Puzzitiello Richard N, Lachance Andrew D, Michalowski Anna, Menendez Mariano E, Salzler Matthew J
From the Department of Orthopaedics (Puzzitiello, Lachance, Michalowski, and Salzler), Tufts Medical Center, Boston, MA and the Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL (Menendez).
J Am Acad Orthop Surg. 2023 Nov 1;31(21):e974-e983. doi: 10.5435/JAAOS-D-22-00604. Epub 2023 Sep 15.
Orthopaedic studies published in high-impact medical journals are often believed to have a high prevalence of negative or neutral results and possess methodological characteristics that may bias toward nonsurgical treatments. The purpose of this study was to compare study characteristics, methodologic quality, exposure, and outcome direction among orthopaedic randomized control trials (RCTs) published in high-impact medical and orthopaedic journals and to identify study attributes associated with greater impact.
RCTs published between January 2010 and December 2020 in the five medical journals and 10 orthopaedic journals with the highest 5-year impact factors were analyzed. Inclusion criteria were RCTs reporting on orthopaedic surgical intervention compared with nonsurgical or less-invasive surgical procedures. Study characteristics, methodologic quality (Jadad scale), outcomes, and altmetric data were collected. Primary outcomes were categorized as positive (favoring surgical/more-extensive surgery), negative (favoring nonsurgical/less-extensive surgery), or neutral.
One hundred twenty-eight RCTs were analyzed; 26 from medical and 102 from orthopaedic journals. Studies published in medical journals included more authors ( P < 0.001), larger sample sizes ( P < 0.001), more institutions ( P < 0.001), and more often received funding ( P < 0.001). The average Jadad scale did not significantly differ between journals ( P = 0.14). The direction of the primary study outcome did not differ between journals ( P = 0.22). Average AAS and annual citation rates were higher in RCTs published in medical journals ( P < 0.001). Publication in a medical journal was the only covariate associated with higher annual citation rates ( P < 0.001) and AAS ( P < 0.001) on multivariable analyses.
High-impact medical journals do not publish orthopaedic RCTs with negative or neutral findings at a rate that significantly differs from orthopaedic journals. However, the higher impact and digital coverage of the studies published in medical journals may disproportionally influence the practices of nonorthopaedic providers. Raising awareness of critical findings published in orthopaedic journals may be particularly important for improving healthcare policies and orthopaedic referral patterns for musculoskeletal problems.
发表在高影响力医学期刊上的骨科研究通常被认为具有较高比例的阴性或中性结果，并且具有可能偏向非手术治疗的方法学特征。本研究的目的是比较发表在高影响力医学期刊和骨科期刊上的骨科随机对照试验（RCT）的研究特征、方法学质量、暴露因素和结果方向，并确定与更大影响力相关的研究属性。
分析了2010年1月至2020年12月期间发表在5种医学期刊和10种骨科期刊上、5年影响因子最高的RCT。纳入标准为报告骨科手术干预与非手术或微创外科手术对比的RCT。收集研究特征、方法学质量（Jadad量表）、结果和替代计量数据。主要结果分为阳性（支持手术/更广泛手术）、阴性（支持非手术/不太广泛手术）或中性。
分析了128项RCT；26项来自医学期刊，102项来自骨科期刊。发表在医学期刊上的研究作者更多（P<0.001）、样本量更大（P<0.001）、机构更多（P<0.001），且更常获得资助（P<0.001）。各期刊之间的平均Jadad量表无显著差异（P=0.14）。各期刊之间主要研究结果的方向无差异（P=0.22）。发表在医学期刊上的RCT的平均替代计量得分（AAS）和年引用率更高（P<0.001）。在多变量分析中，发表在医学期刊上是与更高年引用率（P<0.001）和AAS（P<0.001）相关的唯一协变量。
高影响力医学期刊发表阴性或中性结果的骨科RCT的比例与骨科期刊没有显著差异。然而，发表在医学期刊上的研究具有更高的影响力和数字覆盖面，可能会对非骨科医疗服务提供者的实践产生不成比例的影响。提高对骨科期刊发表的关键研究结果的认识，对于改善医疗政策和肌肉骨骼问题的骨科转诊模式可能尤为重要。
