamilton, Hamilton, ON, L8V 1C3, Canada
| | - Gerard P Slobogean
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mohit Bhandari
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, HHS Hamilton General Hospital, 711 Concession Street Hamilton, Hamilton, ON, L8V 1C3, Canada
| | - John H Healey
- Orthopaedic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - R Lor Randall
- Sarcoma Services, Primary Children's Hospital & Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Faculty of Health Sciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Michelle Ghert
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, HHS Hamilton General Hospital, 711 Concession Street Hamilton, Hamilton, ON, L8V 1C3, Canada.
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23
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Wu HH, Liu M, Patel KR, Turner W, Baltus L, Caldwell AM, Hahn JC, Coughlin RR, Morshed S, Miclau T, Shearer DW. Impact of academic collaboration and quality of clinical orthopaedic research conducted in low- and middle-income countries. SICOT J 2017; 3:6. [PMID: 28134090 PMCID: PMC5278648 DOI: 10.1051/sicotj/2016042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 11/24/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Little is known about the quality of orthopaedic investigations conducted in low- and middle-income countries (LMICs). Academic collaboration is one model to build research capacity and improve research quality. Our study aimed to determine (1) the quality of clinical orthopaedic research conducted in LMICs, (2) the World Bank Regions and LMICs that publish the highest quality studies, (3) the pattern of collaboration among investigators and (4) whether academic collaboration between LMIC and non-LMIC investigators is associated with studies that have higher levels of evidence. METHODS Orthopaedic studies from 2004 to 2014 conducted in LMICs were extracted from multiple electronic databases. The World Bank Region, level of evidence and author country-affiliation were recorded. Collaboration was defined as a study that included an LMIC with non-LMIC investigator. RESULTS There were 958 studies that met inclusion criteria of 22,714 searched. Ninety-seven (10.1%) of included studies achieved Level 1 or 2 evidence, but case series (52.3%) were the most common. Collaboration occurred in 14.4% of studies and the vast majority of these (88.4%) were among academic institutions. Collaborative studies were more likely to be Level 1 or 2 (20.3% vs. 8.4%, p < 0.01), prospective (34.8% vs. 22.9% p = 0.04) and controlled (29.7% vs. 14.4%, p < 0.01) compared to non-collaborative studies. CONCLUSIONS Although orthopaedic studies in LMICs rarely reach Level 1 or 2 evidence, studies published through academic collaboration between LMIC and non-LMIC investigators are associated with higher levels of evidence and more prospective, controlled designs.
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Affiliation(s)
- Hao-Hua Wu
- Department of Orthopaedic Surgery, Orthopaedic Trauma Institute, Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, San Francisco, CA 94110, USA
| | - Max Liu
- Department of Orthopaedic Surgery, Orthopaedic Trauma Institute, Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, San Francisco, CA 94110, USA
| | - Kushal R Patel
- Department of Orthopaedic Surgery, University of Illinois College of Medicine, Chicago, IL 60612, USA
| | - Wes Turner
- Department of Orthopaedic Surgery, Orthopaedic Trauma Institute, Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, San Francisco, CA 94110, USA
| | - Lincoln Baltus
- Department of Orthopaedic Surgery, Orthopaedic Trauma Institute, Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, San Francisco, CA 94110, USA
| | - Amber M Caldwell
- Department of Orthopaedic Surgery, Orthopaedic Trauma Institute, Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, San Francisco, CA 94110, USA
| | - Jesse C Hahn
- Department of Orthopaedic Surgery, Orthopaedic Trauma Institute, Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, San Francisco, CA 94110, USA
| | - Ralph Richard Coughlin
- Department of Orthopaedic Surgery, Orthopaedic Trauma Institute, Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, San Francisco, CA 94110, USA
| | - Saam Morshed
- Department of Orthopaedic Surgery, Orthopaedic Trauma Institute, Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, San Francisco, CA 94110, USA
| | - Theodore Miclau
- Department of Orthopaedic Surgery, Orthopaedic Trauma Institute, Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, San Francisco, CA 94110, USA
| | - David W Shearer
- Department of Orthopaedic Surgery, Orthopaedic Trauma Institute, Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, San Francisco, CA 94110, USA
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Abstract
OBJECTIVE To review and critically assess trends observed regarding the levels of evidence in published articles in orthopaedic traumatology literature. DATA SOURCES The Journal of Orthopaedic Trauma, Journal of Bone and Joint Surgery-American, and Clinical Orthopaedics and Related Research. STUDY SELECTION All articles from the years 1998, 2003, 2008, and 2013 in The Journal of Orthopaedic Trauma (JOT) and orthopaedic trauma-related articles from The Journal of Bone and Joint Surgery-American (JBJS-A) and Clinical Orthopaedics and Related Research (CORR) were analyzed. Articles were categorized by type and ranked for level of evidence according to guidelines from the Centre for Evidence-Based Medicine. DATA EXTRACTION Study type and standardized level of evidence were determined for each article. Articles were subcategorized as high-level evidence (I, II), moderate-level evidence (III), and low-level evidence (IV, V). DATA SYNTHESIS During the study period, Journal of Bone and Joint Surgery-American reduced its low-level studies from 80% to 40% (P = 0.00015), Clinical Orthopaedics and Related Research decreased its low-level studies from 70% to 27%, and Journal of Orthopaedic Trauma decreased its low-level studies from 78% to 45%. Level IV and V therapeutic, prognostic, and diagnostic studies demonstrated significant decreases during the study period (P = 0.0046, P < 0.0001, P = 0.026). The percentage of high-level studies increased from 13% to 19%; however, this was not significant (P = 0.42). There was a trend showing an increase in level I and II studies for therapeutic, prognostic, and diagnostic studies (P = 0.06). CONCLUSIONS There has been a statistically significant decrease in lower level of evidence studies published in the orthopaedic traumatology literature over the past 15 years.
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Brophy RH, Kluck D, Marx RG. Update on the Methodological Quality of Research Published in The American Journal of Sports Medicine: Comparing 2011-2013 to 10 and 20 Years Prior. Am J Sports Med 2016. [PMID: 26202383 DOI: 10.1177/0363546515591264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In recent years, the number of articles in The American Journal of Sports Medicine (AJSM) has risen dramatically, with an increasing emphasis on evidence-based medicine in orthopaedics and sports medicine. HYPOTHESIS Despite the increase in the number of articles published in AJSM over the past decade, the methodological quality of articles in 2011-2013 has improved relative to those in 2001-2003 and 1991-1993. STUDY DESIGN Meta-analysis. METHODS All articles published in AJSM during 2011-2013 were reviewed and classified by study design. For each article, the use of pertinent methodologies, such as prospective data collection, randomization, control groups, and blinding, was recorded. The frequency of each article type and the use of evidence-based techniques were compared relative to 1991-1993 and 2001-2003 by use of Pearson χ(2) testing. RESULTS The number of research articles published in AJSM more than doubled from 402 in 1991-1993 and 423 in 2001-2003 to 953 in 2011-2013. Case reports decreased from 15.2% to 10.6% to 2.1% of articles published over the study period (P < .001). Cadaveric/human studies and meta-analysis/literature review studies increased from 5.7% to 7.1% to 12.4% (P < .001) and from 0.2% to 0.9% to 2.3% (P = .01), respectively. Randomized, prospective clinical trials increased from 2.7% to 5.9% to 7.4% (P = .007). Fewer studies used retrospective compared with prospective data collection (P < .001). More studies tested an explicit hypothesis (P < .001) and used controls (P < .001), randomization (P < .001), and blinding of those assessing outcomes (P < .001). Multi-investigator trials increased (P < .001), as did the proportion of articles citing a funding source (P < .001). CONCLUSION Despite a dramatic increase in the number of published articles, the research published in AJSM shifted toward more prospective, randomized, controlled, and blinded designs during 2011-2013 compared with 2001-2003 and 1991-1993, demonstrating a continued improvement in methodological quality.
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Affiliation(s)
| | - Dylan Kluck
- Washington University, St Louis, Missouri, USA
| | - Robert G Marx
- Hospital for Special Surgery, New York, New York, USA
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Abstract
STUDY DESIGN Bibliometric study of current literature. OBJECTIVE To identify and analyze the 100 most cited publications in cervical spine research. SUMMARY OF BACKGROUND DATA The cervical spine is a dynamic field of research with many advances made within the last century. The literature has, however, never been comprehensively analyzed to identify and compare the most influential articles as measured by the number of citations. METHODS All databases of the Thomson Reuters Web of Knowledge were utilized in a two-step approach. First, the 150 most cited cervical spine studies up to and including 2014 were identified using four keywords. Second, all keywords related to the cervical spine found in the 150 studies (n = 38) were used to conduct a second search of the database. The top 100 most cited articles were hereby selected for further analysis of current and past citations, authorship, geographic origin, article type, and level of evidence. RESULTS Total citations for the 100 studies identified ranged from 173 to 879. They were published in the time frame 1952 to 2008 in a total of 30 different journals. Most studies (n = 42) were published in the decade 1991-2000. Level of evidence ranged from 1 to 5 with 39 studies in the level 4 category. A total of 13 researchers were first author more than once and nine researchers senior author more than once. The two-step approach with a secondary widening of search terms yielded an additional 27 studies, including the first ranking article. CONCLUSION This bibliometric study is likely to include some of the most important milestones in the field of cervical spine research of the last 100 years.
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