Continues discourse about “level V evidence”

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 […]

Views on orthopaedics motivated by recent editorial – Part 1

A recent editorial in the Bone & Joint Journal was about weight-bearing in orthopaedic traumatology. Written by Alex Trompeter, the title was intriguing: A call to arms: it’s time to bear weight! This editorial was best I have read in a while. Besides weight-bearing, Trompeter addressed many other general topics. In following posts I will […]

Population health and orthopaedic surgeries

Both knee arthroscopy for partial meniscectomy and shoulder arthroscopy for acromioplasty were very common procedures few years back in orthopaedic surgery. During the first two decades of this millennium extensive amount of research has been published showing that the effect of these procedures to treat knee and shoulder pain and function is quite weak. Despite […]

No evidence of no evidence

In the null hypothesis significance testing framework, failure to reject the null is never evidence in support of null. However, it is extremely common that failure to reject the null, ie. getting a p-value larger 0.05 is interpreted as “no difference” or “no evidence”. As many experts have said, “absence of evidence is not evidence […]