Publication bias in orthopaedic research: an analysis of scientific factors associated with publication in the Journal of Bone and Joint Surgery (American Volume)

Rates of positive vs negative studies in the spine literature

Background

Accuracy in the interpretation of data, and publication of studies regardless of outcomes are vital to the development of the scientific literature.

Objective

To determine the proportion of studies in the spine literature that report positive results.

Study design

Review article of studies published in nine major spine, pain, and physical medicine and rehabilitation (PM&R) journals from January 1, 2018-December 31, 2022.

Patient sample

Not applicable.

Methods

Articles that reported on pain and/or function from 2018 to 2022 in nine major journals were reviewed by two independent evaluators. The articles were graded as either positive or negative based on the authors' own conclusions about their work.

Results

Overall, 91 % [95 % CI 88-94 %] of all articles were reported to have positive results. No significant differences were found between the broad categories of spine, pain, and PM&R journals. When comparing different categories of treatments, there were lower rates of positive results from medication/supplement studies (54 % [95 % CI 27-81 %]) compared to studies of spine injections/interventions (95 % [95 % CI 91-99 %]) and those of surgery (100 % [95 % CI 96-100 %]), and a lower rate of positive results from studies on physical treatments (85 % [95 % CI 75-95 %]) compared to those of surgery (100 % [95 % CI 96-100 %]). Studies with placebo controls were less likely to report positive results (60 % [95 % CI 44-76 %]) compared to those that did not use placebo controls (96 % [95 % CI 94-98 %]).

Conclusions

Despite the vast majority of studies in the spine literature concluding positive results, the high disease prevalence of spine conditions and the enormous burden on the healthcare system remain.

Positive Outcome Bias in the Influential Otolaryngology Clinical Trial Literature

OBJECTIVE

To assess for the presence of positive outcome bias in the otolaryngology clinical trial literature. Specifically, we investigate the prevalence of clinical trials with positive findings (CTP) and clinical trials with negative findings (CTN), as well as their quality of evidence and subsequent impact.

STUDY DESIGN

Retrospective analysis.

SETTING

Clinical Trials in the Influential Otolaryngology Literature.

METHODS

We reviewed all clinical trials published in 4 major otolaryngology journals between 2000 and 2020. We constructed several multivariable regression models to investigate the relationship of finding direction with randomization status and citation count. Subsequently, we incorporated an interaction term between year and the primary covariate of each model to assess the temporal trajectory of these relationships. All models accounted for sample size, journal, subspecialty, and the affiliated program prestige.

RESULTS

Of the 1367 trials analyzed, 1143 (84%) were CTPs, a rate that persisted throughout the study period (aOR 1.00, 95% CI 0.98-1.03). CTPs were significantly less likely to be randomized compared to CTNs (aOR 0.25, 0.17-0.37), a relationship that persisted over time (aOR 1.05, 0.99-1.03). CTPs received significantly more citations compared to CTNs (aIRR 1.41, 1.25-1.60), a disparity that also persisted over time (aIRR 0.99, 0.97-1.01).

CONCLUSION

The otolaryngology clinical trial literature has been heavily dominated by positive findings. CTPs were more frequently cited and published even with a lower level of evidence compared to CTNs. This bias may influence the objectivity of evidence used to guide clinical practice and warrants attention when reviewing findings and changing practices.

Discontinuation and nonpublication of clinical trials in orthopaedic oncology

BACKGROUND

Despite the pivotal role of clinical trials in advancing orthopaedic oncology knowledge and treatment strategies, the persistent issues of trial discontinuation and nonpublication are significant problems. This study conducted an analysis examining clinical trial discontinuation rates, associations between intervention types and discontinuation/nonpublication, and the role of funding, enrollment size, and their implications for trial success and completion.

METHODS

This study, conducted on May 1, 2023, utilized a cross-sectional design to comprehensively analyze phase 3 and 4 randomized controlled trials within the realm of orthopaedic oncology. We specifically incorporated Phase 3 and 4 trials as they are designed to evaluate prolonged outcomes in human subjects and are more likely to reach publication. Study characteristics of interest included the intervention utilized in the clinical trial, presence of funding, whether the trial was published, completed, and trial enrollment size. The investigation involved an examination of ClinicalTrials.gov, a prominent online repository of clinical trial data managed by the National Library of Medicine of the USA. Descriptive statistics and multivariate logistic regressions were used to determine statistical significance.

RESULTS

Among the cohort of 130 trials, 19.2% were prematurely discontinued. Completion rates varied based on intervention type; 111 pharmaceutical trials demonstrated a completion rate of 83.8%, whereas 19 non-pharmaceutical trials exhibited a completion rate of 8.0% (P < .001). Surgical trials, totaling 10, showed a completion rate of 90%. The overall trial publication rate was 86.15%, with pharmaceutical interventions achieving a publication rate of 91.96%. Larger-scale trials (≥ 261 participants) emerged as a protective factor against both discontinuation (Adjusted Odds Ratio [AOR]: 0.85, 95% Confidence Interval [CI] 0.42-0.95) and nonpublication (AOR: 0.19, 95% CI 0.13-.47), compared to smaller-scale trials.

CONCLUSION

This study accentuates the heightened vulnerability of non-pharmaceutical interventions and trials exhibiting lower rates of enrollment to the issues of discontinuation and nonpublication. Moving forward, the advancement of clinical trials necessitates a concerted effort to enhance trial methodologies, especially concerning nonpharmaceutical interventions, along with a meticulous refinement of participant enrollment criteria.

Comparing Orthopaedic Randomized Control Trials Published in High-Impact Medical and Orthopaedic Journals

INTRODUCTION

Orthopaedic studies published in high-impact medical journals are often believed to have a high prevalence of negative or neutral results and possess methodological characteristics that may bias toward nonsurgical treatments. The purpose of this study was to compare study characteristics, methodologic quality, exposure, and outcome direction among orthopaedic randomized control trials (RCTs) published in high-impact medical and orthopaedic journals and to identify study attributes associated with greater impact.

METHODS

RCTs published between January 2010 and December 2020 in the five medical journals and 10 orthopaedic journals with the highest 5-year impact factors were analyzed. Inclusion criteria were RCTs reporting on orthopaedic surgical intervention compared with nonsurgical or less-invasive surgical procedures. Study characteristics, methodologic quality (Jadad scale), outcomes, and altmetric data were collected. Primary outcomes were categorized as positive (favoring surgical/more-extensive surgery), negative (favoring nonsurgical/less-extensive surgery), or neutral.

RESULTS

One hundred twenty-eight RCTs were analyzed; 26 from medical and 102 from orthopaedic journals. Studies published in medical journals included more authors ( P < 0.001), larger sample sizes ( P < 0.001), more institutions ( P < 0.001), and more often received funding ( P < 0.001). The average Jadad scale did not significantly differ between journals ( P = 0.14). The direction of the primary study outcome did not differ between journals ( P = 0.22). Average AAS and annual citation rates were higher in RCTs published in medical journals ( P < 0.001). Publication in a medical journal was the only covariate associated with higher annual citation rates ( P < 0.001) and AAS ( P < 0.001) on multivariable analyses.

DISCUSSION

High-impact medical journals do not publish orthopaedic RCTs with negative or neutral findings at a rate that significantly differs from orthopaedic journals. However, the higher impact and digital coverage of the studies published in medical journals may disproportionally influence the practices of nonorthopaedic providers. Raising awareness of critical findings published in orthopaedic journals may be particularly important for improving healthcare policies and orthopaedic referral patterns for musculoskeletal problems.

Factors relating to nonpublication and publication bias in clinical trials in Canada: A qualitative interview study

AIMS

This study aims to understand factors contributing to nonpublication and publication bias in clinical trials in Canada.

METHODS

Qualitative interviews were conducted between March 2019 and April 2021 with 34 participants from the Canadian provinces of Alberta, British Columbia and Ontario, including 17 clinical trial investigators, 1 clinical research coordinator, 3 research administrators, 3 research ethics board members and 10 clinical trial participants. We conducted a thematic analysis involving coding of interview transcripts and memo-writing to identify key themes.

RESULTS

Several factors contribute to nonpublication and publication bias in clinical trial research. A core theme was that reporting practices are shaped by incentives within the research system taht favour publication of positive over negative trials. Investigators are discouraged from reporting by experiences or perceptions of difficulty in publishing negative findings but rewarded for publishing positive findings in various ways. Trial investigators more strongly associated positive clinical trials than negative trials with opportunities for industry and nonindustry funding and with academic promotion, bonuses and recognition. Research institutions and ethics boards tended to lack well-resourced, proactive policies and practices to ensure trial findings are reported in registries or journals.

CONCLUSION

Clinical trial reporting practices in Canada are shaped by incentives favouring reporting of positive over negative trials, such as funding opportunities and academic promotion, bonuses and recognition. Research institutions could help change incentives by adopting performance metrics that emphasize full reporting of results in journals or registries.

Evaluating Translational Methods for Personalized Medicine—A Scoping Review

The introduction of personalized medicine, through the increasing multi-omics characterization of disease, brings new challenges to disease modeling. The scope of this review was a broad evaluation of the relevance, validity, and predictive value of the current preclinical methodologies applied in stratified medicine approaches. Two case models were chosen: oncology and brain disorders. We conducted a scoping review, following the Joanna Briggs Institute guidelines, and searched PubMed, EMBASE, and relevant databases for reports describing preclinical models applied in personalized medicine approaches. A total of 1292 and 1516 records were identified from the oncology and brain disorders search, respectively. Quantitative and qualitative synthesis was performed on a final total of 63 oncology and 94 brain disorder studies. The complexity of personalized approaches highlights the need for more sophisticated biological systems to assess the integrated mechanisms of response. Despite the progress in developing innovative and complex preclinical model systems, the currently available methods need to be further developed and validated before their potential in personalized medicine endeavors can be realized. More importantly, we identified underlying gaps in preclinical research relating to the relevance of experimental models, quality assessment practices, reporting, regulation, and a gap between preclinical and clinical research. To achieve a broad implementation of predictive translational models in personalized medicine, these fundamental deficits must be addressed.

Charting the course from abstract to published article

OBJECTIVE

Abstracts act as short, efficient sources of new information. This intentional brevity potentially diminishes scientific reliability of described findings. The authors' objective was to 1) determine the proportion of abstracts submitted to the American Association of Neurological Surgeons (AANS) annual meeting that subsequently are published in peer-reviewed journals, 2) assess AANS abstract publications for publication bias, and 3) assess AANS abstract publications for differing results.

METHODS

The authors screened all abstracts from the annual 2012 AANS meeting and identified their corresponding full-text publication, if applicable, by searching PubMed/MEDLINE. The abstract and subsequent publication were analyzed for result type (positive or negative) and differences in results.

RESULTS

Overall, 49.3% of abstracts were published as papers. Many (18.1%) of these published papers differed in message from their original abstract. Publication bias exists, with positive abstracts being 40% more likely to be published than negative abstracts. The top journals in which the full-text articles were published were Journal of Neurosurgery (13.1%), Neurosurgery (7.3%), and World Neurosurgery (5.4%).

CONCLUSIONS

Here, the authors demonstrate that alone, abstracts are not reliable sources of information. Many abstracts ultimately remain unpublished; therefore, they do not attain a level of scientific scrutiny that merits alteration of clinical care. Furthermore, many that are published have differing results or conclusions. In addition, positive publication bias exists, as positive abstracts are more likely to be published than negative abstracts.

Methods to Mitigate Industry Influence in Industry Sponsored Research

Medical and surgical research has always had a long-standing relationship with industry-based funding from sources, such as drug and device companies. Concerns exist surrounding the association between funding sources, outcome from studies and publication bias. Studies demonstrating increased odds ratios associated with positive results in industry sponsored studies across medicine have stimulated Cochrane reviews, literature reviews and other articles to examine this relationship further. In spine surgery in particular, studies with positive results have an odds ratio of 3.3 of being published. This article discusses the biases associated with industry sponsorship, possible ways to reduce such biases and ways to improve transparency in research relationships. This article explores the types of bias that can be encountered at different stages of research including previous trials in spine surgery. The means of improving transparency including the Physician Payment Sunshine Act of 2010 and International Committee of Medical Journal Editors (ICJME) accreditation are discussed. We recognize that physicians undertaking industry sponsored research should be protected and not be liable to perverse incentives. We conclude that mitigating bias in industry sponsored research is a multistep process and needs a multifaceted approach. The main beneficiary of research should be patients and as such a collective effort from medical professionals, health care institutions, journals and industry should approach research, and publications with that in mind.

Orthopaedic Randomized Controlled Trials Published in General Medical Journals Are Associated With Higher Altmetric Attention Scores and Social Media Attention Than Nonorthopaedic Randomized Controlled Trials

PURPOSE

To (1) compare the Altmetric Attention Score (AAS) and citation rates between orthopaedic and nonorthopaedic randomized controlled trials (RCTs) from 5 high-impact medical journals and (2) identify general characteristics of these articles associated with greater exposure on social media platforms.

METHODS

Articles published in The New England Journal of Medicine (NEJM), Lancet, The Journal of the American Medical Association (JAMA), Annals of Internal Medicine, and Archives of Internal Medicine between January 2011 and December 2016 were analyzed. These journals were selected based on retaining high impact factors with rigorous publication standards and availability of the AAS for their publications. The queried time frame was chosen to balance the inception of the AAS with an optimal period for citation accrual. A total of 14 article characteristics, in addition to number of Tweets, Facebook shares, news mentions, and the AAS, were extracted. Inclusion criteria were orthopaedic RCTs reporting on outcomes after surgical intervention. Linear regression was used to assess the relationship between publication characteristics and the AAS and social media attention.

RESULTS

A total of 9 orthopaedic and 59 nonorthopaedic RCTs were included. The mean AASs were significantly different (574 ± 565.7 versus 256.9 ± 222.3, P = .003), whereas citation rate was not (192.2 ± 117.1 versus 382.3 ± 560.3, P = .317). Orthopaedic RCTs had a significantly greater number of mentions on Twitter and Facebook (P < .001). A higher AAS significantly associated with a greater number of citations (β = 0.75, P = .019) for orthopaedic RCTs. The mean AAS of orthopaedic RCTs favoring nonoperative management (809.6 ± 676.3) was greater than those favoring operative treatment (292.0 ± 248.9) but was not statistically significant (P = .361).

CONCLUSION

Orthopaedic RCTs published in 5 high-impact general medical journals had a significantly greater mean AAS relative to nonorthopaedic RCTs, with no differences in citation rates. Additionally, there was a strong association between the AAS and citation rate of orthopaedic RCTs. Orthopaedic RCTs had greater social media exposure on both Twitter and Facebook.

CLINICAL RELEVANCE

Orthopaedic surgeons, researchers, and providers who publish RCTs in high-impact medical journals can anticipate extensive social media attention for their articles relative to other nonorthopaedic RCTs in the same journals. Social media attention may be related to operative versus nonoperative management topics. This study provides further evidence for the increasing use of the AAS and its association with citation accrual.

The Outcomes of "Submitted" Publications From Applicants to Orthopaedic Surgery Residency Programs: A Retrospective Review of 1303 Residency Applications

Purpose:

To evaluate research listed as “Submitted” on orthopaedic surgery residency applications for eventual publication rates and quality.

Significance:

As the orthopaedic surgery residency selection process becomes increasingly competitive, the number of research publications listed on applications continually increases. However, the utility of using publications listed as “Submitted” in the applicant evaluation process remains unknown.

Methods:

Demographic and publication data were retrospectively collected from 1303 applications to an orthopaedic surgery residency program. The PubMed database was used to verify “Submitted” publications for (1) publication fruition or (2) publication mismatch, defined as discordance between the listed journal of submission and the eventual journal of publication.

Results:

A total of 594 applications (45.6%) listed ≥1 publication as “Submitted.” Out of 1636 “Submitted” publications, 565 were unverifiable (32.5%). Of the 1071 verified publications, 362 (33.8%) experienced publication mismatch. Within this subgroup, a significant difference existed between the mean impact factors of the listed journal of submission and the eventual journal of publication (1.5 ± 2.7 versus 3.0 ± 2.5, P < 0.01). Demographic data were not predictive of having an unverified publication.

Conclusion:

Publications listed as “Submitted” in orthopaedic surgery residency applications frequently remain unpublished or are published in less impactful journals than originally intended.

Assessing the level of evidence in the orthopaedic literature, 2013-2018: a review of 3449 articles in leading orthopaedic journals

Background

In biomedical research, level of evidence (LOE) indicates the quality of a study. Recent studies evaluating orthopaedic trauma literature between 1998 and 2013 have indicated that LOE in this field has improved. The objective of this study was to determine the validity of one such study by 1) comparing our results and how they relate to more recent years of publications; and 2) assessing how our findings may be used to estimate future changes.

Methods

A total of 3449 articles published from 2013 to 2018 in The Journal of Orthopaedic Trauma (JOT); Journal of Bone and Joint Surgery, American Volume (JBJS-Am); and Clinical Orthopaedics and Related Research (CORR) were evaluated for their LOE. Articles published in JBJS-Am or CORR were classified as trauma or nontrauma studies; articles published in JOT were considered trauma studies. Articles were assigned a LOE using guidance published by JBJS-Am in 2015.

Results

The percentage of total high-level (level I or II) trauma and nontrauma articles published in JOT, JBJS-Am, and CORR decreased from 2013 to 2018 (trauma 23.1 to 19.2%, p = 0.190; nontrauma 28.8 to 24.9%, p = 0.037). JBJS-Am published the highest percentage of level-I trauma studies, and CORR published the lowest percentage of level-IV studies. JBJS-Am and CORR published higher percentages of level-I trauma studies and lower percentages of level-IV nontrauma studies than all trauma studies.

Conclusions

Based on our results we cannot validate the findings of previous studies as we found the overall LOE of both trauma and nontrauma orthopaedic literature has decreased in recent years. JBJS-Am published a greater percentage of high-level studies than did JOT and CORR. Although the number and percentage of high-level studies published in JOT increased during the study period, it still lagged behind JBJS-Am and CORR.

Last five years audit of Journal of Clinical Orthopaedics and Trauma (JCOT) - A scientometric analysis

BACKGROUND

We have studied the growth of Journal of Clinical Orthopaedics and Trauma (JCOT), the official journal of the Delhi Orthopaedic Association indexed in PubMed, Scopus and Embase, along with an analysis of citation trends and levels of evidence of published articles in the last five years.

METHODS

SCOPUS and PubMed databases (2015-19) were used to extract publication-related data for the last five years. The official website of the journal was also used to retrieve issue-specific data. An audit of recent publications in the JCOT was conducted focusing on number of issues and publications(year wise), types of articles published, review speed, level of evidence of publications, types of publication(speciality wise), number of publications in PubMed and SCOPUS, number of citations(year wise), national and international authorship and the Cite Scores.

RESULTS

The submissions were increased by 2.8 times and the citations rocketed to 16.6 times in 2019, compared to 2015. A total of 890 papers were there and the journal was cited 1702 times in the last five years. More articles with higher levels of evidence papers are now being published.

CONCLUSION

There has been a significant increase in the numbers of submissions, publications, citations, Cite Score, h-index and contribution by the International authors. Its Editorial efficiency has also been outstanding with timely reviews and editorial decisions. The JCOT has become increasingly internationally relevant in the last five years, in the orthopaedic community. However, JCOT needs to publish more papers with a higher level of evidence like Systematic reviews, Meta-analyses, Randomized Controlled Trials and should only publish top-class lower hierarchy papers (like Case reports, Case-controlled and Retrospective studies).

Publication bias in diagnostic imaging: conference abstracts with positive conclusions are more likely to be published

OBJECTIVE

To evaluate whether imaging diagnostic test accuracy conference abstracts with positive conclusions or titles are more likely to reach full-text publication than those with negative (or neutral) conclusions or titles.

METHODS

Diagnostic accuracy research abstracts were included if they were presented at the 2011 or 2012 Radiological Society of North America conference. Full-text publication status at 5 years post conference abstract submission was determined. Conclusion and title positivity of conference abstracts were extracted, as well as potential confounding factors. The associations of conclusion and title positivity with publication status at 5 years post conference abstract submission were assessed using a multivariable logistic regression model. Conditional odds ratios were calculated to express the strength of associations, adjusting for the confounders.

RESULTS

In total, 282/400 (71%) of included conference abstracts reached full-text publication. A total of 246 out of 337 (74%) conference abstracts with positive conclusions resulted in full-text publications, compared with 26/48 (54%) with neutral conclusions and 5/15 (33%) with negative conclusions. In multivariable logistic regression, conclusion positivity was significantly associated with full-text publication (odds ratio 3.6; 95% CI 1.9-6.7 for conference abstracts with positive conclusions, compared with those with non-positive conclusions); this did not apply to title positivity (odds ratio 1.2; 95% CI 0.47-3.0).

CONCLUSION

Imaging conference abstracts with positive conclusions were more likely to be published as full-text articles. Title positivity was not associated with publication. This preferential publication pattern may lead to an overrepresentation of positive studies in the literature. An overrepresentation of positive studies may contribute to inflated estimates of test accuracy and has the potential to adversely influence patient care.

KEY POINTS

• Imaging diagnostic test accuracy conference abstracts with positive conclusions were more likely to be reported as full-text articles than those with non-positive conclusions. • The majority (75%) of imaging diagnostic test accuracy conference abstracts with positive conclusions were published, compared with only 53% and 33% with neutral and negative conclusions, respectively. • Conclusion positivity remained associated with the full-text publication of conference abstracts when controlling for multiple potential confounding variables.

Current State in Scientific Publishing: AOA Critical Issues Symposium

Orthopaedic surgery has a rich history of publication of the science that supports the practice of our specialty, which dates from 1887. Orthopaedic publishing has evolved since that time, expanding from print to online access, with increasing variation in publication models, including open-access journals and article repositories, and methods of information delivery that include video, data archives, and commentary. This symposium provides an overview of the changes and challenges in the publication of orthopaedic science.

Trends in Foot and Ankle Studies Published in High-Impact General Medical Journals: A Systematic Review

The foot and ankle surgery literature lacks an analysis of studies published in general medical journals. Studies published in general medical journals have high visibility and significant impact on decision making by medical practitioners and health care policy makers. Knowledge of the subject matter and methodologic characteristics of foot and ankle publications being read by general medical practitioners and the lay public is important to the practicing foot and ankle surgeon. A systematic review of foot and ankle studies published from 2000 to 2017 in 5 high-impact general medical journals was undertaken. Data extracted included study topic, study design, study demographics, and methodologic characteristics of randomized controlled trials (RCTs). There were 47 foot and ankle studies published in the selected medical journals examined during the study time period. Most common topics were diabetic foot ulcers (n = 25 [53.2%]), plantar fasciitis (n = 6 [12.8%]), and Achilles tendinopathy (n = 5 [10.6%]). The most common study types were reviews (n = 24 [51.1%]), RCTs (n = 12 [25.4%], and prospective studies (n = 6 [12.8%]). Of the published RCTs, the most common journal of publication was the Journal of the American Medical Association (n = 7 [58.3%]). The median number of citations for RCTs published before 2016 was 242.5. Of the small number of RCTs that compared operative with nonoperative treatment, the majority supported nonoperative management (n = 3 [75%]). Diabetic foot ulcers, plantar fasciitis, and Achilles tendinopathy are the most commonly published foot and ankle topics in general medical journals.

An Evaluation of Publication Bias in High-Impact Orthopaedic Literature

Background:

Statistical analysis of systematic reviews allows the results of previous studies to be combined and synthesized to assess the overall health effect of the intervention in question. Systematic reviews can also be used to guide the creation of clinical practice guidelines and are considered to have a high level of evidence. Thus, it is important that their methodological quality is of the highest standard. Publication bias presents 2 problems: (1) studies with significant results may be overrepresented in systematic reviews and meta-analyses (“false positives”) and (2) studies without significant results may not be included in systematic reviews and meta-analyses (“false negatives”) because each study, on its own, was underpowered, meaning that some treatment options that may have clinical benefit will not be adopted.

Methods:

We performed a study to evaluate the techniques used by authors to report and evaluate publication bias in the top 10 orthopaedic journals as well as 3 orthopaedic-related Cochrane groups. Two authors independently screened the titles and abstracts to identify systematic reviews and meta-analyses. We assessed publication bias in the systematic reviews that did not assess publication bias themselves.

Results:

Our final sample included 694 systematic reviews or meta-analyses that met our inclusion criteria. Our review included 502 studies (72%) that focused on clinical outcomes, with the majority of the remaining studies focused on predictive and prognostic accuracy (20%) or diagnostic accuracy (5%). Publication bias was discussed in 295 (42.5%) of the included studies and was assessed in 135 (19.5%). Of the studies that assessed publication bias, 31.9% demonstrated evidence of publication bias. Only 43% and 22% of studies that involved use of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines discussed and assessed publication bias, respectively.

Conclusions:

Publication bias is infrequently discussed and assessed in the high-impact orthopaedic literature. Furthermore, nearly one-third of the studies that assessed for publication bias demonstrated evidence of publication bias. In addition to these shortcomings, fewer than half of these studies involved use of the PRISMA guidelines and yet only one-fourth of the studies assessed for publication bias.

Clinical Relevance:

By understanding the degree to which publication bias is discussed and presented in high-impact orthopaedic literature, changes can be made by journals and researchers alike to improve the overall quality of research produced and reported.

Research integrity and the law that never was

Evidence-based medicine is arguably among the most important innovations of the modern era, but publication bias and inadequate research transparency are serious issues affecting the very foundation of evidence-based practice. Despite this truth, these crucial issues have gone largely unaddressed or inadequately addressed for a distressingly long period of time. Regulatory efforts have thus far proven insufficient in eliminating these issues. Fortunately, the last 5 years in particular have seen developments that one hopes will contribute to the eradication of these issues and a future where we can look back on these issues as a sordid story of our past. However, much like the purported fixes of the past, time will be the final arbiter of the efficacy of remedial measures currently underway. This article chronicles the history of these issues, failed attempts to fix these issues, and what can be and is being done with the hope of bringing about true resolution.

Fifty Most-cited Articles on Lateral Epicondylitis of the Elbow

Introduction:

Citation number can be used as a marker of a scientific article's influence. This study sought to determine and characterize the most-cited investigations on lateral epicondylitis and identify the most influential studies pertaining to this pathology.

Methods:

The Institute for Scientific Information Web of Science database was queried for articles investigating lateral epicondylitis, and the 50 most-cited articles were selected. For each article, number of citations, citation density, journal, publication year, country of origin, language, article type, article subtype, and level of evidence were recorded.

Results:

Citation numbers ranged from 72 to 332 (mean, 127.4), and densities ranged from 1.6 to 34.0 (mean, 9.4). Articles were published across 26 different journals. Most articles (41) were clinical, with randomized controlled trials (29.3%) being the most commonly cited articles.

Discussion:

Compared with previous investigations looking at citation density within orthopaedics, the most commonly cited clinical articles on lateral epicondylitis had a high percentage of level I or II evidence (39.0%). This compilation of the literature can aid in establishing reading curriculums for trainees in both orthopaedic residencies and fellowships. This is a Level V study.

Oral presentation to publication: publication rates of abstract presentations across two pediatric neurosurgical meetings

OBJECTIVE Both the American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Section on Pediatric Neurological Surgery (AANS/CNS Pediatric Section) and the International Society for Pediatric Neurosurgery (ISPN) annual meetings provide a platform for pediatric neurosurgeons to present, discuss, and disseminate current academic research. An ultimate goal of these meetings is to publish presented results in peer-reviewed journals. The purpose of the present study was to investigate the publication rates of oral presentations from the 2009, 2010, and 2011 AANS/CNS Pediatric Section and ISPN annual meetings in peer-reviewed journals. METHODS All oral presentations from the 2009, 2010, and 2011 AANS/CNS Pediatric Section and ISPN annual meetings were reviewed. Abstracts were obtained from the AANS/CNS Pediatric Section and ISPN conference proceedings, which are available online. Author and title information were used to search PubMed to identify those abstracts that had progressed to publication in peer-reviewed journals. The title of the journal, year of the publication, and authors' country of origin were also recorded. RESULTS Overall, 60.6% of the presented oral abstracts from the AANS/CNS Pediatric Section meetings progressed to publication in peer-reviewed journals, as compared with 40.6% of the ISPN presented abstracts (p = 0.0001). The journals in which the AANS/CNS Pediatric Section abstract-based publications most commonly appeared were Journal of Neurosurgery: Pediatrics (52%), Child's Nervous System (11%), and Journal of Neurosurgery (8%). The ISPN abstracts most often appeared in the journals Child's Nervous System (29%), Journal of Neurosurgery: Pediatrics (14%), and Neurosurgery (9%). Overall, more than 90% of the abstract-based articles were published within 4 years after presentation of the abstracts on which they were based. CONCLUSIONS Oral abstract presentations at two annual pediatric neurosurgery meetings have publication rates in peer-reviewed journal comparable to those for oral abstracts at other national and international neurosurgery meetings. The vast majority of abstract-based papers are published within 4 years of the meeting at which the abstract was presented; however, the AANS/CNS Pediatric Section abstracts are published at a significantly higher rate than ISPN abstracts, which could indicate the different meeting sizes, research goals, and resources of US authors compared with those of authors from other countries.

What Factors Influence Resident Research Publication in the Division of Plastic Surgery?

BACKGROUND

Less than half of abstracts presented at biomedical conferences are published in peer-reviewed journals. The publication rate of these abstracts and factors influencing their publication warrants investigation to optimize knowledge dissemination.

PURPOSE

To determine publication rates of abstracts published at the University of Toronto, Division of Plastic and Reconstructive Surgery Annual Research Symposium. Following, to explore the barriers and facilitators of publication rate through a focus group with senior residents.

METHODS

PubMed, MedLine, and Scopus were searched to determine the successful publication rate of abstracts published in the University of Toronto Research Symposium Program in a 9-year period. Multiple logistical regression analysis was undertaken to discern factors associated with publication. Thematic analysis of a focus group with plastic surgery residents was undertaken to further explore the barriers and facilitators of publication.

RESULTS

Of 126 abstracts presented, 39.7% were published as peer-reviewed articles. The association between abstract topic, type (basic science or clinical), presenting author rank, faculty investigator rank, or publication rate were not statistically significant. Faculty investigator affiliated site was statistically significantly associated with publication. Six major themes arose from the qualitative analysis: quality of research question, faculty investigator attributes, availability of supports, research program expectations, time factors, and collaboration between residents. These results implicate variables that influence quantitatively determined publication rates and point to implementation of changes that may improve resident research experience and productivity in Plastic Surgery.

Hip and Knee Arthroplasty Orthopedic Literature in Medical Journals-Is It Negatively Biased?

BACKGROUND

Healthcare policy is often determined by well-designed studies most often published in high-impact medical journals. However, concern about the presence of publication bias against lower-extremity arthroplasty-related studies has called into question some of the validity of certain reports. There are only a few studies investigating the presence of the bias in high-impact medical journals against lower-extremity arthroplasty intervention, particularly in the Journal of American Medical Association (JAMA), New England Journal of Medicine (NEJM), and the Lancet. Thus, the purpose of this study was to assess (1) the distribution of positive, neutral, and negative results; (2) the number of reports focused on lower-extremity arthroplasty complications among these 3 journals; and (3) difference in bias between 2 time periods (1975 to 1990 and 2000 to 2016).

METHODS

A review of the literature from 3 major medical journals (NEJM, Lancet, and JAMA) was performed using PubMed electronic databases, which retrieved articles between January 1976 and December 2016. Studies were categorized as being positive, neutral, and negatively biased by 2 reviewers. Studies were categorized as reporting on lower-extremity arthroplasty-related complications if they were based on complications including deep vein thrombosis, infection, metal-related complication, fat embolism, readmission, or mortality. In addition, we have compared the journal bias between 2 different time points (1975 to 1990 and 2000 to 2016). Descriptive analyses were performed to assess frequencies. Chi-squared analysis was conducted for categorical variables, whereas a z-test was performed for dichotomous data.

RESULTS

When assessing all 3 journals, there were 46 positive (30.3%), 46 negative (30.3%), and 60 neutral reports (39.5%). There was no statistically significant difference in classification proportions between the 3 groups (P = .905). There was a higher percentage of medical literature reporting on the complications of arthroplasty (55.9%); however, this was not statistically significant (z-score = 1.38; 95% confidence interval, 0.48-0.64; P = .17). There was no difference in overall journal reporting between 1975 to 1990 and 2000 to 2016 (P = .548).

CONCLUSION

There was no evidence of publication bias of lower-extremity arthroplasty reports in the major medical journals (JAMA, NEJM, and Lancet). However, there were more published studies reporting on complications of lower-extremity arthroplasty. This may be due to systematic bias among journal editors in these journals, or due to low journal submission reporting noncomplications after arthroplasty intervention. We did not find the time period to be a factor in bias reporting of orthopedic literature in major medical journals. More work is needed to verify the results of this study.

Publication rates of the abstracts presented at the annual meeting of International Society for Pediatric Neurosurgery

INTRODUCTION

Publication of a study is the end point of the process to contribute to the literature and confirm the scientific value of the study. Publication rates of the abstracts presented at the annual meetings of neurosurgery have been studied, previously. However, publication rates of the abstracts presented at the annual meetings of pediatric neurosurgery have not been reported, yet. We evaluated abstracts presented at the 38th annual meeting of the International Society for Pediatric Neurosurgery (ISPN) held in South Korea, 2010.

METHODS

We conducted this cross-sectional study by reviewing the abstracts presented at the annual meeting of the ISPN, 2010. Titles and authors of the abstracts were surveyed using Google Scholar and PubMed/MEDLINE. Time to publication, origin of the study, journal name in which the study has been accepted and published, and type of study has been analyzed for each abstract.

RESULTS

The abstract booklet included 235 abstracts, consisted of 128 oral presentations (54%) and 107 electronic posters (46%). Fifty-nine (46%) of the oral presentations were published in a peer-reviewed journal. Laboratory studies were more likely to be published when compared to the clinical studies (72 vs. 39%). Thirty-two (30%) of the electronic posters were published in peer-reviewed journals. Most of the published abstracts were from Asia and Europe. Most of the abstracts were published in Child's Nervous System and Journal of Neurosurgery: Pediatrics.

CONCLUSION

Publication rates of the abstracts presented at annual meeting of the ISPN were comparable to the other similar congresses. Oral presentations were more likely to be published. High publication rates of the abstracts presented at the annual meeting of the ISPN suggested that the meeting had a high scientific value.

Dealing with the positive publication bias: Why you should really publish your negative results

Studies with positive results are greatly more represented in literature than studies with negative results, producing so-called publication bias. This review aims to discuss occurring problems around negative results and to emphasize the importance of reporting negative results. Underreporting of negative results introduces bias into meta-analysis, which consequently misinforms researchers, doctors and policymakers. More resources are potentially wasted on already disputed research that remains unpublished and therefore unavailable to the scientific community. Ethical obligations need to be considered when reporting results of studies on human subjects as people have exposed themselves to risk with the assurance that the study is performed to benefit others. Some studies disprove the common conception that journal editors preferably publish positive findings, which are considered as more citable. Therefore, all stakeholders, but especially researchers, need to be conscious of disseminating negative and positive findings alike.

Characteristics of Orthopedic Publications in High-Impact General Medical Journals

Orthopedic studies are occasionally published in high-impact general medical journals; these studies are often given high visibility and have significant potential to impact health care policy and inform clinical decision-making. The purpose of this review was to investigate the characteristics of operative orthopedic studies published in high-impact medical journals. The number of orthopedic studies published in high-impact medical journals is relatively low; however, these studies demonstrate methodological characteristics that may bias toward nonoperative treatment. Careful analysis and interpretation of orthopedic studies published in these journals is warranted. [Orthopedics. 2017; 40(3):e405-e412.].

P-Hacking in Orthopaedic Literature: A Twist to the Tail

BACKGROUND

"P-hacking" occurs when researchers preferentially select data or statistical analyses until nonsignificant results become significant. We wanted to evaluate if the phenomenon of p-hacking was evident in orthopaedic literature.

METHODS

We text-mined through all articles published in three top orthopaedic journals in 2015. For anonymity, we cipher-coded the three journals. We included all studies that reported a single p value to answer their main hypothesis. These p values were then charted and frequency graphs were generated to illustrate any evidence of p-hacking. Binomial tests were employed to look for evidence of evidential value and significance of p-hacking.

RESULTS

Frequency plots for all three journals revealed evidence of p-hacking. Binomial tests for all three journals were significant for evidence of evidential value (p < 0.0001 for all). However, the binomial test for p-hacking was significant only for one journal (p = 0.0092).

CONCLUSIONS

P-hacking is an evolving phenomenon that threatens to jeopardize the evidence-based practice of medicine. Although our results show that there is good evidential value for orthopaedic literature published in our top journals, there is some evidence of p-hacking of which authors and readers should be wary.

The Early Impact of an Administrative Processing Fee on Manuscript Submissions at The Journal of Bone & Joint Surgery

BACKGROUND

There was a dramatic increase in the volume of manuscripts submitted to The Journal of Bone & Joint Surgery (JBJS) between 2009 and 2012. This resulted in increased journal administrative costs. To offset this financial burden, in May 2013, JBJS started charging authors an administrative processing fee at the time of submission. The purpose of this study was to assess the impact of the administrative fee on the volume and characteristics of manuscripts submitted to JBJS.

METHODS

Our analysis included 866 manuscripts submitted to JBJS between November 2012 and November 2013. We compared manuscripts submitted 6 months prior to fee implementation and prior to the announcement (denoted as the baseline group), in the several months prior to fee implementation but after the fee implementation announcement (denoted as the fee announcement group), and in the 6 months after fee implementation (denoted as the fee implementation group). Manuscripts were reviewed for institutional and author demographic characteristics, as well as for general study characteristics.

RESULTS

In the first full calendar year (2014) after the implementation of the fee, the annual volume of submissions to JBJS declined by 33.5% compared with the annual submission volume in 2010 to 2012. In a comparative analysis, the geographical region of origin (p = 0.003), level of evidence (p < 0.0001), funding, and specialty differed between the 3 submission periods. However, subgroup analyses demonstrated that differences were attributable to the fee announcement group and that there were few important differences between the baseline and fee implementation groups. Reporting of funding information improved significantly between the baseline and fee implementation groups; in the post-fee implementation period, studies were more likely to have declared no external funding source (p = 0.001).

CONCLUSIONS

The administrative processing fee at JBJS has been associated with a decrease in submission volume, but, overall, there has not been a change in the characteristics of studies submitted. However, decreased overall volume implies a decrease in the absolute number of high-level studies submitted to the journal. Administrative processing fees at high-volume journals may be a financially viable way to offset high administrative costs without substantially changing the characteristics of submitted articles.

Complications and Adverse Events of a Randomized Clinical Trial Comparing 3 Graft Types for ACL Reconstruction

OBJECTIVE

Complications/adverse events of anterior cruciate ligament (ACL) surgery are underreported, despite pooled level 1 data in systematic reviews. All adverse events/complications occurring within a 2-year postoperative period after primary ACL reconstruction, as part of a large randomized clinical trial (RCT), were identified and described.

DESIGN

Prospective, double-blind randomized clinical trial. Patients and the independent trained examiner were blinded to treatment allocation.

SETTING

University-based orthopedic referral practice.

PATIENTS

Three hundred thirty patients (14-50 years; 183 males) with isolated ACL deficiency were intraoperatively randomized to ACL reconstruction with 1 autograft type. Graft harvest and arthroscopic portal incisions were identical.

INTERVENTION

Patients were equally distributed to patellar tendon (PT), quadruple-stranded hamstring tendon (HT), and double-bundle (DB) hamstring autograft ACL reconstruction.

MAIN OUTCOME MEASURES

Adverse events/complications were patient reported, documented, and diagnoses confirmed.

RESULTS

Two major complications occurred: pulmonary embolism and septic arthritis. Twenty-four patients (7.3%) required repeat surgery, including 25 separate operations: PT = 7 (6.4%), HT = 9 (8.2%), and DB = 8 (7.3%). Repeat surgery was performed for meniscal tears (3.6%; n = 12), intra-articular scarring (2.7%; n = 9), chondral pathology (0.6%; n = 2), and wound dehiscence (0.3%; n = 1). Other complications included wound problems, sensory nerve damage, muscle tendon injury, tibial periostitis, and suspected meniscal tears and chondral lesions. Overall, more complications occurred in the HT/DB groups (PT = 24; HT = 31; DB = 45), but more PT patients complained of moderate or severe kneeling pain (PT = 17; HT = 9; DB = 4) at 2 years.

CONCLUSIONS

Overall, ACL reconstructive surgery is safe. Major complications were uncommon. Secondary surgery was necessary 7.3% of the time for complications/adverse events (excluding graft reinjury or revisions) within the first 2 years.

LEVEL OF EVIDENCE

Level 1 (therapeutic studies).

CLINICAL RELEVANCE

This article reports on the complications/adverse events that were prospectively identified up to 2 years postoperatively, in a defined patient population participating in a large double-blind randomized clinical trial comparing PT, single-bundle hamstring, and DB hamstring reconstructions for ACL rupture.

The Incidence of Positive Modifications to Nerve Conduits in Rodent Nerve Repair Models

BACKGROUND

The nerve conduit is a generally accepted tool to facilitate the repair of short nerve gaps. Limitations in effectiveness have been recognized, and a steady stream of possible conduit improvements has been published in the scientific literature. Analysis of this information, particularly when small animal models have been utilized, seems to indicate that nearly any modification of a nerve conduit improves outcomes in repairs of short gaps over standard nerve conduits. This seems statistically and biologically improbable and suggests a bias in the literature.

METHODS

A standardized systemic review of the scientific literature on rodent model studies assessing conduit modifications was undertaken to determine the incidence of positive or supportive outcomes.

RESULTS

Modifications were deemed superior in 97.3% of studies when compared with unmodified conduits and deemed equivalent or superior in 52.1% of studies when compared with autograft.

CONCLUSIONS

A seemingly disproportionate number of positive results suggest that the literature on nerve conduit modifications may be skewed. We believe that there is a publication bias in the literature, and this warrants further investigation.

The Ethics of Sports Medicine Research

This article explores the background and foundations of ethics in research. Some important documents and codes are mentioned, such as The Belmont Report and the International Conference of Harmonisation. Some influential historical events involving research ethics are recounted. The article provides a detailed discussion of the Declaration of Helsinki, which is considered the international standard for guidelines in medical research ethics. The most salient features of the Declaration are described and related to orthopaedic surgery and sports medicine. Some of the most controversial aspects of the Declaration are discussed, which helps examine contentious areas of research in sports medicine.

Publication Bias in Methodological Computational Research

The problem of publication bias has long been discussed in research fields such as medicine. There is a consensus that publication bias is a reality and that solutions should be found to reduce it. In methodological computational research, including cancer informatics, publication bias may also be at work. The publication of negative research findings is certainly also a relevant issue, but has attracted very little attention to date. The present paper aims at providing a new formal framework to describe the notion of publication bias in the context of methodological computational research, facilitate and stimulate discussions on this topic, and increase awareness in the scientific community. We report an exemplary pilot study that aims at gaining experiences with the collection and analysis of information on unpublished research efforts with respect to publication bias, and we outline the encountered problems. Based on these experiences, we try to formalize the notion of publication bias.

The Quality of Cost-Utility Analyses in Orthopedic Trauma

As health care in the United States transitions toward a value-based model, there is increasing interest in applying cost-effectiveness analysis within orthopedic surgery. Orthopedic trauma care has traditionally underemphasized economic analysis. The goals of this review were to identify US-based cost-utility analysis in orthopedic trauma, to assess the quality of the available evidence, and to identify cost-effective strategies within orthopedic trauma. Based on a review of 971 abstracts, 8 US-based cost-utility analyses evaluating operative strategies in orthopedic trauma were identified. Study findings were recorded, and the Quality of Health Economic Studies (QHES) instrument was used to grade the overall quality. Of the 8 studies included in this review, 4 studies evaluated hip and femur fractures, 3 studies analyzed upper extremity fractures, and 1 study assessed open tibial fracture management. Cost-effective interventions identified in this review include total hip arthroplasty (over hemiarthroplasty) for femoral neck fractures in the active elderly, open reduction and internal fixation (over nonoperative management) for distal radius and scaphoid fractures, limb salvage (over amputation) for complex open tibial fractures, and systems-based interventions to prevent delay in hip fracture surgery. The mean QHES score of the studies was 79.25 (range, 67-89). Overall, there is a paucity of cost-utility analyses in orthopedic trauma; however, the available evidence suggests that certain operative interventions can be cost-effective. The quality of these studies, however, is fair, based on QHES grading. More attention should be paid to evaluating the cost-effectiveness of operative intervention in orthopedic trauma.

Cost-effectiveness analyses in orthopaedic sports medicine: a systematic review

BACKGROUND

As increasing attention is paid to the cost of health care delivered in the United States (US), cost-effectiveness analyses (CEAs) are gaining in popularity. Reviews of the CEA literature have been performed in other areas of medicine, including some subspecialties within orthopaedics. Demonstrating the value of medical procedures is of utmost importance, yet very little is known about the overall quality and findings of CEAs in sports medicine.

PURPOSE

To identify and summarize CEA studies in orthopaedic sports medicine and to grade the quality of the available literature.

STUDY DESIGN

Systematic review.

METHODS

A systematic review of the literature was performed to compile findings and grade the methodological quality of US-based CEA studies in sports medicine. The Quality of Health Economic Studies (QHES) instrument and the checklist by the US Panel on Cost-effectiveness in Health and Medicine were used to assess study quality. One-sided Fisher exact testing was performed to analyze the predictors of high-quality CEAs.

RESULTS

Twelve studies met inclusion criteria. Five studies examined anterior cruciate ligament reconstruction, 3 studies examined rotator cuff repair, 2 examined autologous chondrocyte implantation, 1 study examined hip arthroscopic surgery, and 1 study examined the operative management of shoulder dislocations. Based on study findings, operative intervention in sports medicine is highly cost-effective. The quality of published evidence is good, with a mean quality score of 81.8 (range, 70-94). There is a trend toward higher quality in more recent publications. No significant predictor of high-quality evidence was found.

CONCLUSION

The CEA literature in sports medicine is good; however, there is a paucity of studies, and the available evidence is focused on a few procedures. More work needs to be conducted to quantify the cost-effectiveness of different techniques and procedures within sports medicine. The QHES tool may be useful for the evaluation of future CEAs.

Current status of cost utility analyses in total joint arthroplasty: a systematic review

BACKGROUND

Total joint arthroplasty (TJA), although considered to be highly beneficial, is associated with substantial costs to the US healthcare system. Cost utility analysis has become an increasingly important means to objectively evaluate the value of a healthcare intervention from the perspective of both extending the quantity and improving the quality of life. Relatively little is known about the overall cost utility analysis evidence base in TJA.

QUESTIONS/PURPOSES

The goals of this review were to (1) determine the cost utility of TJA interventions; (2) critically assess the quality of published US-based cost utility analyses using the Quality of Health Economic Studies instrument; and (3) determine what characteristics were common among studies receiving a high quality score.

METHODS

A systematic review of the literature using the MEDLINE database was performed to compile findings and critically appraise US-based cost utility analysis studies for total hip and knee arthroplasty. Based on review of 676 identified articles, 23 studies were included. We used the Quality of Health Economic Studies instrument to assess study quality and one-sided Fisher's exact tests were applied to analyze the predictors of high-quality cost utility analysis.

RESULTS

Very few studies compare the cost utility of TJA versus nonoperative intervention; however, the available evidence suggests that TJA can be cost-saving and is highly cost-effective compared with conservative management of end-stage arthritis. The majority of identified studies are focused on the cost utility of new implant technologies or comparisons among surgical alternatives. These studies suggest that the upfront costs associated with new technologies are cost-effective when there is a major reduction in a future cost. The quality of identified studies is quite high (Quality of Health Economic Studies Instrument score: mean 86.5; range, 63-100). National funding source (p = 0.095) and lifetime horizon for analysis (p = 0.07) correlate with high-quality evidence but do not reach significance.

CONCLUSIONS

Over the past 15 years, there has been a major increase in the volume of cost utility analyses published in total hip and knee arthroplasty. The quality of cost utility analyses published during that period is good. As increasing attention is paid to value in US health care, more attention should be paid to understanding the cost utility of TJA compared with nonoperative treatment modalities. Future studies may also look to incorporate patient willingness to pay.

Static progressive versus dynamic splinting for posttraumatic elbow stiffness: a systematic review of 232 patients

INTRODUCTION

The elbow is prone to stiffness after trauma. To regain functional elbow motion, several conservative and surgical treatment options are available. Nonoperative treatment includes physical therapy, intra-articular injections with corticosteroids, and a static progressive or dynamic splinting program. The objective of this study was to perform a comprehensive review of the literature to evaluate the best current evidence for nonoperative treatment options for posttraumatic elbow stiffness.

METHODS

We performed a search of all studies on nonoperative treatment for elbow stiffness in human adults. All articles describing nonoperative treatment of elbow stiffness, written in the English, German, French or Dutch language, including human adult patients and with the functional outcome reported were included in this study.

RESULTS

Eight studies (including 232 patients) met our eligibility criteria and were included for data analysis and pooling. These studies included one randomized controlled trial and seven retrospective cohort studies. Static progressive splinting was evaluated in 160 patients. The average pre-splinting range of motion of all elbows was 72°, which improved by 36° after splinting to an average post-splinting arc of motion of 108°. Dynamic splinting was evaluated in 72 patients with an average pre-splinting range of motion of 63°. The average improvement was 37° to an average post-splinting arc of motion of 100°.

CONCLUSIONS

Both dynamic orthoses and static progressive splinting show good results for the treatment of elbow stiffness, regardless of etiology. The choice for one treatment over the other is based on the preference of the surgeon and patient. We recommend to continue nonoperative treatment with dynamic or static bracing for 12 months or until patients stop making progression in range of elbow motion.

Characteristics of clinical shoulder research over the last decade: a review of shoulder articles in The Journal of Bone & Joint Surgery from 2004 to 2014

BACKGROUND

The purpose of this study was to determine characteristics and trends in published shoulder research over the last decade in a leading orthopaedic journal.

METHODS

We examined all clinical shoulder articles published in The Journal of Bone & Joint Surgery from 2004 to 2014. The number of citations, authorship, academic degrees of the authors, country and institution of origin, topic, level of evidence, positive or nonpositive outcome, and inclusion of validated patient-reported outcome measures were assessed for each article.

RESULTS

Shoulder articles that included an author with an advanced research degree (MD [Doctor of Medicine] with a PhD [Doctor of Philosophy] or other advanced degree) increased during the study period (p = 0.047). Level-I, II, and III studies were more likely to have an author with an advanced research degree, and Level-IV studies were more likely to have MDs only (p = 0.03). Overall, there was great variability of outcome measures, with at least thirty-nine different validated or nonvalidated outcome measures reported.

CONCLUSIONS

Over the last decade, there was an improvement in the level of evidence of shoulder articles published in The Journal of Bone & Joint Surgery that corresponds with recent emphasis on evidence-based medicine. A consensus is needed in shoulder research for more consistent application of validated patient-reported outcome measurement tools.

Authors report lack of time as main reason for unpublished research presented at biomedical conferences: a systematic review

OBJECTIVES

To systematically review reports that queried abstract authors about reasons for not subsequently publishing abstract results as full-length articles.

STUDY DESIGN AND SETTING

Systematic review of MEDLINE, EMBASE, The Cochrane Library, ISI Web of Science, and study bibliographies for empirical studies in which investigators examined subsequent full publication of results presented at a biomedical conference and reasons for nonpublication.

RESULTS

The mean full publication rate was 55.9% [95% confidence interval (CI): 54.8%, 56.9%] for 24 of 27 eligible reports providing this information and 73.0% (95% CI: 71.2%, 74.7%) for seven reports of abstracts describing clinical trials. Twenty-four studies itemized 1,831 reasons for nonpublication, and six itemized 428 reasons considered the most important reason. "Lack of time" was the most frequently reported reason [weighted average = 30.2% (95% CI: 27.9%, 32.4%)] and the most important reason [weighted average = 38.4% (95% CI: 33.7%, 43.2%)]. Other commonly stated reasons were "lack of time and/or resources," "publication not an aim," "low priority," "incomplete study," and "trouble with co-authors."

CONCLUSIONS

Across medical specialties, the main reasons for not subsequently publishing an abstract in full lie with factors related to the abstract author rather than with journals.

How do you know it is true? Integrity in research and publications: AOA critical issues

High-quality medical care is the result of clinical decisions based upon scientific principles garnered from basic, translational, and clinical research. Information regarding the natural history of diseases and their responses to various treatments is introduced into the medical literature through the approximately one million PubMed journal articles published each year. Pharmaceutical and device companies, universities, departments, and researchers all stand to gain from research publication. Basic and translational research is highly competitive. Success in obtaining research funding and career advancement requires scientific publication in the medical literature. Clinical research findings can lead to changes in the pattern of orthopaedic practice and have implications for the utilization of pharmaceuticals and orthopaedic devices. Research findings can be biased by ownership of patents and materials, funding sources, and consulting arrangements. The current high-stakes research environment has been characterized by an increase in plagiarism, falsification or manipulation of data, selected presentation of results, research bias, and inappropriate statistical analyses. It is the responsibility of the orthopaedic community to work collaboratively with industry, universities, departments, and medical researchers and educators to ensure the integrity of the content of the orthopaedic literature and to enable the incorporation of best practices in the care of orthopaedic patients.

Cost-utility analyses in spine care: a qualitative and systematic review

STUDY DESIGN

Systematic review.

OBJECTIVE

A systematic review was performed to identify US-based cost-utility analyses (CUA) studies in spine care and to critically evaluate the quality of the available literature.

SUMMARY OF BACKGROUND DATA

There has been a recent trend in the United States toward increased publication of economic analyses in spine care. The cost-effectiveness of spine interventions and the quality of published literature is not well understood.

METHODS

A MEDLINE search was conducted to identify cost analyses in spine care. Articles were excluded on the basis of the following criteria: nonspine care, nonoperative, non-US based, nonclinical, and not CUA. Of the 424 screened articles, 20 met inclusion criteria. Quality of studies was assessed using the Quality of Health Economic Studies instrument.

RESULTS

Evidence for the cost-effectiveness of operative spinal intervention is varied. The majority of available studies report favorable cost-effectiveness ratios, however, a few studies suggest that certain operative interventions are not cost-effective. Average Quality of Health Economic Studies score of all included studies was 75.1 (60-93). The quality of evidence is variable and there are a number of weaknesses in the available literature, most significant of which is that few studies adopt a long-term time horizon or have sufficient follow-up (N = 3/20). High Quality of Health Economic Studies scoring studies were more likely to have sensitivity analysis (P = 0.016), societal cost perspective (P = 0.014), and a funding disclosure (P = 0.03).

CONCLUSION

There is a small but rapidly growing body of US-based CUA in spine care. The quality of CUA evidence is variable but there are significant opportunities to strengthen future CUA studies in spine. This study highlights the need for more attention to CUA research and the quality of these studies in spine care.

Social science. Publication bias in the social sciences: unlocking the file drawer

We studied publication bias in the social sciences by analyzing a known population of conducted studies--221 in total--in which there is a full accounting of what is published and unpublished. We leveraged Time-sharing Experiments in the Social Sciences (TESS), a National Science Foundation-sponsored program in which researchers propose survey-based experiments to be run on representative samples of American adults. Because TESS proposals undergo rigorous peer review, the studies in the sample all exceed a substantial quality threshold. Strong results are 40 percentage points more likely to be published than are null results and 60 percentage points more likely to be written up. We provide direct evidence of publication bias and identify the stage of research production at which publication bias occurs: Authors do not write up and submit null findings.

Role of editorial and peer review processes in publication bias: analysis of drug trials submitted to eight medical journals

BACKGROUND

Publication bias is generally ascribed to authors and sponsors failing to submit studies with negative results, but may also occur after submission. We evaluated whether submitted manuscripts on randomized controlled trials (RCTs) with drugs are more likely to be accepted if they report positive results.

METHODS

Manuscripts submitted from January 2010 through April 2012 to one general medical journal (BMJ) and seven specialty journals (Annals of the Rheumatic Diseases, British Journal of Ophthalmology, Gut, Heart, Thorax, Diabetologia, and Journal of Hepatology) were included, if at least one study arm assessed the efficacy or safety of a drug and a statistical test was used to evaluate treatment effects. Publication status was retrospectively retrieved from submission systems or provided by journals. Sponsorship and trial results were extracted from manuscripts and classified according to predefined criteria. Main outcome measure was acceptance for publication.

RESULTS

Of 15,972 manuscripts submitted, 472 (3.0%) were drug RCTs, of which 98 (20.8%) were published. Among submitted drug RCTs, 287 (60.8%) had positive and 185 (39.2%) negative results. Of these, 60 (20.9%) and 38 (20.5%), respectively, were published. Manuscripts on non-industry trials (n = 213) reported positive results in 138 (64.8%) manuscripts, compared to 71 (47.7%) on industry-supported trials (n = 149), and 78 (70.9%) on industry-sponsored trials (n = 110). Twenty-seven (12.7%) non-industry trials were published, compared to 27 (18.1%) industry-supported and 44 (40.0%) industry-sponsored trials. After adjustment for other trial characteristics, manuscripts reporting positive results were not more likely to be published (OR, 1.00; 95% CI, 0.61 to 1.66). Submission to specialty journals, sample size, multicentre status, journal impact factor, and corresponding authors from Europe or US were significantly associated with publication.

CONCLUSIONS

For the selected journals, there was no tendency to preferably publish manuscripts on drug RCTs that reported positive results, suggesting that publication bias may occur mainly prior to submission.

Analysis of scientific articles published in two general orthopaedic journals

OBJECTIVE

To give an overview of the behaviour and scientific contributions of the Journal of Bone and Joint Surgery American (JBJS-A) and British Volume (JBJS-B).

METHODS

480 original articles published in 2009 were identified through a combined comprehensive computer and manual library search. Articles were assigned to 11 orthopaedic categories and by country, type and specialty of the institution. Possible grants and citations were analysed. USA led all countries in published articles (36,87%), followed by UK (20,62%) and South Korea (5,83%). Most studies published were performed at academic institutions (65,83 %), only 4,16% at private practices.

RESULTS

Almost half of the articles (46,24%) were published in three categories: hip (19.16%), knee (13.75%) and trauma (13.33%). In both journals 47.15% articles had at least one funding source. A review of articles published in major journals allows to show how research in orthopaedics is distributed worldwide.

CONCLUSION

This study shows that a variety of different journals is neccessary to reflect the broad spectrum of orthopaedics in depth. Level of Evidence III, Retrospective Comparative Study.