In my recent post I discussed about “Level V Guideline” for subacromial decompression. I naturally participated to the discussion Drs Poolman and van den Bekerom had started. We wrote in our letter: ‘Optimal patient selection’ can be considered a myth until evidence of effect modifiers arises. We argue that if there were subpopulations that benefit […]
Nth conclusion about hip resurfacings
It can´t be argued that the theoretical premises of hip resurfacing arthroplasty would not have been truly great. What could sound any better than “restoring native anatomy and hip biomechanics”? As we know, everything went a different road. Clough & Clough outlined quite accurate statement about hip resurfacings: Whilst MoM HRA can, in very limited […]
Crusade against low value care continues
Hohmann et al. published a truly exceptional “Level V Guideline” in the Arthroscopy Journal. They conclude: However, when indicated, SAD has stood the test of time and long-term studies have clearly demonstrated good and excellent outcomes. So, two recent high-quality sham-controlled studies clearly demonstrate that arthroscopic subacromial decompression offers no relevant benefit over sham-surgery. Apparently […]
Patient preferences in orthopaedic conditions
What doctors think is important don´t always align with what patients think is important. I think this is a growing aspect in medicine and very important foundation for the shared decision making. Shapira et al. published an interesting study in the Medical Decision Making journal titled: “When Is a Harm a Harm? Discordance between Patient […]
What sort of improvement we need in our research?
This is not a new study but I came across to this study by Brophy et al. titled “Update on the Methodological Quality of Research Published in The American Journal of Sports Medicine“. They concluded: Despite a dramatic increase in the number of published articles, the research published in AJSM shifted toward more prospective, randomized, […]
Improvement after APM?
Clinical improvement after certain surgical procedure is a fundamental aspect when evaluating success of a surgical treatment. The most important aspect is outlined in a question: “How would have this patient fared without the procedure?”. This is also major paradigm in the surgical and orthopaedic research. Our clinical experience is usually based on observations how […]
S-values in statistical inference
James Brophy writes about key issues in the statistical interpretation of RCTs in the Canadian Journal of Cardiology. What caught my eye was the mention about S-values: Enhanced understanding of the strength of the evidence against not only the null hypothesis but against any specific alternative hypotheses can be more easily appreciated by considering p […]
Three-to-one response to our letter
In my previous blog post I told about our letter to editor concerning a study criticizing sham-controlled studies in orthopaedics. Another letter was also submitted and accepted at the same time by Harris, Poolman and Buchbinder. They had also very important aspects regarding the criticism towards sham-controlled RCTs: We agree that there are other methods […]
Rules of thumb or just rules in statistics?
I just had to blog this tweet because it encapsulates so many things which are lost in modern biomedical research:
Our response to Sochacki et al. regarding sham-controlled RCTs
Sochacki et al. wrote in their study: Randomized sham-controlled studies in orthopaedic sports medicine have significant methodologic deficiencies that may invalidate their conclusions. High quality sham-controlled RCTs in the field of sports and arthroscopic surgery have met severe objection from people who are advocates of these common procedures. A study after another study show that […]