Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Oct 2019
ReviewWhat Are the Implications of Alternative Alpha Thresholds for Hypothesis Testing in Orthopaedics?
Clinical research in orthopaedics typically reports the presence of an association after rejecting a null hypothesis of no association using an alpha threshold of 0.05 at which to evaluate a calculated p value. This arbitrary value is a factor that results in the current difficulties reproducing research findings. A proposal is gaining attention to lower the alpha threshold to 0.005. However, it is currently unknown how alpha thresholds are used in orthopaedics and the distribution of p values reported. ⋯ Surgeons and scientists in orthopaedics should understand that the default alpha threshold of 0.05 represents an arbitrary value that could be lowered to help reduce type-I errors; however, it must also be appreciated that such a change could increase type-II errors, increase resource utilization, and preferentially select findings from lower-quality studies.
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Clin. Orthop. Relat. Res. · Oct 2019
Polytrauma and High-energy Injury Mechanisms Are Associated with Worse Patient-reported Outcomes After Distal Radius Fractures.
Patient-reported outcomes (PROs) are increasingly relevant when evaluating the treatment of orthopaedic injuries. Little is known about how PROs may vary in the setting of polytrauma or secondary to high-energy injury mechanisms, even for common injuries such as distal radius fractures. ⋯ Level III, therapeutic study.
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Clin. Orthop. Relat. Res. · Oct 2019
Does the SORG Algorithm Predict 5-year Survival in Patients with Chondrosarcoma? An External Validation.
We developed a machine learning algorithm to predict the survival of patients with chondrosarcoma. The algorithm demonstrated excellent discrimination and calibration on internal validation in a derivation cohort based on data from the Surveillance, Epidemiology, and End Results (SEER) registry. However, the algorithm has not been validated in an independent external dataset. ⋯ Level III, prognostic study.
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Clin. Orthop. Relat. Res. · Oct 2019
Determining the Generalizability of the PROMIS Depression Domain's Floor Effect and Completion Time in Patients Undergoing Orthopaedic Surgery.
Depression is common and can decrease the likelihood that a patient undergoing an orthopaedic procedure will improve after that intervention. Research at a single institution using the Patient-reported Outcomes Measurement Information System (PROMIS) showed that the PROMIS Depression domain had a substantial floor effect (lowest depressive symptoms measurable) in patients with orthopaedic conditions, although the instrument is designed to follow a population-based normal distribution. Patients with the lowest scores (floor) completed the questionnaire more quickly than those who did not have the lowest scores, which suggests that patients may not want to report or discuss depressive symptoms with their orthopaedic surgeon. ⋯ Level II, diagnostic study.
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Clin. Orthop. Relat. Res. · Oct 2019
Patient Characteristics, Treatment, and Presenting PROMIS Scores Associated with Number of Office Visits for Traumatic Hand and Wrist Conditions.
Overuse of healthcare resources is burdensome on society. Prior research has demonstrated that many patients with traumatic musculoskeletal injuries continue to seek care long after appropriate healing is well established, suggesting an overuse of services. However, few studies have examined the factors-including patient-reported outcomes-associated with an increased number of clinic visits for traumatic hand and wrist conditions. ⋯ Level IV, prognostic study.