ElAbd Rawan, Barone Natasha, Richa Yasmina, Do Uyen, Thibaudeau Stephanie, Samargandi Osama
Division of Plastic & Reconstructive Surgery, McGill University Health Centre, Montreal, QC, Canada.
Division of Plastic & Reconstructive Surgery, University of Toronto, ON, Canada.
Hand (N Y). 2025 Jul 31:15589447251352123. doi: 10.1177/15589447251352123.
Hand surgery studies often include data from multiple hands, digits, or joints from 1 individual without using appropriate statistical approaches to assess within-individual observations, allowing for potential bias regarding treatment effects. We critically appraised the statistical methods used among studies, including dependent observations in hand surgery literature. All publications from the year 2020 to 2022 were retrieved from PubMed for 5 hand surgery journals. Studies containing ≥5 participants who performed a hand intervention in the operating theater were included. The proportion of patients with nonindependent observations and the proportion of nonindependent observations were calculated. A total of 10 128 articles were screened, of which a total of 465 studies were identified. Of these, 124 studies (27%) included multiple hands, joints, or digits from 1 individual. Only 79 (64%) studies provided data on the number of the digits, hands, and joints from a given patient. Of these, the proportion of patients with nonindependent observations was 14%. The proportion of nonindependent observations was 26%. Sixty-seven percent of articles did statistical comparisons between groups, but only 14.5% used methodological adjustments for within-patient relationships. Of the 71 studies that did not do proper statistical adjustments, 63 (88.7%) reported at least one significant result. In conclusion, there is a significant amount of nonindependent observations from single individuals and limited studies accounting for multiple observations in hand surgery literature. Most studies that did not do statistical adjustments for nonindependent observations still reported a significant finding, which raises the risk of bias.
手外科研究通常包含来自同一个体的多只手、多个手指或多个关节的数据，但却未使用适当的统计方法来评估个体内部的观察结果，这可能导致在治疗效果方面出现潜在偏差。我们严格评估了各项研究中所使用的统计方法，包括手外科文献中的相关观察结果。从2020年至2022年期间发表在5种手外科期刊上的所有文献均从PubMed数据库中检索获取。纳入的研究需包含≥5名在手术室接受手部干预的参与者。计算了具有非独立观察结果的患者比例以及非独立观察结果的比例。总共筛选了10128篇文章，从中确定了465项研究。其中，124项研究（27%）纳入了来自同一个体的多只手、多个关节或多个手指。只有79项研究（64%）提供了给定患者的手指、手和关节数量的数据。在这些研究中，具有非独立观察结果的患者比例为14%。非独立观察结果的比例为26%。67%的文章对组间进行了统计比较，但只有14.5%针对患者内部关系进行了方法学调整。在71项未进行适当统计调整的研究中，63项（88.7%）报告了至少一项显著结果。总之，在手外科文献中，来自单个个体的非独立观察结果数量众多，而考虑到多个观察结果的研究有限。大多数未对非独立观察结果进行统计调整的研究仍报告了显著发现，这增加了偏差风险。
