Authors: Daniel M Lerman Matthew G Cable Patrick Thornley Nathan Evaniew Gerard P Slobogean Mohit Bhandari John H Healey R Lor Randall Michelle Ghert
Publish Date: 2016/02/26
Volume: 475, Issue: 3, Pages: 853-860
Abstract
Level of evidence LOE framework is a tool with which to categorize clinical studies based on their likelihood to be influenced by bias Improvements in LOE have been demonstrated throughout orthopaedics prompting our evaluation of orthopaedic oncology research LOE to determine if it has changed in kind1 Has the LOE presented at the Musculoskeletal Tumor Society MSTS annual meeting improved over time 2 Over the past decade how do the MSTS and Orthopaedic Trauma Association OTA annual meetings compare regarding LOE overall and for the subset of therapeutic studiesWe reviewed abstracts from MSTS and OTA annual meeting podium presentations from 2005 to 2014 Three independent reviewers evaluated a total of 1222 abstracts for study type and LOE there were 577 abstracts from MSTS and 645 from OTA Changes in the distributions of study type and LOE over time were evaluated by Pearson chisquare testThere was no change over time in MSTS LOE for all study types p = 013 and therapeutic p = 036 study types during the reviewed decade In contrast OTA LOE increased over this time for all study types p 001 The proportion of Level I therapeutic studies was higher at the OTA than the MSTS 3 14 of 413 versus 05 two of 387 respectively whereas the proportion of Level IV studies was lower at the OTA than the MSTS 32 134 of 413 versus 75 292 of 387 respectively during the reviewed decade The proportion of controlled therapeutic studies LOE I through III versus uncontrolled studies LOE IV increased over time at OTA p 0021 but not at MSTS p = 010Uncontrolled case series continue to dominate the MSTS scientific program limiting progress in evidencebased clinical care Techniques used by the OTA to improve LOE may be emulated by the MSTS These techniques focus on broad participation in multicenter collaborations that are designed in a comprehensive manner and answer a pragmatic clinical questionEach author certifies that he or she or a member of his or her immediate family has no funding or commercial associations eg consultancies stock ownership equity interest patent/licensing arrangements etc that might pose a conflict of interest in connection with the submitted articleClinical Orthopaedics and Related Research ® neither advocates nor endorses the use of any treatment drug or device Readers are encouraged to always seek additional information including FDAapproval status of any drug or device prior to clinical use
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