Average Level Of Evidence Of Papers Published In Six Orthopedic Journals

Background An assessment of the average level of evidence (LOE) of clinical research papers in peer reviewed orthopedic surgery journals has not previously been published. In this paper we report on the average LOE of papers published in six of the top English language orthopedic surgery journals. Methods Six well established orthopedic journals were identified by using the Google Scholar H5 Journal Index. We selected 6 of the top ten journals identified by the Index. The six journals that were evaluated for this project were as follows: The American Journal Of Sports Medicine (AJSM); Clinical Orthopedics and Related Research (CORR); Journal of Bone and Joint Surgery (JBJS); Knee Surgery, Sports, Traumatology, Arthroscopy (KSSTA); Journal of Arthroscopy (Arthros.); and the Journal of Shoulder and Elbow Surgery (JSES). Thirteen consecutive monthly issues (July, 2018 - July, 2019) of each journal were evaluated for the LOE of each clinical paper. The assigned LOE was used if published, or the level of evidence was assigned by the senior author (DAB) if one was not listed. For each journal, the overall mean LOE along with the variance and standard deviation was calculated with all confidence intervals set at 95%. Summary data was statistically analyzed to provide an overall mean LOE for the 6 journals evaluated. Results For AJSM, we evaluated 246 clinical research articles that had an average LOE of 2.96 +/- 0.16. For CORR, we evaluated 155 papers that had an average LOE of 2.83 +/- 0.19. For JBJS, we evaluated 164 papers that had an average LOE of 3.04 +/- 0.13. For KSSTA, we evaluated 402 papers that had an average LOE of 3.05 +/- 0.16. For Arthros. we evaluated 226 papers that had an average LOE of 3.19 +/- 0.10. For JSES, we evaluated 237 papers that had an average LOE of 3.25 +/- 0.13. In summary, for the 1425 clinical research papers published in 98 issues of 6 of the top orthopedic journals, we found the average Level Of Evidence to be 3.05 +/- 0.16. Conclusions The goal of scientific study design is to prove or disprove a hypothesis while minimizing bias and errors. The gold standard for therapeutic studies has been a double blind, randomized controlled trial (RCT). However, it is not possible or feasible for every clinical study to have a blinded RCT design. Additionally, clinically relevant and actionable data can come from studies that are not RCTs. In a medical discipline like orthopedics many interventions are invasive, making controlled trials or blinded trials unethical or technically not practical. Our analysis of over 1400 peer reviewed publications in one year in 6 of the top English language orthopedic journals reveals that the average level of evidence deemed worthy of publication is level 3. In terms of the most common study design, the average published clinical study in these orthopedic journals was a case-control study.

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Risk Factors for Injuries in Runners: A Systematic Review of Foot Strike Technique and Its Classification at Impact

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211020283 ◽

2021 ◽

Vol 9 (9) ◽

pp. 232596712110202

Author(s):

Aoife Burke ◽

Sarah Dillon ◽

Siobhán O’Connor ◽

Enda F. Whyte ◽

Shane Gore ◽

...

Keyword(s):

Systematic Review ◽

Study Design ◽

Large Scale ◽

English Language ◽

Injury Rate ◽

Initial Contact ◽

Level Of Evidence ◽

Foot Strike ◽

Continuous Measures ◽

The Relationship

Background: It has been suggested that foot strike technique (FST) at initial contact is related to running-related injuries (RRIs). Purpose: To explore the relationship between FST and RRIs. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic electronic search was performed using MEDLINE, PubMed, SPORTDiscus, Scopus, and Web of Science databases. Included were studies published in the English language that explored the relationship between FST and RRIs between January 1960 and November 2020. Results were extracted and collated. The Grading of Recommendations, Assessment, Development and Evaluation approach was applied to synthesize the quality of evidence. Results: We reviewed 13 studies exploring the relationship between FST and RRIs. Of these, 6 studies reported FST categorically (foot strike pattern [FSP]), and 7 reported continuous measures (foot contact angle, ankle flexion angle, and strike index). Three of the 6 studies looking at categorical FSP found rearfoot strikers have a significantly greater retrospective injury rate than do non– rearfoot strikers, with 1 other study noting a greater risk associated with midfoot and forefoot strike. Regarding the continuous measures of FST, only 1 of the 7 studies reported a significant relationship with RRIs. Conclusion: There was low evidence to suggest a relationship between FST (or its subcategories of categorical FSP and continuous measures) and RRIs. While two-thirds of the categorical studies found a relationship between FSP and RRIs, these studies were very low quality, with limitations such as retrospective study design, low participant numbers, and poor FSP assessment methods. More large-scale prospective studies are required.

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Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS) Society Recommendations: Part 1—Preoperative: Diagnosis, Rapid Assessment and Optimization

World Journal of Surgery ◽

10.1007/s00268-021-05994-9 ◽

2021 ◽

Author(s):

Carol J. Peden ◽

Geeta Aggarwal ◽

Robert J. Aitken ◽

Iain D. Anderson ◽

Nicolai Bang Foss ◽

...

Keyword(s):

High Risk ◽

English Language ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Preoperative Care ◽

Surgical Patient ◽

Emergency Laparotomy ◽

Emergency General Surgery ◽

Optimal Care ◽

Level Of Evidence

Abstract Background Enhanced Recovery After Surgery (ERAS) protocols reduce length of stay, complications and costs for a large number of elective surgical procedures. A similar, structured approach appears to improve outcomes, including mortality, for patients undergoing high-risk emergency general surgery, and specifically emergency laparotomy. These are the first consensus guidelines for optimal care of these patients using an ERAS approach. Methods Experts in aspects of management of the high-risk and emergency general surgical patient were invited to contribute by the International ERAS® Society. Pubmed, Cochrane, Embase, and MEDLINE database searches on English language publications were performed for ERAS elements and relevant specific topics. Studies on each item were selected with particular attention to randomized controlled trials, systematic reviews, meta-analyses and large cohort studies, and reviewed and graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Recommendations were made on the best level of evidence, or extrapolation from studies on non-emergency patients when appropriate. The Delphi method was used to validate final recommendations. The guideline has been divided into two parts: Part 1—Preoperative Care and Part 2—Intraoperative and Postoperative management. This paper provides guidelines for Part 1. Results Twelve components of preoperative care were considered. Consensus was reached after three rounds. Conclusions These guidelines are based on the best available evidence for an ERAS approach to patients undergoing emergency laparotomy. Initial management is particularly important for patients with sepsis and physiological derangement. These guidelines should be used to improve outcomes for these high-risk patients.

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Foot and Ankle Injections in Athletes

Sports Health A Multidisciplinary Approach ◽

10.1177/19417381211003619 ◽

2021 ◽

pp. 194173812110036

Author(s):

Jonathan K. Ochoa ◽

Christopher E. Gross ◽

Robert B. Anderson ◽

Andrew R. Hsu

Keyword(s):

English Language ◽

Platelet Rich Plasma ◽

Empirical Studies ◽

Autologous Blood ◽

Case Series ◽

Placental Tissue ◽

Ankle Injuries ◽

Extensive Literature ◽

Foot And Ankle ◽

Level Of Evidence

Context: Injections are commonly used by health care practitioners to treat foot and ankle injuries in athletes despite ongoing questions regarding efficacy and safety. Evidence Acquisition: An extensive literature review was performed through MEDLINE, Google Scholar, and EBSCOhost from database inception to 2021. Keywords searched were injections, athletes, sports, foot and ankle, corticosteroids, platelet-rich plasma, and placental tissue. Search results included articles written in the English language and encompassed reviews, case series, empirical studies, and basic science articles. Study Design: Clinical review. Level of Evidence: Level 4. Results: Corticosteroids, platelet-rich plasma/autologous blood, anesthetic, and placental tissue injections are commonly used in the treatment of foot and ankle injuries. Primary indications for injections in athletes include plantar fasciitis, Achilles tendinosis, isolated syndesmotic injury, and ankle impingement with varying clinical results. Conclusions: Despite promising results from limited case series and comparative studies, the data for safety and efficacy of injections for foot and ankle injuries in athletes remain inconclusive.

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Diagnosis of Anosmia and Hyposmia: A Systematic Review

Allergy & Rhinology ◽

10.1177/21526567211026568 ◽

2021 ◽

Vol 12 ◽

pp. 215265672110265

Author(s):

Abdul K. Saltagi ◽

Mohamad Z. Saltagi ◽

Amit K. Nag ◽

Arthur W. Wu ◽

Thomas S. Higgins ◽

...

Keyword(s):

English Language ◽

Viral Infections ◽

Original Data ◽

Olfactory Dysfunction ◽

Imaging Modalities ◽

Diagnostic Tools ◽

Validity And Reliability ◽

Medical Subject Headings ◽

Level Of Evidence ◽

Smell Tests

Background Anosmia and hyposmia have many etiologies, including trauma, chronic sinusitis, neoplasms, and respiratory viral infections such as rhinovirus and SARS-CoV-2. We aimed to systematically review the literature on the diagnostic evaluation of anosmia/hyposmia. Methods PubMed, EMBASE, and Cochrane databases were searched for articles published since January 1990 using terms combined with Medical Subject Headings (MeSH). We included articles evaluating diagnostic modalities for anosmia, written in the English language, used original data, and had two or more patients. Results A total of 2065 unique titles were returned upon the initial search. Of these, 226 abstracts were examined, yielding 27 full-text articles meeting inclusion criteria (Level of evidence ranging from 1 to 4; most level 2). The studies included a total of 13,577 patients. The most utilized diagnostic tools were orthonasal smell tests (such as the Sniffin’ Sticks and the UPSIT, along with validated abridged smell tests). Though various imaging modalities (including MRI and CT) were frequently mentioned in the workup of olfactory dysfunction, routine imaging was not used to primarily diagnose smell loss. Conclusion The literature includes several studies on validity and reliability for various smell tests in diagnosing anosmia. Along with a thorough history and physical, validated orthonasal smell tests should be part of the workup of the patient with suspected olfactory dysfunction. The most widely studied modality was MRI, but criteria for the timing and sequence of imaging modalities was heterogenous.

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Current status of wet lab and cadaveric simulation in urological training: A systematic review

Canadian Urological Association Journal ◽

10.5489/cuaj.6520 ◽

2020 ◽

Vol 14 (11) ◽

Author(s):

Ahmed Al-Jabir ◽

Abdullatif Aydin ◽

Hussain Al-Jabir ◽

M. Shamim Khan ◽

Prokar Dasgupta ◽

...

Keyword(s):

Systematic Review ◽

English Language ◽

In Vivo Studies ◽

Current Status ◽

Level Of Evidence ◽

Cadaveric Simulation ◽

Randomized Controlled Studies ◽

Wet Lab ◽

Urological Training

Introduction: We undertook a systematic review of the use of wet lab (animal and cadaveric) simulation models in urological training, with an aim to establishing a level of evidence (LoE) for studies and level of recommendation (LoR) for models, as well as evaluating types of validation. Methods: Medline, EMBASE, and Cochrane databases were searched for English-language studies using search terms including a combination of surgery, surgical training, and medical education. These results were combined with wet lab, animal model, cadaveric, and in-vivo. Studies were then assigned a LoE and LoR if appropriate as per the education-modified Oxford Centre for Evidence-Based Medicine classification. Results: A total of 43 articles met the inclusion criteria. There was a mean of 23.1 (±19.2) participants per study with a median of 20. Overall, the studies were largely of low quality, with 90.7% of studies being lower than 2a LoE (n=26 for LoE 2b and n=13 for LoE 3). The majority (72.1%, n=31) of studies were in animal models and 27.9% (n=12) were in cadaveric models. Conclusions: Simulation in urological education is becoming more prevalent in the literature, however, there is a focus on animal rather than cadaveric simulation, possibly due to cost and ethical considerations. Studies are also predominately of a low LoE; more higher LoEs, especially randomized controlled studies, are needed.

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The most frequently asked question to a statistician: The sample size

Multiple Sclerosis Journal ◽

10.1177/1352458517695471 ◽

2017 ◽

Vol 23 (5) ◽

pp. 644-646 ◽

Cited By ~ 2

Author(s):

Maria Pia Sormani

Keyword(s):

Clinical Study ◽

Sample Size ◽

Study Design ◽

Treatment Effect ◽

Sample Size Calculation ◽

Ethical Implications ◽

Number Of Patients ◽

Reducing Costs ◽

Correct Size

The calculation of the sample size needed for a clinical study is the challenge most frequently put to statisticians, and it is one of the most relevant issues in the study design. The correct size of the study sample optimizes the number of patients needed to get the result, that is, to detect the minimum treatment effect that is clinically relevant. Minimizing the sample size of a study has the advantage of reducing costs, enhancing feasibility, and also has ethical implications. In this brief report, I will explore the main concepts on which the sample size calculation is based.

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Infrared Thermography for the Evaluation of Inflammatory and Degenerative Joint Diseases: A Systematic Review

Cartilage ◽

10.1177/19476035211063862 ◽

2021 ◽

Vol 13 (2_suppl) ◽

pp. 1790S-1801S

Author(s):

Guglielmo Schiavon ◽

Gianluigi Capone ◽

Monique Frize ◽

Stefano Zaffagnini ◽

Christian Candrian ◽

...

Keyword(s):

Systematic Review ◽

Disease Progression ◽

Infrared Thermography ◽

Rheumatic Diseases ◽

English Language ◽

Response To Treatment ◽

Cochrane Library ◽

Joint Diseases ◽

Level Of Evidence ◽

Post Evaluation

Objective Inflammation plays a central role in the pathophysiology of rheumatic diseases as well as in osteoarthritis. Temperature, which can be quantified using infrared thermography, provides information about the inflammatory component of joint diseases. This systematic review aims at assessing infrared thermography potential and limitations in these pathologies. Design A systematic review was performed on 3 major databases: PubMed, Cochrane library, and Web of Science, on clinical reports of any level of evidence in English language, published from 1990 to May 2021, with infrared thermography used for diagnosis of osteoarthritis and rheumatic diseases, monitoring disease progression, or response to treatment. Relevant data were extracted, collected in a database, and analyzed for the purpose of this systematic review. Results Of 718 screened articles 32 were found to be eligible for inclusion, for a total of 2094 patients. Nine studies reported the application to osteoarthritis, 21 to rheumatic diseases, 2 on both. The publication trend showed an increasing interest in the last decade. Seven studies investigated the correlation of temperature changes with osteoarthritis, 16 with rheumatic diseases, and 2 with both, whereas 2 focused on the pre-post evaluation to investigate treatment results in patients with osteoarthritis and 5 in patients with rheumatic diseases. A correlation was shown between thermal findings and disease presence and stage, as well as the clinical assessment of disease activity and response to treatment, supporting infrared thermography role in the study and management of rheumatic diseases and osteoarthritis. Conclusions The systematic literature review showed an increasing interest in this technology, with several applications in different joints affected by inflammatory and degenerative pathologies. Infrared thermography proved to be a simple, accurate, noninvasive, and radiation-free method, which could be used in addition to the currently available tools for screening, diagnosis, monitoring of disease progression, and response to medical treatment.

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Consensus-based recommendations for the use of biosimilars to treat rheumatological diseases

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2017-211937 ◽

2017 ◽

Vol 77 (2) ◽

pp. 165-174 ◽

Cited By ~ 91

Author(s):

Jonathan Kay ◽

Monika M Schoels ◽

Thomas Dörner ◽

Paul Emery ◽

Tore K Kvien ◽

...

Keyword(s):

English Language ◽

Task Force ◽

Level Of Evidence ◽

Conference Abstract ◽

Consensus Recommendations ◽

American College Of Rheumatology ◽

Published Evidence ◽

Grade Of Recommendation ◽

Scientific Meetings ◽

Rheumatological Diseases

The study aimed to develop evidence-based recommendations regarding the evaluation and use of biosimilars to treat rheumatological diseases. The task force comprised an expert group of specialists in rheumatology, dermatology and gastroenterology, and pharmacologists, patients and a regulator from ten countries. Four key topics regarding biosimilars were identified through a process of discussion and consensus. Using a Delphi process, specific questions were then formulated to guide a systematic literature review. Relevant English-language publications through November 2016 were searched systematically for each topic using Medline; selected papers and pertinent reviews were examined for additional relevant references; and abstracts presented at the 2015 and 2016 American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) annual scientific meetings were searched for those about biosimilars. The experts used evidence obtained from these studies to develop a set of overarching principles and consensus recommendations. The level of evidence and grade of recommendation were determined for each. By the search strategy, 490 references were identified. Of these, 29 full-text papers were included in the systematic review. Additionally, 20 abstracts were retrieved from the ACR and EULAR conference abstract databases. Five overarching principles and eight consensus recommendations were generated, encompassing considerations regarding clinical trials, immunogenicity, extrapolation of indications, switching between bio-originators and biosimilars and among biosimilars, and cost. The level of evidence and grade of recommendation for each varied according to available published evidence. Five overarching principles and eight consensus recommendations regarding the evaluation and use of biosimilars to treat rheumatological diseases were developed using research-based evidence and expert opinion.

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Return to Sport After Ankle Syndesmotic Injury: A Systematic Review

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738118816282 ◽

2018 ◽

Vol 11 (2) ◽

pp. 116-122 ◽

Cited By ~ 1

Author(s):

Seline Y. Vancolen ◽

Ibrahim Nadeem ◽

Nolan S. Horner ◽

Herman Johal ◽

Bashar Alolabi ◽

...

Keyword(s):

Systematic Review ◽

Study Design ◽

Return To Sport ◽

Nonoperative Treatment ◽

High Rate ◽

Rate Of Return ◽

Syndesmotic Injury ◽

Level Of Evidence ◽

Treatment Groups ◽

Pertinent Data

Context: Ankle syndesmotic injuries present a significant challenge for athletes due to prolonged disability and recovery periods. The optimal management of these injuries and rates of return to sport in athletes remains unclear. Objective: The purpose of this study was to evaluate return to sport for athletes after ankle syndesmotic injuries. Data Source: The electronic databases MEDLINE, EMBASE, and PubMed were searched for relevant studies from database inception to January 15, 2017, and pertinent data were abstracted. Study Selection: Only studies reporting return-to-sport rates after ankle syndesmotic injuries were included. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: Two reviewers extracted data from the included studies, which were stored in a standardized collection form (Microsoft Excel). Recorded data included demographics (eg, author, year of publication, study design), descriptive statistics (eg, patient age, percentage male, number of athletes, sample size), and outcomes (eg, time to return to sport, proportion of those who returned to sport, the self-reported questionnaire the Olerud-Molander Ankle Score). Results: A total of 10 studies and 312 patients with ankle syndesmotic injuries were included in this systematic review. The rate of return to preinjury or any injury level of sport after ankle syndesmotic injuries was 93.8% ± 1.2% and 97.6% ± 1.5%, respectively, for the corresponding 7 and 3 studies that reported this characteristic. The mean time to return to sport was 46.4 days (range, 15.4-70 days), with 55.2 ± 15.8 and 41.7 ± 9.8 days for operative and nonoperative management, respectively. Conclusion: This systematic review found a high rate of return to any as well as preinjury level of sport after ankle syndesmotic injury in both operative and nonoperative treatment groups. However, further high-level studies are required to compare operative and nonoperative treatment groups associated with return to sport after ankle syndesmotic injury.

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