The high volume of Level IV studies means that Levels I, II and III combined make up only slightly more than half of the orthopedic research studies published. Producing Level I studies, which are important for practicing evidence-based medicine, have been traditionally difficult in orthopedic surgery. The current literature has suffered from Level IV case studies, which are subject to regression to the mean, according to the report.
For example, an open-label, randomized study of vertebroplasty versus conservative treatment published in The Lancet showed that the two groups differed in 60 percent of their outcomes at baseline, which is not something that would happen in a randomized controlled trial. There was greater improvement reported in the vertebroplasty group than the control group.
“This is exactly what you would expect from regression to the mean,” said Charles M. Turkelson, PhD, head of the AAOS research department, in the report. “At no time did the authors test to see whether there was a difference between the two groups. It only tested for differences from baseline.”
Orthopedics could benefit from evidence-based medicine, as in some cases an objective and systematic approach to evaluating the efficacy of one treatment over another could lead to choosing a more effective method of treatment for orthopedic patients, according to the report.
Read the AAOS Now report on evidence-based medicine.
Read other coverage on evidence based medicine:
– 6 Ways Evidence-Based Medicine Impacts Orthopedic and Spine Surgery
– 6 Ways Orthopedic Practices Can Implement Evidence-Based Medicine
– 10 Biggest Concerns Facing Spine Surgeons From Healthcare Reform
